Wednesday, September 17, 2014

Subscription Box Review -

Recently, I stumbled across - a subscription box service that offers a healthy alternative to the usual snacktime staples (chips, cookies, and whatever other crap I can find).  The twist is that your snack boxes are a surprise - you can go onto the website to view the snack options, trash any snacks that don't appeal to you, and rate the remaining snacks on a try/like/love scale.  Then, each box is a random selection using their crazy algorithm that takes your ratings into account.

The first thing I did was trash anything with mango (I'm allergic), peanut (gross), and walnut (Aidan's allergic, and that one makes me nervous enough that I don't like to have it in the house.  (On an allergy note - everything's packed in the same kitchen, so keep that in mind.).  I set my box frequency to every 2 weeks (weekly is also an option).  Then, I chose to receive a Calorie Counter box, so that all of my snacks would be 150 calories or less.  I'm on Weight Watchers, so this has meant that all of my snacks have been 2, 3, or 4 PointsPlus. 

If you'd like to try it, the below link (or the code RXNYN96TU) will get you a FREE first box, and if you stick with the subscription, your fifth box will be free too!

So, this is all well and good, but how's the food???

My first box arrived in just a few days, and I was really excited to try it.  Knowing we were going to the hospital soon, I decided to save my snacks for our stay, and ordered another box immediately (very easy to do) so that I'd have plenty of healthy snacks to munch on while cooped up in CHOP. My second box arrived the day before we left for the hospital - well timed, Graze!

Box 1
Garden of England - 2 PointsPlus.  This is a mix of strawberries, apples, and blackcurrants.  They are dried fruits, but not freeze-dried.  Everything is sweet and fresh.  The apples and blackcurrants are nice and tart.  The strawberries are sweet.  It was what I expected it to be.  Nothing amazingly surprising, but a nice sweet 2 PP+ treat.  The apples are my favorite part.  I rated this as a Like - I'd be happy to receive this occasionally.
Peach Cobbler - 3 PointsPlus.  This is a mix of peach strings, honey almonds, yogurt-covered sunflower seeds, and amaretti drops.  The first thing I noticed was the smell - it smells like fruit snacks.  I think it's because of the peach strings, which are texturally somewhere between a fruit snack and a fruit leather.  They taste great.  The honey almonds are decadent and delicious, and I liked that they were chopped almonds - not whole.  The yogurt seeds are mouthwatering - literally.  And the amaretti drops - the most mysterious of the ingredients - turned out to be a sweet but not-too-sweet almond cookie.  Similar to the sponge pieces found in some of the other snacks.  I loved each individual ingredient, but the pieces were pretty small, so I wound up eating handfuls at a time - resulting in many Perfect Bites, which were pretty much snacking heaven.  This snack reminds me a lot of the Hot Cross Yum (see Box 2, below) - it felt like I was eating a super decadent treat, but somehow it was only 3 PointsPlus.  I rated this love and hope to see it often.
Toffee Apple - 2 PointsPlus - This is dried granny smith apples with toffee sauce for dipping.  The sauce is amazing - thin enough consistency to be a good dipper.  The apples are tart and tangy and go really well with the sauce.  I rated this one love because this sauce is to die for, and at only 2 PP, it's a steal of a snack.
Morning Energizer - 4 PointsPlus.  This is a mix of cherry, pear, and walnut.  I didn't intend to receive this, because it has walnuts and Aidan's deathly allergic.  I must have missed it when I went through and trashed everything walnutty.  But it's here, so I tried it.  I was pleasantly surprised at how fresh the fruit tastes, and I think the cherries are a really good companion to balance out the bitter walnut.  The Perfect Bite of all three is actually really delicious - enough so that I'm actually considering removing it from the trash bin and just bringing it into the office to eat away from Aidan.

Box 2
Banana Caramel Dippers - 4 PointsPlus - These are banana shortbread cookies with caramel toffee sauce for dipping.  I was more excited about this than any other Graze snack.  Cookies with caramel sauce?  Yes please!  On their own, the cookies are a true shortbread - not terribly sweet, flaky and crumbly, but you definitely do get a strong taste of banana.  And it tastes like real banana, not kinda-banana.  The caramel sauce is pretty tasty too - thin enough to make it a good dip for a crumbly cookie.  Together, the cookie and the sauce are a divine treat.  Thankfully, they're portion-controlled, because I could eat this all day.  Easily rated this one love.  I wish the sauce container weren't so narrow - it makes it harder to humiliate myself by licking the inside.  Note - I said harder.  Not impossible.  Side note - I kind of feel like I'm eating my feelings with this one.  I think my grandma would have loved this snack.
Hot Cross Yum - 4 PointsPlus - This is a mix of orange-infused raisins, sponge pieces, and cinnamon honey almonds.  Whatever sorcery they use to infuse fruit with the flavors of other fruit is insane (in a good way).  These are the orangiest raisins I've ever tasted!  I had no idea what to expect out of sponge pieces - which are used in a few Graze snacks - but essentially they are a slightly eggier-tasting Nilla Wafer, which doesn't sound all that appetizing, I know, but it works.  Cinnamon honey almonds are fabulously decadent candied nuts.  I truly don't know how this is only 4 PP+.  The Perfect Bite (one of each piece) is amazing, but actually, I really love each ingredient on its own, too.  I rated this love.  It felt like eating cookies and candy, but in a controlled and still satisfying portion.  I'd be happy to receive this often.
Raspberry Coconut Muffin - 4 PointsPlus - This is a mix of raspberry cranberries, coconut, amaretti drops, and almond slices.  The first thing I noticed was a delicious tropical smell, which has to be the coconut and almond.  Seriously, this is the most fragrant of the eight snacks I've tried.  I think I trashed almost every snack containing coconut, but I'm rethinking this decision, because these coconut flakes are really good!  Normally, I think coconut flakes taste suspiciously like hair - but these taste fresh and coconutty.  Awesome!  I fell in love with amaretti drops while enjoying Peach Cobbler, so those are a win.  The raspberry cranberries are a delightful treat - I continue to be amazed at the fruit infusion technology.  And the almond slivers add some protein in to make this a really filling snack.  I love how the sweet, tart raspberry cranberries balance out the nutty almonds and the coconut.  It's at the higher end of my snack rage, coming in at 4 PP+, but the portion seems generous.  I love it - please send more!
Super Berry Detox - 3 PointsPlus - This is a mix of blueberries, cranberries, goji berries, and green raisins.  As usual, everything tastes really fresh (I always worry with dried fruit that it will taste - you know - dry).  The portion size on this feels pretty generous, actually.  I like the green raisins, cranberries, and blueberries individually, but it turns out that goji berries (which I'd never tried before) are not terribly delicious on their own.  I wish there were more blueberries in the mix, and fewer goji berries. But I'm sure it's the goji berries doing all of the heavy lifting, nutritionally-speaking.  This mix is a full serving of fruit, and a "good source" of iron and Vitamin A.  Whatever that means.  I rated this "trash", because I know how many other, more delicious options Graze has to offer.  More Peach Cobbler!  Fewer goji berries!

What I found was that these feel so much less "empty" than eating 3-4 PointsPlus by way of a 100 calorie pack of cookies or crackers.  Sure, points are points, but I feel better about using mine on something with healthier ingredients.  Would I use these snacks to replace fresh fruits and vegetables or lowfat yogurt and cheese, all of which I currently snack on frequently?  Of course not.  But these are a great option for the times when those fresh and refrigerated options aren't available or appealing.  It's something different, something additional.  To be honest, a challenge that I have on Weight Watchers is actually using up all of the points I've been given.  At the end of the night, I hate the idea of eating just to eat, so I don't, but it's not uncommon for me to go to bed with points uneaten.  Many points uneaten.  Adding a few graze snacks into my week may be just the thing!

Graze note: Go online and rate rate rate!  Rate the snacks you get, and check often for new snacks!  I would love to see new snacks pop up when you log in, so that you can rate them before they show up in a box.  I want the chance to "catch" them before they show up in my box, if I wouldn't want them coming.  But I suppose it's an incentive to log in often and see what's new.  I might have to bump up my frequency to weekly - by the end of the second week, I'm really craving a new box. 

Thursday, September 11, 2014

Inpatient - Endocrinology - Day 4

This post will be blessedly short.  On day 3, we felt like we had his Endocrinology stuff figured out as best we could, but true to form, Aidan's motility tanked, because why wouldn't it?  We spent one last night tucked into an impossibly tiny hospital crib up on 5 West.  Did we sleep?  Nah.  But we were together, so who needs sleep?!

Love this guy

Saturday morning found Aidan feeling much better.  The docs had given him Senna, which is what GI recommended the last time we were in.  It worked great.  After two doses, things were moving again, and we felt good enough to get a move on.

See this forlorn face?  He was sad to leave because he likes it there.
All in all, it was such a productive trip.  We learned how to better manage Aidan at home (no more breaks from feeds, no more fasting at home before procedures!).  We learned what to look out for and how to better recognize when he's in trouble with respect to his blood sugar.  Every hospital stay finds him less anxious and fearful, and more trusting of doctors and what they're doing to help him.  And, sadly, we learned not to just trust that CHOP will have the nutrition he needs.  I wish that weren't the case, but the fact is, we don't need the added stress every time we go there.  We need to start bringing our home supply.

Thank you - all of you - for all of your well-wishes and thoughts while we were at CHOP this time.  While he's not old enough to understand, I certainly am.  It means the world to me.  We are happy to be home, and even happier that we made it home in time for this year's Strides for Safe Kids Food Allergy Walk and Expo!

Friday, September 5, 2014

Inpatient - Endocrinology - Day 3 (Come for the Endo, Stay for the Gastro!)

Last night was a long one.  Since we didn't begin the IV fluids until 10pm, we couldn't start weaning the formula until then either.  So, starting at 10pm, we began weaning his formula by 14ml and checking his BG and ketones every 30 minutes.  I don't know how our poor nurse (Annie) got anything else done all night, honestly.  The feed wean went from 10pm to midnight, and his BG went from 113 to 86, ketones holding steady at 0.2.  All good.  In the next half hour, he dropped to a BG of 74 (while still on IV dextrose) and his ketones climbed a bit, reaching 0.5 (still fine).  I vaguely remember a BG of 70 at 1:30am, while we were weaning down the dextrose, and then I drifted off to sleep sometime shortly thereafter.  Kind of.  I was in and out every time Annie, bless her heart, continued to check his BG and ketones all night long.  She later told me that his ketones were slowly climbing during that time.

Annie's party ended uneventfully at shift change (7am) and Aidan was holding steady around 70.  Our morning nurse got him at critical on her very first check - 46.  When she rechecked him, he was 51, and when she sent off bloodwork for confirmation, it came back at 51.  Just a hair over "critical."  So the fast continued.  His checks at 8:30 were in the low 50's.  Then, at 9am, a new wrinkle.  BG 51, but ketones were suddenly at 3.3.  WHAT?  Where did that come from?  The 9:30 check showed BG 41, ketones 3.8 - so the fast officially ended, both for low BG and high ketones.  Things happened pretty quickly after that - the lab confirmed his BG at 41, and the first round of bloodwork went in.  He got a shot of Glucagon (a hormone that's supposed to bring up his BG quickly) at 9:45, which immediately made him nauseous, and didn't even help.  He fell down to 33 by 10:00, and they decided to halt the test and put him back on IV dextrose. 15 minutes later, on IV dextrose, he was up to 50, which is still too low, but heading in the right direction.  He spent the rest of the morning slowly working his way back up to 70 on IV dextrose.

Not a happy camper
Dr. Langdon decided to go ahead with some growth hormone labs, so those were drawn an hour after the Glucagon and every 30 minutes after that until lunchtime, when the final labs were drawn and feeds were restarted.  The results that could come back immediately came back around 4pm - it doesn't look like he has a growth hormone deficiency - or at least not one severe enough to be the cause of his hypoglycemia.  So, this means a couple of things.

1. This tells us that Aidan's form of hypoglycemia is called ketotic hypoglycemia.  This basically just means that his body doesn't tolerate fasting, and while his blood sugar falls, he produces ketones, which are no bueno

2. We still don't have any answers about his poor growth.  I guess we'll have to take that up with his Endocrinologist when we follow up with her in a few weeks for the rest of the bloodwork results.

The plan is to remain on 24/7 feeds, since fasting proves dangerous to him, but it's thought that with a careful wean, Aidan could probably tolerate up to 4 hours off feeds safely.  He absolutely cannot just halt feeds (you know, exactly the thing we were doing).  We've been instructed that if he's sick and not tolerating feeds for more than 2 hours, we are to take him to an Emergency Room for IV dextrose.  We have a letter explaining his condition as "severe" and giving treatment protocols for him.  It uses intentionally terrifying phrases like "seizures" and "brain damage" when explaining the consequences of untreated hypoglycemia.  Honestly, it's kind of sobering and gives a new air of fragility to an already nerve-wracking kid.

The way he acted with critically low BG and high ketones makes me concerned that his sugars are low and ketones are high from time to time at home while he's on feeds, and we're not aware, because how on earth would we even know?  His face was flushed but clammy, he was acting really tired, and he was insistent that he's "really thirsty" - which is something that he very rarely says. Except for the times that he acts exactly like that, late at night.  Or maybe he's just 3 and manipulative.  Ugh.  I hate this.

We'll be checking his BG a few times a day, and probably also overnight, with additional checks anytime he's symptomatic. I know that we are okay, and we can do this.  There's just suddenly so much more to think about.  How will we prep him for scopes?  What about tube changes?  He needs to go NPO so he can be sedated.  But now we can't safely go NPO.  What happens when his pump breaks (a-g-a-i-n) and Homecare says they'll be there in "a few hours"?  Do we wait for him to crash?  Proactively bring him in for dextrose, knowing that he'll definitely crash? 

The biggest positive is that we're told most kids grow out of this.  We get to repeat this little slumber party next year, to see if he can pass the 36 hour fast.  That seems so absurdly impossible right now.  But eventually, most kids do.

So Endocrinology is ready to release us, and we'll be going home tomorrow morning sometime.  We're spending one more night for a GI concern - his motility seems to have slowed way down and we're worried about heading home without being sure he's going to continue tolerating feeds, especially now that not tolerating feeds is not an option.

It's a good thing he's cute...