Sunday, May 24, 2009

Food Sense 3- Bulking up with rice

One of the best ways in my experience to get a feeling of fullness is to eat bulky foods. White and brown rice work well: One cup of rice (a lot... trust me) contains around 240 calories with just 4 from fat.

Many "instant" rices suffer from the same problems as other prepared foods: A lot of sodium and other additives. But regular rice can take a long time (up to an hour) to prepare if you follow the directions. While I love rice, I often skipped making it because of the time. But now I've found a solution. In How to Eat Supper, an outstanding book by Lynne Rossetto Kasper, she presents a recipe called "Dumbed Down Rice". With it, you'll have rice prepared in the time it takes you to make the food to go with it.

The process is simple: You treat the rice like pasta. Here's the process:

1. Bring 3 quarts of water to boil (salt the water lightly).
2. Add one cup of white long-grain rice.
3. Boil for 8-10 minutes, stirring on occasion.
4. Dump the pot into a colander, then turn the rice back into the pot. Make sure to take the pot off of the burner.
5. Cover the pot and let the rice rest for 5 minutes. Fluff and serve.

I was amazed at how nicely the rice turned out, and as a consequence I'll make rice much more frequently. Buy this book!

Monday, May 18, 2009

The Procedure Begins

I had to fast after midnight. I woke up Friday morning and wandered around the house. I was nervous, but Beth helped keep me grounded. We had to be on site about 50 miles north at 9:30, so we headed out about 8:00. We stopped for gas, Beth picked up some coffee, and we got on the road. Shortly after 9:00, we pulled into the lot and headed inside.

I’ve been in a lot of hospitals in my day. I have to say that this was one of the nicest I’ve ever been in. The outpatient heart institute had a large, comfortable waiting area complete with a large waterfall. We checked in and took a seat.

Shortly after, a nurse came out; when we checked in, the volunteer assistant noted where we sat, so the nurse walked directly up to us. I hugged Beth, and she was told that she could come in to join me in a few minutes. The nurse and I walked back into the outpatient cardiology suite; she did the obligatory weigh-in (278.1 pounds) and took me to a small room. The room had a bed, a nightstand, a chair, and a wall full of medical gear. One whole wall was a sliding glass door. They had me strip down and put on that most comfortable of items, the hospital gown. I swear the person with the highest self esteem in the world would lose it with his or her nether regions catching the breeze from the non-closing flap in those things.

I climbed into bed and settled down to wait. The nurse returned and started an IV. It wasn’t without some excitement; one of my veins kept rolling and all that ended up happening was copious bleeding. She gave up on that one (she apologized profusely) and popped the IV into the other wrist. My blood pressure was high (170 over something), but I put it off to white coat syndrome. Twelve chest electrodes for my EKG, and then I settled in. Beth came in, and we started to wait.

While waiting, we talked, answered the occasional medical history question, and chatted. I was still nervous, but time passed. After about an hour, I had a couple of visitors: Two folks from the research arm of the hospital briefed me on a study that was running in the unit. The hospital was participating in research on a new stent, and the two asked if I would be interested in participating in the study if I was a candidate. The benefit to me? As part of the study one of the necessary drugs would be partially covered each month, for years. They left and Beth and I discussed whether or not to participate. For me it was easy, because in a previous life I was a research scientist. The two researchers returned and I consented (it took a fourteen-page consent form, which is hard to initial when you’re right-handed and have an IV hanging out of the back of your wrist).

The interventional cardiologist stopped in and briefed us on the process; he was straightforward and put us at ease. He answered our questions and then headed back into the procedure room.

Time dragged on; there were some procedures that took longer than anticipated before me. As an added bonus, the nurse popped in a video for us to watch on heart catheterizations; I was surprised that was never put up for an Emmy. Finally about 12:15 they chased Beth out, and got me ready to go. About 12:30, the team came in and wheeled me into the suite. It was time.

Wednesday, May 13, 2009

The Cardiologist: First Verse

When I called Beth I used the same "successful" dorky guy “if-I-tell-you-something-do-you-promise-not-to-freak-out” approach. “Honey? The doctor called. She wants me to come in now and see the cardiologist.” This was just as successful as the first time I used it. I could tell she was worried; I told her “It’s going to be OK… I’ll see you in the lobby of the hospital.”

I was nervous driving to the hospital, but I still kept telling myself that things were going to be fine. The bigger part of me characterized it as whistling past the graveyard, but I kept up the mantra: It’s going to be fine. It’s going to be fine. It’s going to be fine. I pulled into the parking lot, locked up the car, and walked inside. Since Beth works four blocks away, she was there already. When I saw her I could tell she was scared and nervous, so I put my arm around her and tried to be strong. Inside, I felt the same way that she did.

We took the elevator up to the top floor and headed to the cardiologist’s office. Within minutes, we were ushered into the exam room and the nurse started taking my history. I tried to keep a stiff demeanor, because I knew that if I let down my guard I’d lose it myself.

Soon enough, the doctor came in. He had enough age on him to make me feel comfortable. He seemed to be my age or a bit older, so that meant he had experience. It’s not like you say to yourself, “Hey. I want to be a cardiologist” and head off to med school in your late forties. He didn’t pull any punches; he asked why I was there and what my symptoms had been. I recited the litany again, and I kept telling myself “You’re just fat.”

The doctor disabused me of that: “You have some blockages. We need to do an angiogram.”

While I was wrestling with that, he went on: “There are three things that can happen. We can go in, find out that the stress test was completely wrong and you have no blockages. We can go in, find out that you have major blockages and immediately perform emergency bypass surgery. Those are the two extremes. Or, most likely, we’ll go in and find out that you have blockages and we’ll fix them right there either with angioplasty or stents.”

Lots of things went through my mind: I’ve taken statin drugs for years. My cholesterol has been good. My LDL and HDL have been good. I had a clean stress test seven years ago. How could this be? The fact was, it probably was what the doctor said.

Now for the vagaries of the healthcare system: Last year, my employer made us an offer. Choose a narrow provider network, and we’d get a reduction in our insurance costs. After discussion, Beth and I decided it made good sense. As I sat there trying to wrap my head around all of this, it suddenly occurred to me that this doctor (who I had grown to like in the short time we spent together) was outside of my narrow network. The doctor who had referred me to him had referred me out of network.

As an aside, we live in a rural area of Wisconsin. The joke is, we’re 100 miles from everywhere: Madison, Eau Claire, La Crosse, Appleton, Green Bay. But we’re blessed to have multiple world-class hospitals within easy driving distance. In one town, we have a major research hospital with another large hospital right next door; in a town of 30,000 there are more than 1,000 doctors. Nearly the same distance north, there’s another hospital that was ranked in the top 50 in the US recently. The hospital to the north is in my network, and this doctor was from the other hospital. When this dawned on me I put the brakes on and asked the doc if I could call my insurance carrier. He stepped out, and the nurse helped me dial out.

Bottom line: If I went with this doctor, my deductable would double and insurance would only cover 80% of the cost. After discussion, Beth and I decided that as much as we liked this doctor, we had to stay in network (we were scared about the cost of the procedure, and as it turned out, rightly so). When he came back in, I explained and he understood completely. I asked him for a recommendation and he gave us the name of one of his former students at the hospital to the north.

Before we left, the doctor told us about his wife. She had started a kitchen store and cooking school in the town where his hospital was. She focused on the Mediterranean diet, and had great success working with patients trying to move to a healthier lifestyle. This doctor was the one who told Beth and me that we needed to come home, turn on some music, and make food together. This has been some of the best advice either of us have even been given.

We left the office, crossed over to our family doctor’s office, and got the number for the in-network cardiologist. We called and they told us to expect a call; they wanted to schedule the angiogram for Thursday or Friday. So, we did what we often do: Instead of going home, we went to our friend’s wine bar and had a glass to calm our nerves. We came home to a message, and at 7:00 AM on Thursday morning I called. We scheduled the angiogram for 9:30 on Friday morning.

Next: The procedure begins. Plus, some good recipes we’ve found just following doctor’s orders.

Saturday, May 9, 2009

Reality Rears its Ugly Head

Day 2 of the stress test was a walk in the park compared to the first day, but without the walk. In this type of stress test, on day 2 the technicians image your heart at rest as a comparison to the imaging that was done on day 1 when your heart was under load.

I showed up at the imaging department at 10:00 AM. The nurse injected me with the thallium, gave me a glass of milk, and told me to come back in an hour. I headed to the coffee shop in the hospital (giving the cafeteria in the place wide berth based on my experience from the day before), grabbed a cup of coffee and a glass of milk, and started killing time.

As an aside, Beth bought me an HP netbook with a solid-state drive for my fiftieth birthday. I love that thing! With public wi-fi in the coffee shop, the hour went quickly. I checked email, worked on the online class I was teaching, and did some more reading on angina. Then, I headed back to the imaging department.

Day 2 of the imaging was the same as the first day: You lie down on a table and hold your hands and arms above your head. The table has a strap to hang on to; keeping your arms out of the way gives the imaging head of the unit (which looks almost exactly like an open suitcase) a clear shot at your internal bits. If I had more sense (or been in less of a state of denial), I probably would have brooded. However, yours truly was fat and happy, so I dozed, did breathing exercises, and waited for the process to finish.

At the end of the 16 minutes, I headed out of the hospital. Since it was nearly 11:30, I decided to grab lunch so I headed to a hut that served pizza to eat a salad and a couple of slices. That done, I went back to the office. When the stress test was set up, I made an appointment with my personal physician for Friday morning to go over the stress test.

Several hours later, at work, the phone rang. You hear about times when everything changed? This was mine. The doctor who had ordered the stress test was on the line. She said, “The cardiologist is in the clinic. Could you please come in now?” I gathered myself together, called Beth, and we headed to the hospital. After that, things started happening fast.

Next up, the cardiologist and the vagaries of the healthcare insurance system.

Friday, May 8, 2009

Food Sense 2- Black bean croquettes and fresh salsa

The first cardiologist I met with turned out to be out of my healthcare network (more on how I started up with him later), but he gave Beth and me some great advice: Make time together for dinner. He told us that dinner was a time for us to wind down, have a glass of wine, and prepare the meal. What great advice!

Neither of us realized how wonderful it would be to break our routine and actively do something together at the end of the day like cooking. For us, it’s hard not to smile and have fun when you’re cooking and talking. This is the first recipe we made under doctor’s orders. This recipe came from Food Network’s site, although I’ve made a few modifications:

Black Bean Croquettes with fresh salsa
4 servings

Make the Salsa
Salsa is one of the easiest, quickest, most flavorful things you can make:
Ingredients: 1 lb. grape tomatoes, 2 green onions, 6-10 sprigs of fresh cilantro, salt and chipotle pepper powder
1. Coarsely chop 2 cups of tomatoes. For more sweetness use grape tomatoes, although regular tomatoes would work as well. You can pulse the tomatoes in a food processor; don’t over-process the tomatoes or you’ll end up with sauce. You want to see recognizable chunks of tomato.
2. Thinly slice 2 green onions, both the green and white parts.
3. Finely chop the cilantro sprigs
4. Combine the ingredients from the first three steps. Add chipotle pepper powder to taste (I used about 1 tsp measured by eye), and a pinch of kosher salt. Refrigerate.

Make the Croquettes
Ingredients: 2 15-oz cans of black beans, 1 tsp chipotle pepper powder (divided), 1 c frozen corn, 1/2 c bread crumbs (divided), 1 tbsp extra virgin olive oil, 1 ripe avocado
1. Preheat the oven to 375.
2. Open and drain the black beans. Pour the beans into a bowl, add half of the chipotle pepper powder, and mash until the beans are smooth.
3. Work half of the breadcrumbs into the bean mixture, and add the corn.
4. Mix in half of the fresh salsa you made.
5. Combine the remaining breadcrumbs, chipotle pepper powder, and the olive oil in a small bowl until the breadcrumbs are completely integrated with the oil.
6. Take the bean mixture and press into a half-cup measuring cup. Take the mixture from the measuring cup and form it into a ball. You should get about eight croquettes.
7. Take each ball and roll lightly in the bowl of crumbs until it has a light coating of crumbs. Place the croquette on a baking sheet sprayed with low-fat cooking spray.
8. Bake until heated through and the breadcrumbs are golden-brown, about 20 minutes.
9. While baking, stir the chopped avocado into the remaining salsa.
10. One serving equals 2 croquettes and a half-cup of salsa.
Per serving: 400 cals, 12g fat (2g sat), 61g carbs, cholesterol 0g, fiber 16g

Thursday, May 7, 2009

The Active Stress Test

I’m an early riser: I’m usually awake by 5:00 AM and sometimes even earlier. On Tuesday morning I had to be at the hospital for the first part of my stress test at 7:00, and I was up quite early. My doctor scheduled me for a thallium stress test, which would take place over two days.

The first day of the test would take place under exercise; they essentially stand you on a treadmill and work your heart rate up, then inject a nuclear material into your bloodstream. Afterward, they take pictures of your heart to see where the material was taken up by the muscle. The second day was similar, without the exercise: An injection, a wait for the material to be taken up, and pictures at rest.

I showed up at the hospital at 7:00 AM. I had been on caffeine restriction for the previous 24 hours, to ensure that the test wasn’t influenced by that drug most of us crave and subsist on. I only fell off the wagon once; I brought in doughnuts for my staff and somehow a chocolate-covered cake doughnut leaped into my mouth of its own accord (healthy, eh?) but that was at 8:15 AM the day before so I figured I was safe.

They had me change into workout clothes, popped on a slew of electrocardiogram (ECG) leads (12, in fact), a blood-pressure cuff, and then we waited for the doctor. The ECG leads are a pain for me, as I’m a rather hirsute guy; the tech whipped out a set of electric clippers and made some dandy racing stripes for me. Classy. The respiratory technician said a 9-minute test would be a long one, so I set my sights on that.

The doctor showed up and we started the test. At first, walking was slow and easy, about 2.5 mph and a slight grade. Every three minutes, the treadmill sped up and the incline increased. At my weight (a bit more than an eighth of a ton… Do the math) and age, they were trying to get me to 150 beats per minute. At six minutes, the treadmill went to 3.4 mph and a 14.5 percent grade. Still, I kept working; my heart rate was 154. Then, near the end of the 9 minutes the nuclear medicine tech showed up, opened up his little lead-lined carrying case, and pulled out the syringe. A few seconds later, I had a glow about me. They kept me working hard for another minute, to get the tracer through my entire system. Then they moved the treadmill into a cool-down mode.

After the workout, they made me drink a couple of glasses of whole-fat milk (fat helps increase the uptake of the thallium), and scheduled me to report to the imaging department in an hour. In the meantime, they told me to go eat (the fattier, the better they told me: Something I don’t expect to hear any more any time soon!).

I went to the hospital cafeteria. Not being a big fan of cafeteria food, I can honestly say the experience didn’t change my opinion. My meal? An omelet, a bowl of oatmeal, and another glass of milk. The omelet was right up there with the worst I’ve had (and I’m a foodie, mind you); when I first saw it I thought it was a taco of some sort. I had that corn-meally look, and about the same size as an Ortega shell. The oatmeal approximated school paste from my elementary days, and wasn’t much better. But I ate it all, just to kill time.

I showed up to the imaging lab, and they laid me down on the table. The process took 16 minutes. The test works by looking for where the thallium was taken up by the heart muscle: No thallium means reduced blood flow to that part of the heart. From reduced blood flow, the doctors deduce that there is a blockage somewhere in the web of arteries that supply the heart. A good overview of the test and a picture can be found here:

After the test they sent me on my way. None of the technicians would tell me anything; since they’re not doctors they’re not qualified to perform diagnosis. So I went blithely back to work, thinking I was fine. The dialog went like this:

Me: Hey, that went ok. I mean, I’m fat and all, but I made 9 minutes.

Me2: Yeah, there’s that.

Me: And no chest pain. That’s got to be a good sign.

Me2: Yeah.

Me: So it’s got to be anxiety. See, I was worried about nothing.

In the next post, reality rears its ugly head. Plus, a healthy recipe that was really good.

Tuesday, May 5, 2009

The Doctor Visit

I went to the doctor’s appointment on Wednesday. I had convinced myself that it was anxiety (I’ve had anxiety attacks before), and the doctor would tell me that I had been worrying for nothing. What I got was something else.

But first, some background. I have a family history; my father had his first heart attack at age 45, ended up on permanent disability, and died at age 54. He died six weeks before my daughter was born, who would have been his first grandchild. It wasn’t a heart attack that killed him. Rather, he died from a ruptured aneurysm on his abdominal aorta. The aorta is a huge vessel, about the size of your thumb. The University of Maryland Medical Center web site says “Many patients do not even survive long enough to make it to the hospital, and among those who do, more than half eventually die of complications. In fact, ruptured aortic aneurysm[s] are the 13th leading cause of death in the US…” (Source: Back in 1988 when my father died there wasn’t a good treatment for abdominal aortic aneurysms (AAA), so he never had bypass surgery; it was simply too risky.

Because of this history, I had been aggressively treating my cholesterol and getting screened for AAA, both of which have hereditary components. I have an annual physical, I’ve had a couple of stress tests before (both clean), I've had an abdominal ultrasound to check for AAA, and my blood work numbers were pretty good (target numbers are in parentheses):

Total cholesterol: 159 mg/dl (110-200)
Triglyceride: 189 mg/dl (38-150)
Good cholesterol (HDL): 43 mg/dl (60+)
Bad cholesterol (LDL): 78 mg/dl (0-100)

All this lulled me into a false sense of security: How could it be anything but anxiety when I had numbers like these and I was taking statin drugs?

Blood work at the doctor’s visit showed that I hadn’t had a heart attack or pulmonary blood clots; the doctor diagnosed me as having “exercise-induced angina” and scheduled me for a stress test the next week. The stress test involved two days of tests, first under exercise and then at rest. I went through the weekend convinced that it was anxiety, bolstered by the fact that I tried to induce the angina over the next few days without success (in hindsight, this was kind of like the old Bugs Bunny cartoons where a character bangs a cannon shell with a hammer... But more on that later).

I will also post recipes here as Beth and I try to get back into healthier eating. Only good stuff... If a recipe doesn't make the grade (we're foodies, you know!) it won't be in here. And in the next installment, the test.

Monday, May 4, 2009

Food Sense 1- Eating out

On Sunday Beth and I went out to do what people do, putzing around the shopping area about 15 miles from where we live. We decided to stop for lunch.

Now, being on a healthy eating kick for some reason, I flipped to the "Guiltless Grill" section of a mid-priced family place. Emblazoned across the top of the section was copy that screamed "...All items are under 750 calories, 25 grams of fat and 8 grams of saturated fat...". I have a love of vegetables, so of course I locked on to the black bean burger with a side of seasonal vegetables. It was good.

When I got home, I added it to my food log: Surprise! The black bean burger was the most calorie-dense main-course selection in that section of the menu, with more than three times the calorie load of the least calorie-dense menu entry (609 calories for my choice, versus 199 for the other).

Lesson: When you're on your way to correcting a lifetime of bad habits to mitigate coronary artery disease, do your homework before eating out. It's hard enough!

Sunday, May 3, 2009

Welcome to Dodging the Bullet


I've been thinking about blogging for a while. I'm a successful guy, with a couple of master's degrees and a doctorate. I have a great wife and daughter, a small but dedicated and fun-loving group of friends, and a job I love at a two-year college. So why start blogging, and why the title of this blog? Therein lies a tale, my friends.

In mid-April, I was in Chicago for the annual meeting of our regional accreditor (you education types will know all about that stuff, for the rest of you it won't matter). While rushing down the Magnificent Mile, I found myself very short of breath. A pause, for just a minute, and I was just fine.

Now, once I could have passed off on any number of things: It was cold and rainy, it was after dark and I was in the big city, I missed my own bed, et cetera ad nauseum ad infinitum. But it wasn't just once: It happened the next day, and the next. I drove home after the meeting thinking about it; five hours is a long time to be left to yourself, mulling scenarios over in your brain.

At dinner that night with my wife Beth, I did what I like to think most dorky introverted husbands would do: I botched it.

Me: Honey, do you promise not to freak out if I tell you something?

Beth: (Panic-stricken look on her face, smoke pouring from her ears as I hear the gears working so quickly in her head) WHAT?

You see, three graduate degrees does not a genius make.

So, I told her about the pain, and asked her if she thought I should see the doctor. The final vote: Yes, 2. No, 0.

I called the doctor on Wednesday morning; my regular doctor was off, so I visited another. This blog will be about what I found out, what I learned, and what changes are going on in my life. My hope is that others out there in similar situations will learn from my experience. Stay tuned for more.