Saturday, January 31, 2009

Restorative Nutrition for Nasopharyngeal Cancer Patients



When I came back home in 2003, I thought I would be able to work, gain more experience in a professional kitchen before going back to Vancouver as a Canadian Immigrant. Unfortunately, it didn’t happen. I was left with no choice except to take care and cook for my late-father. My father was diagnosed with nasopharyngeal cancer and was undergoing radiation treatment before I went back to the Philippines. When I saw him in his room watching television (probably the stock market) on his usual chair, he was thin, frail and weak. The inflammation in his throat will always be there and the muscles and the nerves around it have been damaged done by radiation. And for someone who loves to cook, who loves to taste food and who loves to eat, I knew I will never taste my father’s cooking again and he knew that eating will never be the same again.



In the middle of his radiation therapy, he was unable to swallow. It took him almost an hour to finish his meal replacement drink. He cannot ingest whatever I cook for him, not even the ability to drink water. I was wondering what in the world the doctors were doing. At that time, I was still ignorant regarding this matter and didn’t know exactly what to do. The doctor ordered another round of chemotherapy. We all know what this treatment does to our body. Unable to eat anything and doing chemotherapy is a recipe to disaster. He was brought to the hospital to receive for further treatment.



As he learned how to swallow through the help of an oral therapist, he started eating pureed foods such as mashed potatoes or carrots. Along with this therapy, the GI doctor decided to attach a percutaneous endoscopic gastrostomy (PEG) via his stomach through the abdominal wall to obtain the right nutrition. With patience and persistence, he was able to swallow but with difficulty.

I’ve spent time doing research on what to feed recovering cancer patients. Reading materials could give you a lot of information but wasn’t really satisfied with what I’ve found. But being holistic in nature, I did my own thing and followed my instinct.



My father struggled with the food I cooked for him. They are mainly consist of soft food but it’s not that simple. Most of them were rejected during the first few weeks. The food is either too salty or it has a metallic taste. Sometimes it would be too grainy, too chunky, too rough, too thin or too thick. Different ingredient combinations create different textures.

Sometimes he would do well with pureed foods, but there were times that he would choke on it. Another tricky part is that even though the food is smooth and silky enough for me to swallow; he would experience a different sensation. He might do well with bite-sized tender poached chicken, rice and broccoli in chicken broth than a puree of eggplant soup.



Everyday is a different experience whenever I cook for him. The weather and the humidity level of the room affected the moisture of his throat and his swallowing ability. I always feel nervous every time I serve his food. When the food goes directly to his lungs, then, I’m in big, big trouble. But for the past 12 months of his life, he never ate anything except through the feeding tube. I remember the whole family would go to the hospital every Sunday and while we’re having dinner and he’s wide awake, he would watch us eat. I wonder who he watches the most.



Below are some of the ideas that I’ve come up that concerns flavor and consistency. I hope they would be helpful for future reference.

FLAVOR

When a patient is on chemotherapy, you will notice a lot of changes. You may not know exactly how the patient feels but this treatment is very damaging to all organs of our body and one of them is taste. Taste problems include being nauseous and wanting to vomit as well as changes in taste perception. Like I’ve said from the previous paragraphs, it’s either the patient finds the food too salty or metallic. For my father, I’ve never heard him complain about my food being under seasoned. However, there are a number of ways you can do to improve the taste of the food.

  • Finish the dish with extra-virgin olive oil or flax seed oil. The oil will coat the surface of the tongue providing a richness, creaminess and silkiness to the palate.

  • Brighten up the dish with fresh lemon juice. Lemon juice wakes up the flavors of the ingredients and it improves the taste of the whole dish. You can also use other citrus fruits such as oranges or lime but nothing works better then lemon juice. Just be careful not to add too much.

  • Replace refined salt with unrefined salt. Salt bought in the supermarket are all refined most especially if they are labeled iodized table salt. When you add this kind of salt to your dish, it leaves an unusual metallic taste and it is harsh to the throat upon swallowing. Unrefined sea salt has almost all the minerals intact and they didn’t undergo rigid processing to make it look pretty and pristine to the eyes of the consumer. The rustic and grayish-colored salt is actually gorgeous. They don’t leave a harsh sensation down your throat. And they do notice it.

  • Sweeten with honey, agave nectar or pure maple syrup. Dad has been a diabetic for many years so I don’t use a lot of sweeteners.

  • Avoid adding dried herbs to the dish unless they are braised or stewed. Dried herbs are irritating to the throat. Just avoid them and use fresh herbs instead.

  • Use spices with caution. Spices are anti-inflammatory but they have to be finely ground and blended well with the dish.

  • Avoid using black, white and other peppers including chilies of all kinds and anything spicy and pungent such as horseradish, mustard, strong vinegars.

CONSISTENCY

  • Fiber is important but if patients find it hard to swallow it, don’t give it. Rough textures of broccoli or cauliflower could aggravate their throat. Always remember that most likely, they underwent radiation in that area. It’s important to cut them a little bit smaller and cook them until tender but not over cooked. They won't do well on a raw food diet unless it's served as a juice or a soup.

  • Add avocado to the patient’s diet. Avocado is the ultimate comfort food (next to café latte) of my father. This fruit is nutrient dense. It contains carbohydrates, protein, good fats, vitamin, minerals and fiber. They are satisfying because of their high fat content which is what cancer patients need after losing a lot of weight. They are easy to swallow because of their creaminess butter-like, silky texture. Macrobiotic advocates shun avocado because they have an unhealthful acidifying effect on the blood. Avocados are seasonal and you don’t eat them everyday, so go ahead and consume them.

  • Consider smoothies for breakfast or anytime of the day. They are a great vehicle for many supplements. My father couldn’t swallow pills and capsules so I use the mortar and pestle to grind them and add them to the smoothie. I always add them when the fruits have been pureed so the heat won’t destroy the enzymes of the supplement. Just keep in mind the blood glucose of the patient before making any fruit smoothies high in sugar.

  • Cook grains until they’re soft. If you cook brown rice with a ratio of 1 part rice to 2 parts water, you need to increase the amount of water to 3-4 parts. I don’t usually give him brown rice unless they’re made into congee. The bran of the rice is considered a disturbance to the patient’s throat.

  • Combine legumes and grains. When using only legumes, puree in to soups. Again, the fiber is an annoyance to them. When I first made Adzuki Bean and Shiitake Mushroom Soup, I didn’t add any mushrooms. The soup was a little bit rough upon swallowing and with all the spices that I’ve added, it wasn’t a great soup for my father. So, I modified the recipe by adding some shiitake mushrooms for creaminess and finish it off with yogurt and extra-virgin olive oil for silkiness. I don’t give this soup on a daily basis since adzuki bean is considered a diuretic.

  • Add raw vegetables in the form of fresh vegetable juice or raw vegetable soup.

  • When it comes to other protein, I always include organic eggs, chicken or tofu. I rarely use pork or beef as they might be laden with antibiotics and hormones.

  • Invest on powdered supplements and meal replacement drinks. When you are dealing with this kind of patients, they won’t be able to obtain all the nutrients through food alone. Of course, the mere act of providing them food is to allow them to live a normal life as much as possible and for their enjoyment most especially if they like iced café latte.

  • Make a big batch of chicken stock. You're going to need to make a lot of soups.


These are some of the suggestions. It would take a whole book to write something about this and that excludes dealing dealing withe mind and the soul. Of course, I want to feed the healthiest food possible for my dad, but I also need to be flexible. Although it’s very important to restore his health during his recovery, for me, restoring his soul is the most important. It's integrated.


My father died almost 1 ½ years ago but I felt that I needed to write something as my way of surrendering and releasing any memories of the past. I think I haven’t let go completely of what my existence had become these past few years because taking care of him affected every area of my life to the point that I have to start all over again. Even if I move two steps forward, I always move three steps back. I guess honoring my feelings is my way of acknowledging closure and welcoming a new path that I truly deserve. I don’t want to be on the same place this year and if I’m attracting all the new opportunities, possibilities and good things in my life right now, then I am ready to receive and accept them.

Attracting the right people, right job, right resources and right opportunities,

Divina


Sunday, January 11, 2009

Where Do I Go From Here?



When I was in college, a lot of people would tell me that I should open my own restaurant one day because of my hotel and restaurant management course. Years later, after graduating from culinary arts, I’ve been told the same thing by my relative. Having my own restaurant is not what I really want at that time as I felt that I still need to gain more experience. Then, a friend of mine just learned about my natural nutrition background and suggested that I should open my own organic café. After what happened to my visa (many thanks to the embassy for letting me wait for four and half years), I am still considering it but not without having enough resources and the right ingredients to make all things possible. But I still do want to gain more experience, knowledge and skills from a great mentor before I continue on my own venture.



Right now, I am considering my other options while I’m still working on my visa. Honestly, what other options do I have when I have been unemployed for more than 5 years? My late-father could have written me a Certificate of Employment and even if he did, people (that includes everyone) may not accept what I’ve done as a job, not even as a work experience because it’s not compensated (most especially I’m not paying taxes, etc, etc.) But if I look outside of the box and my sometimes non-conventional way of thinking, I can consider this a work or job experience. Today, more than ever, I need to shut off of what other people say against me. I know that more five years of being jobless is not a good impression to anyone. But I think society should open up their minds that although I have not been in the workforce for so many years for some inevitable reason, it doesn’t mean that I have allowed myself to become futile.

I thought I can always go back and work in a restaurant or hotel kitchen. Five years ago, I worked as a prep cook in an Italian Restaurant, then five years later, do you think I still want to work as a prep cook or is it just my pride? But is this what I really want? Would working there bring me joy? Is it because everyone wants to become a hot-shot chef and I want to be one of them? Most people are asking if I’m still into culinary arts. I still certainly do. I believe that my approach to cooking and how I work with food has taken a slightly different route. I think I have found my niche in the food industry in the world of healthy/natural/holistic cooking (but still in the process of living holistically). I may not know exactly what I want but this is what I know, I would love to cook and extend my services to other people and to the world aside from my family.


Allow me to DREAM BIG for awhile and this is what I see myself doing:

  • I am working in a health and spa resort as a holistic nutritionist and as a natural food chef with extensive knowledge in food therapy, raw food and Macrobiotics. I am using ingredients that are grown in the resort’s farm. Recycling and decomposting scraps from the kitchen is part of the resort’s program. I am also working with other health professionals in alternative medicine such as naturopathic doctors, acupuncturists, chiropractors, herbalist and so forth. Think of it as a hospital but it’s holistically inclined.

  • I am the owner and chef of an organic restorative café with my own organic farm. Again, recycling and decomposting waste from the kitchen is part of the café’s contribution to mother earth.

  • I own a tea bar where I a serve a variety of healing beverages and where people can purchase a selection of tea products and accessories. Of course, it wouldn’t hurt to have my own line of handcrafted raw organic dark chocolate collection to go with it.

  • I am a holistic nutritionist and a personal natural food chef to a famous celebrity. I don’t have anyone in mind at the moment. Actually, I do but you don’t have to know.

  • I am working on my book which will be published by Harper Collins USA or Canada.

  • I am launching my own holistic health/natural food magazine in the Philippines. I believe this kind of magazine that solely focuses on the holistic side of food and health doesn’t exist yet in the market (unless I am not just aware of it).


I was wondering how I am going to make those dreams come to pass. Right now it doesn’t matter for as long as I have those goals in front of me, even in the bleak of economic times.

Coming back to reality, I am still sitting in front of my computer reading-through my resume which may not be as impressive as other more experienced cooks out there but I believe that it has substance, integrity and sincerity. Twelve years ago, there’s only one culinary school in Metro Manila area. Today, almost every school is offering culinary arts and twice a year many students are graduating and looking for a job in the food industry. Competition is so tough these days and that scares me a bit. The truth is, going back to the hotel or restaurant kitchen is not what I have in mind but it could be my only choice at the moment. But then again, I have nothing to worry about because I know I’m going to do something great right now and in the future. Now, that’s the spirit.

Your comments, thoughts, ideas and plans are welcome.