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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!

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06/10/2012

Posted by thetickthatbitme in Choline Diet, Reblogs.
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Great post about the importance of choline intake during pregnacy.

This week’s choline diet highlights 05/20/2012

Posted by thetickthatbitme in Uncategorized.
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I tried to be good and cook simple, choline-rich meals at home this week. Here are some highlights:

McBreakfast Sandwich

I love making my own version of a fast food breakfast sandwich for several reasons. One, it’s healthier because I can use better ingredients. Two, it’s relatively inexpensive. Three, I don’t have to drive anywhere to get it.

eggs and canadian bacon

Start with an egg and a slice of Canadian bacon.

Sometimes I use an English muffin or a bagel, but this week I didn’t have those, so I used sourdough, which I actually like better. I also subbed out boring old American cheese for some spicy pepperjack.

sourdough pepperjack

Pepperjack on toasted sourdough. They’re big slices, so I just used one and folded it in half.

To drink, I had Treetop orange-pinapple juice, which I water down.

orange pineapple juice

Choline count: fried egg (125 mg) + Canadian bacon (19 mg) + sourdough bread (15 mg) = 159 mg

breakfast sandwich juice

Rainbow Coleslaw

I grew up on traditional southern-style coleslaw, and when the weather gets hot, I start craving it. I love putting it on pulled-pork BBQ sandwiches. Being that eating cabbage covered in mayonaise (or in my case, Miracle Whip) is not the healthiest way to get one’s veggies, when I make coleslaw at home, I try to make it a little healthier (and more rich in choline). One of the ways to do this is to use broccoli slaw. You can make it yourself in a food processor, or if you’re lazy like me, you can buy it already shredded up in a bag.

rainbow slaw

In a small bowl, I mix the dressing, which consists of Miracle Whip, sweet pickle juice (I didn’t have any, so I skimmed some out of the pickle relish jar), and horseradish sauce (for a kick). Some people also like to add vinegar (in place of pickle juice) and dijon mustard.

condiments

The condiment lineup.

Then I dump the shredded veggies into a big bowl, add a diced tomato, and mix in the dressing. It’s best to refrigerate slaw for a few hours before eating, but I always sneak a few spoonfulls to make sure it tastes right.

Choline count: broccoli, cauliflower, carrot, cabbage, tomato

coleslaw

Ready to refrigerate.

California Sandwich

I’ve been eating a lot of sandwiches lately. Boyfriend brought back several loaves of bread from Eric Schat’s Bakery, including some delicious rye bread, so I used some of it to make this sandwich.

tomato avocado egg sandwich

I topped that slice of delicious rye bread with Miracle Whip, horseradish sauce, tomato slices, a fried egg, and half an avocado.

milk and sandwich

Choline count:  fried egg (125 mg) + tomato (12 mg) + 1/2 avocado (9 mg) + rye bread (5 mg) + milk (39 mg) = 190 mg

Chorizo Scramble

Toward the end of the week, I started feeling guilty about eating so much bread, so I cooked up some Mexican chorizo with eggs and topped it with diced avocado and tomato. Cooking for two, I use five eggs and one package (a long link) of chorizo.

chorizo eggs avocado tomato

Choline count: 2 eggs (250 mg) + chorizo (58 mg) + tomato (12 mg) + 1/2 avocado (9 mg) = 329 mg

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.

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.

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!

My Story 04/18/2012

Posted by thetickthatbitme in Diagnosis, meta-blog, Treatment.
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Like many people who have suffered from tick-borne illnesses, I struggled with my symptoms for a long time before I got a diagnosis and effective treatment. At the time when I hypothesize I was infected—I say ‘hypothesize’ because I never discovered a tick or a tick bite, I never had a rash, and I never had a fever—I was already dealing with a number of medical problems that had begun in my early twenties. I’ll save all the gory details for another time, but my laundry list included irritable bowel syndrome (later diagnosed as an Entamoeba histolytica infection and treated with Metronidazole), a dysfunctional bladder (still unresolved), a spinal deformity (for which I underwent major surgery in 2010), and a ptosis in my right eye.

In the summer of 2009 I had finished graduate school and started my first professional teaching job. I’d been suffering from bladder and bowel issues for several years and had begun seeing an urologist and a neurologist who were trying to figure out if my problems were neurological, and if so, what to do about them. I spent the Fourth of July weekend in Yosemite National Park on a girls’ retreat with some friends from high school. We stayed in a yurt—with bunk beds—and hiked two or three trails a day for several days. I remember having a head cold that I picked up on the plane ride from Long Beach to Oakland and blowing my nose all night. I remember being eaten alive by mosquitoes one morning, despite having worn bug spray. I don’t remember any ticks, but I’m not much of an outdoor girl, and at the time, my tick-awareness was nonexistent. The kind of tick that bit me was likely a soft-bodied tick, the kind that fall off when they’re done, so it’s understandable that I never saw it. If there was a fever or a rash, I didn’t notice them because I was already sick and swollen with mosquito bites.

This is when I believe I was bitten, but there is really no way to know. According to CDC reports, the area of Southern California in which I live is known to be infested with ticks that carry Borrelia hermsii. I could have been bitten while walking my dog or sitting at a picnic table in the park.

After my Yosemite trip, I returned to LA and the neurologist, who referred me to a neurosurgeon. The surgeon, after ordering MRIs, concluded that I was cursed with a spinal column that was too long for my spinal cord, which was causing the cord to stretch like a rubber band and causing nerve damage that might account for the bladder and bowel problems. After much convincing (and much freaking out), I decided to undergo surgery to shorten my spine the following summer. At the time, I was under a lot of stress, trying to balance work, my teaching credential program, my relationship with my boyfriend, and routine doctor visits. If I was exhausted, I attributed it to this balancing act, not to the infection that was, unbeknownst to me, festering in my bloodstream.

The spine surgery was traumatic–nine hours face-down on the table, nine days in the hospital–but successful. My mobility was impaired for the first six months. I wore a hard brace until December and a corset until February. I was able to drive (and teach again) by September, and my life got back into full swing with student teaching, paid teaching, and two other part-time jobs. When I wasn’t working, I spent most of my time lying on my back in bed. I got an iPhone so I could be more productive in that position, and most of the time, friends who wanted to hang out came to me. After the first six months, when my surgeon said–according to imaging–that the bone had completely healed, I wondered why I was still so tired and achey all the time. I was having trouble getting up in the mornings, and I wasn’t making expected progress in cutting back on my pain medication. Maybe it was just stress, I reasoned. Maybe I was depressed. After all, at 25, my life hadn’t exactly panned out the way I’d planned it. Maybe it was part laziness. That was the conclusion of one of my mentor teachers. I had no real framework for understanding what was happening to me, so I just tried to push through it.

A little more than a year following my surgery, I went up to my parents’ house for a summer visit. I’d had the second of two eye surgeries in May to correct the ptosis, which so far has stuck–no more ptosis. (The surgeon attributed my ptosis to having worn hard contact lenses as a teenager.) School was out, and my back was doing all right, but I felt perpetually exhausted. I helped out at my dad’s medical practice for a week, and he ordered some blood tests for me. I didn’t find out the results until I got home to LA. Three little surprises: 1) Entamoeba histolytica, my parasitic souvenir from my time studying abroad in China; 2) Borrelia hermsii, from a tick I’d never seen evidence of; and 3) Anaplasma phagocytophilum, another tick-borne infection.

We treated the Entamoeba histolytica with a course of Metronidazole, an oral antibiotic and the Anaplasma phagocytophilum with three weeks of Doxycycline. The treatment for Borrelia hermsii was 42 days of intravenous Ceftriaxone therapy.

The treatment of tick-borne infections with IV antibiotics is controversial because research, professional guidelines, and doctors’ practices based on their experiences treating these diseases often contradict each other.

The CDC does not have specific guidelines for the treatment of Tick-borne Relapsing Fever (TBRF), the name of the illness caused by a Borrelia hermsii infection. Here’s what the CDC has to say about treatment procedures: “Experts generally recommend tetracycline 500 mg every 6 hours for 10 days as the preferred oral regimen for adults. Erythromycin, 500 mg (or 12.5 mg/kg) every 6 hours for 10 days is an effective alternative when tetracyclines are contraindicated. Parenteral therapy with ceftriaxone 2 grams per day for 10-14 days is preferred for patients with central nervous system involvement.”

You’ll notice that they only recommend one to two weeks of antibiotic therapy, in contrast to the six weeks of therapy that I received.

The Infectious Disease Society of America doesn’t have treatment guidelines for Borrelia hermsii, but they have guidelines for its Lyme Disease-causing cousin, Borrelia burgdorferi. They recommend treating what they term “Lyme arthritis” with Doxycycline, an oral antibiotic, for 28 days. Treatment suggested for “Late neurologic Lyme disease” is intravenous Ceftriaxone for 2-4 weeks.

Many of the patients that I met in clinic had tried oral antibiotics—sometimes for months at a time—with less than stellar results. Others had been given intravenous antibiotics on an inconsistent basis (for example, Monday through Friday, but not on the weekends). The patients I met who got better were ones who had had a minimum of 28 days of IV antibiotic therapy.

I can’t prove anyone wrong or right, and I am most certainly biased as a patient and a doctor’s daughter, but I can point you to facts and information that may help you in your own journey to health. So here is an abbreviated description of my experience being treated for Borrelia hermsii by an experienced infectious disease specialist:

I came to the clinic every day for 42 consecutive days, except for the day that I had gallbladder surgery. I know you must be thinking the Ceftriaxone caused my gall stones, but the stones were revealed to me by an ultrasound that was done in LA two weeks before I started treatment; they were probably brought on by a combination of heredity–my mother had hers out–and my weight loss following back surgery.

The doctor prepared the drug in a sterile hood. He used a butterfly needle (which is very small as needles go) in the top of my hand. It wasn’t very painful for me, and I’m not squeamish, so the process was not traumatic. Each day, the drug infused over about 45 minutes. The doctor said this method was better than an injection because it lowered the risk of adverse reaction. If I’d had any problems, they could have switched me to saline quickly.

The first two weeks were the most difficult. I was still extremely fatigued, and I began getting more arthralgias (aches and pains) in my wrists, hips, knees, and ankles. It was explained to me that Borrelia like to “hide” in joints, and my pain probably meant that the bacteria were dying. Knowing this, I could reluctantly accept the pain as a good sign.

In week three, I had my gallbladder out. My surgeon was very talented and did the laproscopic procedure, so it only took a few days for me to get back to normal. They gave me Ceftriaxone through IV in recovery, so I didn’t technically skip my infusion that day.

At the end of week four, I started to notice that I had more energy. I was working during the day, helping my dad, then coming home at night and doing my own work (I do freelance editing when I’m not teaching.). It was the first time in more than a year that I felt truly alert and productive.

Weeks five and six went by more quickly. I found myself laughing more, and even singing in the clinic. It helped that there was a piano there. For the first time, my back felt almost as good as it had before my surgery. And my mind…well, I’m sure you can tell how sharp I am based on my excellent writing skills.

For those who believe in more holistic treatment methods, I’ll note that a few other components played a role in my recovery:

1. Exercise: I joined the small pool where my mom takes arthritis water aerobics classes and went with her two to three times per week. The warm water made my joints feel better, and the exercises strengthened my muscles and improved my balance. Because the class is zero impact, I didn’t get sore like I would from walking the dog or playing a sport. The class I took was designed by the Arthritis Foundation and is offered at hundreds of facilities around the country. Though you could say I had a reactive arthritis, you don’t have to have arthritis to take the class. You do, however, need a doctor’s approval.

2. Diet: My doctor recommended a diet high in choline. Choline is an essential nutrient that is classified as the newest member of the B Vitamin family. It’s important because it is required for the proper transmission of nerve impulses from the brain through the central nervous system. You can find information about high-choline diets here.

3. Fun: During the six weeks of my treatment, I tried to find ways to relax and fun things to do. I attended a musical and several movies with friends. I read some “guilty pleasure” novels (you know, the kind with romance, vampires, etc.). I took walks on the beach with my family. I also benefited from the relaxed atmosphere of the infusion center. The doctor invited a piano player to entertain patients, and a few patients, including myself and a former opera singer, often sang along. There were a handful of regulars, like me, “doing time” for 28 days or more, and they became my friends. We swapped stories about doctors, work, and life. We gave each other nicknames and told each other jokes. My six weeks of treatment were filled with song and laughter. Could that have affected my prognosis? If I were a betting kind of woman, I’d bet on it.

I am still a work in progress. I’m back home in LA and feeling better than I’ve felt in a long time, but I’m not done with doctors. I’m determined to stay on top of everything from now on. Never again will I let one discouraging doctor visit interfere with my care.

I invite you to stay tuned and learn with me as I gather articles, resources, and stories from others.

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