We’re back in action. I suppose it’s fitting that I return to the blogosphere with a scary story on Halloween. If you follow the Rambling Spoon Facebook page, you might know about the incident last week that landed Jerry in the ER for 25 hours, followed by three days and nights on the fifth floor of UNM Hospital. He has/had a couple of inexplicable blood clots in his leg and two pulmonary emboli threatening his lungs. Thank you so much for all of your messages, comments and notes of concern—Jerry is home now and on the mend. He’s back on his bike(s), thrilled to be moving and breathing freely. We’re lucky to have him around.
But the incident will change his life, at least for the next six months, possibly longer. He’s taking a couple of anticoagulant medications—Arixtra by shot and Coumadin (warfarin) by pill. The latter requires strict attention to diet and lifestyle.
The scary thing is, we have no idea why this happened. Jerry is otherwise extremely healthy. He had the best vitals in the ward, and doctors couldn’t explain the cause of his clots. Sometimes, that’s just the way it is. The human body is a complicated machine, and it’s amazing it doesn’t go awry more often. In this case, the long drive to and from Missoula almost certainly exacerbated the condition. But something had to trigger the clots before he traversed the vast territory beneath the Big Sky. He does not have a cholesterol problem, and these are not such clots anyway. He needed an injury—something memorable, like a gash in the leg—to have started the internal bleeding and clotting cycle. But he can’t think of a thing. In the past six weeks he trained for a 50-mile bike ride, and he did all the usual house and yard work with all the usual minor bumps, bruises, scrapes and scratches. In theory, none of that would have been cause enough.
Fascinating, though, is that he probably unwittingly intensified the clotting through his normal, excessively healthy diet rich in salads and green tea—both of which he consumed in great quantities while on the road. What? How? Why?
Leafy green vegetables and tea leaves are both high in vitamin K, which increases the blood’s clotting factors (interesting etymology: the “K” comes from the German word koagulation). In an otherwise healthy body, clotting is not a bad thing. It’s what keeps us from bleeding to death when we slice our finger while cutting onions. We need to clot. And, in fact, most people develop regular internal clots that naturally dissolve in the blood stream. We never know we have them. But when they grow large enough to lodge in the arteries and veins, threatening travel to other parts of the body (the lungs, heart, brain), they act as time bombs in the blood.
Thus, a person with clot problems needs a controlled diet that won’t interfere with the Coumadin (which actually doesn’t make the blood thinner but increases the time it takes for blood to clot). We’re thankful Jerry is in good hands. He’ll be a regular visitor to the UNM Coumadin clinic, which houses some of the world’s leading minds in anticoagulation research. His case manager pointed us to Dr. Gourmet, whose website is full of information on Coumadin diets, vitamin K and appropriate recipes for people on anti-clotting drugs.
The great news is that he need not change his tea-loving, green-eating ways. In some situations, physicians recommend that patients avoid foods high in vitamin K. But more often, in recent times, medical experts say consistency is key. If Jerry drinks a pot of tea and eats a plate of kale every day, he should continue to drink a pot of tea and eat a plate of kale every day while taking Coumadin. His caregivers will adjust his dosage to fit the diet he already knows and loves. (If you saw our jungle of a garden—full of Swiss chard, collards, green onions, arugula, parsley, basil, sage, oregano and thyme—you’d understand how ecstatic we are about this news.)
My husband/patient finally returned home one night last week with a bag of drugs and a serious itch to ride his bike (which is fine, so long as he doesn’t crash and bleed). I returned to the kitchen with a serious itch to cook. So I spent the next couple of days in the garden, sorting weeds from greens and harvesting the last of the tomatoes and peppers amid reports of impending frost. I picked a whole bucket of pomegranates, already split, which signals their ripeness. I pounded a red curry paste for an upcoming Asian cooking demo I’m giving in Boulder.
And I went to work on a five-pound bag of organic carrots. I didn’t take pictures (and neither did Jerry). I just enjoyed the time at home, in a kitchen I rarely see these days. I juiced the whole bag of carrots with a bit of ginger. Then I turned the pulp into a soup that fed us through the week. Here’s that recipe:
Carrot Pulp Soup with Sage Butter
Pulp from 5lb bag of juiced carrots
1 yellow onion, chopped
Handful of garlic cloves, minced
Juice of 1 lemon
Cracked black pepper
Healthy spoonful of NM chile powder
2 tablespoons butter
Handful of fresh sage, chopped
Grated Parmesan cheese
Sauté garlic and onion in olive oil until soft. Add carrot pulp and top with enough water to cover. Add salt, pepper and chile (use as much chile as you like). Bring to a boil, then simmer at least 20 minutes until flavors mingle. Squeeze in lemon juice, then remove from heat. Let cool, then puree in a blender.
To make the sage butter, heat butter in skillet until browned but not burnt (as though making ghee). Add chopped sage, let sizzle a few moments and remove from heat. Serve soup warm, topped with sage butter and Parmesan shavings.