The Great Weight Debate

There is no question that I’ve lost a lot of weight through this illness. Which kind of goes without saying when you spent 5 months last year in an intimate relationship with the nearest available toilet. Unintended weight loss is a hallmark symptom of both Crohn’s Disease and other forms of Inflammatory Bowel Disease.

I’m not typical of most women in a lot of ways, and my relationship with my weight is no different. Unlike most of the girls I knew in my teens, I made a conscious choice not to go down the route of obsessing over what I put in my mouth or worrying about the numbers on scales. In fact, I don’t own a scale, other than my kitchen one (and I only own that because the British measure cooking by weight, not volume). I generally couldn’t tell you what I weigh, because frankly, who cares? I would rather worry about how I feel than numbers.

Unfortunately, the medical system doesn’t see things this way. I can’t walk into the IBD clinic without being promptly swept away by a nurse to be weighed. Again. And again. And again. And to have them obsess over every gram. It’s like they have a giant institutional eating disorder.

The thing is, when the weight was shedding off of me at an alarming rate in the autumn, no one seemed to care. None of the GPs I saw ever weighed me. Even the IBD clinic didn’t ask me what I weighed before this all started (not that I could really tell them). If it concerned them, they didn’t say so. To me, anyway. Of course, I was concerned, but no one else was.

Until the start of January. When the oedema cleared out of my legs virtually overnight, I lost 4.5kg in a week. That dropped me just below a Body Mass Index (BMI) of 18.5, which makes me officially underweight. Now, the clinic are having kittens.

Did you think this blog would be free of pictures of kittens?

On one hand, it’s nice that this is finally being taken seriously, but on the other, it's all they seem to be worried about. The fact that my kidney and liver function tests have come back almost normal now (and as an aside, my albumin levels are now completely normal, so no more hypoalbumineia), that I’m still not anaemic, that I’m feeling better and have more energy (and that everyone keeps telling me how much better I look) doesn’t compute. Nothing about me as an individual. All that matters is the number. That number has triggered an alarm on NICE guidance and they need to be seen to be doing something to comply with it. Again, it’s back to numbers -  http://foodlovingcrohnie.blogspot.co.uk/2014/01/what-having-hysterectomy-taught-me.html

The problem for me is that I think the BMI is a deeply flawed measure of body mass and health. I went to a conference on eating disorders about 12 years ago for work, and went to a session on BMI. One of the speakers was a woman who was a varsity volleyball player at a local university. She was going to the Canada Games that year and was hoping to get on Canada’s Olympic Team.  And after sharing this and talking a bit about what she was researching in her post-grad, she then announced that she is “obese”. She didn’t have an ounce of fat on her and judging by the size of her biceps, she could have probably taken down most of the men’s wrestling team at her university single handed. But according to the BMI, she is obese, because BMI is a simple calculation of mass in kg divided by height squared. No acknowledgement of body composition, age (in adults), ethnicity, body frame size, bone density, pregnancy, overall health or nutritional status, etc. This totally changed my view of BMI, and I have been a confirmed sceptic of it as a measure of health ever since.

There was an interesting article on the BBC about BMI this week - http://www.bbc.co.uk/news/magazine-21229387

There was also this (brilliantly titled) article about this theory published by Oxford University - http://www.ox.ac.uk/media/science_blog/130116.html

Under this person’s proposed BMI formula, I am just inside “normal” at what I weighed at the IBD clinic this morning. Not that I think his calculation is any better than the current system, especially when you factor in that this guy is a Professor of Numerical Analysis and doesn’t have a health background. But at least he is pointing out some of the inherent flaws in the measure.

There are lots of web articles out there slagging the BMI. Most of them are about obesity rather than being underweight, but they get at the point. My favourite is this video from lacigreen on YouTube - http://www.youtube.com/watch?v=GlXxoG98urc


As an aside, I really like lacigreen's videos. You should check them out.

The thing is, the clinic's institutional obsession with this measure is making me obsess about getting my weight up just to satisfy them. And I don’t want to turn into one of those women who obsesses about weight. The numbers are only part of the picture, not the end all and be all.

And for the clinic’s reference, I have not bottomed out at the lowest weight I have ever been at in my adult life. I have a way to go before that. Ironically, that also happened when I was on a high level of steroids. But the IBD clinic never asked about that. . . .

Trying to Find the humour in the Prednisolone Situation Part 2

I bought another t-shirt. I laughed when I saw it and had to get it.

This is the back -

The printer did a crap job on the back, but I don't care. It's helping me regain my twisted sense of humour about dealing with my wonky health.

Thanks again to the people from the Wegener's Granulomatosis group in Canada for making these shirts!

Got Milk?

I haven’t really been cooking anything new this week, but have been making good use of some of the recipes I’ve posted here. The reason for this, is this -



Milk. Lactose-free milk.

I really like the dietitian that works in the IBD clinic, but NHS constraints mean that I’ve only managed to see her for about 5 minutes at a time when I’ve been in. So I decided that it was worth hiring a freelance dietitian.

Worth. Every. Penny.

She spent 1 ½ hours with me on Saturday afternoon going through absolutely everything I was eating, explaining everything really in depth, and giving me some really helpful and useful suggestions to get my calorie and protein intake up to help get some weight back on and to help combat the malabsorption and malnutrition.

One of the biggest frustrations of this illness for me has been not being able to get dairy down. Normally, I’m a dairy fiend. Milk on cereal in the morning. Yoghurt almost every day. Butter instead of margerine. Ice cream. And cheese!

Cheese, Gromitt!!!!!!

Oh, how I love cheese!! There are very few cheeses that I don’t like, I like them all!!

And I haven’t been able to eat dairy since the end of August. Everyone says that yoghurt is good for you and is fairly low in lactose, but that was the first thing to start bothering me. Soon, I couldn’t get milk down on my cereal, and I switched to toast. Then even hard cheese was making me sick.

You have no idea how much this has pained me. Not only are these some of my most favourite foods, they are also full of calcium, which I desperately need while on steroids (yes, I’m taking calcium tablets, but it’s just not the same thing) and are a source of protein. I know there are many people out there who argue that human’s aren’t meant to consume animal milk, but I don’t belong to that camp. Whether or not we are meant to, it tastes great!

Having been a carer most of my life, I know that dairy can often be the key ingredient to increasing protein and calorie intake. Use evaporated milk in cooking. Fortify milk by adding dried milk powder. Cook with copious amounts of cheese. Slather butter on everything. And none of these have been options. Not that huge amounts of dairy are consistent with a low-residue/low-fibre/fat restricted diet. On low residue, milk is limited to no more than two cups a day. And lots of cheese, particularly the ones that tend to be lower in lactose, have a lot of fat. But still, at least it’s something.

As I have a long-standing intolerance to soya (I can handle a small amount of soya sauce and soya letchin in chocolate, but that’s about it), soya based alternatives are not options. I’ve started trying out some other dairy-free alternatives, but I find them a bit hit and miss. Oat milk, while being rather tasty in hot chocolate in a slightly oatmeal/Horlicks kind of way, didn’t sit too well on my stomach. Oats never have. Almond milk has a reasonable taste, and cooks up a mean dairy-free Alfredo sauce, but isn’t really consistent with a low-fibre diet and is low in calories, which isn't going to help my current situation. Rice milk is quite palatable on cereal, but virtually useless in cooking and has no protein in it.

And to me, none of these are substitutes for cow's (or goat's, or sheep's) milk.

The bigger frustration is not knowing what’s causing it. Is it the milk protein? Milk protein allergies are pretty uncommon, but with my allergic nature, it wouldn’t have surprised me. If so, virtually all of the dietary supplements the hospital prescribes have cow's milk protein in them. The one I'm currently using gives me wicked wind and it isn't clear what's causing that. The only non-milk alternative is soya based.

Is it the lactose? Hard to know until it’s been tested for, and neither my GP nor the GI doc have been willing to do this.

Is it just the Crohn’s flare, and this will go away eventually? That’s what the IBD clinic keep telling me (God I hope!). Either way, it’s frustrated me, and when I was really unwell, I just didn’t want to challenge my stomach by finding out the hard way.

The dietitian on Saturday did hear this frustration though, and really encouraged me to give lactose free milk a go. I am under strict instructions to not to introduce anything else new into my diet this week other than the milk, and to start with 1/4 cup the first day, and ½ cup the second day, and hopefully rounding up to 1 cup on the third day, provided that it doesn’t all go disastrously wrong.  Then next week, I’m to try yoghurt the same way. In her view, even if I can only tolerate ½ cup, that’s an improvement, and then I can add that amount into my diet every day, say for example, having half lactose-free milk and half rice-milk on cereal, or making custard.

I’m on day 2 at the moment, and so far, so good. I think. I made the mistake on the first day of having it not long after having one of the nutritional supplements the hospital gave me, so it was hard to know how that one went. This morning I had half a cup after breakfast, and it seemed to go down okay. My tummy has been slightly unhappy, but I’ve also doubled up those nutritional supplements on advice of the hospital dietitian (ugh!) and dropped the dose of Prednisolone down a bit this week (yeah!). I’m hoping it will settle more over the next few days. And I’m really hoping that tomorrow’s “dose” of milk goes down okay too. Fingers crossed!

 

Dairy Free Lasagne

I feel wrong just writing those words. But that’s what I made yesterday. Seriously! I can hear the Italian mothers of friends back in Canada tutting at the whole idea.

While lying awake in my usual Prednisolone induced insomnia state (it’s now been seven weeks since I had a full night’s sleep!), I had the thought that I could use that Dairy-Free Alfredo sauce I made last week as white sauce in a lasagne. So I thought I would give it a go and see how it turned out.

I made the Alfredo Sauce exactly the same way as I did on the previous post - http://foodlovingcrohnie.blogspot.co.uk/2014/01/experiments-in-pasta-making-part-3.html

I cooked up a sort of bolognaise. I browned about 1/4lb of extra lean beef mince in a bit of olive oil, added about half a jar of passata, onion powder, garlic powder, salt, pepper, oregano, basil and a bit of sugar (cuts the acidity in the tomatoes) and cooked that until it thickened.

I also had some spinach to use up, so I steamed that.

I could have made fresh lasagne noodles, but was feeling lazy and had some no pre-cooking required lasagne noodles in the cupboard. I put a bit of the red sauce on the bottom, then a layer of noodles. Then I put some of the white sauce in, then noddles, then red sauce . . . you get the picture. I didn’t have a lot of spinach, so it went in the middle layer. I topped it with more passata.

Then I put it in the oven at 180C/350F for 50 minutes.

It was pretty good! It’s not the same as a proper, mozzarella cheese filled lasagne, and it most certainly isn’t my friend’s Italian mother’s lasagne (I never turned down an invitation for dinner in that house, or an invitation to raid leftovers!), but for someone who hasn’t been able to do dairy for some time, it was a pretty good substitute. Hopefully it will freeze well like a proper lasagne. I’ll find out!

What Having a Hysterectomy Taught Me About Crohn’s Disease Part 6 - Consultants Have Very Big, But Very Fragile, Egos

I’ve almost lost count of the number of consultants I’ve seen over the years. Some have been good, most have been pretty mediocre. One was a total bastard extremely unprofessional.

Every one of them has had a very big ego. Some of them even have a bit of a God-complex.

I guess that comes with the constant academic butt-kissing success that comes with achieving that level within their field. But I also find that their egos can be very fragile. Bless.

In my experience, most of them don’t take well to being questioned. “Why do you think that’s the best option for me?”, I ask. “Because it is”, is what they say. “But that’s not answering my question . . .” and around and around we go.

They don’t like it when you point out inconsistencies. “Why are you still taking that much Prednisolone?”, the consultant asked me yesterday. “Because when I was here three weeks ago, you told me to stay on this dose until I next saw you.” “ No, I didn’t”. “Um, that’s what’s printed on the box from pharmacy. Do you want me to show you?” The consultant quickly changes the subject.

They get very offended when you question or disagree with their clinical decisions. Very. In fact, it’s like you have personally smote them, leaving them with a nasty scar. Some of them get so offended that it is a like toddler going to have a pout in the corner who then glares back at you with this expression that says “See how you made me feel, you big meanie? You should feel guilty for making me feel like this!”

They get especially offended when you start quoting research from scientific journals at them. Most especially when you quote from a paper that they wrote . . . .

In fact, they really don’t seem to like you doing your own research at all. “Where did you get that information?” the consultant asks. “NICE Guidance and the British Medical Journal.” “You don’t need to read that”. Um, yes I do. It’s called being an informed and empowered patient. Ironically, NICE's chairman just released a statement on this - http://www.bbc.co.uk/news/uk-25890572

And then there is their reaction when you ask for a second opinion or admit that you use complimentary medicine. That goes beyond being offended, and moves into them feeling that you are undermining them. On a personal level. Evilly.

Few will ever admit that they are wrong or be humble enough to admit that they don’t know everything.

Surgeons, on the other hand, are a different breed of consultant. They still have big egos, sometimes even bigger than other consultants. But ultimately, surgeons are really just frustrated plumbers/mechanics/electricians/carpenters. They want to open the lid have a look, fix it, close the lid, and send you on your (hopefully) merry way.

I find them a lot easier to deal with. In fact, they are rather like dealing with tradesmen. My non-committal meeting with the surgeon yesterday felt like I was negotiating with my gardener. He explained just about everything without me asking, fully admitting the limitations of what he can do. The surgeon who did my hysterectomy and one of my diagnostic laps was rather the same. Not people you go to for sympathy, but people who will tell it like it is from their perspective. Fair play really.

I find negotiating my way around consultant’s egos probably the most frustrating part of being a patient. I have no patience for people who need their egos stroked at the best of times, and have even less patience for it when my health is on the line. In my line of work, there is no room for that. If you ever get the point that your head is so inflated that you think you know everything and don’t question your practise, you need to leave the profession.

As the surgeon said yesterday, “Ultimately, you know your body better than I do”. Damn straight.

Experiments with Sweet Potatoes

I’ve never been a big fan of vegetables. Some have always disagreed with me (cauliflower is devil spawn!), others I just don’t like (peas are disgusting, green wiggly things!). But I know that veg is good for me, so I force myself to eat them.

I had a limited, but varied enough repertoire of veg that I would eat before this whole Crohn’s thing. The problem is, I prefer veg raw and half the veg that would be my fall backs (mushrooms and peppers, for example) are on the “no go” list for a low-residue, low-fibre diet. So, I’m trying to see this as an opportunity to make myself learn to like veg that I don’t normally eat. As sweet potatoes are on the “go” list, I thought I would give them a go.

Continuing with my experiments with turkey mince, I adapted this recipe http://www.bbc.co.uk/food/recipes/turkeyballswithtomat_80567

This is what I did

For the meatballs -
½ lb of turkey breast mince
100 g of breadcrumbs
1 tsp of dried thyme
1 egg, beaten
Salt and freshly ground black pepper

I combined everything in a bowl and rolled the turkey into balls, then popped them in the fridge while I made the sauce.

For the sauce,
300ml of tomato passata
1 tsp of thyme
1 tbsp of tomato puree
1 tbsp of onion granules
Salt and freshly ground black pepper

I put everything in a big pot and heated it to the boiling point, then I covered it and simmered for 5 minutes. I then added the meatballs, covered it, and let it simmer for 15 minutes, giving it a stir every few minutes.

For the sweet potatoes,
1 tsp of dried thyme
1 tbsp of olive oil
1 tsp of garlic infused olive oil
100 ml chicken stock
1 sweet potato, cut into rounds

I put all of the ingredients into a frying pan over medium heat and left it to cook, stirring and turning the sweet potatoes occasionally.

I served it up with a big serving of rice. Overall, it turned out pretty well, and was a nice change from bolognese sauce. I think there are a few things I would do differently next time though.

As turkey breast mince is so very lean, the meatballs didn’t have much flavour to them, and needed a huge amount of breadcrumbs to stick together. Thigh mince really does make better meatballs. The passata cooked down pretty quickly, and I really could have done with using more or adding water to the pot, as the resulting sauce was a bit too thick.

The sweet potatoes turned out surprisingly well. However, having never made potato “fondant”, I didn’t realise that the direction that said “sliced into thin rounds” was actually meant to look like this, rather than what I did.

 

Oh well. I thought it turned out pretty good anyway. The chicken stock gave it a good flavour and kept them quite moist.

The recipe says that this serves one. It made 15 meatballs! Okay, I know I’m not a big eater, but really? It served both me and my boyfriend, I had leftovers for lunch (we ate all the rice, so I did a jacket potato in the microwave to go with it), and I put another meal's worth of meatballs in the freezer. I think it serves more than one!

After having the leftovers for lunch today, I didn’t really fancy a big supper, so I made soup.

I adapted this recipe http://talesofakitchen.com/soups/carrot-and-sweet-potato-soup-with-ginger-and-coriander/

Here’s how I did it -

1 tbsp of olive oilhttps://www.blogger.com/blogger.g?blogID=2897700776388279193#editor/target=post;postID=4304336999748978823
2 tsp of garlic powder
1 tbsp of onion granules
1 tsp of ground ginger
2 big carrots, peeled and chopped
1 medium sweet potato, peeled and chopped
3 cups of homemade chicken stock, plus a bit more water if needed
1 ½ tsp of ground coriander (I’m not a big fan of coriander, so I reduced the amount)
Salt and pepper to taste
Dash of chili powder

Using a big pot, I heated the olive oil, then added onion granules, garlic powder, ginger, carrots and sweet potatoes, and let them soften for 5 minutes.

Then I added the chicken stock and the coriander, salt, pepper and chili powder and brought it to the boil, then turned the heat down and simmered, covered, for 20 minutes.

Then I blended it with the hand blender.

As it was quite thick, I added a bit more water, and it came out with a really nice consistency. I served it up with some big slices of homemade bread (the bread machine has re-emerged from the cupboard recently). It made a rather lovely supper.

Maybe I do like sweet potatoes after all!

What Having a Hysterectomy Taught Me About Crohn’s Disease Part 5 - Things Don’t Get Better Overnight

I was lucky that I was able to have my hysterectomy done through laparoscopy (keyhole). There are a lot of advantages to having it done laparoscopy; reduced infection risk, reduced risk of haematoma, not having a big nasty scar (just three tiny ones, to go with the tiny ones from previous laparoscopic surgeries). Surgeons also tout that the recovery time is shorter. “6 to 8 weeks, and you’ll be back at work, good as new!” my cocky, arrogant, over-confident (but, otherwise excellent) surgeon declared.


“In my experience with patients who've had hysterectomies,” my very sensible osteopath said, “it takes anywhere from 6 to 12 months to get over it, regardless of how it’s done. Keyhole or open, on the inside, you're having the same surgery. Based on your fitness level going into this, I would guess 9 months”. He was right. Virtually to the day.

Aside from a pain management crisis when I was in hospital, my recovery from the hyst was pretty unremarkable. I was off all painkillers aside from Paracetomol four days after coming out of hospital. Aside from post-hospital tummy bug that lasted a few days, I had no infections. I had a small area of granuloma (over healing) in a place I won’t name, but it didn’t need any treatment and it didn’t cause any trouble. I went back to Tai Chi class after 4 weeks. I started swimming (gently) after 6 weeks. I was back at work on a phased return after 7 weeks (in hindsight, that was too soon, but that’s another story). I went camping after 12 weeks. Overall, I was a model case.

But I certainly wasn’t “good as new” in 6 to 8 weeks. My abdominal and pelvic floor muscles were very weak, and I couldn’t stand for long periods. I couldn't lift much, and definitely couldn’t carry things. And more than anything was the fatigue. Bone-crushing, hits you-like-a-ton-of-bricks fatigue. Fatigue so overwhelming that you can do nothing but go to bed.

 

That’s what took 9 months to get over. And that’s normal for a hysterectomy.

I know people mean well when they ask “Are you better yet?”, but the reality is that there is not a simple answer to that. Yes, the steroids have stopped the vomiting and diarrhoea, and have recently started getting the stomach cramps and horrible stomach noises under control. I'm eating better than I have in months and I'm keeping it down. As a result, my energy levels are much better and I feel slightly more human. The clearing of the oedema in my legs means that I can get around better and am no longer struggling to get up a flight of stairs. So, yes, I feel better.

BUT, it’s not that simple. I’ve already spoken at length in this blog about the effects Prednisolone have had on me, and that’s been awful. Granted, I’ll take it any day over the vomiting and diarrhoea, but it’s awful. On top of that, I’ve lost a lot of weight and have effectively been suffering the effects of malnutrition thanks the malabsorption syndrome that comes with Crohn’s and thanks to living on a diet of Lucozade, Dioralyte and Jelly when the diarrhoea and vomiting were at their worst in the autumn. Even though I’m eating much better now, it’s going to take time for those things to get corrected and to put weight back on. That will take months, if not possibly a year. In the meantime, I'm stuck on this boring, restrictive diet, which doesn't lend itself to weight gain and is so unbalanced that I have to take nutritional supplements.

Although the fatigue is nothing like it was with the hysterectomy, it's still making itself feel present.

And to answer the question I keep getting from my fellow beer drinkers, no, I’m not back to drinking beer. And probably won’t be for a long time.

It’s almost been 7 weeks since I was told that I have Crohn’s Disease, and 7 weeks of being on Prednisolone to treat it. It’s been 3 weeks since giving up on the Azathioprine, which took about 10 days to get out of my system. That's not that long.

I’ve been sick since the summer. In fact, I counted up the weeks from when the being physically sick started to the diagnosis, and it was 20 weeks. It's been 32 weeks since the general tummy unhappiness started. I keep reminding myself that it took me a long time to get this sick, and it’s going to take me a long time to get better. It’s not going to happen overnight.

Trying to Look on the Bright Side?

As a follow up to my post on hypoalbuminemia a few weeks ago, after the oedema seemed to clear virtually overnight just before New Years, it hasn’t come back. I can happily get my signature Doc Marten boots on again, but to be honest, they are stretched from walking around with swollen feet in them so I really need to order a new pair. In the meantime, I’m enjoying wearing those shit kickers steel toed shoes I found in the back of the closet again. My last round of blood work the first week of January indicated a slight elevation in my albumin levels, although they had a way to go before they were normal. When I am having good days, I’m hopeful that things are moving in the right direction.

Although I will always have chunky calves, the clearing of the oedema has made it clear just how much fluid I was retaining in my lower limbs. Amongst other things, it also shows how much weight I’ve lost over the past few months, which I am NOT happy about. I’ll probably do some agonising post about body image in the future.

As someone who exits on the slightly dark/Goth side of life (we have cookies, you know!), I have a couple of pairs of New Rock boots. Both pairs I was able to bag on eBay for about £30 (advantages of wearing a shoe size no one else does!). One pair come most of the way up my calves, and I have never, ever, been able to zip them up the whole way. I could typically get the zipper up about half way and that was it.

Until today . . . .

I should enjoy this while it lasts. With the weight of these babies, I’ll have those calf muscles built back up in no time!!

Adventures in Pasta Making Part 3

I’ve been in a big pasta mood this week. So I’ve been trying some new pasta recipes, and gave the pasta machine a whirl again.

To make a change from tomato based sauces, I tried out this recipe which I found through Jeanette’s Healthy Living’s post on Low-Residue Recipes. http://www.pinterest.com/pin/120330621266926475/

I adjusted the portions for one person, but otherwise followed the recipe, including Jeanette’s suggestions on making it low residue by using garlic infused olive oil rather than garlic. I also threw in some leftover turkey leg that I had taken out of the freezer.

Fairly tasty. For spinach.

It was pretty tasty, especially for something that involves spinach (I’m not a huge fan of spinach. I’m trying to get used to it because at least it is a vegetable I can have, and is apparently good for me, or something).

I decided to have a go making something other than ravioli with the pasta maker. So I thought I would try making some fettuccine. This time around, I remembered to run a small amount of dough through the machine to clean it beforehand rather than putting through a big amount.

I used the machine to flatten out the dough to the third level (any thinner would have been too thin), and then ran it through the cutter.

Flattened dough

Cutting the pasta at an awkward angle

This turned out to be a bit tricky, and as the cutter is on the other side, meaning I was turning the handle with the wrong hand! But I eventually got the hang of it. Once I cut the pasta, I cooked it in boiling salted water for about 4 minutes and it was done.

Ready for boiling

So now, what to do with it.

I’ve been looking around for more dairy free recipes to try out. As I have some almond milk at the moment, I looked around for things to cook with that. I came across this recipe for dairy-free fetticuine alfredo. http://silk.com/recipes/fast-easy-fettuccine-alfredo

I only did half the recipe as I was only cooking for me. I used vegetable stock instead of wine, almond milk instead of soya milk and olive oil rather than soya margarine. I also added some cooked shredded chicken.

I've decided that almond milk is a reasonable dairy substitute

Making Alfredo sauce without milk, cream or cheese. Is this right?!

I have only three words for this.

OH. MY. GOD!!!!!!

I haven’t had a cream type sauce in months and months, and I don’t remember the last time I had Alfredo. I really really wish this had involved gabs of milk and cheese, but failing that for the past several months, this was a damn good substitute! I put some leftover shredded chicken in it, and was this every tasty! I so enjoyed this! Like really really enjoyed this! Like so enjoyed this, I actually Skyped my mother just to say “You’ll never guess what I just made and ate?!”.

So tasty!! But maybe that's because I'm deprived of cheese.

And so far (touch wood), it’s gone down absolutely fine. And I have loads of leftovers for tomorrow!

Adventures in Turkey Mince Part 2

In trying to keep things interesting, I’ve been trying think of other ways to use turkey mince and turkey leftovers.

On Friday, I woke up really fancying meatloaf (are the infamous, overdue Prednisolone munchies finally kicking in after 6 weeks?!). I had a go with this a few weeks ago, but didn’t take pictures. Meatloaf is kind of the ultimate in American comfort food. Lots of people in North America grew up on it. I was never really fussy about it growing up, but for some reason during this “flare”, I’ve been really fancying it. It might just be the ketchup as I can’t have chips at the moment. Not that I eat a lot of chips anyway. In my view, chips are really just a conduit for ketchup. (You can tell I wasn't born British.).

I adapted the “mini meatloaf” recipe from the recipes I have from Cooking for One or Two, which I have mentioned a few other times in this blog. It’s kind of the ideal size for one person with enough leftovers for another meal, or for two people as long as neither of you is a huge eater.

The version from the recipe involves onions and celery, which are both out on low-residue, so I used onion powder and more carrot instead. This is how I made it -

250g ground turkey thigh
4 tbsp of shredded carrot (I used the fine side of my grater)
2 tsp (ish) of onion powder
3 tbsp (ish) of bread crumbs
Dash of salt and pepper
2 tbsp of ketchup

Preheat oven to 180C. I sprayed a bit of non-stick cooking spray (olive oil) in a mini loaf pan and shaped the mixture into the pan. I mixed the first five ingredients plus 1tbsp of ketchup by hand in a bowl. I brushed the rest of the ketchup over the top.

To keep it moist (as turkey is much drier than beef), I put a pan of water underneath to create steam. I cooked it for 35-40 minutes. That really helped this batch, it was much moister than the last one I made! It was yummy! I made a jacket potato to go with it.

Mini Meatloaf!

As my boyfriend brought me a bunch of HUGE jacket potatoes last week, I’ve been trying to use them up before they sprout. So I decided to experiment with making cottage pie with turkey mince. This was considerably more challenging for me.

You see, I make a mean beef cottage pie. A really mean one. Cooked in porter (God, I miss beer!). One so mean, that you go to a pub and have theirs and say to yourself “My homemade one is way better than this!”. But beef still isn’t going down to well. And I haven’t been able to drink alcohol since July, and opening a bottle of beer to cook with and not being able to exercise cooks’ privilege of drinking whatever doesn’t go in the recipe while cooking it . . . . .

You have no idea how much I miss beer!

Anyway, back to turkey cottage pie. As cottage pie is pretty much just mince and veg cooked in some form of gravy with mashed potato on top, I figured I could figure something out.

Most of the websites I found that had recipes for turkey cottage pie didn’t look particularly appetising. So I just improvised, replacing what would normally be the beer portion (porter is too heavy for poultry. Wainwrights or a nice bitter would have been nice with turkey, but I digress) with more stock.

250g turkey thigh mince
1 tbsp of onion powder
1 carrots, finely chopped
1 tbsp of flour
½ thyme
1 cup of chicken stock
Salt and pepper
About 1 tsp of tomato puree
Mashed potatoes (made with a bit of dairy/soya free margarine, but no milk)

I cooked the turkey in a frying pan with the onion powder until no longer pink.

I added the carrots and let them cook for about 5 minutes, then mixed in the flour and thyme, giving in a good stir. Then I added the chicken stock, brought it to a boil, then reduced the heat and let it simmer for about 25 minutes until the gravy thickened. I added salt and pepper and the tomato puree at the end, which I mixed in well.

In the meantime, I peeled and chopped one of the HUGE potatoes (one was more than enough!) and cooked that in boiling water until soft. I drained them, then mashed them with a bit of sunflower oil margarine.

When the meat was done, I transferred it to a casserole dish and topped it with the mashed potatoes. Then I put it under the grill for about 15 minutes until the mashed started to brown. Voila, turkey mince cottage pie.

It was nice enough, but it was missing something. (Beer)

Trying to Find Some Humour in Prednisolone Situation

In attempts to re-capture my sense of humour about things, I found this t-shirt on-line and ordered it -  

I should have worn this to that meeting with that senior manager a few weeks ago . . . .

I'm trying to decide if I should wear this to my next appointment with the consultant when I need to discuss our "communication problem" with him . . ..

I didn't realise until it arrived that it was actually created by a Canadian support group for people with Wegener's Granulomatosis http://en.wikipedia.org/wiki/Granulomatosis_with_polyangiitis which is a form of vasculitis, but hey, those of us with auto-immune disorders stuck in the craziness of steroid side effects need to stick together. They've also done one on Pred Insomnia, which I think I will order next. 

“Sleep Deprivation is a Form of Torture”

Truer words were never spoken by one of my friends this week. A fellow veteran of my Frenemy Prednisolone, she knows wherefore she speaks.

I haven’t had a full night’s sleep in 5 ½ weeks. I’m averaging about 4 hours a night. If I’m lucky, I get 5 ½ hours. If I’m really unlucky, I get virtually none. If I go to bed during the day, I don’t sleep, no matter how tired I am.

My previous experiences with my Frenemy always came with insomnia, but as I only took it for short periods, it was manageable and I often ended up getting a lot of housework done. The problem now is that I’m too tired to do anything with the insomnia and just lie there, and my mind spins away on me, leaving me a ball of nerves, sometimes to the point of paranoia.

I’ve never been a good sleeper. It takes me ages to settle, I wake easily to any noise or light, and when I wake up in the middle of the night, I can’t get back to sleep. My Frenemy turns the volume up on this by eleven.

In my manic anxiety over the past week, I haven’t felt safe to drive, and some of my friends have been very kind and bailed me out when I needed to get somewhere. I even broke down and had my weekly grocery shop delivered last week (why hadn’t I done that before?!) so that I wouldn't have to drive to the supermarket (or wander the aisles looking at things I can't eat). Initially, I thought it was the anxiety and panic attacks that were taking me off the road. But now I’ve realised that that’s not the bigger picture. The reality is that I’m not safe to drive because I'm sleep deprived. And this lack of sleep isn't helping my body to heal either.

I’m hoping that I’ve hit a turning point on dealing with the mental health side of things this week. After totally melting down on Sunday, I have finally come to the painful realisation that I was allowing the anxiety to take over my life. Now I need to take control of it. I need to “put it in the box”, and sit on the lid if need be.

I need to force myself into the shower every day, do the washing up every day, make sure that I eat regularly, and leave the house every day, even if it is just to go as far as the postbox. When the anxiety completely tries to take over, I need to distract myself by doing something mindless, even if it's just cleaning the kitchen counter for the 80th time this week. And I need to do it no matter how much my mind is trying to play tricks on me. I need to win the battle on the mental health front before I can do battle with the Crohn's.

What’s frustrating is that in my “normal” state (such as that may be), this isn’t like me. I’m normally a fairly confident person who is adventurous with no fear of public speaking and who can be direct to the point of being a bit blunt (if not a bit of a bitch when needed). I have a good, if not at times, dark sense of humour, which has always helped me to work through adversity. Yes, I can be a worrier, but usually I can move on from my worries by venting joking talking about them. I have coached other people through dealing with anxiety and panic attacks, so why the hell can’t I take my own advice? I guess this one of the things that people refer to as a “personal growth moment”.