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Choline Breakfast in Mom’s Kitchen 07/29/2012

Posted by thetickthatbitme in Choline Diet, Whole Person.
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I’m excited to be visiting my parents this week, especially because their kitchen is always filled with fresh fruits and vegetables. I missed the Central Coast’s superior tomatoes!

Tomato and egg sandwich on toasted sourdough.

Tomato and egg sandwich on toasted sourdough.

Choline count: 2 eggs (250 mg) + 1 tomato (12 mg) + sourdough bread (15 mg) = 277 mg of choline

Happy Sunday everybody!

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The Choline Diet: Herbivore Style 07/01/2012

Posted by thetickthatbitme in Choline Diet, Tick-Lit, Whole Person.
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In the past, my choline diet posts have been mostly geared towards omnivores, as eating eggs and meat is an easy way to get one’s daily dose of choline. If you’re new to this blog–or just forgetful–I’ve been on a choline-rich diet since I started getting treated for Borrelia hermsii and Anaplasmosis last year. My doctor recommended this because I had some neurological involvement with my illness–brain fog, chronic fatigue, arthralgias–and there’s research that suggests that eating choline helps our bodies produce more of the neurotransmitter acetylcholine. Choline has also been linked to lower levels of inflammation. In addition, choline is particularly important for pregnant women, as higher choline intake during pregnancy is associated with a lower risk of neural tube defects in infants.

choline dude

Image via doubleeaglefitness.wordpress.com

So that’s why I’m always telling my readers to eat their eggs and meat and green veggies. However, since a study led by Scott Commins at the University of Virginia linking lone star tick bites to red meat allergies gained national media attention (ABC, CNN) a few weeks ago, I’ve been thinking about how to make my choline recipe recommendations more herbivore-friendly.

After my last choline-related post, I stumbled upon the USDA Database for the Choline Content of Common Foods, which is a fairly good resource (and handy since it comes in a searchable PDF), although it doesn’t include everything I like to eat. (For example, the desserts section is severely lacking.) The other issue with it is that the choline values are reported in mg per 100 grams of food, and the average person may not eat 100 grams of some of those food items in one sitting–particularly the spices. (100 grams of chili powder, anyone?) So keep in mind that the choline numbers below are based on that ratio, and don’t think you’re getting 120 mg of choline in a pinch of mustard seed. This week, I decided to go through the database and find the foods with the most choline. For my herbivore/vegetarian readers out there, whatever your reason for avoiding meat (moral, dietary, tick-bite-induced allergy…), here are the top choline sources from several non-meat categories:

Top 10 Veggies:

  1. edamame—56 mg*
  2. broccoli (boiled) —40 mg
  3. cauliflower (boiled) —39 mg
  4. tomato paste—39 mg
  5. artichokes (boiled)—34 mg
  6. peas (boiled)—28 mg
  7. spinach (cooked) —28 mg
  8. asparagus (boiled) —28 mg
  9. sweet corn (boiled) —22 mg
  10. red potatoes (baked) —19 mg

Top 10 Fruits:

  1. dried figs—16 mg
  2. clementines—14 mg
  3. avocados—14 mg
  4. dried apricots—14 mg
  5. raspberries—12 mg
  6. raisins—11 mg
  7. prunes—10 mg
  8. mandarin oranges—10 mg
  9. medjool dates—9.9 mg
  10. bananas—9.8 mg

Top 10 Nuts and Seeds:

  1. flaxseed—79 mg
  2. dry roasted pistachios—71 mg
  3. roasted pumpkin seed kernels—63 mg
  4. roasted cashews—61 mg
  5. dried pine nuts—56 mg
  6. sunflower seed kernels—55 mg
  7. almonds—52 mg
  8. hazelnuts—46 mg
  9. dry roasted macadamia nuts—45 mg
  10. pecans—41 mg

Top 5 Legumes:

  1. creamy peanutbutter—66 mg
  2. boiled navy beans—45 mg
  3. baked beans—28 mg
  4. firm tofu—28 mg
  5. soft tofu—27 mg

Top 10 Spices:

  1. mustard seed—120 mg
  2. dried parsley—97 mg
  3. garlic powder—68 mg
  4. chili powder—67 mg
  5. curry powder—64 mg
  6. dried basil—55 mg
  7. paprika—52 mg
  8. ground turmeric—49 mg
  9. ground ginger—41 mg
  10. onion powder—39 mg

*All measurements are given in mg/100 g of food

I hope these lists get you on your way to a diet more rich in choline, whether it includes meat or not.

This concludes the herbivore section of this post. If you don’t want to be tempted with any meat, try clicking over to some of my other posts.

***

If you’re here in search of choline diet inspiration of the omnivore variety, I haven’t completely forgotten you. Here’s a glimpse of what I had for lunch.

steak sandwich tomato avocado

Steak sandwich on pumpernickel with avocado and tomato.

Happy Sunday, everybody! And watch out for ticks!

Eating out {in the name of choline} 05/13/2012

Posted by thetickthatbitme in Choline Diet, Whole Person.
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One of my dear friends is a new mommy who’s been going a little stir-crazy for the past two months waiting for her son to get his first shots and be allowed to leave the house more regularly. Yesterday, she got a few baby-free hours, which presented a perfect opportunity for some fine dining (or at least what we frugal ladies consider fine dining), and that’s how we found ourselves at a little place called Cafe Mundial in Monrovia.

Now, I must confess, I wasn’t thinking about my choline diet at all as I was scanning drooling over the menu, but it turned out that both my friend and I did fairly well on the choline count without really trying. Here’s what we had:

To Start

This restaurant serves their complimentary bread with a side of hummus (which is really not to be confused with humus). Much to my delight, when I looked up hummus today, I discovered it has 4 mg per tablespoon. (Side note: if you look up “humus,” which is how WordPress spellcheck thinks “hummus” should be spelled, you’ll find it has no choline. So if anyone ever commands you to “Eat dirt!” tell them, “I can’t. I’m on a choline diet.”) We also each ordered the soup du jour, which was tomato basil. (I have no picture of this, and couldn’t find one from Cafe Mundial.) Not much choline in the soup, but it was delicious!

cafe mundial hummus

Yummy hummus with bread for dipping. (Image via Yelp)

The Main Course

I had the duck conflit, which was accompanied by a small scoop of mashed potatoes and generous helpings of carrots and zucchini. You can see it pictured below with beans instead. Choline count for roast duck: 43 mg for half a pound. Cooked carrots and zucchini add 7 mg and 8.5 mg choline, respectively, for half a cup each.

Duck Conflit

Duck Conflit with veggies. (Image via Yelp)

The Finale

Though I admire the philosophy of “Life is short; eat dessert first,” this isn’t really possible with soufflé, owing to the long prep time. It was more like, “Life is short; order dessert first, or else it won’t be ready.” This one was accompanied by fresh strawberry slices and a vanilla bean sauce. We were a few bites into it when I said, “Hold on, I should take a picture of this.”  It was just as delicious as it looks. I couldn’t find any nutritional data for chocolate soufflé, but boring old grocery-store-bakery chocolate cake has about 20 mg per slice. With all the eggs and chocolate in soufflé, I’m guessing this little treat comes it at around 30 mg.

chocolate soufflé

Chocolate soufflé, a.k.a. Heaven.

So how well did I fare in the choline department? According to my (rough) estimate, I had about 100 mg of choline. My friend, who ordered the filet mignon (77 mg choline in 3 oz), out-cholined me by about 40 mg.

All IV therapy is the same, right? 05/09/2012

Posted by thetickthatbitme in Treatment, Whole Person.
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As you might have noticed, I am quite the internet researcher these days. I’ve been googling around, reading about different people’s experiences with IV therapy, and I have to say, some of the things I’ve seen are downright horrifying to me. To make sense of it all, I started researching the different ways that people can be hooked up to IVs and thinking about this in the context of my own experiences being poked with needles. I admit, I couldn’t figure it all out by myself, so yesterday, I requested an interview with Dr. W and he explained some of the nuances of IV practices to me. The following is my layman’s term translation of what I found out.

There are four main ways to do IV antibiotic therapy, and some methods are more popular than others. I’ll describe a little about each one, and then we’ll compare.

Catheters

hand catheter

Here’s my hand with a catheter in it following spine surgery in 2010. I think they took it out shortly after this because it was getting kind of gross.

One method of IV therapy is to insert a catheter into a vein in the hand or arm. The catheter can then be connected to a bag containing the prepared antibiotic. (If you’ve ever had general anesthesia, you’re probably familiar with this one.) Catheters can be left in up to three days, but after that, they need to be removed to avoid infection. When a catheter is taken out, another one cannot be put back right away in the same place, as this can damage the vein. One problem this poses is that a doctor treating a patient with IV therapy for an extended period of time may run out of places to put the catheter. Having a catheter can also inhibit a patient’s normal activities (like bathing, for example).

PICC line/Intravascular device

A PICC line (PICC stands for peripherally inserted central catheter) is inserted into the cephalic vein in the arm, which runs up into the subclavian vein. This line can be left in the vein for weeks at a time, so it is often used for long-term antibiotic treatment because it is more convenient (for the doctor) than inserting a catheter every 3 days. On the downside, having a PICC line inserted can cost thousands of dollars and may or may not be covered by insurance. The dressing needs to be changed weekly by a nurse, which is another added expense. If any complications arise, this may mean time spent in the hospital emergency room.

PICC line

This is what a PICC line in someone’s arm looks like. The line has a bandage/dressing over it to keep it clean. Usually, you have to wear a sleeve over it to protect it and keep it from catching on stuff. (Image via ucdmc.ucdavis.edu)

One patient I know who was getting treated with vancomycin through a PICC line (for a non-tick-borne infection; vancomycin can only be done through a PICC line because of the nature of the drug) developed a severe allergic reaction to the adhesive that was used to tape the line. It looked like she had burns on her arm! Other people develop serious infections. How common is infection with PICC lines? In a study of 200 patients being treated with antibiotic therapy via PICC line, 15 patients had complications related to the PICC line itself, and six suspected line infections were reported. Now, I don’t know about you, but I wouldn’t want to be one of those six people, especially if I were paying thousands of dollars out-of-pocket for this treatment. So why do doctors who treat TBIDs like to use PICC lines? A PICC line usually means that a patient only needs to be seen by the doctor every week or so, so it is certainly less work for the doctor. In between doctor visits, a nurse is supposed to assist the patient with administering the medication. I’ve seen a lot of patient testimonials online, however, that indicate that in between doctor visits, patients are basically left to their own devices. I shudder to think of what happens to these patients if they have adverse reactions to the antibiotics or if they contaminate their lines while administering their own treatments.

Implantable Portacath

This method is not very common with IV antibiotic treatment, but it does exist, so I am mentioning it. A portacath is surgically inserted under the skin into the subclavian vein (which is a big vein) in the upper chest or the arm. The port has a silicone bubble called a septum, where the needle is inserted to administer the drug. The risk of infection with a portacath is purportedly lower than with a PICC line or catheter. The downside would be having to undergo the surgery to implant the port, as well as the surgery to remove it. Though it’s considered a minor surgery, I’m sure it’s not cheap, especially if it’s not deemed medically necessary by your insurance company.

Daily (Butterfly) Needle Insertion

This is the method with which I am most familiar, as it is how I was treated for 42 days. My doctor used a 23 gauge butterfly needle (which is an itty-bitty needle originally designed to be used in babies’ heads) and inserted it into a vein on the back of my hand. The needle was connected by a line to a bag containing the antibiotic, which was prepared fresh daily in a sterile hood. I sat in a comfy chair in the doctor’s office for about 45 minutes each day with the itty-bitty needle in my hand.

Butterfly_needle

This, in my humble opinion, is the best (read: least painful) kind of needle. (Image via Wikipedia)

This method has several advantages. First, I didn’t have to worry about purchasing and storing the drug or any equipment. Everything was provided at my doctor’s office and included in the cost of my visit. I also didn’t have to worry about ‘doing it wrong’ because the doctor did all the work. All I had to do was keep my hand relatively still for 45 minutes. Aside from this time spent in the clinic, this drug delivery method didn’t inhibit my activities because I wasn’t walking around with a needle stuck in my vein. I could shower normally. I could go to the swimming pool. I could wear long-sleeved shirts and jewelry. I also didn’t get a scar like I did from the catheter in my hand after my back surgery. For comparison’s sake, I was curious about the risk of infection with the needle-in-hand method, so I asked Dr. W about it yesterday. He said that in the past year at his clinic, he has inserted more than 4,000 needles for IV infusions, and there have been zero infections.

hands

Can you tell which hand got stuck 40 days in a row?

Okay, so let’s recap the pros and cons of each method.

Method

Pros

Cons

Catheter

  • Can do treatment at home with a nurse
  • Has to be changed every 3 days
  • Risk of infection
  • Leaves a scar

PICC line

  • Can do treatment at home with a nurse
  • Only have to see doctor weekly

 

  • Risk of infection
  • Risk of allergic reaction to bandage adhesive
  • Patient may have to self-administer
  • Leaves a scar
  • Expensive

Portacath

  • Can do treatment at home with a nurse
  • Has to be surgically implanted and removed
  • Expensive

Butterfly   needle

  • Doesn’t leave a scar
  • Lower risk of infection
  • No prep work for patient
  • Have to visit doctor every day
  • Have to get stuck with a needle every day

Stuff I’ve been tested for and WHY 05/08/2012

Posted by thetickthatbitme in Diagnosis, TBI Facts, Whole Person.
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I apologize for the inconsistent posting lately; it’s been a busy couple weeks. No tick-lit today, so I’ll owe you some later in the week!

Tonight’s question: How did my doctor find 3 crazy infections that five other doctors missed? (One of which went undiagnosed for 7 years!)

medical records

This is the small binder I carry with me to doctor’s appointments. I have about half a file drawer dedicated to the rest.

Answer: He sent me to get tested for a whole lot of stuff.

How did he know what to order? He considered my risk factors and exposure to disease vectors (like ticks and pets). Is it important for your doctor to know if you’ve been out of the country? If you used to live in another state? If you have pets? If you hike or camp? If you’ve had food poisoning? Yes, yes, yes, yes, and yes!

Below, rather than listing the name of each disease/infection I was tested for, I’ve listed the names of the tests as they appear in my lab reports from Quest Diagnostics. (No, Quest did not pay me to mention their name. I just happen to like them, since they’re always nice to me and their tests helped find my infections.) They’re sorted according to why my doctor thought to order them.

Quest sends me pretty labs in color (as if that matters). Tip: always check the box on your lab slip that says “mail patient a copy” or something like that.

DISCLAIMER: Just because I’ve been tested for something doesn’t mean that you need to be. Only you and your doctor can decide what you should be tested for based on your history, risk factors, and symptoms.

Tick exposure

Borrelia hermsii AB IFA

Anaplasma phagocytophilum IFA

Ehrlichia chaffeensis IFA

Lyme Disease Antibody (IgG/IgM) Western Blot

WA1 (Babesia duncani) IgG Antibody, IFA

Babesia microti Antibody IgG/IgM

Cat exposure

Bartonella Species Antibody test w/reflex (FYI: One of my cats has tested positive for Bartonella, but I was negative. He’s never scratched or bitten me, but I have been bitten by a different cat.)

Toxoplasma IgG Antibody

Toxocara Antibody, ELISA (serum)

Having food poisoning in Mexico and China

Entamoeba histolytica IgG, ELISA

Giardia lamblia AB Panel, IFA

Helicobacter pylori IgG

Helicobacter pylori breath test

Salmonella and Shigella Culture (this was not fun, but I’m glad they were negative)

Camphylobacter Culture

Additional tests:

Immunoblobulins G, A, and M (to see if I was deficient, as this would affect the results of antibody tests and would mean I might need additional treatment, like IVIG—luckily I was not deficient)

CBC (to see if I was low on any particular kinds of blood cells, which might indicate an infection)

Questions? Feel free to comment/e-mail. For whatever reason, I seem to enjoy discussing labs.

5 Things That Helped Me Heal 05/02/2012

Posted by thetickthatbitme in Humor, Whole Person.
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1. Shower chair

We got this after I had my back surgery (to help me avoid bending, slipping, and falling), and I continued to use it after I was diagnosed with hermsii and Anaplasmosis. It really makes a difference being able to sit and relax while bathing. My boyfriend (who is healthy as a horse) also enjoys using it when he just wants to wash his feet!

My chair. Note: It only works if you put it IN the shower.

2. Thermalon heating pads

heating pad

One of my four heating pads.

These heating pads are my best friends. My mom, who has Arthritis, introduced me to them. I put mine in the microwave for about a minute, and it will stay warm for about 30, depending on how cold my house is. After the initial heating, you can reheat them for 30-40 seconds at a time.  I prefer these to an electric heating pad because they provide moist heat, and I can fall asleep with one without burning myself. They helped me get off painkillers and sleep better on cold nights. They can also double as cold packs if you store them in the freezer inside a ziplock bag. I found them on sale at Walgreens for $15 each.

3. Low-impact exercise

Arthritis Foundation

Image via Arthritis.org

Taking an Arthritis Foundation water aerobics class at a warm water therapy pool helped me stay active while I was getting treated. The warm water helped my joints feel better, and I think all the endorphins from exercising made me happier. I also made some great friends in the class who are just slightly older and much wiser than me. (Shout out to the pool ladies!) If you’re interested in this type of class, you can search for one in your area here.

4. Memory foam mattress pad

This was also a purchase made after my back surgery. My mattress is quite firm. (That’s how I used to like it when I was a young thing with no health problems.) I’ve always slept best on my side, but after surgery, and as I began developing more joint problems in my neck, hips, and knees, the mattress was too hard for me. Rather than shelling out $800 for a new mattress, I spent about $150 for this memory foam mattress topper from Costco. Now the bed is soft enough that I don’t feel like I’m sleeping on a plank, but not so soft that I sink in too far. I’m still able to roll over during the night so I don’t get too stiff.

5. Geoff Peterson

I can’t stress enough how much laughter helped me recover. My parents are a little obsessed with Craig Ferguson, and I started watching him, too, when I was staying with them and getting IV therapy. Craig’s exchanges with his robot sidekick Geoff Peterson make me laugh the hardest.

What are some things that have helped your healing process?

Omelet you in on these yummy high-choline recipes 04/29/2012

Posted by thetickthatbitme in Choline Diet, Whole Person.
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In my family, omelets are somewhat of a sacred tradition. My dad was the omelet-master when I was growing up, and whenever we had weekend company, he’d make each guest and family member his or her own made-to-order omelet. By the time I was in high school, I’d picked up his technique and was making omelets for all my friends after school. Little did I know back then what a great source of the B vitamin choline omelets can be! (For more on choline, see the Choline Diet page.)The best thing about omelets besides the choline factor is the infinite possibilities–there are no rules about what cannot go in an omelet. Here are some of my favorites.

Smoked Salmon, Spinach, and Avocado Omelet

salmon omelet avocado

Image via cuisineaustralia.com.

I love smoked salmon, and I’m always looking for new ways to cook with it (aside from just eating it on a bagel with cream cheese–yum). Check out this salmon omelet recipe from cuisineaustralia.com.

Choline Count: eggs (2) 200 mg + salmon (3 oz) 80 mg + spinach (2 oz) 11 mg + avocado (1) 19 mg = 300 mg of choline!

Mushroom, Spinach, and Feta Omelet

mushroom spinach feta omelet

Image via closetcooking.com

What do I like almost as much as smoked salmon? Crumbly cheeses! Feta and spinach are always delicious together, why not put them in an omelet? Add shiitake mushrooms for a bonus 66 mg of choline! Check out this recipe on closetcooking.com.

http://www.closetcooking.com/2008/03/mushroom-spinach-and-feta-omelet.html

Choline count: eggs (3) 300 mg + shiitake mushrooms (4 oz) 66 mg + spinach (2 oz) 11 mg + feta cheese (1 oz) 4 mg = 381 mg choline!

Leftover Stir-fry Omelet

This was my go-to omelet when I was a college student and rarely went grocery shopping or planned meals. I always seemed to have leftover Chinese food in my fridge, so I devised this omelet to make leftovers into breakfast. I usually use two eggs per person with a little milk. If you’ve got the jumbo eggs, you can get away with using one and use a little more milk (1 oz of skim milk has 5 mg of choline!). I whisk up the eggs and the milk in a bowl, then pour them into my omelet pan (yes, they make a size of frying pan that’s just for omelets). Meanwhile, I heat up the leftover stir-fry in a separate pan. Once that’s heated through and the egg mixture has set in the pan, I spoon some stir-fry onto one side. After a few minutes, the other side will be ready to fold over.

orang ginger beef stir fry

Image via mccormick.com

If you want to make a healthy stir-fry at home to use for your leftovers, you can try this recipe for Orange Ginger Beef Stir-fry from mccormick.com.

Choline count: eggs (2) 200 mg + beef sirloin (1/4 lb) 96 mg + broccoli (1/2 cup) 31 mg = 327 mg choline!

Hope you enjoyed this week’s high-choline recipes. Eggspect (sorry, I promise I’ll try to stop) to see more next Sunday!

Have a high-choline recipe (and mouth-watering photos) you’d like to showcase on this blog? E-mail thetickthatbitme AT gmail DOT com.

My Friend (Frenemy?) Anti-panty: Healing Humor 04/28/2012

Posted by thetickthatbitme in Humor, Whole Person.
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During my 42 days “doing time” in the infusion clinic, I became acquainted with three women from the same family—a young woman, her mother, and her grandmother—who were all being treated by Dr. W for various conditions. I’ll call them the Kind family, because they are amazingly kind and generous people. Grandma Kind lived on the east coast, and would be seen periodically by Dr. W when she visited her daughter and granddaughter. She’d had some lab work done, and the results came into Dr. W’s office by fax at the very end of a workday.

Credit: Louise Docker

Seeing that the elder Mrs. Kind had tested positive for an infection, Dr. W thought it wise to telephone her right away so that she could make arrangements to get treated for it. It was nearly 7:00 p.m. pacific time, 10:00 p.m. eastern time, when he called Mrs. Kind to inform her of the lab results. He hadn’t considered the time difference until she answered the phone with a groggy “hello.” He apologized for disturbing her at such a late hour, but went ahead and quickly explained that she had an Anaplasma phagocytophilum infection, and asked that she call his office within the next few days to arrange for treatment.

The next morning, Dr. W received a distressed phone call, not from the elder Mrs. Kind, but from her daughter.

“Dr. W, my mother said you called last night, and I’m a little worried about her diagnosis. I tried to Google it, but I can’t find any information on Anti-panty-poo-poo.”

Dr. W thought his hearing aid must have malfunctioned and said, “Excuse me?” to which Mrs. Kind replied, “My mother says you said she has Anti-panty-poo-poo. What exactly is that?”

Anyone who hears this story can’t help thereafter referring to Anaplasma phagocytophilum as anti-panty-poo-poo.

Eat Your Eggs, Benedict! 04/22/2012

Posted by thetickthatbitme in Choline Diet, Whole Person.
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If you know my story, you know that when I was diagnosed with B. hermsii and Anaplasmosis, my doctor put me on a high-choline diet. Why choline, you ask? Choline is a B vitamin that aids in the transmission of nerve impulses from the brain through the central nervous system–this process is essential to functions like memory and muscle control. Since Borrelia like to attack the central nervous system, choline is especially important for people with (past and present) B. hermsii and B. burgdorferi infections. People who eat diets high in choline have also been shown to have lower levels of inflammation (like inflammation of the joints in Arthritis) than people who don’t. You can read more about choline here.

Enter the Benedict. It is by far my favorite egg-based dish, and I enjoy making it at home just as much as I do eating it for brunch in a fancy restaurant.

"Eggs" Benedict Talley (Mehcad Brooks) from HBO's True Blood. Photo via hbo.com.

One large poached egg has 100 mg of choline, so if you eat two, you get about half of your recommended daily amount (425 mg for women, 550 mg for men). Add to that other high-choline foods like smoked salmon (129 mg), Canadian bacon (39 mg), portabella mushrooms (39 mg), spinach (35 mg), asparagus (23 mg), avocado (21 mg), and tomato (6 mg) to get your choline fix!

Here are my top five Benedicts:

1. Old Fashioned but Fried

for those mornings (or afternoons, or evenings!) when I’m feeling traditional, yet lazy

I learned this simple recipe from my mother, and it

Benedict Asparagus

Image via firsttimerscookbook.com

brings back all kinds of fond childhood memories. A toasted whole-wheat English muffin, topped with pan-fried Canadian bacon and over-easy eggs (make sure they’re still a little runny, because that’s the best part). The hollandaise sauce I usually make with one of those sauce packets you can find in the grocery store (next to the gravy packets). It’s easy–you only need to add milk and butter–and, in my opinion, it tastes better than the from-scratch hollandaise recipes I’ve tried. Because of the butter and bacon, this is a slightly fattening meal, so I balance it with a side of boiled asparagus, which tastes delicious with the hollandaise sauce and adds 23 mg of choline to this meal!

Choline count: eggs 200 mg + Canadian bacon 39 mg + asparagus 23 mg = 262 mg of choline

2. Crab Benedict

for when I’m feeling crabby or rooting for the Terps

I’ve never made this one at home, but I’ve had it at Toasties Cafe, and it is delicious!

Toasties Crab Benedict

Image via Yelp.com.

Choline count: eggs 200 mg

3. Portabello Mushroom Benedict

for the fungus-lovers amongus

If you’re looking for a meatless meal or just craving these yummy mushrooms, this is the Benedict for you. Check out Jackie Dodd’s recipe at TastyKitchen.com, which also includes spinach, tomatoes, and Sriracha for a kick!

Portobello Mushroom Benedict

Image via TastyKitchen.com

Choline count: eggs 200 mg + portabello mushrooms 39 mg + spinach 35 mg = 274 mg of choline

4. Tomato Avocado Benedict

because I’m a California girl

My mouth was watering as I scrolled through SoupBelly.com’s deliciously illustrated recipe for this west-coast Benedict. If you want to make it even more California, use sourdough English muffins.

Avocado Tomato Benedict

Image via soupbelly.com.

Choline count: eggs 200 mg + avocado 21 mg + tomato 6 mg = 227 mg of choline

5. Eggs Hemingway

for when I’m feeling literary

This one may seem a bit fishy, but I assure you it’s delicious and packed with choline. It’s also called Norwegian Benedict. Here’s a recipe at food.com that includes not only salmon but spinach, too!

Salmon Benedict

Image via Wikipedia.

Choline count: eggs 200 mg + smoked salmon 129 mg + spinach 35 mg = 364 mg of choline

Now that I’ve made myself really hungry, I’m going to go make my own Benedict. Hope you enjoy these eggcellent (sorry, I couldn’t resist) high-choline meals!

The Proactive Patient Manifesto 04/20/2012

Posted by thetickthatbitme in Whole Person.
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I don’t know about you, but sometimes going to the doctor makes me feel sicker! Why is that? Maybe it’s because I often feel that I have no control over my patient experience. Over the years, I have developed strategies for being proactive about my medical care that assist my doctors in understanding my needs and concerns AND give me more control and peace of mind. So here is my *proactive patient manifesto* of sorts.

As a proactive patient, I vow to…

Keep organized medical records. At most doctors’ offices, you can request copies of all your records, including office visit notes, procedure/surgery notes, labs, and imaging. When you get labs, always request that the lab mail a copy of the results to you (in addition to forwarding them to your doctor). When you get imaging, you can often get your own copy on CD. I keep all of my records in a three-ring binder and use tabs to sort them into categories like infectious disease labs, general labs, gastroenterology, urology, neurology, ophthalmology, etc. I also typed up a one-page medical history summary that lists my past surgeries, medications, and diagnosed conditions, which I keep at the front of the binder. I bring this binder to every doctor visit so that 1) if my doctor needs to copy my records, he/she can do so easily; 2) doctors and their staff know that I mean business and I pay attention; and 3) I can hold my doctors accountable for explaining my current condition in the context of my medical history. For example, I may have lab work ordered by one doctor that is related to a condition for which I am seeing a different specialist.

Communicate as openly and directly with my doctor as I possibly can. This means honestly disclosing symptoms and describing concerns. This means that when my doctor says something I don’t understand, I must ask him/her to repeat it. This means keeping each specialist informed of what’s going on with all my other specialists (the medical history summary really helps with this).

Come to the doctor prepared with a (written) list of questions and concerns. This is essential to me because 99% of the doctors I’ve been to always try to rush me out of the appointment after the first 5 to 10 minutes. Have you ever noticed how when doctors ask us, Do you have any questions? our instinct is always to say no? A discourse analysis professor I had in grad school had studied this phenomenon in doctor visits and found that the use of the word “any” deterred patients from asking questions! He suggested that doctors instead ask, Do you have some questions? because this seemed to elicit a more positive response from patients. My doctors have always used any, but it’s much easier for me to respond, “Yes, I have some questions,” if I have a list of them right in front of me.

Report incidents of mistreatment by my doctor or his or her staff. If your doctor is part of a large practice or a hospital group, there is usually a Patient Experience or Risk Management department or person whom you can contact to report inappropriate treatment. I recommend writing down a detailed account of what happened as soon as you can. Often, these experiences can be so distressing that we forget the order or the particulars of what happened, and that can compromise our credibility when we go to report the incident. When you speak with Patient Experience, try to communicate what outcome you are hoping for, whether it’s waiving the fee for your appointment or a simple apology. If you are mistreated in a doctor’s office, I don’t recommend making a scene or threatening to sue. Doctors take being sued very seriously, and if you sue one doctor in the town (or county, or state) you live in, you may have difficulty finding another doctor to treat you.

Stay informed about research related to my health conditions. This means reading articles, asking doctors to recommend written resources, participating in patient support groups, and—of course—writing this blog.

Am I missing anything? What strategies do you have for staying proactive?

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