Tuesday, February 6, 2007

Amazing Grace

I just returned from a wonderful trip. The first part, in Houston, included an exceptionally productive day spent with a couple of people with whom I love working. Few things are as satisfying as the feeling of accomplishment that comes from creating something really good. That part of the trip also included dinner with some old friends from France who recently moved to Houston. It is their third stint in the US, and their second in Houston, but we met them in Chicago, in their first stint, and we have kept in touch through their subsequent moves. It was so cool to see the newborn who was taken everywhere in a little basket; now, he’s a teenager getting ready to apply for a driving license!

The second part of the trip was a visit home to Arkansas – for my grandmother’s birthday. It was lovely to see everyone, but the really lovely thing is that my grandmother is here to have a birthday at all.

It’s been nearly three years since Mama, my grandmother, was diagnosed with end stage renal disease – i.e., kidney failure. At that time, her doctors said she had less than 15% function left in one of her kidneys and that without dialysis, she had approximately two months to live. It’s doubtful that Mama would have told me about this because we have often discussed the off-putting tendency my mother’s family have for recounting a litany of woes whenever you see them (Mama is my father’s mother; she and my other grandmother could not be more different.). However, Mama lives with Auntie (Daddy’s sister), and Auntie knew I would want to see Mama at least one more time, so she told me.

I was terribly sad about Mama's prognosis because although she was over 90, it was only her age that had changed; the rest of her was still the same witty intelligent woman who I spent every summer with from the time I was eight, until I was about to graduate from high school. When I made that visit, I thought I was probably saying goodbye. Mama hung in there, however, and I had the chance to say goodbye again at Christmas that year. By then, four months after her diagnosis, she had outlived her doctors’ projected life expectancy by two months. In the spring of that year, though Mama was still hanging on, I told my co-workers that my grandmother was dying and that I might need to leave suddenly, either to see her one last time, or to attend her funeral.

About a year after Mama’s diagnosis, she and Auntie moved to a new house, and Mama, who is blind from severe macular degeneration, tripped on the unfamiliar front steps, fell, and broke her jaw. I was sure, then, that it was the beginning of the end. A broken jaw is not only incredibly painful, it can also cause nutrition problems. In anyone else, it probably would have been the beginning of the end. But it wasn’t for Mama because she has a secret weapon: Auntie.

To illustrate the extent of Auntie’s feat, consider a few statistics:

According to a recent press release press release for a study in the Annals of Internal Medicine:
The Number of Very Elderly Beginning Dialysis Increased Greatly in Last Decade But Only 46 Percent Were Alive One Year Later

According to the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH:
If you withdraw from dialysis treatments or refuse to begin them, you may live for a few days or for several weeks, depending on your health and your remaining kidney function.

So. Mama’s chances of being alive with dialysis would have been less than 50%, probably significantly less since none of the patients in the above mentioned study were over 90. With no dialysis, her prognosis was “a few days or weeks”.

To survive beyond a few weeks, Mama’s little remaining kidney function had to be preserved. That’s where Auntie comes in. She sorted through all the useless advice she received about diet, and targeted the thing that matters most (though she does many many others as well). Mama had high blood pressure, in spite of multiple medications, and high blood pressure inflicts kidney damage (among other things), so Auntie's target was sodium (salt).

When I say Auntie “targeted” sodium, I don’t mean she followed the standard generic “avoid salting your food” advice. Auntie went way beyond that meaningless yadda yadda yadda crap to preserve what was left of my grandmother’s kidney function. She pressed the doctor who told her to limit Mama’s diet to foods containing less than 50 mgs of sodium per serving until he gave her specifics -- she felt that if sodium was important, then she needed to know the true limit and the optimum. Apparently, he was reluctant to tell her because it is restrictive (and possibly depressing) and few patients will do it. I suppose it’s understandable he would feel this way – until he met Auntie and Mama. His views have been altered; he wants Auntie to write up some of her methods so he can use them with his other patients, and he recently said he’s thinking of writing up Mama’s case for a journal.

Here is a rough outline of Auntie and Mama’s methods. If you or someone you love suffers from high blood pressure and/or kidney damage and you’d like more information, feel free to leave a request in the comments.
  1. Get over it.

    This is critical to success with Auntie and Mama’s methods. If it is tough to decide between life and eating some specific food, then you should eat the food and enjoy it because that’s what’s important to you. Mama’s quality of life is good, so the decision isn’t hard. That’s not to say she doesn’t miss some things, but rather that the decision to forgo them was easy. In fact, I think Mama is glad to have had the opportunity to make the decision: she has no litany of woes about what she can no longer have because what she can have is a longer life. That’s a pretty nice trade-off for skipping the olives.

  2. Learn about it.

    This is not as easy as it seems because there is so much misleading information about sodium/salt. For example, the most common piece of advice seems to be to “avoid processed foods”. Well, yes; processed foods probably do contain the highest proportions of sodium. However, if you need to sharply restrict sodium to avoid death, but your only actions are to avoid the salt shaker and processed foods, then you are probably still going to die. To live, you have to learn how much sodium is in the foods you eat, including the natural foods (and these may be surprising).

    The typical advice for a low sodium diet is to restrict sodium to 2300 mgs per day. In comparison, the upper limit for Mama’s daily sodium intake is 500 mgs. The doctor was right; that is restrictive – especially when you consider that she has never been a fan of processed foods, nor did she use much salt for seasoning. That meant there were no easy targets for elimination, so to limit Mama’s sodium, Auntie had to become a detective.

    Approximate sodium content for a few foods:

    1 cup (247 grams / 8 fl. Oz) of whole milk = 100 mgs
    1 cup of skim milk = 130 mgs
    1 teaspoon of baking soda = 1,000 mgs
    1 teaspoon of baking powder = 500 mgs
    1 egg = 60 mgs
    1 oz of cheese = 200-500 mgs (depends on type; cheddar has most)
    1 stalk of celery = 70 mgs
    1 tablespoon of ketchup = 150/200 mgs
    1 cup of cooked peas = 140 mgs
    1 cup cooked spinach = 126 mgs

    Auntie has worked out alternative recipes for all the important things like baked goods. For example, she made a delicious low sodium banana cake for Mama’s birthday (with mascarpone instead of cream cheese in the frosting), and DH made his famous biscotti for Mama on Saturday, using Auntie’s work-arounds for reducing baking soda/baking powder – and they were good!

  3. Live with it.

    The list above gives just a few examples, but the difficulty of the diet is obvious. Mama and Auntie’s strategy here is to embrace the positives and to never ever fixate on the foods Mama can’t have. Mama doesn’t indulge in “woe is me; I’m miserable because I can’t have this or that.” She’s far more likely to say, “that tastes good, but why would I want to eat something that will kill me?” High-end chocolate, by the way, has very little, if any, sodium, proving not only that there is a God, but that s/he isn’t cruel.
Mama may die any day now, just as any of us may, but this extra time with her is beyond compare. As for Auntie … well, Auntie will go to heaven; I am absolutely certain of it.

1 comment:

Tess said...

Your Auntie and Mama are truly inspirational!!!

140 mg of sodium in a cup of skim milk????? Who knew! Yikes.