one pager for doctors appointments

I made a tiktok that got a little bit of traction about how a tool I created for going to the vet, has helped shape my doctors appointments... and I realized I should create a higher contrast version and share it everywhere. 

I stutter, and its not something I talk about, but it is something that has ebbed and flowed for me. There are periods of time when I don't and most people who have spoken to me face-to-face would never know. There are other times when verbal communication is really challenging and I will switch to pen/paper, text or chat, or a few words in ASL. High-stress environments with a time-crunch really ramp of the likelihood that stuttering will just be part of what happens.  

Recently, I had to bring a sick cat to a new vet and created a one-pager to help me manage the appointment. It had all of the major things I needed to convey so if/when I started to stutter, I could point to the exact word or piece of info on the sheet. I was surprised at how both the tech and vet responded. 

They were thrilled. One even said "I wish everyone did this!"

There was no condescension or pandering, it was just a good disability tool that helped more than just me. And that is the thing we know - the Curb-cut Effect - where something that is created for disabled people, helps more currently non-disabled folks. (Curb-cuts designed for wheel chair access improve access for strollers, people using carts, children, and folks with different mobility aids - the impact is bigger and more inclusive than the original design.) 

The structure is kinda of like a meeting agenda + a rubric smooshed. Why am I here + what is wrong + what I am specifically asking help for + the other stuff going on that other doctors are concerned about. Its a way of keeping everyone on task, while acknowledging that your care provider might have another piece of the puzzle you don't and you want their expertise... but they can only share that if they have the data.  

Here is a high-contrast image: 

I admit that if you have chronic illness, this is unlikely to be able to be a true "one pager", but it is a framework that I hope helps others and making their own version. Medical appointments can and are so stressful for so many reasons. There is such a short amount of time to relay so much information and the fear of forgetting something is really a challenge. To be fair, I don't know anyone with long-term health issues that hasn't experienced little-t or big-T trauma from the healthcare system and/or a provider. These are not neutral situations, there is an inherent power imbalance and there are so many obstacles to being listened to, believed, and getting care - especially if you are not neurotypical, not able bodied, not white, not cis, not amab, English isn't your first language, not thin, not a citizen, and not wealthy. 

This isn't gonna fix that. We need universal healthcare, trauma-informed care, new systems for understanding pain and bodies, ways of communicating information so people understand their body and options, and a better way for care providers to admit how little science/medicine actually know/understand... AND that they are still going to try to help. We need true care coordinators. We need health-care rather than the sick-care model we have. Harm prevention models show over and over again how metrics of health improve when people have access to stable housing, fresh foods and vegetables, stable income - these things actually take pressure off ERs and improve our neighbors' lives. 

At the same time, I need to get through a bunch of healthcare appointments with smart people who aren't yet skilled in how to always pivot communication methods. I am testing this method out for a few months to see if it helps me navigate care and solve the problem of not every provider being on Epic/MyChart. 

Short Overview
-1-3 sentences or "elevator pitch" aka why are you in the room here today 

Concerns/Questions
-if you can only ask a few questions or highlight a few concerns what are they 
-make sure the most important are first

Symptom Changes
-new symptoms
-worse
-same
-better
Add photos if needed

Rx and Supplements
-changes
-new reactions or allergies
-same meds (meds that haven't changed since they last saw you)

Other Test Results
-date, test, ab/normal 

Upcoming dr/tests 
-date, name, specialty, who ordered/referred 

Other
-stuff that doesn't fit in any other place and is not critical 

Again I think this is a starting point and mostly it has come from the realization that care providers cannot quickly view all current medications and prescribers, or see test results easily - especially if its from outside their facility - and the reality is, most providers do not have the time to review your chart before your appointment. It is awful and unfair, but it is the reality that we truly have to do that work if we don't want to loose 10 precious minutes of an appointment to them scrolling to try to find something on their computer. 

If you read this far, thanks and I am sorry you are in this boat. I also hope that its super clear that I don't believe in using AI for asking medical questions or managing care, especially for chronic health. It is often inaccurate and also unsafe. I am not a doctor or a healthcare provider and I am not YOUR doctor or healthcare provider. You need to ask people who not only know about a topic, understand the specific critical thinking needed for a very specialized topic. It is important for you to know the source of your information - and it is ok to ask your doctor for more information on where they received the info. Ask for studies on efficacy, side effects, risks for a medication they are recommending. Doctors are scientists and they love sharing information! Part of their job is to make sure you understand what is happening and why they are recommending a test, procedure, lifestyle change, or medication. AI can't and doesn't hold the nuance of what a specific person need and it doesn't have the critical thinking to read the footnotes and know if some piece of information is wrong or invalid. 

Food recalls, drug shortages, disease information - CDC

If you are looking for information about food recalls, drug shortages, and/or disease outbreaks in the US, there is an allergist (Dr. Rubin) who is collecting and sharing this information via a free substack collecting and sharing this information while the CDC is barred from publishing their weekly reports. 

Please share especial with life threatening food allergies and those loving and caring for immune-compromised folks. 

If there are additional folks filling in gaps, please share in comments.

gluten free egg replacements

Chicken egg replacements for gluten free sweet baking*

This isn't an exhaustive list, there are lots of other options but a lot of them rely on gluten doing some of the work of holding/binding a baked good together. Here are the ones I have used and recommend with lil notes.  

Flax

1tbsp ground flax + 3 tbsp + 10 minutes = 1 egg

Too much flax seed can sometimes have a mineral/fishy taste to baked goods. I have only noticed it when trying to make flax crackers... but I would never try to make a flax seed souffle, otherwise it is a great option. This also works well for savory breads. Low histamine

Chia

1tbsp ground chia seeds + 1/3 cup water + 10 minutes = 1 egg

Chia seed will get stuck in your teeth like a larger poppy seed. You can use ground chia seeds instead - just measure the amount whole you need then grind for your recipe. The soaking time will also be a little less. This also works well for savory breads. Low histamine

Yogurt

1/4cup cow or nut milk yogurt or silken tofu = 1 egg

Yogurts work well as egg substitutes, but they all have different textures/thicknesses. If you are making a recipe you know know, you may need to adjust with a bit more water/milk/liquid to ensure the consistency is correct. Don't use Greek style yogurt or sour cream here, it won't have enough water content. 

Fruit

1/4 cup of cooked applesauce or raw mashed banana = 1 egg

Applesauce or banana is great for texture but will increase the sugar and fiber content of your recipe. If you are making pancakes, waffles, brownies, etc. it won't really be noticeable. 

Honorable mention - Psyllium Husk Fiber
This works best when it is powdered and mixed 1/3cup water to 1/2tsp psyllium husk powder + 20 minutes to re-hydrate before use. I didn't list it here because I usually use psyllium as my xanthan gum replacement for gluten free baking... so it is already doing work and I usually call in one of the other options above. I do not like the whole husk for aesthetic reasons. (We all have our quirks)

Not listed...

I don't mess with aquafaba - a great savory egg replacement option made from cooked chick pea liquid. Lots of other people love it - it really can be a very close faux whipped egg white option.

I also omitted the club soda + baking powder, or extra water + oil, and the arrowroot+water options because they don't work well as 1:1 substitutes for all gluten free baking. 

*I said sweet baking. I meant it. These are all going to make gross egg-free quiches. Don't.

Gluten Free Brown Butter Coconut Blondies

These take a few extra steps to make, but are worth it. Seriously browning the butter is a great way to almost always improve your baking. The other extra step is soaking the coconut in sweetened condensed coconut milk for added flavor and soft-cookie texture. You must use a parchment sling to get these dudes out of the pan. You are making basically one giant cookie that will want to stick to the edges, cooking spray is not enough. 

As with most cookies, the goal is to NOT develop gluten, so its a forgiving recipe for any 1:1 gluten free flour blend. The only I wouldn't use is one that has pea flour or chick pea flour - since it sometimes overtakes desserts.

This is a modified double batch version of Fifteen Spatula's Brown Butter Toffee Blondies. 

 

Gluten Free Brown Butter Coconut Blondies

9"x13" pan
parchment paper
cooking spray
rubber scraper/spatula
350F oven

1 cup unsalted butter

1.5 cup unsweetened shredded coconut
1 can, 11.25oz of sweetened condensed coconut milk

2 cups packed brown sugar  

4 large eggs
1 TBSP vanilla extract
2 cups of gluten free flour blend (with xanthan gum or psyllium husk)
1.5 tsp baking powder
1.5 tsp salt
1 cup of unsweetened flaked coconut
1-2 tsp flaky sea salt

1. In a sauce pan, brown the butter over medium heat. Remove from the heat and put into a stand mixer. 

 

2. Put the sweetened condensed coconut milk in the warm pan with the shredded coconut. Warm over medium heat for 5-10 minutes. Turn off the heat, cover. (you are steaming the coconut to soften it)

 

YOU CAN TAKE A BREAK HERE - and let everything cool and come back after. Otherwise you really want to make sure that the coconut and brown butter are not hot before adding them to the mix. If you push it, you could scramble the eggs.

3. Line your baking pan with parchment paper slings and cooking spray.

4. Once the brown butter has cooled a bit - put your hand on the side of the mixer bowl - if it is HOT, you need to wait. If it is warm, you are good to add the brown sugar and mix.

5. Once the brown sugar is mixed in thoroughly, add in the eggs and vanilla. Mix well. 

6. Scrape down the bowl and mix again. 

7. Add in the baking flour, baking powder, salt. Mix well. 

8. Scrape down and mix again. 

9. Add in the cooled shredded coconut / sweetened condensed coconut mix. Mix well.

10. Spread into lined baking pan. Use a spatula to level. 

11. Sprinkle flaked coconut and flaky sea salt. 

12. Bake at 350F for 35-50 minutes, until a toothpick inserted comes out cleanly.

13. Allow to completely cool in pan. Remove from pan and slice.

fermented mustard

Fermented Mustard
1 1/2 cups whole mustard seeds, pulsed a few times in a spice grinder
4 tsp sea salt
1 cup raw apple cider vinegar (the bottles that says "with mother")
1/2 cup filtered water (no chlorine is key)
2 tbsp raw sauerkraut juice
1/4 cup verjus*

Mix all ingredients in a glass jar. Leave slightly covered at room temp for 1-3 weeks. Store in refrigerator.

I was watching It's Alive, because fermenting things is one of my most favorite things. Seriously, it makes me feel like a kitchen witch every time I can transform a thing into another thing that doesn't go bad because it rotted in the BEST way.

The episode where Brad ferments mustard really blew me away. I had never thought of fermenting mustard seeds and immediately wanted to know what it tasted like.

The first batch I made was much hotter and had some ground mustard, garlic and onion powder. With this recipe I really wanted to see how paired down I could get it. The grind on the seeds is pretty course; I pulsed them just a few times to break most of them up.

For the first few days the mix smells so strong its almost painful. After about a week it started to mellow out, but it was still hot, think Chinese mustard hot. 3 weeks in is when I decided it was done and moved it to the fridge. The finished product tastes like mustard, but better. It is hot, but just at the start, then chills out.

I have used it in marinades, sauces, and salad dressings (really great with a bit of honey, lemon, olive oil).

*Verjus is a pretty special and hard to find ingredient.You can replace it with some sugar - the goal is to give the bacteria something to kick start the fermentation process.
I happened to have some around because I was recreating a medieval fish recipe. It is made from unfermented green grapes. It has a wonderful bright sour flavor that is sweeter than vinegar. (It was also used in cocktails when limes were difficult to procure. It makes a FANTASTIC margarita!)

resolutions

On New Year's Day, I said aloud: "every time I have gained weight, my body has been protecting me."
This is a realization I came to a while ago, but voicing it has changed so many things.

2018 was the year that I decided to love my body, exactly as it is.

For most humans, this is radical self love, for those managing chronic disease and pain... it is something I don't have the words to describe.

Seeing my body as working with me, not against me, shifted something. My body and I started working together in a new way.

I thought I loved it before, but all of my love was conditional:
-I love my body, but I wish my stomach didn't have rolls
-I love my body, except for my knee/back/chest/broken toe
-I love my body, why can't it love gluten

The lists continued and I never really loved all of me. I hated gaining weight after surgery/injury/depression and saw it as a moral failing or lack of will power, or some new task I needed to accomplish. When my body was doing what I needed, conserving resources so I could heal. 

I honestly am not sure this is the space to share this, but I also know how many folks struggle with eating disorders brought on or intensified by food-related health issues (raises hand).
I also know that this time of year, we are bombarded with shame, guilt, marketing to "undo" the holidays or "regain" control over our bodies.

Diets have been proven over and over to not work to create and maintain weight loss, and weight is not the sole indicator of health. The trendy new "clean eating" is another form of disordered eating, which is very dangerous to those in recovery for eating disorders.

Today, I love my body. I love it for what it has done and what it is doing. It turned food into energy so I could think this, type this, and share this. That is truly amazing!

I am sharing with you my only resolution for this year, to thank my body for existing and supporting me every day. I take a moment every morning and evening to say it aloud, to be in a moment of complete gratitude. (I am not saying this while I am washing my face and wondering how adult acne hasn't been cured, I am not saying it while pushing on a sore muscle or painful spot.)
I am holding a few seconds or a minute of just pure gratitude.

There are parts of my body that I would like to work differently. I want to be more flexible, I excited to be able to feel stronger, and having better posture means fewer migraines. Instead of being frustrated that I am not these things yet, I am actively saying thank you for every step my body is taking working towards these goals.

Examples of gratitude:
+I am so grateful for making it through 26 minutes of yoga and am proud of listening to my body and taking 2 breaks when I needed them
+I am so lucky for being able to have learned things in PT that keep my back safe, happy, and healthy and I use them every day
+Lymphatic systems are amazing! I am so glad mine is working and clearing out this cold.

It is as simple to be upset that I was sick, or dread exercise, or be frustrated that I couldn't push through something without a break. Or, I could see the joy and accomplishment.

I am human, there are days I am going to probably get it wrong, but I am going to forgive myself and step right back into saying thank you - thanks for having a body that can make mistakes, learn, and do something new and different.

Wishing you your best year filled with love, delicious food, joy, and abundance.

oven roasted chick peas

This is a recipe that I forget where it came from. I think it happened after I "discovered" kale chips last year and decided to try to oven roast/fry nearly everything. These chick peas have become the single-most popular (and requested) party snack I make.

The recipe is really easy to modify or adapt to your particular tastes - I often omit the cayenne if I am bringing it to a group of unknown human mouths who might not love the warm kick. You really can't go wrong unless you put dried herbs in - those babies will burn and make your delicious fried orbs taste horrible - trust me. 

If you are going to make a big batch, it is worth it to buy dried chick peas and soak and boil them yourself. It  takes more time, but is so much cheaper. (if you do this, you will need to add more salt) That said, canned chick peas aren't that expensive and you are the boss of you, so do what feels right. 

oven roasted chick peas

2 cans of chick peas, drained and washed well

1/4 cup olive oil 

1/4 tsp smoked cinnamon

cayenne (you can substitute something more mild like aleppo, but hold off and add it half way through cooking)

sea salt (you are going to use this 2x)

1/2 tsp ground celery seed

1 tsp toasted onion powder or garlic powder -both if you are awesome

2 tsp ground coriander

1 tsp ground cumin 

Pre-heat oven to 400F

1. Drain those chick peas really well

2. Spread them out on to a sheet pan or a baking dish - you don't want them doubled up

3. Generously coat the chick peas in olive oil - you should see extra puddling 

4. Sprinkle on the spices and salt. You will be tempted to roll the chick peas around to coat them DON'T. It will cause most of the deliciousness to fall off into the oil. 

5. Place the peas in the oven for 35-45 minutes - you are going to want to flip them at least 2x

6. Done = the chick peas shrinking to half their size, and darkening without burning. If you see some of them start to flake off their outer shell and crisp, you are there. 

So now you have a choice - take them out of the oven when they are crispy on the outside and a little soft in the middle, or keep on cooking for another ~10 minutes to get them to be more like the texture of spicy Indian snack mix. I prefer them the first way, but the second is also great

7. Remove from oven and allow to cool in the pan. 

8. If you manage to not devour them immediately, store in an air-tight container. If you make them a few days ahead of time, they will get a little soggy. You can pop them back in the oven, or a toaster oven, for a few minutes on 400 until you hear them start to sizzle, remove, cool, and serve. 

. 

gluten free, dairy free hot cross buns

This is the closest I have come to a dairy-free brioche! I modified my brioche recipe to make a Greek Easter Bread and Hot Cross Buns. It worked well and my only complaint is that the buns/bread deflated a bit post-cooling. I would add a bit of psyllium husk next time and see if that helped create a more robust crumb. 

The buns were stellar, the Greek Bread had too much lemon oil, so I think it could work well if you just omitted that one pesky ingredient. This technique doesn't require an overnight proof, but I find it easier to work with dough that has rested and had the time to build it's yeasties, especially if it is cooler out. (The extra yeast also means more flavor, so if you can let this sticky mess rest!)

 dairy-free brioche dough

1 1/4 cup sweet rice flour

1/2 cup tapioca starch

1 cup arrowroot

1 1/4 cup corn starch

1 cup millet flour

3/4 cup potato starch

2 tbsp yeast

1 tbsp kosher salt

2 tbsp xathan gum

2  3/4 cup almond milk cup water

1/2 cup honey

4 eggs

1 cup canola oil

1. Combine all the dry ingredients in a mixing bowl, with the paddle attachment at the ready. 
When you are ready to bake your bread(s) preheat the oven to 350F
**

2. Combine all the wet ingredients into a separate bowl and mix them until they are incorporated. 

3. With the paddle attachment on the lowest setting, gently mix the dry ingredients. Slowly pour in the wet ingredients.

4. Once all of the wet ingredients have been added in, turn the mixer up to high and mix for at least 5 minutes, stopping at least 2x to scrape down the bowl. 

The dough is going to be very very sticky and look quite wet. 

5. Cover the dough with plastic wrap and refrigerate overnight.

6. Punch down the dough, divide it into 2 bowls, add in your flavorings. 

7. Shape the dough - since the dough is so soft and sticky a disher is the best for this

8. Allow it to proof - this is going to take 20-60 minutes depending on size and temperature of your house. 

9. Bake at 350F until golden brown and cooked through (~30min)

Greek Easter Bread add-ins

2 tbsp lemon zest

1 tsp lemon oil (this was too much, should omit)

1 tbsp lemon juice

**

hot cross bun add-ins

1/4 cup chopped dried fruit

1 tbsp extract di sicily*

1 tbsp orange zest

1 tbsp orange juice

1 tsp lemon juice

*I not so secretly tried to recreate the flavors of panettone, so not super traditional, but they tasted great!

Hot Cross Bun Icing - 1/2 cup powdered sugar, a few drops of vanilla extract, and a few drops of coconut milk until it just comes together. You want to squeeze it onto the buns while they are still warm. 

ghostfish

My 11 year gluten-free anniversary came and went without any fanfare. There is something pleasant about it being a non-event. I remember when everything felt, so ick. My body felt awful, going out to eat was not fun (Can't have wheat?! Just get the white bread instead!), gluten-free packaged replacement foods were very expensive and only available at specialty shops.

It is a lot easier now. Gluten-free became a fad, and while cross-contamination is a much bigger issue now, everything else is, for the most part, a lot easier.

There is a lot more awareness, more blogs, more books, more support groups, more doctors who don't think "it must be in your head", though plenty still don't listen to women.

One thing I still miss is beer. More than beer I miss the flexibility of spontaneity and not having to plan meals, but I digress.

There are lovely gluten-free beers, but it is not the same as being able to share a beer that a friend is excited about. Gluten-free beers still have significant hurdles:
-the finish is often sweet or soapy
-the texture is often thin
-for some reason hops are driven by the building, but never make it into the beer
-there are a lot more gluten-removed beers, which are not safe for people with celiac (this irks me more than I can say... but I guess "yay" for those folks who can drink them)

Ghostfish was a pleasant surprise! Dedicated gluten-free facility and beer that tastes like my memory of "real" beer. The Grapefruit IPA is definitely less bitter than Groundbreaker's #5, but the grapefruit comes through in a way that doesn't overpower the hops.

Shrouded Summer is not something I would normally pick up because juniper is an ingredient. (also big props to beer makers who go above and beyond the required labeling laws and list ALL ingredients)
I really dislike juniper, but it is not loud and in no way gin-like... and I like what it does in this beer, providing something in the background that is needed.

I am excited to try more in the line-up.

Food access & activism

If you ever wondered why this blog was never turned into a cookbook, I talk about that and food activism in the The New England Unsettler's latest episode: Feel Your Eatings.

I was trepidatious to do a radio show, but I had a wonderful time and every once in a while it is really great to have to explain one's feelings, morals, ethics and push into the contradictions.