a blab by idle

I've managed to get myself completely off of the Wellbutrin XL, but I can't yet quite shake Lexapro. Every few days, I start getting these strange fuzzy head withdrawal symptoms, and they're consistent with what used to happen when I'd skip my Lexapro a few days in a row. I only take a quarter tablet now (2.5 mg) when that happens, but it doesn't always fully fix things; it just takes the edge off of it. However, I really, really do not want to start taking 5 mg of Lexapro again — not when I've come this far. I'm tempted to start taking 5-HTP, whose next byproduct in the body is in fact serotonin (also known as 5-HT) itself. Thus, rather than using an SSRI to keep the free pool of serotonin larger by stopping the cleansing of old serotonin (which is necessary to form melatonin!), I'll simply increase the available pool of serotonin — and not risk depleting melatonin which can cause all sorts of weird side effects.

One last psychopharmacological stumbling block. That's it. So close, and yet so far away.

I love big pharma. Really.

Celebrex, one of my old mainstay drugs for acute gout attacks, is a member of a class of drugs called COX-2 inhibitors. It is considered superior to traditional NSAIDs such as ibuprofen (Advil) and naproxen (Aleve), because those block both COX-1 and COX-2; COX-1 inhibition is what traditionally causes the gastric side effects of NSAIDs.

However, with Merck's recent recall and suspension of Vioxx, their COX-2 offering, the FDA is starting to call into question the risks involved with selective suppression of COX-2, especially on cardiac health. A detailed article from Medscape (free registration required) gives some great details on this, including the following passage:

According to Dr. Wolfe, the COX-2 enzyme has important functions throughout the body, including bone healing, repair of tendon rupture, circulation to the heart, and other protective and restorative roles, especially in emergency situations. "The body needs to be able to produce [the COX-2 enzyme] and use it as part of the healing process," Dr. Wolfe said. "By inhibiting it as the COX-2 inhibitors do, more so than the older NSAIDs, you're asking for trouble.... I think the safe way to go is really not to use any of the drugs in this class, even the ones left after Vioxx is coming off the market."

I think it's important for everyone to take a long, hard look at whether or not COX-2 inhibition is an appropriate treatment mechanism, especially for arthritic conditions.

It appears that Celebrex, the #1 prescribed COX-2 inhibitor, may not be so safe after all.

Interestingly, there is now a prescription product out to address rheumatoid arthritis that is not a COX-2 inhibitor, but rather a collection of supplements: Animi-3.

The question is, do we see this as good, as it indicates that allopathic practitioners are finally getting alternative options for treatments of systemic/pernicious conditions, or do we see this as bad, as the potential first step towards the regulation of all of our herbs and nutritional supplement choices?

Medtronic, makers of ICDs, are pushing the results of SCD-HeFT (the Sudden Cardiac Death in Heart Failure Trial): The landmark clinical study demonstrates that ICDs on top of optimal drug therapy reduce mortality by 23% in Class II or III heart failure patients with LVEF less than or equal to 35%.

Charming.

Dammit, if they suggest an ICD next month, I am not going to be happy.

I remember being blown away when they started doing TGA repairs in infancy back in the 80s and 90s.

Check out how far they can push the envelope now.

For those who are more technically aware of this kind of work: does anybody know if DeLeon had a Rastelli switch performed, or some other form? Since they did not use bypass (and I assume were relying on his PDA for whatever perfusion there was), was he even a candidate for Rastelli?

One other thing of which I was not aware was the relative frequency of TGA in the populace: "Jerrick’s condition, known as transposition of the great arteries, occurs in about 40 of every 100,000 live births." 0.04%? That's a lot higher than I had thought.

From Reuters, via a Medscape article earlier this week:

Thiazide diuretics, used to treat hypertension and cardiovascular disease, may increase the risk of cholecystitis, new study results suggest. There is evidence that thiazide treatment increases biliary cholesterol saturation, but studies evaluating its association with gallbladder disease have yielded mixed results. … The age-adjusted relative risk of cholecystectomy for thiazide users was 1.57. … To rule out a generic effect of diuretics on gallbladder disease, Dr. Leitzmann's group examined the association between furosemide diuretics and cholecystectomy risk. In this situation the multivariate relative risk was 1.05.

Fun fun fun! Enjoy your ongoing organ deterioration, kiddies. I know I will!

Yesterday, after dinner, my nose bled for about 50 minutes.

Today, after I got home, my nose bled for an hour and half continuously and then intermittently for another hour (and it's still going).

This is starting to get old. This is starting to get annoying. Three times now I've had a few moments of wooziness and light-headedness during this time. In theory my secondary polycythemia should make me all but immune to the effects to the effects of hemoglobin loss due to a minor wound like a nosebleed. So I'm faced with the possibility that (a) I'm having psychosomatic effects or (b) I'm losing enough blood to actually cause a hypovolemic issue (which I really have a hard time believing).

I found a couple of references that seem to refer to vitamin C and cayenne as both powerful anti-epistaxis agents, including some vaguely on the fringe. Since I've been a little low on the C of late, that might be a factor. Also, I drank for the first time in a long time this week. Perhaps my platelet counts have been dropping even more than I previously realized and this was enough to push me over the edge?

I think I really need a new CBC with diff and CMP. So maybe next week I can start to get some answers.

Ahh, HIPAA: all you have done for me so far is keep me away from my own lab work.

After days of browbeating my doctor's office for lab results, I finally get a call today: "Mr. Swanson? Your hemoglobin — that's your red blood cells — is a little high, as is what we call your hematocrit. Dr. [redacted] suggests you go see your GP."

I felt like Bruce Banner. All I could think of, after all the run-arounds and phone calls to nowhere, was "Don't make me angry. You wouldn't like me when I'm angry."

So I tried to stay calm and just say "Um, alright, can I have any abnormal data?"

She paused, almost stuttering. "You, uh, want the actual numbers?"

I lost it. "Yes, of course I want the numbers! What good is data without actual numbers? How can I make informed decisions without actual data?"

She was aghast, clearly. "Well, what do you want?"

"Anything abnormal."

"For all of it?"

"Well, yes, of course. Give me the results of the dig check and the BNP, plus anything out of range in the CMP and the CBC/diff — and I know the crit, hgb, and platelet will be off, so let's start with those."

She was stammering. "Um, uh, what ones did you want again?"

Sigh.

She gave me most of the abnormals, except on the CMP. She reverted back to infanti-care for that one: "And on the CMP, one of your liver indicators was slightly off."

Must… not… snarl… "Ah, let me guess, bilirubin, right?"

Again, I seem to be rocking the world of this poor nurse's aide: a LAY PERSON who is asking after the CROWN JEWELS of MEDICAL KNOWLEDGE! "Uh, um, yes, that's right."

Needless to say, she gave me the value.

After I got off the phone, I let loose with a short rant to the effect of "heaven forfend I want the read DATA with which to make INFORMED DECISIONS about my own HEALTH CARE!" Neal (who had been standing there waiting for me to finish) just smiled tightly and said, "That wouldn't be BITTER I heard just there, was it?"

I laughed ruefully — well, as best I could with this annoying little cold. "No, no. I'm not bitter."

Without missing a beat he simply responded, "Oh, that's right, I confuse that with homicidal rage all the time."

Then we went for Chinese food. But, hey; at least I got the abnormal values.

Now to fight with Medical Records to get full faxes of everything….

This is… subtly demoralizing, to say the least. I finally found the proceedings of the 32nd Bethesda Conference, which was on "Care of the Adult with Congenital Heart Disease". This occurred in October of 2000. Table 1 from the report of Task Force 2 is, perhaps, one of those most quietly depressing things I've seen in quite some time.

Also, today, someone forwarded me an article on those bent on "Reclaiming America for Christ" from Rolling Stone. It was a surprisingly insightful article on some people and organizations that make my blood run cold.

Finally, I've been trying to figure out just what's my damage on being able to keep things neat and organized. Why I don't seem to be able to deal well with any things domestic. And why people seem to think that even when I admit to a mistake, it's up to them to treat me like a child and make sure I don't ever make another one, again.

Yeah. I guess the word for the day is "demoralized."

It seems that I've noticed a potential trend — I've been getting really exhausted (as in bone-tired) every day at work. But I've just realized that it seems to be concomitant with the ingestion of my daily vitamins and medication (which I tend to do in one fell swoop).

I don't really see the buffered C as a culprit, but more likely one of the following:

1. some rogue agent in the massive multi-vitamin I take having a weird interaction with my system
2. the three diuretics slamming my metabolic system at once and overloading my body

I'll have to "lab rat" myself in the days to come to see if I can isolate one or two as the specific culprit(s).

The only test I wasn't familiar with from the appointment was the BNP. Turns out that it's a highly correlative marker for CHF.

So I finally have an (implied) diagnosis based on the result (199.9).

The thing that gets me is: in four years of living in Arizona and three years of interacting with medical professionals there, why did nobody ever order this for me? It's a simple test, part of a standard venipuncture series. I had blood drawn several times between 2000 and 2004. Once the puncture's been ordered, it's nearly trivial to draw a standard 5mL lavender tube off the same stick.

*sigh* The more I read about the bumblings of adult cardiologists in dealing with ACHD issues, the more I realize that the recommendations put forth from Task Force 4 at the 32nd Bethesda Conference may actually be important to consider implementing.

For three months, I've been trying to blog about one thing, and I still can't find my way to do it. Every time I start, I shut down in fear.

In five hours, it'll be a fait accompli. Still, I have sat here for an hour trying to post. And still I cannot.

*sigh*

When something freezes, it becomes brittle.

Hit it hard enough at that point, right along a fault line, and it shatters.

One cry today… that's all it took.

One scream proved that it's all shifted.

That everything's changed.

That nothing is as it was.

That the brittle, hardened, crystalline, bitter, dead layer has exploded….

All that's left underneath is the fragile, moist, pupal skin; raw, glistening, emerging for the first time.

It's the moment of abject fear and hesitant euphoria.

Of holding your breath to the count of twelve, and not knowing if you're on the cusp of victory… or the brink of annihilation.

Or, perhaps, both simultaneously, and that may be the paradoxical truth of paramount importance.

Nothing is as it was.

Everything is as it should be.

On July 26, 2005, I went into an appointment for which I had been waiting for months, perhaps even years. The location was a surprise to me and the whole event was filled with triggers, echoes, and shifts from 32 years of trauma, the best and the darkest places of me.

It was an appointment to have some pictures taken while lying in a one-foot-radius tube while a 1.5 Tesla electromagnet circled me; in other words, a cardiac MRI. Of course, given my unique history, we needed a specialist, someone who knew pediatric morphology at its most bizarre and a staff to support it, so we went to one of the midwest's finest centers for it: Children's Memorial Hospital.

Yes, old friends, the same place all four surgeries to date came before. The same place that gave me the breath of life back and stole my sanity and my future fifteen years later. Yes, dear readers, the same place you may have read about elsewhere in this blog.

I knew I couldn't make it through without help, though. Yeah, it's "only an MRI", but I have too much history here… plus there is more, so much more, than unfolds after this. So I had asked for help — a difficult enough thing to do, but one that I think I finally figured out how to do — and among the help I received was an offer from my co-worker Jim to be my ride and psychoemotive backup for the morning's events.

Jim picked me up at 5:30 AM, by our plans, and we got to CMH early — 6:00 AM — as per their request. First they held me in the lobby for 20 minutes after check-in, as they were waiting for my bed to be prepped. "?" thought I. Then the receptionist told us that that they were ready and sent me to outpatient surgery ("!?!") on 3 ("??"), where there was a bed waiting for me. As we entered the waiting room, then the combination waiting/recovery ward, I started to feel distinctly uncomfortable. "This is hitting a closer than I expected," I remember remarking quietly to Jim. We waited at the checkin desk, but while waiting I looked at the board, and saw that they had an entry for Brianna Swanson. I got to the front and they asked why we were there. I mentioned "Well, I'm supposed to have an MRI at 7," and they frowned and said, "With sedation?" Again, the alarms went off a little in my head. "Uh, nobody even mentioned the possibility of sedation, so if it's all the same to you I wasn't thinking so…." They made some calls, and said, "Well, we think you're supposed to go to Desk E on 2." So (with a note of relief) we fled outpatient surgery and went down the elevator to 2, which is where I knew the MRI unit actually was physically. However, desk E appeared to be something like the immunology the desk. Predictably, those people had no clue where I was supposed to go. They made more calls and finally said "Go to medical imaging on 1." Finally we get down to 1 (using a "patients and staff only" elevator — I was a patient, right?). On 1 they took my info, growled about me being late (being as now that it was 6:45 AM) and then said they couldn't process me because I hadn't been registered — which couldn't happen until 7:00, because registration didn't open until 7:00, even though my appointment was for 7:00. So we waited on the colorful, low couches until 7:00, picked up the house phone for registration and gave them my updated info (which took all of three minutes). I reported back, "Okay, now I'm registered". They asked if I had been there before, to which I had an answer akin to "Yes, but not for so long that whatever form you were thinking about having me sign, you really need to have me sign again." The radiology clerk was really not in a humorous mode and asked me very flatly when the last time I was in the hospital was. "1988, so that'd be 17 years." She just looked at me. "And a few weeks on top," I added helpfully. So she produced a HIPAA form (ahh, yes, it finally made sense), I signed it, and we got escorted to the MRI on (you guessed it) 2.

When I got there, things felt much more at ease. Kristin, my very nice but not overly saccharine nurse, was incredibly kind about acknowledging my freak-out potential, asking me what in advance she could do to make things easier for me and what she needed to be most careful with. Since they were going to start an IV for contrast (I had figured, but nobody had ever actually gotten back to me to tell me no matter how many times I called), she wanted to know (for instance) if I needed a countdown or if she should just stick me and get it over with. Even her mere saying that started to raise my panic-gorge and I quickly said "No, you need to let me know everything that's going to happen. No surprises. It's surprises that I react badly to. That and watching. Countdowns and aversion of gaze." So she started an IV for contrast, offering to "let my dad hold my hand." I thought about how revolting of a concept that was, since he's been dead for almost twenty years, and then Jim and I explained through much laughter that he's my coworker, not my dad (despite a visually-obvious generational difference), and that we compare notes on parenting teenagers and such. I decided to make the revolting comment out loud (it's my way of defusing stress, I suppose) and she just gave me this look as if to say, "Oh, so you're into the med professional gallows humor as well, I see."

Somewhere in there, she explained that my 7:00 slot (and first appointment, set up by design to have the least likelihood of getting bumped by a stat case) was given to the next patient in line and I was given their slot. So while waiting for the tube to clear up (it's maybe 7:30 at this point), I hear them telling the kid in the next berth "We're sorry, but it seems the machine broke down." I ask Jim if he heard that — he hadn't — and I made some comment about "boy, I hope that refers to some other kind of machine." Two minutes later, the MRI tech comes in, introduces herself, and tells us the same thing. (Turns out the kid in the first appointment — which was supposed to be me — wasn't actually finished with the study yet, and he was in the tube when it crashed. Thank you, universe!) Jim and I, both technical people, play a round of "second guess the troubleshooter" by asking her some questions, such as "what have you tried so far?", "has it ever done this before?", "how long was it down last time it crashed?", and perhaps the most important "is the magnet still actually powered up?" She mentioned that a GE tech was on the way and that he would be there very soon; we could wait around for a little bit to see what would happen, although last time it was down this badly, it took them six hours to get the machine back up and running. Since I already had my IV in, we decided to stay around for an hour or so to see if a technician could just reboot the thing and get it running, or if it was really hosed and needed parts.

Kristin offered us a "consolation prize" of some passes for food downstairs, and said that we should go down to the lobby to wait for them. They put a shield over my IV to keep it secure, which I very much appreciated, and explained how this positive pressure ender worked and allowed me to travel around without having to wheel around a stand with a unit of normal saline hanging. So I went back into the bathroom and changed out of the medical nightie (with an IV in my arm, even vaclock'd as it was, it was a challenge) back into my button down and jeans, and headed off with Jim to the lobby (with him very kindly toting my laptop as well as his own).

We were downstairs waiting (what else?) for a bit and the same receptionist came out and produced some gift certificates for McDonald's, which is in the basement. (Rant digression: Why is there a McDonalds in a CHILDREN'S HOSPITAL?!) We spent our five bucks on some orange juice (which tasted better than I remember McD's OJ tasting) and hash browns and biscuits, and talking about team policies and implementation. An hour later, just after finishing our food and saying "so now what do we do?", we get a call (you can use cell phones in the hospital now? what?!) that the machine is back online! So of course we scrambled upstairs and I bolt into the bathroom to change back into the sillygown. They'd given me a new one, this time the right size — adult instead of child — but with a broken tie so that I had to hold the thing closed to keep from traumatizing children (and probably the nurses).

It was at this point that I experienced the event that motivated this post. But it's almost a completely separate event and it will get its own write-up — later.

We entered the main room and removed most metallic items (I removed everything except my staples; Jim got to keep his glasses on). While looking at the tube, I asked them if they had shrunk the bore. It looked smaller than I remembered it, and I didn't think I was that much larger than seven years ago, which was my last one. (It turns out that the difference was the vendor of the machine; the GE bores are only about one foot in radius, which is significantly smaller than the Siemens units.) I never had claustrophobia until my second MRI, when I was fully in the tube (head-first) for two and half hours with no earplugs, no companions, no break, and nothing but a unit of saline tubed into my arm perched by my side to keep me company. So I looked at that tube and felt like I was going to freak out. That was narrow; so narrow, in fact, that they had to angle my arms up, because my wide nordic frame (and that's not the weight; that's literally the shoulder set) was almost the same width as the diameter of the bore itself! There were two saving graces, though; one was that while it was narrower, it was *shorter* — only about three or four feet long, perhaps — which means that while inside, I could wiggle my toes and feel air; the other was that I got to go in feet-first! So much nicer (and I will NEVER go in head-first again, thank you very much); even when I was in the tube, I could angle my neck back and see the light of the outside world (and that's one of the other humane things about the CMH second floor facility; there's an outside window that provides natural light to the room). Which was helpful, because they had layered a breathing sensor around me, a plus-and-square sensor resting on my ribcage, and wrapped all of it (with my arms) up in some kind of retaining blanket that kept me more or less snugly affixed to the sensors (and immobile, in a large sense, in the tube).

The study itself was very easy for the first half; about 45 minutes of noise (tempered well by the earplugs they had put in) punctuated by requests for me to inhale, exhale, and hold my breath for N seconds (with N most often being 11, 12, or, rarely, 30). For the second half, they pulled me out, started the contrast into my IV (a gadolinium chelate whose name I forget now), and put me back in the bore. The contrast was very warm coursing into my arm and was not totally comfortable; the studies were getting longer and more uncomfortable; the fingertip pulse ox was tighter and pinching kind of badly on my pinky, and the noise was a whole new level; I would have been seriously worried about hearing damage if I hadn't had -30 or so dB earplugs in! (Turns out the "advanced" sounds were due to two MRA analyses they were doing with the contrast. I had never heard anything like that before.)

They pulled me out in a record (for me) 90 minutes. I was woozy for a minute, but regained my footing fairly quickly. I got to have them pull the IV (I had already doffed the pulseox sensor and pulled the earplugs). I was shaky, sore, and tired, but I was done.

I met with the MRI tech and the diagnostic cardiologist afterwards. Apparently, their recently-upgraded machine gave great pictures; imaging on morphology, shunts, flow, velocity, R-L shunting, and everything else they were looking for were all good. The map was going to require at least a week of data processing… but a map would be had. Combine that with the echo results from April and the comparisons from past MRIs and echos, and we'd have enough information to start the Plan.

Let me take a moment to say thanks to everybody who lent well wishes and support in various ways through this whole process. As they say, the fun's just getting started, and you'll definitely be hearing from me more on this topic.

Because we're really in it this time. Cycle 5.

But more on that to come.

An amusing footnote: the bill arrived on Friday. The total amount for the MRI? $6,095.00.

Let's see how high it'll go. My guesstimate is somewhere in the neighborhood of $500,000. I think perhaps I should start a betting pool….

It's times like these that I sort of wish I had an E cylinder stashed under my desk and could sneak a cannula on without anyone really noticing.

I don't know if I'm just fighting off a little respiratory bug or what, but something's set my system off into a decompensation spiral, and frankly, it bites. My midsection's tight as a drum, all my limbs are aching, my legs feel waterlogged and like somewhat immobile tree trunks, every breath holds discomfort, my arms feel sort of bloated, and my hands feel like they want to crack open.

Add to this my doctor holding back a medication because I haven't seen him in a while and this all comes together to form a nasty, abrupt physical mess.

Now, I only have to pack the other half of my stuff and move it in the next 24 hours, and prep for the flight to New York in another 20… while decompensating…. Okay, yeah. I'm getting a bit frustrated. I need to go home and sleep to ensure maximum health for being able to do what I need and want to do in New York this weekend, but I can't — I have to pack. Yet here I am, struggling to walk down the hall without looking like I'm in some sort of crisis — something I'm not pulling off well, especially given the increasing amount of cyanosis that's occurring today. One of my coworkers gave me a look today and asked me how I was doing. I know that look. She gave me the same look 17 years ago when, as Dean of Student Life, she was making sure that her three-month post-operative student was okay. She's a VP now, but the look was the same. I truly appreciate the concern; it's just that I wish it wasn't so glaringly obvious that it's appropriate.

Ah, well. Breathe as much as I can. Hold the moment, hold the space. Mind over matter. Just get it done. Each day. Each hour. Just get it done.

It's just over three hours before I have to get up to catch my flight to New York, so I'll need to make this brief and spare the hilarious theatrics that involved today's almost–not–quite–an–appointment, starring a clinic director who thought the appointment had been cancelled, a diagnostician at the wrong facility, and two flunkies in residency who were practically drooling at the chance to get their hands on someone Really Different.

The long and short of it: even with the MRI, they still can't determine pulmonary pressures, which is necessary to determine whether or not I'm eligible for a modified Fontan; the only way to determine that is (you knew it was coming) with a cath.

So, now we start getting serious. Appointments soon to be booked, schedules shifted… and procedures to be executed.

For the med geeks out there, read on to get the MRI summary, with my offset commentary.

I went to Northwestern Memorial Hospital's ER on the morning of Friday, 9 December 2005, and shortly admitted to the hospital.

I was then discharged yesterday (Saturday, 10 December 2005) evening.

I was diagnosed with atrial flutter and had some significant medication changes which brought the pulse down, hopefully allowing the flutter to self-correct. They are also worried about my kidney function. I will be following up with the clinic tomorrow, Monday 12 December 2005, and we'll see where to go from there. If the flutter has not self-corrected in 4 weeks, they will cardiovert to forcibly correct it.

I'm sore, I'm exhausted, I'm reeling, I'm congested, I'm bruised, I'm upset, I'm shell-shocked, I'm going to be on anticoagulants for the foreseeable future, and I still have a cold. But at least I'm home.

More updates later. Right now, I'm just trying to breathe.

Yes, for all those who have been asking: I am finally going to get a MedicAlert bracelet (or, more likely, necklace). I know I should have had one for a long time now — and sort of had a home-brew version for a bit back in Arizona until it broke — but now that I am on Coumadin I absolutely cannot afford not to.

So, I will be ordering that.

Yes, I will also be updating my wallet info card as soon as I have access to a decent printer again (and can find my medicard templates, which should just require artful use of Spotlight).

Three sweet letters.

Normal sinus rhythm. NSR.

Which means, no messing with cardioversion, no zapping me with paddles, no nothing. Just a friendly "well done, keep doing whatever it is that has worked so far" from the EP docs, and I'm done with them.

Moreover, they've updated one of my diuretics, Aldactone (spironolactone) to a more modern form, Inspra (eplenerone). Since eplenerone is far more selective as an aldosterone antagonist than spironolactone, some of the side effects should abate. Hopefully, some of the resultant tissue changes will also abate (though I've been warned that will take months, if it happens at all).

They also transitioned me from generic warfarin to name-brand Coumadin. That'll be a bit expensive, but so it goes. I won't mess with a DAW order from a cardiologist. (Well, not a Fellow, anyway. A resident would get a debate, and an intern, a full-out argument, I suppose.)

So anyway… woot!

Now I just have to file the paperwork with the court, buy and receive all the oils, finish the curriculum, and work on the website by January 9….

There still might be room for doubt, but I think it's not worth testing any further.

Memo to self: You are allergic to certain (but not all) raw walnuts. You may be allergic to certain (but not all) raw honey. You are most definitely allergic, as a result, to baklava. The nature of that allergy is, most likely, "anaphylaxis." Please avoid in the future.

One of the things that is markedly different about my new life is my salt intake. Before I was "watching my salt" and was supposed to avoid anything high salt, including Chinese and Japanese food (as if!), and avoid cooking with it or adding it to anything (which was easy for me).

Now, it's an absolute imperative. I'm limited to 1,000 mg per day of sodium; the US RDA is 2,400 mg per day and the average American consumes between 4,000 mg and 5,000 mg daily. (The UK RNI is a much more reasonable 1,600 mg per day.) The human body only actually needs roughly 500 mg of sodium per day to function properly, so I try to keep it down at those levels. Given that your average store-bought food is incredibly oversalted, I've had to start pretty much cooking everything I take in myself from basic raw ingredients, many of them organic. It does mean, however, that I am getting a lot of practice in the kitchen and really shaking the rust off my cooking skills, as well as pushing into new places I'd always wanted to go but never had before (such as roasting my own red peppers). Since there are probably other people who are looking for ideas for minimized salt foods, I'll be posting some of my recipes — the successes and the failures — in the days to come.

I only cooked one new dish today, but boy did it take a long time. I'd have to call it a hearty tuscan tomato and wild mushroom bisque. It didn't turn out at all how I had planned, but it actually seemed to hit the spot somehow. Definitely a good soup for this fall snap we seem to be having outside. It's getting too late to go into the extended discussion of it, so it (like the rest of the soup) will have to wait for another day to be finished.

This guy is really funny. I'd digg him or give him some other kind of blogosphere cred if I knew how. But I don't, so I'm just posting a link to his blog.