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So what is a hiatus hernia?

February 17, 2010 Leave a comment

I was asked the other day exactly what is a hiatus hernia & why does it cause me grief.

Basically a hiatus hernia is where part of the stomach moves (herniates or protrudes) upwards into the chest cavity via an enlarged hole (the hiatus) in the diaphragm.

The vast majority of people with a hiatus hernia don’t experience any problems.

But a lot of us do.

It’s probably easier to use a few diagrams to illustrate.  Let’s start with normal anatomy.

Your insides. Note that the stomach should be sitting below your diaphragm. This is normal.

There is no hiatus hernia here. The lower oesophageal sphincter can function like a valve with the help of the diaphrgam's pressure.

Notice that for most people the junction between the oesophagus & stomach (called the lower oesophageal sphincter) sits BELOW the diaphragm. This allows the sphincter to act as a valve & prevent reflux of food and acid back up the oesophagus.

Here’s what happens if you have an hiatus hernia, and there are a couple of varieties.

This is the most common hiatus hernia type, a sliding one. See what's happened to that lower oesophageal sphincter? Can't work as well if it's up in the chest cavity.

A different type of hiatus hernia, the rolling one. Not so common. It is possible to have a combination of rolling & sliding.

Notice this time that sphincter is now above the diaphragm, where it can’t function as a valve anywhere near as well. And the diaphragm isn’t able to assist with keeping pressure on the sphincter if it’s sitting above instead of below.  The result can be GORD or GERD (reflux disease).

In my case it means a lot of GORD symptoms & I have to take care when bending over (not good) & with heavy lifting (and that means being careful even when lifting a bag of groceries).

I have adopted some of the “lifestyle” advice: no alcohol, no fatty foods, no hot spices, no fizzy drinks etc. I eat a low-fat vegetarian diet with very small servings & watch my nutritional intake carefully. I use the services of qualified dietician to guide me in food choices.

No, it can’t be treated with alternative therapies. And if you try to do “Visceral manipulation” as per the photo at Figure 5, I will scream. In pain.  Within hours I’ll have very nasty & painful reflux for a few days. And then I will commence litigation proceedings against you. Just saying.

Further information on hiatus hernias can be found at Patient UK, & that same site has some good info on acid reflux & oesophagitis which often accompany hiatus hernia. I particularly like that site’s information as it provides clinical references.

Note on treating GORD (GERD) & hiatus hernias with alternative therapies:

When I was first diagnosed I was a great user of an assortment of alternative therapies to treat any ailments I might have. I look back at those years & see that most of those ailments were self-limiting. They were going to get better with or without any complementary therapies I might choose to swallow or dabble with.

Initially I used herbal medicine to complement my medical treatment. In the first few weeks it worked, it eased my painful symptoms. But I continued to get symptoms and the herbal treatments were doing nothing (yes my doctor knew I was using). The sheer cost of alternative therapies was such that I felt I had to go with the treatment that was having a positive impact on me. That was the scientifically proven, evidence-based MEDICINE.

I do however continue to use peppermint oil to massage lightly over my stomach & abdomen most nights as it takes the edge off the painful bloating pain (& feels nice).  And if I am experiencing oesophagitis (with throat/voice pain) I will drink slippery elm powder mixed with a little apple juice. Because that temporarily eases that pain.  But they are adjuncts to my medical therapy. And I won’t have it any other way.

Baked Mixed Pasta with Gnocchi & Cheese Sauce

February 15, 2010 Leave a comment

I’d made a large pot of pasta sauce last week and now we were down to the dregs. I also had a very small serve of Soyaroni pasta left over. Not enough to really make two generous serves but too much to be thrown away. What to do? Add to it, throw in some more pasta & bake of course!

Baked Mixed Pasta with Gnocchi & Cheese Sauce

Baked Mixed Pasta! This will feed my partner & I for 2 or 3 nights. The other dish feeds us a single serve each (scroll down to other photos).

This is the large casserole dish before it went into the oven. I had enough pasta between the soyaroni & the gnocchi to warrant making a second, smaller dish (see below).

I cooked up a packet of fresh potato gnocchi to add to my left-over Soyaroni pasta (pasta made with soy flour).

I tossed the combined pastas into the large casserole dish with the left-over pasta sauce & mixed it thoroughly.

Because I had some & felt inspired, I also cooked up some bacon cut into strips (of course I used “fake” bacon being vego).

Looking at the amount of sauce-coated pasta in the casserole dish, I decided there was now quite a lot so opted to ladle out a few spoons into a second dish.

Now to make the cheese sauce. Yes, it’s low-fat but still yummy.

Cheese Sauce

600ml milk (I use 250ml full-cream milk + 350ml WATER)(this makes a low-fat milk but still leaves the fat molecules in which are handy for ensuring easy & even thickening when you add the cornflour)

4 tbs cornflour (I always try to use maize cornflour)

¼ – ½ tsp butter (for the colour & those fatty molecules)(OPTIONAL)

Dried parsley, cracked pepper (a sprinkle or more of each to your own taste)(OPTIONAL)

Low-fat grated tasty cheddar cheese (about 1 cup, maybe a bit more)(or use a similar cheese)

A pinch or more of grated parmesan (okay, this isn’t low-fat)

I make my sauce in the microwave on HIGH power, using a large 1 litre jug.

  • Add enough milk to the cornflour to make a smooth, runny paste.
  • Add the butter into the milk (it’s going to melt).
  • Heat the milk mixture in the jug for 90secs. Then stir or whisk the melting butter.
  • Whilst stirring the milk mixture, add the cornflour paste. Stir briskly.
  • Heat the mixture for 2 mins.

The mixture should be thickened & have a glossy surface. Stir. (It’s normal to have thick, chunky bits of cornflour at the bottom but even after removing those there should still be enough cornflour in the milk to ensure a nice, thick sauce.)

  • Add the parsley & pepper & stir in.
  • Add the grated cheese(s) and stir through. Leave for 2-5 mins to allow cheese to melt. Stir again.

Cheese sauce is ready to use!

  • Pour your cheese sauce over your sauce-coated pasta.
  • Sprinkle with a little extra grated cheese of your choosing (I used tasty cheddar & parmesan).
  • And finish off with a tiny sprinkle of sweet paprika (to give it a “browned” look when cooked).
  • Bake at 180C in a fan-forced oven for 30-40 mins. (This step may be done later in the day if pre-preparing your meal.)

Ready for the oven!

Now it's ready to eat!

Enjoy!

Fruitcake!

February 13, 2010 2 comments

It was my birthday earlier this week. No big celebratory deal for me but I did think I should at least have a cake.

Given the fragility of my stomach I opted for a healthy, low-fat fruit cake. Made with pumpkin no less! It’s been years (decades) since I baked a fruit cake. It turned out well & we’re enjoying it immensely. And it has not upset my GORD (GERD) in spite of the presence of a little ginger.

Healthy, home made, easy fruit cake.

Moist Fruit Cake

3 cups (500g) mixed dried fruit – (I used an uneven mix of sultanas, raisins, cranberries, apricots & glace ginger)

½ cup of caster sugar (yes, you could use Splenda or similar sugar substitute)

1 tsp mixed spice (I used ¼ tsp each cinnamon & nutmeg)

½ cup water

1 tsp bi-carb soda

1 cup cooled mashed pumpkin (squash) (250g raw aprx) – (you could use sweet potato)

2 eggs, lightly beaten – (OR 3 egg whites)

A few drops of lemon & vanilla essences

2 cups self raising flour

Pre-heat oven to 180°C. Lightly grease a large loaf tin or 19cm round tin (or use baking paper).

Place fruit, sugar, mixed spice & water into a saucepan. Bring to boil & let boil for 3 minutes.

Stir in the bi-carb. (It will fizz.)

Stir in the cooled mashed pumpkin. (At this point I transferred mixture to a very large bowl.)

Stir in the eggs.

Finally add the flour, folding it in to the mixture. (I needed to add a wee bit more flour as it looked more like a batter than a cake mix.)

Pour the mixture into your prepared tin.

Bake for around 1 hour. Check that it is cooked all the way through by inserting a skewer into the cake – if it’s ready the skewer will come out clean.)

Let cool initially in the tin then turn out on to a rack.

Close up of the cake showing the fruit & you can even see the pumpkin fibres. No, it doesn't taste like pumpkin. At all.

I cut the cake in half (because it is heavy & large), then lengthwise followed by small slices. Then I bravely wrapped & froze most of the slices so we wouldn’t eat it all at once!

Next time I make this I will experiment with adding some nuts into the mixture.

Orange & Almond Cake

January 19, 2010 1 comment

Let’s cook!

Something sweet, indulgent yet quite nutritionally dense. Orange & almond cake. It’s gluten free for those that seek such recipes for their diet.

This is a very easy recipe and doesn’t use as many eggs as traditional Jewish recipes I’ve seen over the years.

Orange & almond cake.

Orange & Almond Cake

3 oranges

3 eggs

1 cup caster sugar

300g almond meal (ground almonds)

1 teaspoon baking powder

extra 3/4 cup caster sugar (approximate measure, you might need less)

Grease a 22cm cake tin. (I used a large loaf tin)

Pre-heat oven to 170° Celsius.

  • Place whole oranges in a saucepan, cover with water, bring to the boil then simmer for 15 mins.
  • Drain & repeat.
  • Chop 2 of the oranges & remove the pips.
  • Place those oranges into a blender or food processor. Process until smooth.
  • In a large bowl, whisk the eggs & 1 cup of caster sugar until thick and creamy.
  • Add in the processed oranges, almond meal & baking powder. Gently fold together. (Mixture is often quite runny depending on how large your oranges are. If it’s too runny, you can add some plain flour.)
  • Pour mixture into prepared tin.
  • Bake at 170° C for 1 hour. (Should be golden brown, and an inserted skewer should come out clean when cooked.) (My cake today took 1 hour & 15 mins.)
  • Allow to cool initially in the tin. Be careful when tipping out on to a rack.

Whilst the cake is cooking, here’s what you’ll do with that remaining orange & extra sugar:

  • Remove the peel from the 3rd orange in strips.
  • Put peel in saucepan, cover with some water & boil for 5 mins.
  • Squeeze in the juice of the orange.
  • Add the extra sugar, up to 3/4 cup. (I use less than half that.)
  • Stir until dissolved and thickened.
  • When cake is cool, use a knife or skewer to make slight holes in the cake. Drizzle over the orange syrup. (Note” you may not actually need to use syrup if cake is very moist.)
  • Serve in small slices.

I find this cake is excellent to freeze. It also seems to be a little less wet if I refrigerate it.

I find I can use a small slice of this cake as a meal replacement and not irritate my GORD (GERD). Acid reflux sufferers it may be worth experimenting with this if you’ve not tried it before. Thanks to all that almond meal the cake is very filling. Enjoy!

Road trips & coffee shops

September 9, 2009 Leave a comment

You can’t do a road trip without sampling a few coffee shops and bakeries along the way. A small handful deserve mention for providing outstanding food and friendly service. Remember, many of these coffee shops are located in very small towns, far from the plentiful supplies of the capital cities. That they’re able to serve such good, wholesome food is truly wonderful. Well done!

Coonabarabran, NSW – Coona is a very small town of around 3000 people. Top marks go to Cardians Coffee Lounge at the river end of the town. Much to my sister’s delight the coffee shop not only had lovely fresh scones, they served chai with soy milk. Local artworks are displayed along the wall, some creative people in this small town, the walls are worth browsing.

Peak Hill, NSWCino 86, this has to be the tiny village’s best coffee shop? The coffee and teas were terrific, soy milk was an option thoroughly enjoyed by the Playwright. The toasted sandwiches were not only scrumptious (and oh so perfect for a super chilly day), they also arrived with perfect timing with the coffees. Not bad for a lone operator who was filling in for the owner before the lunchtime rush which started early! Special mention too about the village’s beautiful garden beds along the main street – the flowers were all in luscious bloom and the plants look incredibly healthy. Hearty congratulations to the town for coming up with the idea and for obviously putting much time and effort in to maintaining these very pretty gardens.

Jerilderie, NSWthe bakery. Again, soy milk was available, and the coffees were good. The teas were fine, not the best, but very welcome and tasty. Food was fresh and delightful. We bought a loaf of bread there and it saw us through some very fine toast over the next few mornings at breakfast.

Warracknabeal, Victoria – the Warrack Hot Bread Bakery & Cafe. Very plain, just looks like your average small town bakery, we didn’t expect too high a standard. Well, were we surprised! Coffees and teas were perfect, soy milk was available, and the sweet buns were lovely. Terrific tucker for an early lunch and very friendly service. And to top off the Warracknabeal experience, there’s a wonderful op-shop with a great range of second hand books. We managed to fill any empty spaces in the car’s boot with books! The town has some lovely heritage buildings, many in the art deco style.

Ouyen, Victoria – home of the Vanilla Slice apparently. We just missed the annual bake off, held in early September. Look, select any of the open eateries (and there are many, the service stations are not to be overlooked here either), choose your vanilla slices and you’ll be well satisfied. A great little town. Will be back. Not just for the vanilla slices.  One of the best motels we experienced was Ouyen’s Hilltop Motel. If you’re passing through, I cannot recommend it highly enough! A very relaxing stay in a beautiful setting. Thanks to Phil & Julie.