Archive | December, 2011

The Ketogenic Diet – A Festive Feast

28 Dec

With the Happy Season upon us and me mentioning the Ketogenic Diet so much, I thought it was time for some practical information on my “daily bread”. Well, bread is something that hasn’t passed my lips since January – nor have any other carbohydrates (pasta, potato, rice, etc for the uninitiated).

Nor have I eaten fruit, nor anything with sugar – no cakes or biscuits!

Here’s a suggested menu for the day:

Breakfast

A two egg omelet to your taste – add tomatoes or mushrooms. In true Israeli style you can always add a salad – tomatoes, cucumbers, peppers, olives.

If I’m out for breakfast, then I’ll always go for “Shakshuka”. But beware. I ask the chef whether he adds any sugar – including tomato puree or ketcthup which invariably include sugar and/or carbs! If there’s sugar I need to order something else.

Lunch

Try my winter fish soup[8]:

Ingredients:

Half a cup olive oil, 1 onion, 1 head of garlic, 3 courgettes,1 red pepper, 1 tomato, 600gms of your favorite (white) fish. Feeds 4 comfortably – or myself for a week.

This is what you do: Heat the olive oil (in a heavy “Le Creuset” type pot). Not too hot a temperature. Add sliced onion, about 10 cloves of garlic, sliced red pepper, pieces of courgette in rings and lastly cubed tomato – don’t chop the courgette and tomato too small. When they’re all softening up – less than ten minutes – add just less than a litre of boiling water. Put in your fish in nice sized pieces and let the lot simmer for about 15 minutes. Simple and delicious.

 Alternatively – Pam’s mean minestrone:

Fry onions in butter or olive oil and then add your favourite veggies – fry till soft, cover with water and boil.  Pam uses cauliflower, courgette, leeks, onions, red peppers and tomatoes – as much as you want.  Salt, pepper, curcum (tumeric) and curry powder to taste. Big pieces, small pieces or through a mixer.  

Desserts

Chocolate Swiss Roll[9]

Ingredients:

150 gms butter, 3 slabs sugarless chocolate (85% min cocoa low carb), 150 ml sugarless cream, 1 tbl spoon cocoa powder, 3 eggs, substitute for sugar (stivia) to taste – we don’t bother with any sweetener.

This is what you do:

Make the sponge – separating the egg whites and the yolks.

Beat the yolks with a fork vigorously for about half a minute.

Beat the whites in a blender/mixer till stiff.

Fold the yolks into the whites – add  cocoa powder and sweetener if you must.

Melt the butter and chocolate together.

Spread the mix not too thinly on baking paper in an oblong baking tray – about 30cms x 12cms.

Bake in pre-heated oven at 170c for about 15 minutes. The secret is to have the “dough” at the right texture – something I can’t explain. Soft yet rollable.

Let the “dough” cool down.

Spread the chocolate mix and the whipped cream over the dough and carefully roll it up.

Refrigerate for an hour or so.

 

Alternative/additional desert – full fat cheeses.

 

Dinner

Hors D’oeuvres

Smoked salmon with asparagus or guacamole

Main Dish

Stew[10] – best to prepare a day before giving time to absorb all the juices from the vegetables.

Ingredients:

A cut of stewing meat, seasoning. aubergine, courgettes, leek, mushrooms, onions and tomatoes. Quantities depend on how many servings you want. 

This is what you do:

Fry meat joint or slice it first, just to seal in juices.

Slice all the vegetables. Fry half of them (separately) until they are lightly browned and half stewed. Place some in the bottom of a pot. Add the meat and the rest of the vegetables on top.

Stew slowly in the oven at 150c until the meat is soft. Can take 3 hours or more, depending on the size of the joint.

Slice the meat when cold and put back in the oven with the veg and reheat before serving.  

Dessert

A few berries– blackberries, blueberries, raspberries and strawberries are allowed in small quantities (three or four of each). They contain fructose not sucrose. One or two small pieces of melon are also okay. I limit myself to berries or melon twice or maximum three times a week. 

 


[8]  Variation of a Chaim Cohen recipe from his TV programme “Garlic, Pepper and Olive Oil”.

[9]  By courtesy of my amazing daughters.

[10]  By courtesy of my sister Rosalind, who keeps me constantly supplied with all sorts of frozen goodies that I can just take out the freezer before the pangs of hunger set in.

My sister-in-law, Fiona, on the other hand, just invites us round all the time and always comes up with gourmet meals. No words of sufficient thanks to either of you. Long may it continue.  

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Reflexology – Seeing is Believing

22 Dec

Some people just have the touch. My daughter, Tal, is one of them. Her massages make you melt. Then one day, now over a year ago, she volunteered to massage my feet. Until then, touching my toes was too ticklish for my liking.

“Ouch” I said – probably sounding irritated, and not too sympathetic. I explained that I must have trodden on a stone or something, and she was touching a very sensitive part of my foot. I had been diagnosed a few days earlier with cancer and was really not doing well.

Tal takes a look and tells me there’s a spot on my pancreas. I ask her to explain. She brings me a print out of a reflexology print of the foot[7] (see  http://reflexologyfootchart.net) and a mirror. Take a look at this – you have a blue mark – a veritable lump – right on the reflexology point of the pancreas; slightly to the right of slap bang centre of my left foot. And boy was it painful. My weight continued to reduce and the spot continued to grow. A couple of weeks later, my feeding tube was inserted. And almost immediately I started experiencing pain in my left eye (referred pain from the tube pressing on a nerve), and from the second toe on my left foot.

 “Dad, did you know the area on your foot causing you pain is the reflexology point for the eye?” asks my devoted daughter. I find it hard to believe. In the best of British understatements, I’m a bit of a cynic at the best of times. But seeing is believing.

We had to get some sort of authoritative opinion. Well, going to see doctors almost daily at Tel Hashomer made that simple. Except the doctors said they weren’t reflexologists – and weren’t familiar with the pressure points. My condition deteriorated still further and I was hospitalized with, among other things, an infection of the gall bladder – with yet another corresponding painful lump on my foot. More medical opinion close at hand – but no-one thought there was any connection between the spots and my cancer. Finally my feeding tubing was removed. And a day later the pain in my foot started to subside.  My gall bladder got better with antibiotics; that spot on the sole of my foot disappeared.  And the spot on the pancreatic pressure point was marginally smaller. We examined it every day. There was no doubt it was getting smaller and causing less pain. Two months later it had completely disappeared.

I had always dated the turn-around in my condition as coinciding with the removal of the feeding tube.

But what were the reflexology points telling me? For me, seeing is believing. I certainly think differently about alternative medicine today.   

I’d really love to hear your comments on this one.

Seasonal Miracles

18 Dec

Two weeks before Christmas is a perfect time, for those lucky enough who can, to travel. Prices are not yet high season. At the moment, I seem to be one of those lucky ones.Vienna at this time of year is bedecked in Christmas decorations and magical lights. I am thinking of Hanukka. As our politically correct friends would say, “Happy Whatever”. 

Our hotel stands on the corner of Dr Karl Lueger Platz. On the diagonally opposite corner stands what was once the Ephrussi Palace, home to one of the richest families in Austria[6]. The building is being refurbished by Casinos Austria – a sign of the times as to what is now considered “business” in Europe – or is it the “financial services” or “entertainment” sector? Dr Karl Lueger was mayor of Vienna. In 1899 he legitimised anti-Semitism. My thoughts return to home and our very special festival of Hanukka.

Hanukka celebrates an eight day miracle; since I became ill, I can identify eight of my own miracles. I’d love to share them, though my list might not be in order of importance:

     – My wife and three daughters                                                                                                    Perhaps they are four separate miracles as each one of them has shown no limits in what they are prepared to do for me.   

     – My closest family 

By whom I mean my sister, brother, sisters-in-law and brothers-in-law. Each one showing their care and concern right up to the level of life-saving itself.          

    – My extended family and friends

Miraculous to me how you really see who your friends are and the extended family coming through. Kindnesses shown and sentiments said that I would never have expected.

     – Those who pray for me

How many people have said that they are praying for me. This will certainly have to be the subject of a future post. And prayer itself.

     – My doctors and their respective treatments

How will I ever know whether my initial dose of radiotherapy, my on-going chemotherapy treatment, or the medical help, advice and directives I’ve been getting are in fact the miracle I’m witnessing?

    – Incorrect initial prognosis

I’m doing better than the original prognosis. I think I say a little prayer for this more often that I care to admit.

     – The Blog’s ability to help me and to help others

This one is the surprise in the package. The more people that can be helped – so much the better.

     – Ketogenic Diet

Where do I place my dramatic change of diet in this list? Is this the exception that is proving to be the winner at the moment? I have no idea. But I firmly believe the diet is worth a try.

 

Happy Whatever and sincere thanks to you all! May we light up for each other for many years to come.   


[6] The Jewish Ephrussi family is the subject of Edmund de Waal’s best selling book “The Hare with the Amber Eyes”. Having just read the book, it became one of the reasons we chose to have a week-end break inVienna.     

 

The BRCA 2 Gene – and other things you might not know

14 Dec

In my very first blog, almost a month ago on 17th November, I said “My mother was a BRCA 2 gene carrier and so am I”. How did I know I was a carrier and how did I know what BRCA 2 was? Come to think of it, how much of the medical world that we meet – or in my case contend with almost daily – do we really know about?

First – I’ll tell you how I found out I was a BRCA 2 carrier. Early last year, I finally made an appointment to see a gastroenterologist. I’d been suffering from mild dyspepsia and also from the “real men don’t get sick” syndrome. A quick check-up and, surprise surprise, the doctor asks me a whole bunch of questions regarding my family history – and is particularly interested when I tell him how many of my mother’s family had breast cancer. He suggests going for genetic counseling at Beilinson Hospital– and I make an appointment for sometime in May.

The genetic counseling session seemed to be almost a repeat of the questions the doctor asked me. Except this time there was the usual form-filling and I was asked to sketch a family tree highlighting the afflicted members in my family. I struggled with the statistical analysis. I was being lectured – and in my usual manner thought to myself: I’ll deal with genetic issues if and when the time comes. I gave a blood sample – and was told they’d let me know.

I asked a couple of “what if” questions – and was surprised that the response was to check my insurance cover. I persisted and got the same answer. I tried to rephrase my question in terms of pre-emptive medical action. Thankfully, I’m one of those who checks insurance policies regularly. I cannot imagine where I’d be today had I not had a policy for loss of earnings and insurance for drugs not granted by the Ministry of Health.

The results came – and I prove to be a carrier of the BRCA 2 gene of the mutation 6174delT.  I rush to my family doctor for an explanation of the mumbo-jumbo report – and he suggests that I have a mammogram – just like my wife and most other women have! I’ll spare you my embarrassment in the waiting room; knowing about BRCA 2 is far more important than my feelings at that moment.

The best thing I can do is refer you to an article on BRCA that Pam has just written. Here’s the link  http://esra-magazine.com/blog/post/knowledge-health.

Two things I’d like to make clear. Firstly, female carriers of the BRCA gene mutation have a dramatically increased chance of breast cancer – by up to 80%! Males increase their chance by about 6%, but also have increased chances of prostate and pancreatic cancer. The appropriate course of action for carriers is constant monitoring. In my case, I found out a bit too late. But at least I had some insurance cover. 

My second point, is indeed the question of insurance. Whether we like it or not, the financial aspects of being ill impact immediately. Life is full of so many risks. Adequate insurance is essential!  Be warned. In the meantime there are so many other administrative aspects that I’m trying to come to terms with – a flank of fighting cancer that cannot be ignored.

To end on a happy note, or, as they say in “The Life of Brian”,  ‘always look on the bright side’: carriers of the BRCA2 gene mutation have a better chance of responding well to chemotherapy.

 

 

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Can you be normal with cancer?

9 Dec

With the sword of Damocles hanging over my head I sometimes ask myself whether my life can return to some form of normalcy.  Then I grapple with the question “What isNormal?”

This week was a treatment week. I’m still on a one-week-on/one-week-off regime of chemotherapy.  I schlep through the traffic to Tel Hashomer on Monday mornings, do the rounds of bureaucracy and blood tests and start my infusion. A long day lingers past lunch-time, I’m hooked up to my 5-F-U and my ever-present wife takes me home. Steroids mask the side-effects till Friday or Saturday, and my “week-on” is almost over. That’s my routine. It’s been like that for a year. Is that “normal”? Well, no; that’s not what I meant.

This morning, Pam was lecturing in Tel Aviv. I still love to listen to her – even though she sometimes asks whether I couldn’t deliver the lectures myself. Today is the hardest day of my cycle; I’m not feeling great.  I sit quietly in a corner and people come up to me. That’s nice. People. Some have the ability to communicate – but a few just say the “wrong” thing. Like telling a story of someone close who didn’t “last long”. Some aren’t able to differentiate between the myriad manifestations of cancer – whether the patient was operable or not. Is it a comfort to hear all these stories, or not?

But mostly I’m amazed at how well-meaning people are. And the importance of communication. How happy I am when someone tells me a chain of coincidences that led to someone having read my blog. Just lately people have been telling me that if they didn’t know I’d been sick …I’m looking really well!  Is that “normal”? Well, no; that’s not what I meant.

Pam’s lecture ends and we meet good friends for lunch. Normal as can be. Or is it? I’ve come prepared with my food supplements and pills. Not such a hardship. But when it’s over 20 pills a day – it’s difficult to swallow.     

My neuropathy[1] is not nornal. Nor is not having bread[2]. I can’t explain how I put up with the phenomena – but I just do.

But in the meantime, to so many out there who really care, please pass on my blog through whatever social network you can – Facebook, Twitter or old-fashioned word of mouth. How gratifying to think we can help each other. and reach even more people that may need help. It really keeps me going.

    


[1] Neuropathy is a functional disturbance or pathological change in the peripheral nervous system. In my case it manifests itself in pins and needle type feeling in my fingers and toes.

[2] I’m sticking religiously to my Ketogenic diet. There’s a growing number of people who believe that this diet is a key weapon in fighting cancer; pancreatic cancer in particular.

Can Cannabis Cure?

7 Dec

Cannabis has made its mark me. Tzachi Klein’s documentary and the relief medical marijuana gave his interviewees, was very impressive.  I must say, I’d never seen myself anywhere near as “ill” or in as much pain as those in his film. I thought I was coping with my pain well enough. This was a new field for me.

As I mentioned, I’ve never taken drugs – not even smoked pot. If the average school teacher had the same charisma and pedagogic skills as my instructor at Abarbanel Hospital (whom I referred to as an ex-junkie in my previous blog) – the Israeli education system might not be the mess it is. And children would certainly be better informed.

“The mood,” he told me, “is what matters most.” You’re not smoking for a high but for the remedial help that cannabis can bring. Pain control, sleep control, relief with bodily functions and movement.  It’s all about mind-set. Be relaxed and ready to enjoy the experience, in controlled quantities and a professional approach. Drink was of the essence – not alcoholic but gentle juices. Lime juice and the like. “Let’s look at what we’re talking about”, he continues. There were a couple of samples on the table. He cuts one open and explains the quality of the leaves – their colour, texture and Government-controlled consistency. Then he cuts open the other – a typical street sample. Even to my untrained eye the difference was striking – seeing is believing. A closer understanding of what goes on in our world. What age do children start smoking? Could they possibly be aware of what they’re buying?

Time to light up. More like a tennis lesson on technique, with the art of breathing thrown in. And then, of course, how to extinguish the remainder; the number of inhalations having been carefully counted. He gave me a few well documented rules and notes to take home. Together with his 24/7 contact numbers. He asked whether I had any questions. I could only think of thanking him. There was a knock at the door. You can leave now – he said. Use the side door – the main door had opened – it was11:40.

Then it hit me. No, I was not seeing naked naughties. It was his language. He had never used the vernacular. No chance of picking up any street jargon or enriching my Ivrit.  He had spoken to me so nicely – in plain and honest  Hebrew. Israel – what a place.

Pip and I walked through into the “shop”. No advertising here. No cigarette packets with Government warnings “Smoking Can Damage Your Health”. Zip-lock looking sandwich bags, neatly packed with medical marijuana – date stamped. And a whole range of ancillary products. I ask for just the “starter package”. I’m reminded that they don’t take cash – just credit cards or personal cheques – together with the original of my police license for “The Holding and Use of Dangerous Substances”.

Pip wheels me back to the car. Not much one can say. We’re on our way home. I gather my girls and tell them all. They’re hanging on my every word. This was such a new experience for us all; none of us know much about drugs.  My family was keen to see me experiment – to safeguard that I could repeat what I had learnt at a later stage if my body and mind might be failing. How Pam and my “kids” – no longer kids by any means – care for me. I lit up in the calm of my home – only to rouse a new sense. Smell. I reminded them that my pain levels were manageable but the smell pervading our living room didn’t fill me with the joys of life. We tried later (according to the pre-determined timetable) in the garden. All that happened was that the procedure irritated me. Maybe I just didn’t want cancer to change my life. I answered my daily follow-up phone call and told my man that it wasn’t “doing it” for me. “No problem – shelve it, safely. Wait till you’re ready,” he replies and reminds me to act responsibly. “The license is in your name for your sole use”.

 Can cannabis cure? Fortunately, my cancer hasn’t needed me to put it to the test.

Medical Marijuana

4 Dec

About 20-odd years ago, a ninety year-old orthodox lady stepped down from opening the Ark at her great-nephew’s Bar-Mitzvah in Jerusalem and said to us as an aside “If you live to my age, you get to do everything”. It was also the first time that Pam and I had sat together in a Reform Synagogue. Years earlier, growing up in London in the swinging 60’s, I was at Wembley Stadium to witness England winning the World Cup and even saw The Beatles live at Hammersmith Odeon. But I’d never taken drugs – not even smoked pot. Then last year, I got cancer – and my life over-turned.

Things deteriorated very rapidly at the beginning. But I don’t think I was desperate. My kids still ask whether I was, or perhaps whether I still am, in some sort of denial. I said “no” then and still say “no” now. I lost of lot of weight, couldn’t eat and was in an unfair amount of pain. Retching had become a routine. I was receiving radiotherapy almost everyday and chemotherapy once a week. Our search for a better solution continued. Tel Hashomer offered alternative medicine as well – acupuncture and medical marijuana.

I acquiesced to acupuncture amicably, but medical marijuana? Me? Go for it Dad – the kids urged me on. This is your chance to get with it. Did they know something I didn’t know? Were they using substances without having told me? We were certainly in new waters. And I’m no great swimmer. You have to try everything – what do have to lose?

I don’t know what made me change my mind but I agreed. Like everything in life you have to negotiate the administrative obstacles. First up, I have to get a letter of consent from my oncologist, then a referral from the professor of alternative medicine and of course, obtain a police license for “The Holding and Use of Dangerous Substances”. Is this really me? But first, I’m told I have to watch the recently aired Channel 2 documentary by Tzachi Klein[1]. I report back to the kids – they seem to think that this is the best thing that’s happened in the family since sliced bread. Dad’s going to become a junkie! I’m given an appointment for 11:20 at Abarbanel Mental Health Hospital, Bat Yam. Abarbanel? Bat Yam? For the uninitiated, it’s as likely as me going for walk at night in Harlem in the 90’s or finding a kosher butcher in Bradford. But first we have to watch the documentary – which we do en famille. It’s one of those true bonding experiences where we all feel part of this “adventure” together. The programme itself brings a sensitivity to those (like myself) with a pre-conceived negative idea of a substance with a suspect image. 

I’m on my way to Abarbanel. My girls each volunteer to take me, but my brother-in-law, Pip, is on hand to help as always – and he drives me there.

We more or less know where Bat Yam is – but nothing could have prepared us for Abarbanel. (See http://www.youtube.com/watch?v=McgJ8G5576g for a general idea). The gates are more like a prison than a hospital. The security tight by Israeli standards, to say the least. I show my documentation, letters, referrals and recently obtained license. The guards, after their laborious check, reluctantly let us in. Not the car – just you – they tell me. I’m wheelchair-bound I reply. Sentiment doesn’t seem part of their job, nor happiness part of the hospital. People are all over the place. Some lying down, some wandering aimlessly around, and others self-inflicting themselves with injuries. What is going on? Park near Building 5, I tell Pip – even though we arrived almost an hour early and I could do with a dose of fresh air. Not only do I want to save Pip a long push of the wheelchair – the place just doesn’t look safe for the likes of us.

Did I say Building? It’s more like a condemned shed that should have been demolished years ago. There are lots of people waiting; no queue, no-one to ask. We finally find a friendly face. I’ve got an appointment for11:20. How many people in front of me? I’m really not feeling well. Any chance of going straight in? Your appointment is for11:20– you’ll be seen at11:20.

If ever there was any need for confirmation that this place was not normal, this was it. Swiss timing in Israel?

11:20 comes and we’re summoned in. I forget to take off my sunglasses. It’s more like an interrogation room in a B-type movie than medicine. I need to go to the toilet but having seen the facility on the way in – I go for restraint. A monologue from my interlocutor. He tells us that he was a junkie and knows where we’re coming from. Legalised marijuana – don’t think you’re going to hallucinate and see naked naughties, he continues. He asks me what I’ve used before. He doesn’t seem convinced by my “Nothing” reply, and says he’ll start from scratch. I’ll teach you and control you – this is no “High and Bye”, he smiles. He’s somehow winning my confidence. The body and mind have to be ready for the experience – you have to act responsibly or your license will be revoked. It is in your name for your sole use. “Where are the kids now?” I ask myself. Shame they’re not here for this delightful demonstration.

I get home with my quantity of cannabis and my girls are giggling with anticipation. They even suggest another bonding experience en famille. I remind them that I really don’t see myself yet as having passed the threshold of pain and I’ll only use it as and when the time comes.

What did the marijuana do for me? Watch this space for my next blog.


[1] The programme (narrated by Uri Glazer) was first aired in January 2010 and is truly illuminating (http://www.youtube.com/watch?v=HQ8HZtD6aZI) . Together with other media exposure (see http://www.jpost.com/servlet/Satellite?cid=1263147921967&pagename=JPArticle%2FShowFull ) it increased public awareness immediately. Demand for medical marijuana (cannabis) in Israel increased 5-fold!