Food Sense 5- Four-bean Vegetarian Chili

When August rolls around, things get hectic. School starts, and that means lots of effort at the college getting things up to speed. Throw in a couple of new staff members, and things really get hectic. Having said that, here’s a recipe with my own twist based on one from a web site I stumbled upon called ProfHacker. What made the original recipe great (and in my opinion, my own version better) is the simplicity. This is literally a “dump it in and walk away” recipe.

Four-bean Vegetarian Chili

Ingredients:
2 15oz cans dark red kidney beans
2 15oz cans black beans
2 15oz cans Great Northern or cannellini beans
2 15oz cans pinto beans
2 15oz cans diced tomatoes
1 cup frozen corn
1 medium onion, diced
1 tbsp chili powder
2 tsp garlic powder
2 tsp cinnamon
1 tsp black pepper
Salt to taste
Hot sauce to taste

Directions
1. Dump the beans and tomatoes (including all of the liquor in the cans) into a large crock pot. Reserve the frozen corn.
2. Add the onions.
3. Stir in the spices (Note: be careful with the salt; most canned beans have some salt in them).
4. Turn the crock pot on low, and cook until the beans are at the desired consistency. Add the frozen corn 20 minutes before serving.

Nutritional information:
Serving Size 232 g.(one cup) Per Serving: Calories, 74; Calories from Fat, 4; Total Fat, 0.4g; Cholesterol, 0mg; Sodium, 14mg; Total Carbohydrates, 16.9g; Dietary Fiber, 6.8g; Sugars, 4.3g; Protein, 3.9g

An interesting observation

Friday was college in-service, the day the faculty return to the college where I work. In-service also marks the end of the more casual days of summer, so I was back in a dress shirt and tie for the event. So imagine my surprise when I came out of the shower on Saturday morning and noticed a large bruise on my right forearm.

Now, understand that before all of this, I almost never bruised. However one of the side effects of drugs you take after stents have been placed, like Plavix, is (according to drugs.com) ”…pale skin, easy bruising or bleeding, weakness, fever, and urinating more or less than usual.” On Thursday night my friend Kristopher held an event here in town called Downtown Classic Cinema Under the Stars. Beth and I helped with logistics; after the event we were loading the large screen (20 feet wide) into the truck and I was supporting the heavy cardboard tube around which it was wrapped with my right forearm. It wasn’t until Saturday morning that I noticed it. Make sure to touch base with your healthcare provider, just to keep them in the loop on this.

Rehab and the second procedure

I was home on Saturday, May 2 with one of my three blockages corrected. I was sore and pretty slow; when I got home I took an opportunity to look at the site in a full-length mirror. What I saw surprised me: A bruise, the color of black velvet, extending from my midline to my right hip. It looked very much like I was wearing a quarter of a black Speedo. It wasn’t a pretty sight. I haven’t had the body for a Speedo since I spent the summer in the Bahamas during my undergraduate days at the Community College of the Finger Lakes field station.

Over the next few weeks the bruise continued to spread, eventually moving into my upper thigh and beyond the midline. The color moderated somewhat but persisted for at least three weeks into May. At the site of the insertion of the inducer sheath, I had a lump that started out the size of the last segment of my little finger; the lump decreased over time. I knew that I was going back into the operating room in four weeks, so the lump was a concern. The cardiac physician’s assistant told me that the second procedure would be performed from the right side as well, since she said it worked better to go in via the right side from an anatomical perspective, although I haven’t found a clear explanation of why this is so.

When I was being discharged from the hospital, I was told that I would be slotted into cardiac rehab. According to The American Heart Association, “Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event or death. Cardiac rehabilitation programs include:

• Counseling so the patient can understand and manage the disease process
  
• Beginning an exercise program
  
• Counseling on nutrition
  
• Helping the patient modify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes.
  
• Providing vocational guidance to enable the patient to return to work
  
• Supplying information on physical limitations
  
• Lending emotional support
  
• Counseling on appropriate use of prescribed medications."
  

My first rehab session was scheduled about a week before my second procedure, which was due on June 1. I showed up at my session; I brought along some workout clothes because I was told that the rehab folks would do a physical assessment. At the rehab session, the staff took a detailed history and gave me a set of questionnaires to complete. They measured my waist, right below my navel; I measured 46.5 inches. The Heart and Stroke Foundation of Canada showed that men with waist measurements larger than 40 inches (at least for European Caucasian, Sub-Saharan Africans, Eastern Mediterranean, and Middle Eastern men) are at risk for high blood pressure, high blood cholesterol, type-2 diabetes, heart disease and stroke. Not good. They ran me through 10 minutes of exercise on a recumbent bike, and 10 minutes on a treadmill. They set me up for 36 sessions, Monday, Wednesday, and Friday from 8:00-9:00 in the mornings.

Monday morning I showed up for my first rehab session. What struck me was the age difference between me and the other men (by chance, my group was all male) in the group. I was youngest by probably 20 years at least. When you go to rehab, the nurses need to monitor your heart. After all, you were just diagnosed and treated for heart disease. Thus, you wear a battery-powered heart monitor. You stick on three electrodes, one just below your right collarbone, and one each just beneath your rib cage on the left and right sides. The electrode leads snap on to the adhesive electrodes, and you clip the monitor to your waistband. Then during exercise, the rehab nurses monitor your heart rhythm and heart rate.

During a typical rehab session you’ll do several things. Understand that one of the purposes of rehab is to learn about how to safely exercise. Thus, you’ll start out by stretching and warming up with hand weights and then move into some very low-level calisthenics like marching in place. Once you’re warmed up, you start working out. Most rehab facilities have a variety of equipment; mine had recumbent bikes, treadmills, and rowing machines. You work out for 40 minutes (that’s the target, although you’ll work out for less time at first), and then go through a cool-down. Several times while you’re exercising, the nurses will take your blood pressure. All of the measurements during and before exercise (including your weight and resting heart rate) are entered into a computer program to track your progress.

During my first week of rehab, I went Monday and Wednesday. Friday I was scheduled for the second procedure. I was a lot less nervous the second time.

The second procedure went off the same as the first, with two significant differences. First, the bruising at the insertion site was completely different; the bruise was just quarter-sized, and after a few days was barely visible. As I described in this post, the nurses put pressure on the inducer-sheath site with their thumbs, pressing directly down into the soft portion on the front of my pelvis. That left a mammoth bruise. This time, the nurse pinched the site against the ilium or hip bone. The pressure was much less, and there was much less pain. Second, the two remaining blockages were in my right coronary artery; the blockages were about 80% and 90%. When they stented the blockages, I didn't feel a thing, unlike the first time when I had significant pain and shortness of breath. I'd heard of people having "silent" heart attacks; the stenting process reinforced to me just how that was possible.

In the next installment, how to get into an exercise routine.

Food Sense 4- Lebanese garlic marinated chicken on the grill

Beth and I started a dinner club, a group of friends who get together periodically to enjoy dinner together. Each couple brings one of the courses. The inaugural event had a Mediterranean theme; a Mediterranean diet is quite healthy. As hosts, we prepared the main course. I chose a recipe from The New Mediterranean Diet by Nancy Harmon Jenkins. The chicken was moist and flavorful, and the accompanying garlic sauce was quickly used up, to the disappointment of those assembled. This recipe is dead easy, and well worth it:

Ingredients: 4 garlic cloves, peeled; 1 tsp kosher salt; 1/2c fresh-squeezed lemon juice; 3/4c extra virgin olive oil; 1 tsp sweet paprika; freshly ground black pepper to taste; 2 lbs boneless skinless chicken breasts.

1. Mince the garlic. Then, place in a small bowl and add the salt. Using the back of a spoon, mash the mixture until you have a creamy paste.
2. Add in the lemon juice, olive oil, paprika, and black pepper. Mix well.
3. Dump the chicken into a zip-lock bag, and pour the marinade over the meat. Seal the bag and toss a few times to ensure all of the meat is covered.
4. Refrigerate for at least four hours (longer is better).
5. Grill over medium heat for at least 10 minutes per side.

Nutrition Facts
Serving Size 136 g. Per Serving: Calories, 397; Calories from fat, 258; Total Fat, 28.7g; Saturated Fat, 5.1g; Cholesterol, 101mg; Sodium, 389mg; Total Carbohydrates, 0.6g; Protein, 32.9g

Garlic sauce
This sauce is outstanding. Note that the recipe in the book calls for ladneh, which is a Lebanese soft cheese made by salting yogurt and then letting the whey drain off for 24-36 hours. There are recipes online and in the cook book from which I got the recipe, but I can tell you that the sour cream I substituted should work just fine.

Ingredients: 6 garlic cloves, peeled; 1 tsp kosher salt; 1/3 to 1/2c extra virgin olive oil; 3-4 tbsp low-fat sour cream.

1. Coarsely chop the garlic. Then, place in a small bowl and add the salt. Using the back of a spoon, mash the mixture until you have a creamy paste.
2. Slowly beat in the olive oil, like you were making mayonnaise. If you can do so without the sauce breaking, add the entire amount of olive oil.
3. Gently fold in the sour cream, making sure to fully incorporate it into the sauce.

Nutrition Facts
Serving Size 23 g. Per Serving: Calories, 136; Calories from Fat, 133; Total Fat, 14.8g; Saturated Fat, 2.6g; Cholesterol, 3mg; Sodium, 295mg; Total Carbohydrates, 1.0g; Protein, 0.3g

To complement the main course, I grilled slices of sweet onions, tomatoes, eggplant, and bell pepper, brushed with olive oil. Serve the chicken breasts, and pass the garlic sauce for guests to spoon on top of the meat. Outstanding!

The aftermath and interim

Beth headed home about 8:30, and left me to my own devices. I read for a while and flipped through the TV channels. Once I was allowed up, I went to the bathroom and checked the location. Although the site in my groin was covered by a four-inch square bandage, it was clear that the bruise was going to be a doozy. I finally shut off the lights at 10:00.

Several times during the night, I had the obligatory wake-ups from the nursing staff. Blood pressure checks, meds, and even a blood draw. Finally, I woke up for good at 7:00.

About 9:00 Beth called and told me she was hitting the shower and would leave soon thereafter. About 10:00 I started entertaining a parade of visitors, all getting me ready for departure. First was a dietician, telling me how to eat healthily. She left me with a booklet, which I have yet to open.

Some words about eating: Since my clean stress test in 2002, I’ve monitored my cholesterol and triglycerides aggressively. While somewhat high back then (in 2002, my total cholesterol was 265 versus a target max of 180), it has been below 200 since 2004 and below 180 since 2006. Since 2002, I’ve had my cholesterol checked more than a dozen times. For many years, I have tended toward salads and almost never eat red meat. Chicken and shrimp probably represent the majority of the animal protein I eat. What I have always struggled with is portion control: It’s the old joke about see-food diets… I see food, I eat it. I made a vow to focus on portions, since I was already eating better than many people.

Next up was a cardio-pulmonary rehab nurse. She told me that I would be in rehab, and my local hospital would be contacting me to set up a schedule. This was the first time it really hit me that my life was going to change, and change in a significant way.

Finally, the cardiac physician’s assistant came in. She did an exam to check the puncture site, asked me how I was feeling, did the usual doctor things, and added new prescriptions for me. The final thing she did was to go over the procedure, tell me what was coming (the second procedure on June 1), and then she gave me a “stent card.” Who knew that you’d have to carry a card with you at all times explaining that you had a small tube stuffed inside a coronary artery?

How big is a stent? Do this: Open a typical ballpoint pen. The tube that holds the ink (in slimline pens, at least) is about 3 millimeters in diameter. Now, for the metrically challenged or resistive among you, there are 25 millimeters to an inch (25.4 to be exact), so 3 millimeters is an eighth of an inch for all intents and purposes. Hack off a piece of the pen tube 18 millimeters long (again, about 3/4”). That’s what saved my life; that tiny medical miracle was holding open my widowmaker (the left anterior descending coronary artery). To put in perspective just how small the stent is, see the accompanying photo.

The PA set up a follow-up visit for a couple of weeks away, gave me a slew of literature, and left me to get dressed. Beth showed up, and we headed out of the hospital. I was moving slowly (I was sore), but we headed home. I was told to take it easy (no driving for 48 hours). In the next installment, the joys of cardiac rehab and the second procedure.

What the doctor found

First, I want to let you know why it’s been a while since the last post: I’ve had a second procedure, which was stacked up on the end of the school term. This blog comes after my day job! Now, what the doctor found.

I was back in the room by 1:30. There was no pain, and I felt pretty mellow (probably due to the sedative injected just before the procedure started). Shortly after getting back into the room, Beth showed up. “The doctor said you had three blockages, but they only fixed one, with a drug-eluting stent. You had a 99% blockage.”

“What?”

That’s when reality set it. I learned I had a 99% blockage in my left anterior descending (LAD) coronary artery. It’s one of the few coronary arteries with a colloquial nickname (in fact, it’s the only one I’ve ever heard): It’s known as the “widowmaker.” Suddenly, everything that I’d done the weekend before to try to make the angina return came rushing back. Plus, all of the times I’d been winded over the past winter running the snowblower. And all of the hours I’d spent at the YMCA on the treadmill at 3 miles per hour on a 12% grade. With a 99% blockage, I was (as Daughter said to Beth) walking around with a time bomb in my chest.

I’ve read about people coming face-to-face with their own mortality. This was my moment.

Once I swallowed that, I learned more. The procedure showed two more blockages, both in my right coronary artery. The doctor estimated those at around 75% and 85%. The reason those weren’t fixed right away was due to caution on the medical team’s part: The molecule that makes up the dye is large and difficult for the kidneys to excrete. Fixing the other two would have meant pumping in more dye, which may have stressed the kidneys. Thus, the team decided to come back in later to fix the remaining two blockages.

Up to this point, the procedure had been relatively painless. What lay ahead was six hours flat on my back, on a hospital gurney with no movement of my right leg. While I was alone, I explored my groin area and was surprised to find a piece of plastic sticking out; I had found the introducer sheath (if you’re into such things, you might check out this web site for pictures. I’m not sure it’s the exact device used, but it gives you the idea what an introducer sheath looks like, courtesy of Gore Medical). Because home was an hour away from the hospital, I also learned that I would be spending the night in the hospital.

Those six hours were awful. I’m a big guy (as I noted in an earlier post, almost 280 pounds at the time), and six hours flat on your back without even a pillow was very painful. The medical team was good, and provided medications to ease the pain, but those six hours were the worst part of the whole process.

At about 4:30, the nurses came in and asked Beth to leave for a while; the plan was to remove the introducer sheath. After getting all sterile, the nurses exposed my groin. They explained that they would remove the device, then apply direct pressure to stop the bleeding. After some tugging and pulling, the first nurse told me, “This is going to be uncomfortable.” This turned out to be an understatement.

She took her two thumbs and leaned hard into my groin. It felt as if she was trying to make a dent in the mattress by pushing through me from the top. When she got tired, the other nurse stepped in. This continued for what seemed like an eternity, although it was just 40 minutes or so. At the end, they slapped a bandage on it, covered me up, warned me not to move, and brought Beth in. We talked, I dozed, and we waited. I was in quite a bit of pain, not from the procedure but from being flat on my back for hours. Around 6:00 they told me my room was ready, and we headed out.

In the room, they transferred me to the bed from the gurney, again admonishing me to not move my leg. I felt bad for the nurses and medical staff, having to slide more than an eighth of a ton from the gurney to the bed. But the bed was such a relief after the hard gurney; the mattress was soft and supportive.

Once we were in the room, Beth took control. By this time I was coming up on 24 hours without food, since I had been instructed to fast after 7:00 the night before. In short order, a tray appeared. Have you ever tried to eat dinner when you’re flat on your back? It’s a lot easier when you have a loving spouse who feeds you (thanks!).

By 8:00 PM, the nurse came in to raise me into a sitting position. Soon thereafter, I sent Beth home to sleep in our own bed while I spent the night at the hospital. At 9:45, more than eight hours after the procedure I was finally allowed out of bed. I was sore, but it felt good to get up. In the next installment, the aftermath and interim.

Mea Culpa

Just a quick post to let you know that I will be posting new material soon. I was pretty busy over the past week, a you'll read about in an upcoming post.