A while back…I reckon it was about a year ago, I think (I am not one for keeping up with what happened when, and if it was more than 2 weeks ago, I just say ‘a while back’) my kidneys crashed. 15 years of super-high doses of lithium then 3 years of super-high doses of motrin on top of the lithium made the kidneys simply give up. I was diagnosed with medication-induced nephrogenic diabetes insipidus. I clearly remember a phone call and and email from The Good Dr. H, my psychiatrist, just a few days after I’d seen him for an appointment. All my appointments included lab work checking for kidney, liver and thyroid function. He actually YELLED at me, both on the phone and in all caps in the email. GET OFF THE LITHIUM NOW! CALL ME ASAP. So I did, and he explained that my kidney function was WAY down and I asked if it was really necessary to get off the lithium and he got kind of snarky and said no, not really, but go ahead and get on the kidney transplant list and find a local dialysis clinic if I wanted to. Oh. That bad, eh. Ok.
Then I made an appointment with Dr. Courage, a local nephrologist, and he did a whole kidney workup and said (imagine a Nigerian accent)”Ooo Mam, you kidneys Not So Good, but I can help. No more salt, Mam, not ever. Cut down on the potassium too.”
Wot…no salt? Never? Ok then, you’re the one with the fancy training, I’ll do what you say.
So for the past year I have been very, very good. No salt, low potassium (which was actually harder than the no salt edict, as potassium in high in leafy greens, whole grains and potatoes. 3 of my favorite things). After about 5 months, Dr. Courage lifted the low potassium order, and I was able to return to my beloved green salads and organic whole grains. But still no (and he meant NO) salt.
So, a couple of months ago I was able to stop taking the medication I was on, and the kidney function had returned to about 50% (from a low of 20%). Everyone was pleased. Perhaps I could start eating some salt now, I was thinking.
So gradually I started eating a bit more salt. Potato chips with my no-salt sandwich. Maybe if I had the soup instead of a salad at a restaurant, and just drank a whole lot of water with it. Maybe if I knew we were going to Longhorn and if I ate absolutely NO salt for 2 days before and 2 days after, I could have one of their highly seasoned steaks…yeah I can justify anything!
Well, last Tuesday we went to Savannah. Lunch was at Panera Bread, and I had a turkey sandwich (with salt!) and a bowl of broccoli cheese soup (very salty!) and whatever we ate the next day (don’t remember) was also salty and the kidneys…they kinda went NO MORE. Talk about water retention- everything bloated, stuff started to hurt, and all the water drinking in the world didn’t help. Did I call Dr. Courage? Of course not! I could handle this! And so I have. I have an appointment to see him anyway later in the month, and I will see The Good Dr. H on Monday. I’ll report all of this to both of them, and have resolved to be more careful about the salt intake. I was getting complacent. Like, oh I am fine now! The kidneys are fine, I feel great, I can eat like a normal person! Only…I can’t.
I don’t think people realize just how much salt is in everything. Canned soups, restaurant food (all of it!!), pre-mixed seasonings…my word, salt is in every singe thing normal people eat. It’s frustrating to know that I can’t go to Olive Garden and get a bowl of their chicken gnocchi soup and simply enjoy it. If I want a steak, I have to fix it myself. The only eat-out foods that are safe (get this!) are the tacos from El Sombrero, because they don’t season the meat. Even the advertised low-salt Healthy Choice things have too much in them.
It’s a good thing I love to cook.
It hasn’t been that difficult to change cooking habits. I simply don’t add salt to anything. There is a shaker on the table, and an oft-repeated statement to anyone who complains “it’s alot easier for you to add salt than it is for me to remove it” and also “it may be inconvenient for you to add salt, but not as inconvenient as it would be if I we in the hospital getting a kidney transplant” which often results in “oh Mom, you’re so dramatic”
I’ve learned flavor-enhancing techniques. Now, I make my own stock, a rich, herbal chicken, beef or pork stock and I’ll use that for cooking grains (rice, barley, wheat, quinoa) instead of water. Sometimes a splash of vinegar or lemon juice will substitute for salt. Searing meat with garlic oil and black pepper is flavor-making, when concocting stews…there are ways around salt, and while none of those are absolute substitutes, they go a long way in the flavor department.
The one real exception is in making bread. Bread of any sort- be it biscuits or yeast or flat- requires salt. So, I simply don’t eat that much of it.
I have had to completely eliminate anything from a package. Soups from a can, boxed dinners like Mac and Cheese or Zatarain’s Red Beans and Rice or even ramen. Nothing from a package is allowed. No packaged or deli meats, nothing pre-made at all. Not even my beloved Hebrew National Hot Dogs. Sigh. Mustard and ketchup are high in salt. Premade sausage…nope. Bacon…forgeddaboutit. I admit to fudging where the bacon is concerned. 2 strips a week, followed by a day of green salads with oil and vinegar. because honestly, bacon? Yeah. I am NOT giving up bacon.
It makes for a difficult time come lunch. Greek yogurt and homemade (no salt) granola is the current favorite. It’s convenient and pretty tasty. It is not, however, an adequate substitute for the time honored favorite of canned tomato soup and grilled (american, too salty) cheese.
Sigh. Yes, this is a culinary pity-party. I remind myself that the alternative was to not take the lithium for 15 years, and probably be dead from suicide, or not take the motrin (because the first 4 orthopedists I went to didn’t believe me when I said I was hurting) and be bedridden and miserable from the pain. All that salt isn’t good for a body anyway…