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Wednesday, January 16, 2013

Gluten free colonoscopy *updated

*Update added to the end
Good food is really important to me. I love getting to talk about it, share recipes, products, and ideas. I am going to pause briefly to highlight the importance of keeping our bodies healthy for more food conversations to come.

If you have passed the 40 marker in life, you have had a colonoscopy. (No you say, well you need to, soon.) They do not hurt and they are the best, and often only way, of detecting colon cancer. If you are no stranger to GI problems, you might have had one, or perhaps you have found this page because you are about to undergo a procedure. WELCOME!

I decided to write this post after googling "colonoscopy prep" and reading that the first page in the search results recommended "keep a good book in your bathroom, you are going to be in there a while." This type of advice infuriates me. It is not fair to lie to people who are frightened of an unknown test that because we culturally have a taboo about talking about poo, people are giving misinformation.

In 2007 I had my first colonoscopy. Later this week I will have my 2nd.

I can only speak to my experiences, but I am going to do so like you are an adult and can handle the truth. If you can't, click away now.

Still here... ok good.

Being told you need a colonoscopy
1. You live in the U.S. and you are 40 and you are told "it is time"
2. You are experiencing some health issue that has prompted at least 2 doctors to say "let's get a colonoscopy to rule out _____"
3. You have family history of colon polups and/or cancer and you get told "it is your time"

This part is scary. No matter what category you are in, it is scary. There is a worry and fear that something might be wrong INSIDE your body. If you have access to the internet, you are going to start searching for any and everything about intestinal health and the procedure details.

At this point - you need a buddy. You need a friend or loved one to help reign you in from watching too many videos and to help put things in perspective. A colonoscopy is a test not a diagnosis of something wrong.

The doctor (or more likely a nurse or receptionist) hands you the Colonoscopy Prep Packet of instructions.
1. There are two main options: Magnesium Citrate or the NuLYTELY aka GoLYTELY 
2. The packet of instructions are important because the process starts 4 days before your scheduled test

Before you leave the office it is important to:
-tell the staff if you are diabetic (you will get special instructions on medications and prep)
-tell the staff if you have anal fissures and/or hemorrhoids*

The Magnesium Citrate prep involves buying a few bottles of magnesium citrate (available at pharmacies, usually comes in a glass bottle that is less than $2 a bottle) and consuming it over a certain time period followed by clear fluids - often Sprite or 7-Up is recommended

The GoLytely involves propolyn glycol (ingredient in Myralax), baking soda, and saccharine flavor packets. You add water to the powder in a gallon jug and consume a glass of the solution every 10 minutes till its gone. 

The GoLytely (I sure hope Audrey Hepburn rolls over every time some utters this word) is less preferred because it costs more, requires a prescription, and requires participants to consume a large volume of liquid, pretty quickly. And doctors find that it is hard for people to finish the jug of product. The problem with that is - if you don't completely empty your bowels, the GI doc will not be able to do the procedure and you will have to start over.

So the goal is to get a clear view of the colon, as easily and as painlessly as possible. Because the Magnesium Citrate Prep is "tolerated" better, it is often the go-to. Here is the one catch: if you have openings in your rectum or anus* this prep can be painful, very painful. I completed this in 2007 and the pain was so bad I briefly passed out. So don't be embarrassed. You are literally going to a poop doctor, and you ALWAYS need to tell physicians if you experience bleeding. 

Preparing for the prep
If you follow a gluten free diet, you will laugh at the the instructions are you given. The whole idea is to go on a "low residue diet" 4 days before the test. The day before you are on an all clear liquids diet, and then you consume the "prep juice". The day of the procedure you don't get to eat or drink anything. So the laughing part is at the recommended list of "low residue foods". It reads like a list of everything you are not suppose to do as a grown-up who understands that eating junk food is not a good idea. (Big pardon to those with Chron's who have to follow this all the time.) The shortest explanation is - don't eat fiber, eat super processed crap and you will be ready!

Saltine crackers, white bread, anything with refined flours, pasta, no raw fruits or vegetables, potatoes without the skins. Meat, sure! No seeds, no nuts, no beans, no whole grains, and nothing with red dye. 

Ok. So what, realistically, are you going to eat?

I am not much of a menu planner, but here is where I break that unofficial rule. I know it is going to be really hard for someone like me, who has to take two fiber supplements in addition to eating several servings of fruits and veggies, and one serving of nuts a day, to make this work without making a mistake. I allow myself a few treats (gluten free junk food I have been eyeing  that is totally processed and has no fiber, why yes Udi's I will get your bagels!)

Some canned or very well cooked fruits (no seeds, no peels) are ok
White rice
Processed gluten free junk food (white breads, muffins, crackers, etc.)
Yogurt without fruit (honey is ok or clear jelly, steer clear from jams)
Cheese
Meats
Eggs
Applesauce 
Ripe bananas
Milk
Clear juices (no pulp, no fiber)

This list can seem rather depressing, but with a little creativity, it is workable. 

Risotto with mushrooms (maybe with some tarragon or thyme)
Frittata 
Chicken soup (well cooked carrots, and onions are ok, fish out the celery and don't eat that)
Rice pudding
Cheese and gf crackers
Applesauce (you can jazz up the canned stuff with a sprinkle of cinnamon)

So if you are looking at this list, you realize that it is likely to make you constipated. Plan for this and have your favorite non-fiber laxative available. 

Day before test
Ok. So you have made it through the low-res diet phase and now it is all clear liquids. I have worked on the day-before-a-colonoscopy and it is possible to do if you have a job that does not require you to do much in the way of movement (aka you have a desk job). But know that you are going to be a bit sluggish and tired. Your whole goal for the day is to stay hydrated. I found that alternating sweet and savory beverages works well. You are also allowed jell-o, just not any with red dye. So black coffee is ok, broth or bouillon, clear juices, popsicle, you get the picture. 

Your paperwork will tell you when you need to start consuming your prep (Magnesium Citrate or GoLytle) and then the fun begins. 

Anyone and everyone who has had a colonoscopy says "the test is fine, its just the prep that is horrible". Let's break down "horrible" shall we?

You are hungry. Your body would very much like solid food, but instead you are going to flood it with laxatives. These laxatives don't taste great. The goal is to pee out your butt. Mmm hmm. That is the desired effect is to so thoroughly clean out your intestines (~20' long) that you no longer pass feces, only clear liquid.

So "horrible" has two main parts:
-drinking stuff that tastes bad
-pooping, and then butt-peeing like you have food poisoning*

*If you have actually had food poisoning, it is not nearly as bad. There is much less stomach cramping, but that sense of urgency, of I NEED A TOILET RIGHT NOW, that is the sensation I am talking about.

Personally, I think the worst part of the prep is the sensation that not matter how close I am to a toilet I feel like I won't be able to make it. The sensation to move your bowels is that strong. So, if it is possible, claim a toilet as your own. If you have a shared living space, you need to let your roommates know. You may not want to, but they at least need to understand that you have claim to the thrown for several hours, no questions asked. 

All of that said, most people do not poop their pants. If you are worried you can buy a small pack of adult diapers or place a menstrual pad in your underwear. Again, it is likely to feel like you will, but you most likely won't. 

Ok, so what got me all hot and bothered about the recommendation to "keep a book in the bathroom" is the fact that it is unlikely you will be up for reading. Perhaps you will, but this is the time for trashy magazines full of pictures. Do not queue up your favorite movie to watch off-and-on during this. You want something easy, light, and meaningless. You will want something to distract you, but you don't want to forever link wonderful cinematography with discomfort. (read - America's Next Top Model, not RuPaul's Drag Race.) 

Technique
Before you start drinking your "prep juice" put on some comfy clothing. Your pants should have the smallest amount of limitations between you and freedom: velcrow, snaps, or elastic waistbands are your friends. I am serious. 

If you read your prep packet of info, it likely recommended you purchasing baby wipes. The idea is to be as gentle to your bottom as possible. While the wipes are nice, and flushable making things easier, don't go overboard with them. Once you start emptying your bowels, you will be doing it a lot. So what is more important than damp wipes designed for a delicate butt, is technique. 

You do not want to wipe your ass, you want to blot it. 
Try to think about it like cleaning a cut. Very gentle patting motions. This is also the time to buy the nicest toilet paper you can find. If there is such thing as 7-ply, you want it. Use what you need but be mindful of what your toilet can handle. This is not the time to realize you need a plunger - have one on hand.

A great recommendation came from the interwebs - zinc oxide ointment. You know, the stuff for diaper rash. It really helps with irritated tushes. You can apply it after ever sitting session on the royal throne to help prevent and quell the discomfort. 

In between doses of the "prep" you can suck on a lemon to help with some of the nausea. Others recommend swishing your mouth out with ginger ale. Try whatever works. I have never puked, but there is a bit of a sea sick feeling that can sometimes happen. (You can also press on the insides of your wrists to alleviate some of the discomfort)

You are nearing the home stretch. You will not want to drink more liquids, but drink you must. You won't get to have any in the morning and the more liquids you can keep in your system the less dehydrated you will feel. I put a post-it on my fridge (where I normally get a morning glass of water) to remind myself to not do it.

Day of the colonoscopy
1. You are a rock star! You made it! Your job is done and now it is up to the nurses and doctors to do their job
2. Bring a list of your medications and allergies to have with you. Your doctor probably has them, but it is good to have a second copy, and note your last does of each medicine.
3. You have to have a buddy to give you a ride home, or ride home with you in a cab - this is MANDATORY 

So off to the hospital you go. If it is possible do not drive yourself. You are going to be really tired, thirsty, hungry, and if you normally have a morning cup of coffee... you are probably going to have a nasty head ache and be craving your first (or second) cup. 

Once you arrive, you will get checked in. You will have to recite your name and date of birth a few times, and it will get you a hospital bracelet. Here is a great time to make sure they have your medication and allergies up-to-date. They will also ask you for the name and phone number of your ride home.

You will then be asked to remove all of your clothing and don a "johnny". If you are lucky you will get 2! The first one you can put on backwards (ties in the back) the second one you can wear like a robe and keep untied, with the strings in the front. You will get to put your personal belongings in a cubby or locker. Some places offer locks, not all do. It is great if you can give your ride your phone, wallet, keys, etc. to remember for you. 

You then get to lie on a gurney and wait. After a bit, a nurse will put an IV in your arm or hand. This can be a welcome source of fluids, cause by now your are pretty thirsty. 

The medication given for the procedure is referred to as conscious sedation. You are technically awake and can move and respond to people, but the brain does not make a memory of the time. This is really great because general anesthesia takes a lot longer to wake up from and has more side effects. 

Some people remember parts of the procedure or conversations bits they had, others don't remember anything at all. (The first time I remember trying to "help" the doctors and nurses rushing over to stop me from removing the scope... whoops!)

The procedure itself
The scope being inserted into the anus does not hurt. It is not very large, (half or 1/3 the diameter of a normal poop), the scope is flexible, and lubricant is used. As the scope goes up and around the colon, air is sometimes pushed into the large intestine to make it easier to see. (This can result in some painful, loud, gas later on) If a biopsy is taken, people sometimes pass a little blood or dried blood - your doctor will let you know and how much to expect.

If you are having an endoscopy, which is often scheduled at the same time, the process is pretty similar. A numbing spray will be spritzed into the back of your throat, and a long, thin, flexible tube is run down your esophagus, into your stomach, and then into the beginning portion of the small intestine. Again, biopsies can be taken here too.

"Waking up"
I can remember waking up after the procedure and being offered cookies. No matter how diligent you are, no matter how many times you tell people "I can't eat gluten" not everyone reads charts. I was "awake" enough to say no, but accept the offer of apple juice. I was surprised at how my voice sounded - I was a lot more horse than I expected. Once you keep down some food/liquids, they usually let you go home. (They have already called your ride if s/he is not sitting in the waiting room)

Getting dress is a tricky sort of thing. If you are comfortable doing so, wear clothing with elastics rather than buttons and zippers. I was a little dizzy and for some reason got really confused about how to put on pants. I am assured this is not everyone's experience, but I will shamelessly be wearing sweatpants next time.

When I got home I just wanted to sleep and eat ice cream - at exactly the same time. If you have an endoscopy, its nice to have some cold treats for your throat. I slept a lot, through most of the day. The only restriction is not going to work, not drinking alcohol, and not driving.

The following day I felt mostly back to normal and my voice was nearly there too.

If you had biopsies taken, the results take a few days to a few weeks to get back.
**

Colonoscopies are not fun, but they are not painful and can save your life! If you have a friend or loved one who needs a push towards getting the guts up to sport a johnny and have pictures taken of their guts - be their buddy. If you are nervous, I hope you are less so now.

If you have made it through a colonoscopy, what other things do you recommend?

*Thank you to everyone who has emailed, posted, and commented about this post. I was a bit hesitant about "going there" but I think it is helpful to be transparent about these things and your words have been very encouraging. 

I also wanted to add that this prep was SIGNIFICANTLY easier for me and I will be using it again next time. Also the zinc oxide butt cream was fantastic and prevented a lot of discomfort. I recommend it most highly.

One part I omitted sharing, was that a polyp was found during this recent test. My pathology results just came back and my abnormal cells were not cancerous. This is very very very good news. But it means I am keeping on the colonoscopy-every-five-year plan to stay atop polyps. Even with maintaining the gluten-free diet, people with celiac disease have a higher chance of getting intestinal cancers. So in addition to eating lots of fruits, veggies, fiber, getting exercise and all the other wonderful things you can do to keep your body healthy - colonoscopies are key!

Monday, September 17, 2012

Above the fold


Gluten-free made it to the teaser at the top of last Wednesday's Boston Globe.

The two pieces, that also got the g-heath cover, tackle gluten in two different ways. The latest fad talks about the popularity of gluten-free "dieting", and Should you go gluten-free? basically shouts at people to not avoid gluten if they don't "medically" need to.

A friend sent me this, and it feels like the appropriate juxtaposition: Modern wheat a "perfect, chronic poison," doctors says


Thursday, August 23, 2012

Get movin

September 1 is coming dangerously near. I have moved 7 times in the past three years, and am preparing for move number 8. Dear readers, learn from my mistakes:

Do not pack fish sauce. 
I hate wasting food, and will almost never say this but it is NOT worth risking a crack or spill to the $0.99 glass jug of the beautiful brown liquor that's unique pungency will resist all forms of laundering. Don't do this to yourself. Don't do this to your friends or movers. Just throw it out. (Or triple wrap it in ziplock, hid it at work for a week until you have your brain back and can deal with delicate substances.)

Don't keep things you don't use. 
That item isn't just sitting there gaining dust. You are loosing money on the possible things you could house and store in place of the [useless] item. Maybe it is space for shoes, (or socks that have functioning elastic), or a bulk quantity of a gluten free flour you actually cook with. Get rid of the junk. Donate it or throw it out. Don't waste your time packing, labeling, moving, unpacking, and restoring it.

You are not going to be smart for a while - plan for it. 
The week before and after packing are not your best. You are in the process of judging your possessions, forgetting where you put things, and trying to adjust to a new environment. Cooking is going to take a back burner, if you can even find that under the piles of boxes. So plan ahead. Make yourself enough pre-made, frozen meals for a few days, or even a week. Make these the last things you pack. Put a note on your old freezer AND the front door to remind you to empty it out. Deposit these directly into your new freezer.  (Bonus if you pack a few sets of silverware in a bag and tape them to the freezer door.) This will keep you from making a hunger-crazed bad decision to try out a new take out place, or eat 5 Lara Bars as "dinner".

The gluten is coming
If you are lucky enough to have friends help you move, pizza is going to happen. If you are lucky to keep a gluten-free kitchen, plan ahead for this outside invader and put your guard up. Remember to wash your hands before you eat or touch your face! The previous tenant probably also was a glutenmouth, so make sure you do a thorough clean of your new place.

Be nice
If you have to move on September 1st, please be kind to yourself and others. Out-of-towners are going to get lost. Every year someone does not read the signs and get's a moving truck stuck in a tunnel. Locals are going to be pissed that you are ruining their last weekend of summer with extra traffic. Stay hydrated! Say thank you! And good luck.

PS - Tacos are my favorite moving food. Most are naturally gluten free, cheap, easy to eat without cutlery. And who doesn't love Jaritos?!

Wednesday, August 22, 2012

Dear Dogfishhead,

You owe me more than a beer. You owe me an apology. For over a year I have been excited, touting the hypothetical glory that would be getting to sip that very first sip of your gluten free beer offering. A small, craft brewer, taking their time to concoct something different, something good, something that didn't taste like all the other gluten free beers out there. The hairs on the back of my neck bristled a bit when I heard you were creating something with fruit. I gave you the benefit of the doubt, perhaps you were making a lambic. No. Still I held out hope that your brew house wouldn't waste your time, and customer's money - customers who are so often disappointed by crappy gluten free offerings. 

And then you went out and one-upped me on all of the worse possible combinations of wrong I ever thought could be shoved into a glass bottle. 

Let's start at the smell shall we?
Nail salon plus ode de Strawberry Shortcake doll from the 80s. How did you bend chemistry to morph fruit and sorghum to reek of acetone?

The taste... not much better.
It is sweet and sour-ish at the same time.
I find it hard to believe a hops came anywhere near the bottle. 
The carbonation is all wrong, bubbles too small and not enough of them.

The Tweason'ale is the only gluten free beer I have not finished. Two sips and I was done, forever. The rest got poured down the drain.

I could not be more dissapointed,

Kristina
 




Saturday, August 11, 2012

fashion nightmare


This season's Louis Vuitton window art looks like a nightmare, something almost conjured up by Tim Burton. Walking by it yesterday I realized that it is a celiac nightmare - damaged villi!

Wednesday, August 8, 2012

South Shore support

This might the most reasonable and accurate gluten-free Globe write-up yet!

Gluten Free and Loving It

(Ok, it omits issues of cross contamination, but on the whole at least it does describe the situation more accurately and it is great to see a support group getting recognition.)

Monday, July 23, 2012

living the dream

I did it. I finally had my dream meal.

For over 4 years I have been pining, experimenting, tasting (sometimes wanting to spit said taste out), tinkering, hemming and hawing, all over pizza.

Last week I went to Risotteria restaurant.

You need to look past the late 90s geo-cities themed website. You must prepare yourself for dining in a sardine can. It helps to have friends who know how awesome a gluten-free restaurant is and who offer up their order to you, so you get to try more things. You should walk around and work up an appetite... because you will need it.

Gluten free bread sticks arrive at the table and the glutenmouths eat them up and go for seconds. A very solid sign and the first time in 5 years I HAD a bread stick! (They had a little bit of gummy-ness in the middle, the only real tell that they aren't the real thing.)

Gluten free beers - check
Surprising wine list - check
Knowledgable servers - check
Solid vegetarian options - check
Menu full of things you can eat - check

I ignored most of the options because I had come for the pizza. The generous friends, noted above, allowed me to sample several types - we got two that were thin crust, one Scicilian. Honestly, skip the thick crust it really didn't work and tasted like a gf knock-off. The thin crust however - actually tasted better than the gluten option one fellow dinner ordered. Everyone noted that the gluten pizza (which is made off site, and shipped in) wasn't nearly as crisp or flavorful.

At the end of the meal my face actually hurt from smiling. I never thought I would get to have New York-style pizza again. Not only did I, it was truly the best pizza I have ever tasted!

I cannot wait for another reason to visit New York!!!!!

(The desserts were nothing to write home about. They weren't bad, they just weren't great. Save room for another slice of pizza.)

Friday, July 13, 2012

NGR in Living Without


Hot off the presses, No Gluten Required is in this month's Living Without magazine. Ok, so it is just a small photo, but it is still very cool.


Thursday, July 12, 2012

Michael Ruhlman's gluten education

It is great when anyone is willing to listen and learn more about gluten and celiac disease. It truly is. Information and knowledge is the first step to a lot of things. While I like the intent about Michael Ruhlman's "What I didn't know about gluten" blog post, I found it left me wanting. Part of me was screaming out:

  • not all of us get symptoms in 30 minutes!
  • not all of us feel better after 3 days!
  • it is NOT an inability to digest gluten, it is an autoimmune disease!
  • there are significant long-term side effects of continuing to ingest gluten, even accidentally
  • it is harder because in the US there is no legal definition of "gluten free"
  • it is not JUST food! there is medications, toothpaste (I am staring at you Sensodine), and bath products that are not necessarily properly labeled and are sources of gluten
  • think of the children!

I am serious about the last one. Having a child with an intolerance, autoimmune disease, or allergy is a minefield beyond wishing you could go out to eat and not being able to all the time. 

I am trying to keep my "no one can do everything in one article" hat on, but I am more frustrated with this piece than not. But again, it is a step forward, and Ruhlman has a following and boy oh boy are the comments section of this piece heating up!

Wednesday, July 11, 2012

Gluten Free Buttermilk Biscuits


They really should not work. Light, fluffy, buttery, biscuits are a thing of beauty, that seems to defy gravity. They are made with some of the richest, densest ingredients, but the end result - when they are good - is ethereal. Ok, I sounds like a commercial, but come on. You know when you break into a REALLY good biscuit that it is something at least a little magical. Little domes of goodness can couch savory or sweet - or both! They can be a delicious side, or a whole meal. There is really little a fantastic biscuit cannot do. So without much more floral language, I give you the very best gluten-free biscuits...

Gluten Free Buttermilk Biscuits
1 tbsp sugar
3/4 cup glutenous rice flour
1/4 cup potato starch
1/2 cup arrowroot starch
1/2 cup corn starch
1/4 cup tapioca starch
1 tsp xanthan gum
1/2 tsp salt (double if you are using unsalted butter)
3 tsp baking powder
1/2 tsp baking soda
8 tbsp very cold butter, cut into cubes
2 eggs
3/4 cup buttermilk

Preheat the oven to 425F
Have 2 baking sheets, lined with parchment, and an ice cream scoop at the ready
1. Combine all of the dry ingredients in a bowl, set aside.
2. In a separate bowl or liquid measuring cup, whisk the eggs and buttermilk together. Set aside.
3. Cut the butter into the dry ingredients, the goal is for pea-sized bits of butter throughout the mixture.
4. Pour the liquids into the butter/flour mix and mix until combined. (You don't want to over mix - not because of gluten - but because you don't want to beat up or melt the butter)
If the batter is sticky, that means you are doing it right. These are "drop" biscuits, which mean you literally drop the dough onto the baking pan rather than rolling and cutting them like scones. 
5. With the ice cream scoop (1-2oz, your choice), drop the biscuits onto the cookie sheets. Allow 1-2 inches of room for them to spread.
6. Bake at 425F for 8-20 minutes. Basically you are looking for them to nearly triple in size and brown evenly. This bake time is going to depend on how big you make the biscuits.
As they bake, you are going to see some butter melting and oozing out. This is OK and normal and is a sign of the deliciousness that is to come.

If you happen to have leftovers (ha!) they make great strawberry shortcake bases.