The unexpected setback

Caretakers of people diagnosed with Alzheimer’s or other forms of dementia know that even the most fluid and comfortable daily routine can be interrupted by the slightest thing: a stuffy nose can be cause for alarm, a clumsy stumble into a chair causing a bruise, water going down the wrong way and causing a coughing fit. Most of what one reads about this disease creates a picture of slow, steady decline, but in my experience the reality is more like a boat on the sea. It can be calm and beautiful, peaceful and serene for a bit, and then the wind picks up and there’s a gentle bobbing up and down that eventually feels manageable. But if bigger waves arrive, you cling to the side of the boat, fighting nausea, and wanting the motion to please, please just stop.

Nerves and neck bones don't
always get along

So it has been for us the past week. First, there was a return of neck pain due to cervical radiculopathy, a pinched nerve that can cause tear-inducing pain through the neck, shoulder, and arm. In desperation, because it was a weekend, I gave my mother the medicine she had previously taken about a year ago, Gabapentin, which is effective but we were glad to get her off it. Although it worked to help the pain subside, it caused great drowsiness. I tried my best to help my mother do the regular exercises that I learned from her physical therapy back in New York, but she was increasingly stiff and unable to turn and tilt her neck. Still, she managed a dental visit to have a permanent

Our traditional Thanksgiving plate

crown fitted, and a Thanksgiving weekend visit with our friends from Reggio Emilia complete with a big roast turkey lunch, and even dinner out the night before. Sunday we went to see our friend perform in a comedic play, and the week that followed was pretty normal, with a social invitation for tea with our neighbors Sunday afternoon.

The following Monday we celebrated because I passed my driving road test, the final hurdle to obtaining an Italian driver’s license. This had been weighing on me since the summer, and it had taken two tries to pass the true-false theory exam as you can only get 4 questions wrong out of 40, and about 10 are really tricky even if you study as if you have to pass a bar exam. But my mother was

Mimi knows when my mother needs her

weaker and started using her cane again, and by Thursday I had rented a walker. Friday was spent mostly asleep in bed, but I managed to get her to the doctor’s office for a 7pm appointment. Her regular doctor was away, and had reassured me on the phone that her colleague would handle whatever was causing the decline (and that might simply be a curable infection). Doctor Bacci was so charming, and having spent a few years in Cleveland and Brooklyn, spoke perfect English. He listened carefully to her lungs and heart, and prescribed a course of antibiotics, switching her from Gabapentin to Tylenol with codeine at half a dose, and ordered some blood work.

By Sunday she could no longer walk or even stand for more than a few moments. The blood work revealed anemia, so we began treating her with iron and vitamin B12 shots. The company that handles her lab work, Bios, also provides at-home nursing care, so I got badly needed help in bathing her in bed and getting other tests done. She continued to eat and drink, although this was all more difficult, but we figured out what worked best (thank goodness for children’s sippy cups). I bought a bedside commode so she could be spared the indignity of giant adult diapers, which she kept trying to rip off at night. As usual, patience and humor paid off and now she seems to have turned the corner back to healing and health and I am finally breathing sighs of relief.

What I have learned is that the unexpected setback, even the most difficult one, is a kind of test to see how to manage stormy seas. Like other challenges in life, it can be viewed as a learning opportunity and provide a window into how to better manage the next curve ball life throws at you. Watching the nurses, I learned a few tricks about moving my mother’s body without hurting her, and found the strength needed to get through nights of sleeping and waking not unlike what new parents go through as their babies try to adjust to life outside the womb. I thought about the young people from my driving school who also passed the road test and now were going to have to cope with the wild west traffic of Rome (although having lived here they are probably more used to it than I am). It takes a close call, or even a fender bender to appreciate the importance of being extra cautious when driving in city traffic.

I know it seems strange, but I feel more ready to accept the end of life when it is coming. My gratitude for the help in seeing my mother through the unexpected setback gives me renewed joy in every precious moment we get to share, no matter how hard.

How We Eat

My local market in the Flaminio neighborhood

I just received in the mail a paperback copy of Dr. Dale Bredesen’s new book, The End of Alzheimer’s, and so far it seems to be everything I was hoping it would be. I cited his 2014 and 2016 articles in the journal Aging in my first post. He has created an individualized approach to treating Alzheimer’s patients that has had great success in reversing the symptoms in his small pool of subjects.

On page 16 he spells out the first bombshell:

"Contrary to the current dogma, therefore, what is referred to as Alzheimer’s disease is actually a protective response to, specifically, three different processes: Inflammation, suboptimal levels of nutrients and other synapse-supporting molecules, and toxic exposures."

What makes his work stand out from the countless self-help medical miracle books is he is quite clear that this is not a one size fits all approach to curing the disease. On the contrary, he goes into great detail to explain the unique metabolic and physiological aspects of human health that require personalization in treating illness. This is different from the majority of doctors who may tinker with different doses or brands of medication, adding vague (and often unwelcome) dietary advice such as “stop eating red meat and butter” or telling us to exercise more. 

You can't just live on salad

Can you tell I am a bit sensitive about this topic? I was suffering from bad swelling, especially in my feet and legs, that no one could quite diagnose or explain. In desperation I tried a typical elimination diet I found through Dr. Elson Haas. Three days of no dairy, gluten, sugar, eggs, corn, soy and peanut and I was like a new woman. No more two alarms to get me out of bed, I was awake and alert early and ready to go. People commented on my face, my eyes, my whole demeanor, and I lost that puffy feeling in my joints that was causing so much pain. Don’t get me wrong, it was REALLY HARD to stay on this plan, but the idea was to slowly introduce one food at a time to test for a reaction, and in my case, it was clear that gluten was the big problem. Long story short, I have been gluten free for about two decades now, even though I tested negative for celiac disease through a genetic test. I just learned from trial and error that gluten hurts my body and my health, and so I keep it out of my diet.

Now you are probably wondering how I manage in the land of pasta, pizza, pastries, and crusty bread of every imaginable variety. Interestingly, Italians are quite understanding about gluten intolerance and the national health plan even pays for celiac patients’ gluten free food products. Restaurants offer gluten free pasta, and are happy to modify dishes with no flour or bread crumbs if asked. But the truth is the bounty of alternatives just doesn’t make me miss my high carb days. Now that I see that gluten and sugar lead to inflammation in the body, and that can potentially lead to dementia, we have even more reasons to improve our diet. Here’s a sample of what my mother and I have been eating since we got to Rome.

Minestrone

A big, delicious bowl of hot vegetable soup is on our weekly menu. My local fruit-vegetable vendor in the market makes it so easy by preparing a bag of mixed veggies for soup. 

I also bought a Wikook from Lagostina, a sort of pressure cooker type pot that speeds things up when I get home from my morning shopping and have to get lunch going quickly.

Minestrone is served with a splash
of olive oil and parmesan cheese.

I saute a bit of onion and fresh tomato with a mix of dried herbs and olive oil, toss in the bag of veg, add water, organic soup stock cube, and a few handfuls of brown rice (known as “integrale” in Italian). It helps that I got this rice at the end of our summer vacation at the beach in Maremma at the Tenuta San Carlo. (Follow them on Facebook for delightful updates about life on the rice farm at the beach).

Insalata Mista

Italians eat a lot of salad. The vegetable vendors make it easy by selling a variety of fresh lettuces, mixes, and these delicious red/green salad tomatoes that just make the salad extra tasty. One thing that varies very little is the dressing. You will not find aisles of salad dressing options the way you do in the US. Italians use the best quality olive oil they can find and red wine vinegar, plus salt and maybe pepper. I throw in my dried mixed herbs just because I like the flavor addition. Our salads have rucola, endive, radicchio, mache, escarole, beet greens, carrots, plus a cut up salad tomato. Right now you can also get puntarelle, a

Puntarelle alla romana
with anchovy garlic dressing

kind of crunchy slightly bitter chicory that curls when cut and put in cold water (the vendor does this for you) and is delicious with an anchovy garlic addition to the usual vinegar/olive oil dressing. That’s how the Romans eat them. I like them just mixed in with my other salad ingredients too.

Risotto

Those who can’t eat pasta console themselves with risotto, which has equally creative variations. I use my Lagostina Wikook pot and get a perfect risotto without having to stir for half an hour (see J. Kenji Lopez-Alt’s advice on risotto techniques).

For the first time this fall, I splurged on fresh porcini while they were in season and made the best mushroom risotto ever. In December, I made a

red/green risotto with the Roman little zucchini (they have ridges) and the sundried tomatoes I soak and then marinate in garlic, herbs, and olive oil.

Fresh porcini mushroom risotto

Roasted Vegetables

Peppers, onions, eggplant, zucchini, cherry tomatoes tossed in olive oil and seasoned with some herbs or saba (that sweet drizzle of grape must that is truly a secret sauce) go in a hot oven and usually there are no leftovers. Sometimes we have them with corn cous-cous or polenta, other times with rice. A variation is to add the long radicchio known as trevisana cut into fourths and some smoked mozzarella. This is a lunch that just cries out for a glass of wine.

A Tart

Artichoke zucchini tart

I wouldn’t know how to make a gluten free crust that is flaky and tasty, but Buitoni makes it easy by selling these uncooked in the supermarket. I saute cleaned, quartered artichokes in olive oil and garlic, add slices of zucchini, scramble three eggs (and Italian eggs have the most gorgeous bright orange yolks and are so tasty), and chop some ricotta salata or other cheese I have on hand, and put the whole thing in the crust in the oven. We usually eat half, and find it tastes even better reheated the next day.

Spremuta

I just love fresh-squeezed orange juice. Here in Italy, the oranges still have their leaves attached, and some have a red color and tart flavor that provide the requisite incentive to do that labor of cutting and squeezing for each glass. You can also find an abundance of fresh pomegranates, and I love the combo with orange juice.

(By the way just this week I was out for drinks with friends visiting from New York and asked for the mixed spremuta with a little Campari, and boy was that delicious).

Is your mouth watering yet? I should mention that all this food is extra delicious when weather permits outdoor eating. We just love to eat on our terrace. We end lunch with espresso with a little whipped cream on top, because why not? That’s what makes the vita extra dolce.