Despite all the gardening posts on this blog, you did know I'm a clinical dietitian at a large, acute care hospital, yes?

Vancouver General Hospital remembers 100 years: Private ward dinner tray, 1933

And now my mind, energy, and time are focused on this work as well as preparing for an upcoming educational event. This is my latest "excuse" for why I'm unable to spend time on my -- or your -- blog.

See you soon, I hope. I miss my online time with you all.

(The photo has very little to do with my day-to-day work -- or present day reality -- but I do love this glimpse into history.)

Dysphagia - This web page from the National Institute on Deafness and Other Communication Disorders in the U.S. provides a basic, easy-to-understand overview of dysphagia in a question and answer format. It also includes a clear diagram of anatomy involved in swallowing.

A Manual for People Living with ALS - ALS stands for Amyotrophic Lateral Sclerosis (ALS), the most common form of Motor Neuron Disease (MND).  A Manual for Living with ALS is available as a free PDF from the ALS Society of Canada. It includes a section on adapting to swallowing problems and maintaining good nutrition (pages 36  through 41) and a page of recommended cook books (page 81) as well as a section on maintaining oral health (pages 55 through 57).

Although some of the manual's information is region-specific (e.g. community resources), the content on food and nutrition will be helpful no matter where one lives.  

Puréed Foods for Swallowing Problems (PDF) - Wendy J. Dahl, PhD RD, developed this clear, concise resource that describes the characteristics of the ideal pureed food and explains how to prepare it as well make meals tasty and appealing. Dr. Dahl also is the author of Textured Modified Foods: A Manual for Food Production for Long Term Care, 2nd Edition.

Plum Crisp, adapted from a recipe for berry crisp in "Food to Live By", The Earthbound Farm Organic Cookbook

Plum Crisp

Makes one 1-quart crisp

FOR THE FILLING:

2 cups frozen, pitted plums, thawed and cut in quarters
1 cup frozen apple-and-pear sauce, thawed
2 tablespoons cornstarch
2 tablespoons Turbinado sugar (use more or less depending on sweetness of fruit and your taste preference)
2 tablespoons maple syrup

FOR THE TOPPING:

1/3 cup unbleached all-purpose flour
1/2 teaspoon cinnamon
1/8 teaspoon salt
1/4 cup firmly packed dark brown sugar
1/3 cup old-fashioned rolled oats
3 tablespoons unsalted butter

1. Make the topping. Place flour, cinnamon, salt and brown sugar in a medium-size bowl. Stir together until blended. Add the butter in small chunks. Work the butter into the dry mixture with a fork or your fingers until it is in small, sweetlet pea-like bits. {Make mental note to self to try Heidi's recipe for crumb topping next time.} Add the rolled oats and stir to combine.

2. Set topping aside. {Take a break to give some love and a treat to any pet who knows some kitchen goodness is happening, a crumb or two may fall, and so is leaning heavily against your lower legs while you stand at the sink.}

3. Position a rack in the centre of the oven and preheat it to 375 degrees Fahrenheit.

4. Make the filling. Place the plums and apple-pear sauce in a large bowl. In a small bowl, combine the cornstarch and sugar until blended. And the cornstarch and sugar to the fruit. Toss gently to combine. Transfer the fruit mixture to a shallow baking dish. {I used a quiche/flan pan.} Drizzle the maple syrup on top of the fruit.

5. Sprinkle the topping over the fruit but do not pack it down.

6. Bake the crisp until the fruit juices bubble up around the edges of the baking dish and the topping turns golden. {In my convection oven, this took about 30 minutes.} Let the crisp cool slightly before serving it warm.

Adapted from a recipe for Summer Berry Crisp, Food to Live By: The Earthbound Farm Organic Cookbook, page 346.

Maple Custard, a nourishing, tasty, easy-to-swallow food

Last November, an intern's question prompted me to update my inventory of education material for people with dysphagia. Keen, energetic interns never fail to inspire me, but when we're so busy collecting and discussing new information, I don't have much time to refine my notes into a publishable blog post. You may have heard me lament I don't write quickly. You also may recall last week I vowed to finish some of the things I've started, blog posts being one of the main unfinished things.

This morning I pulled out the draft post where I'd compiled dysphagia resources, re-visited each site to refresh my memory about its content, and decided, yes, each one is well worth sharing. Here now, with brief commentary, are three resources.

Please note: Not every tip or recipe in these resources will be appropriate or safe for people with specific types of swallowing disorders who must limit their intake to a particular consistency for solids (e.g., pureed) and liquids (e.g., honey-thick).  Though people who can eat soft and minced/finely chopped foods usually also can eat pureed foods, the reverse is not necessarily true.

Meals for Easy Swallowing (PDF)

This is a publication from the ALS division of the Muscular Dystrophy Association (U.S.). An ALS clinic coordinator, registered dietitian, nurse & speech-language pathologist compiled recipes "derived from our patients and their creative spouses who translated their caring into foods that look good, taste good, are easy to chew and to swallow, and minimize discomfort." In addition to recipes for beverages, soups, breads, entrees, sauces, vegetables, and desserts there are helpful tips on food preparation, service, menu-planning. Most recipes are suitable for a pureed diet but there are some recipes for soft and minced textures, too.

A separate Nutrition Issues page discusses related topics such as maintaining weight, hydration, choking and feeding tubes.

WebWhispers Laryngectomee-Friendly Recipe Collection

WebWhispers is an international Internet group that provides information and support to laryngectomees and those with laryngeal cancer as well as more diverse group of persons with other head and neck cancers, permanent tracheostomies, caregivers and health care providers.

To help its members eat safely and with enjoyment, the website's library includes recipes "specifically tailored to laryngectomees at various stages or abilities." The Food-Nutrition-Recipes section also includes books and articles, practical tips for managing eating problems and more recipe links.

Easy to Swallow

Food stopped being a pleasure and instead became a chore.

~ Claire Wade

And so Claire Wade, a young woman with Myalgic Encephalomyelitis (Chronic Fatigue Syndrome), took steps to restore her joy in eating.  She collected recipes from renowned chefs, who included Nigella Lawson, Graham Kerr and Sophie Grigson, and published them on her site, Easy to Swallow. There are recipes for soups, main meals, vegetables, sauces, desserts and drinks.

Though the site hasn't been updated since September 2006, the content remains timely as well as tasty with helpful tips and creative, appealing recipes. I've picked a few to test including the Pumpkin & Ricotta Rotolo and the vegetable mashes and purées.

Twenty days into the new year. Ten months since my last published Dietitian's Journal post. Five drafts partly completed. And one piece of advice (but not the only one) I'm going to try live by this year:

"Finish what you start" by Irina Troitskaya | Advice to Sink in Slowly http://advicetosinkinslowly.net

Yes, wise words, though I think in this case, it's advice to apply quickly.

That all people in the community, at all times, have access to nutritious, safe, personally acceptable and culturally appropriate foods, produced in ways that are environmentally sound and socially just.

Richmond Food Security Society's Mandate

To help my knowledge keep pace with my passion for food security & environmental sustainability, on March 12th I attended the Richmond Food Security Society's Conference where I listened to stories that inspired and informed me.

After the sessions, I did some research to learn more about the speakers & their projects. If you're interested in food security and sustainability issues or setting up a healthy school lunch program or school garden project, I encourage you to check out the following resources:

Food For All – Making Food Security more Inclusive (Jelica Shaw, Claudia Li, Cease Wysse)

Oskayak Garden Project

Shark Truth

Farm 2 School & Food Gardens: How to advocate for healthy food in our schools (Joanne Bays & Michael Wolfe)

Farm to School

Food Gardens in Richmond - School Year Garden Toolkit

A Chilliwack farm field

Last evening while doing a Google search on "soil", I stumbled upon this Slow Food Vancouver feature:

Securing the Food Future of the Lower Mainland by Paul Shorthouse

If you live in this region, I highly recommend reading the article.  And if you live outside the Lower Mainland, you, too, may want to read it for ideas on how to connect with and support local farmers. The feature provides fascinating, if not startling facts about our "food footprint", forecasts climate change's implications for the Fraser Valley and describes steps we can take to protect our farmlands. 

ating is not merely a material pleasure.
 Eating well gives a spectacular joy to life &
 contributes immensely to goodwill & happy companionship.
 It is of great importance to the morale.

~ Elsa Schiaparelli, Italian designer (1890-1973)

To come in subsequent posts: thoughts about the fields in which our food grows.

(Note: Black treacle "E" designed by Allison Carmichael for Jessica Hische's Daily Drop Cap, Guest Alphabet.)

I'd like to go on record: My blog, like these preserves, is a GMO-free zone.

For now (but more to come soon), I will list only one authoritative source that has shaped my opinion and strengthened my convictions; here's one of David Suzuki's recent statements: More science needed on effects of genetically modifying food crops. Also on one of the David Suzuki Foundation blogs, Thought for food: Organic farming is good for you and the planet.