That Thyroid Thing

Click here for No Iodine diet recipe information.

Background

In October 2003 I had my semi-annual physical with my family physician, Dr. Bradley Hillard. I say semi-annual physical because since my retirement eight years ago, Dr. Brad suggested that I come in several times a year for routine blood work and to listen to me complain about my various aches and pains. He said that by so doing we could stay on top of the problems that face those of us in our golden years. I had been feeling great…exercising every day, watching my weight, eating properly and living a very active life. The evening of my physical, Dr. Brad called and told me that the blood tests showed an elevated calcium level and that he would like for me to have another blood test to confirm or reject the results. The additional blood test showed that the calcium levels were high and that I would need to see Dr. Lavertu an ear, nose, throat, head and neck surgeon at University Hospital, who focuses his practice on the treatment of thyroid disorders. He ran additional tests and said that one of my four parathyroid glands was malfunctioning, sapping calcium from my bones and muscles, and that this gland would need to be surgically removed. He explained that parathyroid glands are located in our necks, usually two on each side of the thyroid, although he had seen them higher, near the chin, and as low as in the upper chest. Mine were located in the normal place, (I am as you all know normal) and surgery was scheduled for the middle of November. He said I would be laid up for several days and would only have to stay in the hospital overnight if there was a problem with my parathyroid or if I encountered any unexpected problems.

Surgery Day

Ruth and I arrived at the hospital at 6:00am, as directed, for the 7:15am surgery. I had had all of the regular pre-surgery interviews, tests and scans in preparation for the surgery the previous week. I got into my gown, they inserted the IVs, interviewed me again to make sure I was who I purported to be and that I was having parathyroid surgery. The anesthesiologists explained the sedation procedure and Dr. Lavertu dropped by to say I would be his first surgery. He seemed much more serious than he did in the office…a good thing I guess, as he was about to rip open my throat. He departed, saying he would see me after surgery. The anesthesiologist said he would give me something to relax me and asked if I was ready. I said yes, he injected some magic into my IV and I was gone in the time it took to push me ten feet. I didn’t fade away; I went to sleep as if they had turned a switch.

Complications

Four hours later I awoke, with a splitting headache. It wasn’t a headache, someone had put some bombs in the back of my head and they were going off! My head was clear, but I was hurting. The early fear was that a blood vessel had broken and that they needed to get right on top of this problem. The neurological team arrived and I was taken to get a CAT scan, and later an MRI, and later another MRI. The infectious disease team was called in to consult and they ruled out meningitis after giving me a lumbar puncture at midnight. This stuff wasn’t fun, but the good news was that I hardly noticed the six-inch scar below my Adam’s apple. All told, Ruth counted 21 doctors who came to my room, albeit a number of them were residents. They all still want to feel, knead, press and question you, so I’m counting all of them. The ones I remember best were the residents who talked to me during the early morning hours. They looked more tired than me and we even talked about their families and mine and about how they were progressing in their medical education. They seemed to think it was cool that I had spent a career in medical education, and most voiced how hard the basic sciences had been for them…. and how glad they were now in the practice of medicine. 

The wonderful night nurses put a bed in the room next to mine for Ruth, and even provided her with pajamas, a bathrobe and toilet articles. By mid-day, the next day, I was feeling better and they determined that my pain was probably due to some neck arthritis which had been aggravated during the surgery, because my neck had been extended for such a long period of time.

Good News and Bad News

During the previous day, Dr. Lavertu visited me and told me that he had removed the offending parathyroid and in the process, had found a lump on my thyroid. The growth was biopsied and found to be benign, but upon closer inspection he found some suspicious tissue under the original growth, and it was malignant. He then removed that half of the thyroid and said that he never removes an entire thyroid based on information from a frozen section and that we would have to see more laboratory results before determining the course of treatment. He apologized for my sore neck, and said that I had mentioned while “coming to” that my neck hurt. I guess I was “out” with regard to remembering the surgery, but not “out” with regard to communicating with him at this level. Well, at least the surgery had solved my parathyroid problem I didn’t know I had, but now a new concern, Thyroid Cancer, had been introduced to the list of worries (Dan in Baghdad, Andrew in college, Jay, golf handicap, mowing two acres, and on and on) I sometimes review during the middle of the night when sleep doesn’t arrive. I must say, Dr. Lavertu delivered the news just like I think it should have been delivered…straight forwardly, compassionately and with plenty of opportunities for me to ask questions. He didn’t know this, but I had studied and given workshops on how to deliver bad news, and he got an “A” for the way he handled this uncomfortable task with me. Some professionals never master delivering bad news…as one doctor I followed, informed his patient about MS on the answering machine and another didn’t tell his patient about her diagnosis of MD until after she found out about it on her bill! Thank God, my doctors knew what they were doing.

Dr. Lavertu referred me to Dr. Arafah, an endocrinologist (and his associate, Dr. Krikorian…my apologies for calling them Drs. Arafat and Kevorkian behind their backs), for more follow up testing. I have papillary, multifocal cancer. The way I understand it, multifocal cancers don’t spread like crabgrass (remember, I’m a gardener, not a physician) throughout the thyroid, but pop up like dandelions throughout the thyroid. If you have this type of cancer in one location in your thyroid, it is almost a certainty that it will be throughout the thyroid. Therefore, the thyroid needs to be removed and the any remaining tissue, not excised, must be killed with radioactive iodine. The problem was…the swelling in my neck needed to subside for the surgery to take place. The surgeon and endocrinologist said this could take place at the end of January or the beginning of February. I mentioned that I had a series of speeches to give in Las Vegas the second week of February, but could cancel them. They agreed that was unnecessary. Pushing my luck, I mentioned that we were planning on spending February and the first two weeks on March in Florida, and they both agreed that having the surgery after our return from Florida would be perfectly fine. We agreed to have the surgery March 22 and now all I had to do was stay in shape and not worry too much about what was going to happen in several months.

Recovery I

The recovery from surgery was pretty easy. Ruth babied me for a few days with my favorite foods, took the garbage and recycling out to the curb and kept insisting that I relax and rest a lot. I was not suppose to lift more than five pounds for two weeks because of the stitches in my neck, so I just followed the doctors’ orders and took it easy. Many friends dropped in to see me and some brought gifts (mostly bottles of wine…am I developing a reputation?) I had hoped for bigger gifts, maybe sweaters or season tickets to something, but not from my friends…I mean, folks I have cancer…and yet they treated me as if I was a normal person! My lifelong buddy, Jim Steyer, sent me a picture from our 1954 Midshipman Cruise on board the USS Wisconsin (BB64), insisting that he had suspected that I had thyroid cancer ever since he took this picture...and sent me another picture of his own thyroid cancer surgery.

       

Oh well, two weeks passed and I got to start exercising again…and I found I was normal. Actually, if I had not seen the scar on my neck each morning when I shaved, I would have never known anything had happened to me…I mean, I had had no symptoms and the sore neck was the only pain I had encountered during this whole ordeal. I was ready for Florida and planned to play golf and walk on the beach with Ruth for the next six weeks.

Florida

We had a great time in Las Vegas (where I gave several speeches) and Florida. One of our highlights in Las Vegas was a trip to the desert for a day…and during the excursion we got a call from our daughter, Jill, who was at the Bowling Green vs. Ohio University basketball game. She held up the phone and we got to hear Andrew sing the National Anthem, acappella, to 10,000 fans. We held up the phone too, and our six tour mates got to hear Andrew! It was very exciting to hear the fans shout to Andrew about the good job he had done.

The six weeks in Florida was great too. We have been going to Pensacola for seven years and other Kent folks go there too. In fact, there were four Kent couples and some old college friends from Ohio State. My medical problem fell into the background and we rarely talked about it outside the condo. The doctors had painted such a positive picture about the recovery rates from thyroid cancer that I didn’t worry about it as a life-threatening problem…more of a hurdle that I needed to get over in the spring. 

Surgery II

 We got home from Florida on March 17th and Dr. Lavertu’s office called to say they had an opening for the first surgery on March 18th. I don’t like putting things off, but I wanted to unpack the car before being laid up for a few days (remember the five pound rule). I wanted to go to church on Sunday before the Monday, March 22nd surgery too!

We arrived at University Hospital at 6:00am, just as we had done for the first surgery in November. They have this thing down pat! If I had video taped the pre-surgery routine each time, they would have been almost identical…down to the words the lady said to me about taking my clothes off and putting them into a bag. The one big difference this time was the time the anesthesiologists spent with me, and the questions they asked me about my neck and the neck pain I had experienced during the first surgery (they had done their homework!) Once again, the nurse said they would be giving me something to relax me…and it was lights out! I remembered nothing until I woke up over three hours later. When I woke up, my neck was sore, but not like it had been before. Dr. Lavertu said he had never been as careful with anyone’s neck as he had been with mine. I felt grateful that there was little pain and that I would not have to see the other fifteen or so doctors! Dr. Lavertu said everything went fine and that I would be staying overnight and could go home in the morning. Ruth stayed the night again and after Drs. Arafah and Krikorian visited me in the morning with my new instructions as to how to prepare myself for the forthcoming radioactive iodine treatment, I was released to go home.

Recovery II

I knew more what to expect this time, but I was not prepared for the no-iodine diet that I had to follow. I still did not get lots of gifts (the sweaters and golf clubs), but I got lots of visits from family and friends. I was on a no-iodine diet so when the thyroxin produced by my thyroid was completely gone from my body, any remaining iodine would not detract the radioactive iodine and permit it to go directly to any thyroid tissue, not removed by the surgery, which remained in my neck. The trouble with a no-iodine diet is that everything that tastes good has iodine in it. As my grandson, Connor, said, “If it tastes good, Grandpa can’t eat it!” Do you realize that potato skins have iodine in them, milk products have iodine, canned foods have iodine, most cereals have iodine, and on and on it continues. Ruth was a cooking magician…making things without salt/iodine that tasted good. What saved me was oatmeal with maple syrup or honey. Even fresh meats without seasoning or boiled vegetables get pretty old after a few meals. The good news is that I lost ten pounds rather quickly and then leveled off at 155, or something around there! For the kind of foods one can eat on a no-iodine diet see www.ThyCa.org. And, for other information regarding the thyroid and thyroid treatments see www.thyroid.org.   

Radioactive Iodine

The day (April 23), twenty-one days after surgery, finally came for me to get the radioactive iodine treatment. I was ushered into a room at University Hospital and seated before a table covered with a white disposable cloth. A lady entered in a while uniform, her face covered, carrying a lead container about the size of a gallon jug. She did not say a word, while placing the container on the table, removing the lid and removing a small glass bottle. She opened the bottle and removed three capsules. Handing them to me, with a glass of water, she said, “Swallow these.” This spaced-suited woman made this procedure rather forbidding. She can’t touch these pills without her space suit and gloves, but I’m supposed to swallow them? I did what she said to do.

She said, “Did the doctor tell you what to do after taking these pills?” I said, “No.” She said, “He will.” and left the room. A short time later I was ushered to a doctor’s office and he explained that I would probably not notice any reaction to the radioactive iodine, but that if I did to call the office. He further explained that I should not sleep with Ruth for several days, not hold small children, not be around women of childbearing age…and basically…stay away from everyone for around three days. By that time, the radioactive iodine would be through my system, except for the small portion, which would remain in the thyroid tissue, killing it. He said I could go out in public, which seemed strange to me, as there are women of child bearing age there, I would imagine. So, I stayed home for several days, eating with plastic utensils and paper plates, which could be thrown away. I didn’t notice anything different, except that I now got to eat Ruth’s famous macaroni and cheese!

At my next appointment in May, Dr. Arafah explained that I would need to get one blood test each month, for four months, and this would help determine if my thyroxin levels were adequate and if the thyroid tissue had been obliterated. After the first $1787.00 blood test at Robinson Memorial Hospital (Just one little tube of blood!), Dr. Krikorian called to say that the thyroxin levels were looking good (I felt fine), but they detected small amounts of thyroid tissue, and if this tissue did not die, I would have to have another radioactive iodine treatment. At this point (June), I have taken three tests ($5361.00…that is what they charged, not what my provider paid!), but have heard no more information, although I called several times after each blood test. Ruth thinks I should get “on them” more, but no matter what, nothing will be decided until my next appointment in July 14.

A New Development

In another rather disturbing development, I took a PSA screening test at a golf outing on May 13 and soon after received a registered letter from Summa Health Care System indicating that I needed to have a follow up assessment immediately (It went from 1.1 in November to 4.8 in May). I called Dr. Hillard the same day, and, bless his heart, he said, “Come in tomorrow morning.” His digital exam revealed that I had a node on my prostate and he referred me for a biopsy. If it is not one thing it is another! I feel fine and would not know I have all of these potential problems, if I had not been rigorous in checking up on my own health with tests and appointments. I can see why some folks are afraid to visit their doctors, but this isn’t the way I feel. I’m glad I have caught these things (The Thyroid Thing and now The Prostate Thing) early…but I am getting a little tired of not getting better news. The fact is…I still worry more about my children and grandchildren than I do about the problems posed by these health concerns… Dan in Baghdad, Andrew and his college goals, Connor and Austin going through such important formative years with their Mom working so much, Jill working so many hours at such a stressful job, Jeff racing motorcycles, Jay stagnating in his life, and Sally, Jeff, Mike and David, all working so hard to do their very best for their children. I worry about Ruth too…so solid, so caring…who helps so many and expects so little in return. I’ll just have to wait to see how This Prostate Thing develops.

Back to Dr. Lavertu

Late in June, I visited Dr. Lavertu (surgeon) for my final visit (I think) and he inspects my surgical scars and asks a few questions and tells me I do not have to return unless more surgery is indicated. His nurse, Cheryl, reviews everything I have written in this paper to this point and calls me with suggestions as to how I might make this paper more accurate. She was very helpful, both as a nurse and editor. I send her a copy and wonder if Dr. Lavertu ever had time to read my comments.

Back to Dr. Arafah

In July, Dr. Arafah tells me that we will not know the results of the radioactive iodine therapy for a few more months. He suggests that we meet in February and we will then have a better idea regarding how to proceed.

Back to the Prostate Thing

I was referred to Dr. Jones to have my prostate biopsy. Discussions with my friends who have had this procedure were not very comforting. Jim Schubert, who has beaten prostate cancer (no problems for over five years), said that this was the worst test he had ever taken! He said he was scheduled to have six samples taken from his prostate, but that it was so painful that he asked them to stop after only five were taken. After telling me this, he added that a mutual friend of ours told him that he stayed in bed three days after his biopsy because he was in so much discomfort. Jim said that on the way home from the hospital that Pat stopped at Sam’s Club to pick up some things and that he could hardly wait for her to come back to the car so he could get home. He said he just wanted to go to bed! Needless to say, I wasn’t looking forward to the biopsy. I met Dr. Jones, a University Hospital urologist, and he seemed very nice. He explained the procedure (Inserting a tube containing a camera and a small clam shovel into the prostate area, looking around, and then taking twelve samples!) Yes, I said, twelve samples! He said that he had developed a new procedure for prostate biopsies and spends several days a month traveling around the country teaching other urologists how to do this new procedure. This sounded promising, but twelve I asked? He said that he would be blocking the nerve to the prostate area and that I should not have much discomfort, not counting the camera and the clam shovel.
“Roll over on your left side,” got the whole thing started and the entire procedure lasted only two hours, just kidding, 5 minutes. The only way I can explain it, is to say that it felt like a series for spring-loaded clicks taking place inside me. It reminded me of the clicks my little cap gun used to make when “shooting it without the caps.” Click, click, click…twelve times…wait until I tell Jim Schubert. After the procedure, Ruth and I stopped at the Bahama Breeze Restaurant to get a pineapple-rasberry-bannana daiquiri. I called Jim Schubert to gloat, err, and report my ability to conquer pain. He said, “Well, how did it go?” I said, “I had twelve samples taken.” He said, “where are you now?” I said, “Having a daiquiri at the Babama Breeze.” Jim said, “You are more man than I am!” I just laughed and told him the truth. Thank God for new medical miracles. A week later Dr. Jones called to tell me that I had a healthy prostate and no reason to worry. What a relief!

Waiting Around

The seven-month wait for my next endocrinology meeting with Dr. Arafah went quickly. As Ruth can tell you, I rarely mentioned That Thyroid Thing, and I can tell you I rarely thought about it. During this period, I got the decks stained, delivered about a dozens speeches, continued exercising and got my golf handicap down to 16. Ruth and I took several trips, but our biggest joyful moment was celebrating Dan’s return from Iraqi. He looked great and it was great to have him home. When we picked him up at the airport, along with twenty other balloon-ladened relatives, I was so moved I couldn’t talk without tears running down my cheeks. Just when I thought my emotions were more under control, a stranger, a lady about forty, walked up to Dan, and with tears streaming down her cheeks, kissed him and said, “Thank you for what you have been doing for all of us.” I cried. I have tried to do that for every soldier I have walked nearby in the months since this occurred. I guess it is my age, or This Thyroid Thing, or the fear I felt with Dan in harm’s way, but I have become, as Arnold Palmer said, with tears streaming down his face, when being feted at his last Masters’ appearance, “I guess I’m just becoming an old sop.”

Back to Dr. Arafah

Ruth and I hope to spend part of March and all of April in St. Augustine, FL and so I wonder what this February appointment will hold for us. I get four more blood tests (I only needed two, but the first two given to be by a local lab were processed improperly and needed to be repeated. Have you ever noticed that when more tests are needed you always pay for the, but when they are improperly processed, you also pay for them?) Dr. Arafah said the results of the blood tests showed no presence of thyroid tissue and in the past this is where treatment and testing usually stopped, but that new methods have recently been approved which greatly reduce the reoccurrence of the thyroid cancer. He recommended that I undergo this new procedure later in the spring. I agreed to do so.

Waiting for the Last Procedure

During March and April, Ruth and I traveled to Hilton Head to visit the Schubert’s, to Savannah to deliver several speeches to Heating and Air Conditioning Contractors, to Jacksonville to visit the Naval base and tour the JFK, and to St. Augustine for one month on the shores of the Atlantic Ocean. It was a great time, but Ruth and I are starting to enjoy shorter adventures away form home and looked forwarded to returning to Ohio, even before our time was up. We must be getting old…or is it we just enjoy our home and being around our family more? It is definitely the latter.

The Last(?) Big Test

The first of April I started on the iodine-free diet again (See appendix for a number of Ruth’s culinary creations which eased my one month no iodine diet). I knew what to expect, but it didn’t make it any easier. We attended five banquets/dinners during this period and I couldn’t eat at any of them…oh yes, I got to pay, but didn’t get to eat a bite. Ruth made this period the best of all of my diet periods, as she found new ways to make bland things taste great.

On April 20, I commenced the series of three blood tests and thyrogen injections. The thyrogen stimulates any thyroid tissue in one’s body and helps the medical team determine if more treatments will be required. If they find more thyroid tissue, the tissue that serves as host to my type of cancer, then I will be back to the treatment phase. I had to go to an area University Hospital Center (30 miles) for thyrogen injections/blood tests on Wednesday and Friday and Ruth gave me the injection on Sunday. On Monday, I received another blood test and 4 millicurries of radioactive iodine
(I got 150 millicurries during the treatment phase) and the procedure was the same as before…a technician dressed in white handing me several pills (out of a bottle incased in a lead container) to swallow. Two days later (the 48 hour scan), I had a complete body scan which lasted an hour. The medical staff present said that it had been unnecessary for me to be on a no iodine diet for these scans! What? Unnecessary? Wait until I get my hands on Dr. Arafah! Following the scans, I went up to Dr. Arafah’s office to find out about the diet. The scanning staff was wrong! I had been doing the right thing al along. On Wednesday, I had the 72 hour scan and again it lasted 45 minutes. They said they would be meeting with me right after the scan to tell me the results, but after I waited in the waiting room for one half hour, a technician came out to tell me that I would be hearing from my own doctor in 3-4 days. I went home to wait for the results.

 

Frank Smouse went with me for the last scan, as Ruth had a hospital board meeting to attend. On the way home, Frank and I stopped at the Red Robin for hamburgers…I couldn’t wait to taste regular food and was disappointed when the sandwich came and it was chicken. Normally I would just eat the chicken, but I had been waiting too long and asked them to take it back and bring me the hamburger. The manager came over and when Frank told him what had happened, he brought the new sandwich and a box containing the chicken sandwich too. My friends may not bring me lots of gifts while I’m sick, but the Red Robin manager really know how to treat “sick” folks. That night, Ruth, Andrew and I went to dinner at the Tomato Grille to celebrate the fact that Ruth wouldn’t have to keep cooking those funny meals for me.

The News I have Been Waiting to Hear

Dr. Arafah called two weeks later with the results of all the tests. Ruth and I were sitting in our Ravine Room, having a glass of wine, when the phone rang. Dr. Arafah identified himself and said, “Glenn, I have good news for you. All of your tests were fine and we found no evidence of any thyroid tissue. You won’t have to have any more treatments, but you should make an appointment with me to have some blood tests in a year or so.” I thanked him for all he had done for me in the last year and a half and told him about this story I was writing. He said he would like to read it and I said I would send him a draft, along with the recipes Ruth had been creating. I told him I would let him know when this story was available on my web site, so some of his future patients might read it…or at least copy the recipes.

Life Goes On

I really don’t feel any different that I have all along. I have always been grateful for the many blessings I have received in my life. I guess coming from a farm and getting to go to college, be a naval officer, a professor, have a wife like Ruth, three children who love me and four wonderful grandsons is more than I could ever have hoped for…my parents would have been satisfied if I had been a good farmer. But, not having to worry about That Cancer Thing will enable me to be More Grateful and Appreciative for Ruth, my family, my friends, the medical team which helped me…and to God who has allowed me to have more time to demonstrate that appreciation to those who mean so much to me.

May 2005

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Introduction to No Iodine Diets and Menus
NO IODINE RECIPES

PENNE PASTA WITH TOMATO, GARLIC AND BASIL
                              (serves 2)

½ lb. Penne pasta
2 tomatoes (chopped)
4 cloves garlic (chopped)
¼ cup fresh basil (chopped)
Olive oil

Cook the Penne pasta according to the directions on the box.  Sauté the tomatoes and garlic in olive oil. Add basil, toss with the pasta. Serve

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WHITE BREAD

1 ¼  Cup milk, scalded
1 ½  T. sugar
1 t. salt (non-iodine)
1 ½ T olive oil
1 package dry yeast
1/8 Cup water (105-115 degrees)
3 ½ Cups flour divided
Pam spray

Combine scalded milk, sugar, salt and shortening; stir.  Cool to lukewarm (105-115 degrees).  Dissolve yeast in warm water in a large bowl.  Stir in cooled milk mixture and 2 cups flour;  beat 2 minutes at medium speed of electric mixer or until smooth.  Cover and let rise in a warm place, free from drafts, 45 minutes.  Punch dough down;  gradually stir in 1 cup flour.  Turn dough out on a lightly floured board and add remaining ½ cup flour.  Knead until smooth and elastic.  Place in a well greased bowl (Pam), turning to grease top.  Cover and let rise 20 minutes. Knead bread in bowl 2 minutes.  Turn dough over;  let rise 20 minutes.  Punch dough down; turn out on a lightly floured board.  Let dough rest 10 minutes.  Shape dough and place in a greased 9x5x3 loaf pan.  Cover and let rise 45 minutes.  Bake 350 degrees for 45-50 minutes.  Remove bread from pan and set across top of pan to cool.  Spray with Pam on top.
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VEGIE SANDWICH
        (serves 1)

2 slices white bread
1 slice Vidalia onion
1 slice tomato
3 slices cucumber
Bean sprouts (optional)
Squirt in a little olive oil and Mrs. Dash’s seasoning of choice
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BEEF ROAST WITH VEGETABLES

1 3-4 lb. Top Sirloin Roast
11/2 cup peeled potatoes
1 cup carrots
1 cup onions
2 t. non-iodine salt
½ cup olive oil
¼ cup red wine vinegar
4 cloves chopped garlic
Mrs. Dash’s seasoning to taste

Place roast in a small roaster pan or Dutch oven.  Mix salt, olive oil, vinegar and garlic.  Pour over roast.  Bake 21/2 hour at 325 degrees.  Add vegetables and bake another hour.  Remove roast and vegetables. It is optional to make gravy from the drippings.  Place the drippings in a sauce pan.  Add  ¼ -1/3 cup flour and ½ cup water. Cook until it is smooth and starts to boil.  Serve over the meat and vegetables.
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CHICKEN TETRAZINI

3 T olive oil
1 med. onion
1 stalk celery
2 cups cooked chicken
6 oz. cooked spaghetti
1t salt (non-iodine)
¼ t pepper
2 cups chicken broth
1 cup sliced mushrooms

Heat oil, add onion and celery.  Cook til clear. Pour into a 9X9 pan.  Arrange the chicken in layers then the spaghetti , then mushrooms.  Mix chicken broth, S&P and pour over.  Bake 30 minutes @ 350 degrees
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STUFFED MANICOTTI SHELLS
  (serves 4)

1 # Manicotti shells cooked per directions on package
1# hamburger
½ cup bread crumbs (from homemade white bread)
¼ cup chopped parsley
½ t non iodine salt
fresh tomato sauce (recipe below)

Cook the shells and drain on waxed paper.  Cook hamburger, place in medium bowl.  Add bread crumbs, parsley and salt.  Stuff the hamburger mixture into the manicotti shells and place in a 9x12 pan.
Make the fresh tomato sauce.  Pour over the shells, cover and bake 20-25 minutes or until it bubbles. 350 degrees.

FRESH  TOMATO SAUCE

3 tomatoes chopped
4 cloves garlic chopped
½ green pepper chopped
Italian seasonings and non-iodine salt to taste
Olive oil

Heat the olive oil, sauté the vegetables, and add the seasonings.
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MEAT LOAF
    (serves 4)

1# hamburger
½ cup special white bread crumbs
1 med. onion chopped
1t salt (non iodine)
1 egg white

Mix all the ingredients and place in a 9x5xe loaf pan.  Top with fresh tomato sauce or topping of choice.  Bake 45 minutes-1 hour @ 350 degrees.
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Cook pasta according to package directions.  Meanwhile, coat large skillet with cooking spray.  Heat skillet and sauté vegetables, oregano and garlic powder for 4-5 minutes.  Add salt and pepper to taste.  Add chicken, cover and cook until chicken is heated.  Stir in tomatoes and pasta.  Serve.
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CHICKEN SALAD WITH LEMON AND OIL DRESSING

2 cup cooked and chopped chicken breast
3 hard boiled eggs (whites only) chopped
½ cup chopped celery
¼ cup raisins
¼ cup slivered almonds
parsley
lemon juice and oil dressing

LEMON AND OIL DRESSING

½ cup olive oil
¼ cup lemon juice
¼ t non-iodine salt
Mrs Dash’s seasonings of choice

Blend well and pour over the chicken salad.
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