By Dr. Jim Collins
My Story
As a gerontologist, Caring for the Caregiver has been one of my favorite topics to present, and for a couple reasons. First, there is an endless amount of information to discuss, from stress and burnout, to depression and weight gain, to seeking help, accepting limitations and finding peace within the caregiver role. The other, and probably more important reason, is because I was a caregiver to my mother for several years while she lived with me, my wife and daughter.
My mother, Mary, was a nursing assistant for almost 30 years in the same nursing home. When she retired in her late 70’s, she became bored and went back to work at an assisted living facility, where she worked until she retired at the age of 80! Prior to her retirement, she began to decline physically and mentally. There were plenty of signs of dementia, but when I brought it up to family members and friends, they replied “You think everyone has dementia!” While that is not true, she was becoming forgetful, leaving the stove on, burning pans, and hiding them in the trash. She also began to fall – numerous times, and miraculously, without much injury.
The care I provided, along with assistance from my wife and some family members began 15 years before she moved into an assisted living facility. Making sure she had proper nutrition was top on my list, as was taking her to all of her appointments, shopping trips and social visits. I helped her manage her finances and made sure she always had enough money to do anything she wanted. Keeping her safe while enjoying quality of life was important to me and I always tried to balance the two the best I could. She is now 91 and lives in a long-term care community.
What I Learned
Years of caregiving can be very fulfilling as well as take a toll on you, not only physically, but mentally, emotionally and even spiritually. Typically, caregivers are the oldest adult daughters in the family, but in my family, I was most prepared to take care of my mother. Many years later, I’ve learned a few things about being a caregiver and want to share them with you. My hope is that these tips will help you help yourself, because you must first and foremost take care of yourself in order to provide care to anyone else.
Approach caregiving realistically. You can and will make a difference in the life of the person you care for, but know your limits. You simply cannot control everything, so don’t try. Diseases will progress, memory will decline and you must do what you can but not more than anyone is capable of doing. Nevertheless, do the best that you can and know in your heart you’re doing the right thing.
Monitor your own health and stress level. Listen to your body as it will always tell you the truth. Watch for headaches, stomach pain, and muscle strain. Be aware of your emotions. Are you experiencing sadness, anxiousness, are you over- or undereating, or has your sleep pattern changed? Any of these can be signs of stress, burnout or clinical depression or anxiety.
Take time out for yourself to rejuvenate. Everyone needs to take an occasional break from being a caregiver. Remember, give to yourself time to relax and return to your own hobbies and interests. Reach out to family and friends. Have a responsible person watch your loved one for a while so that you can get out, go shopping, see a movie, or go to dinner with a friend. By giving yourself a break, you will be relaxed and ready to get back to caregiving.
Never be afraid to ask for help. The old saying, “If you want something done right, do it yourself” doesn’t fit the world of caregiving for long. No one can be a doctor, nurse, therapist, cook, housekeeper, and chauffeur all at the same time. We also don’t want to be a “burden” on anyone else, but we must approach caregiving not only livingly, but intelligently. Is there a good neighbor who can take care of a few things around the house for you? Can the grandkids get involved? Look into local health and social services for assistance. You will feel a lot better knowing you have help.
Accept change. As we age, many changes naturally take place biologically, mentally, emotionally, and spiritually. Disorders and diseases come with their own unique changes. Learn to embrace change and accept it as a part of life. Nothing lasts forever, and everything is undergoing constant change. Accepting change will lighten your burden and you won’t feel like you’re fighting a losing battle.
If you are a caregiver, I hope that my words find their way into your mind and heart and help you serve your loved one the best way you can. Be proud. Not everyone is cut out to be a caregiver and that makes you a very special person.
By: Dr. Jim Collins, MD
We are all aging. That’s a fact. Despite this, there are many things that are in our control to slow down the aging process and help us age well. Among these – nutrition and exercise provide the greatest positive impact on how we age and stay healthy later in life. Nutrition and exercise are good for the brain and bones, mood and self-confidence, independence and management of disease and pain. Simply put, there are no down sides to eating an “age-defying” diet and maintaining an active lifestyle.
Age-Defying Foods
What we eats makes a big difference in how we feel and how we age. Our skin will stay more youthful and our heart can stay stronger throughout our lives. There is a plethora of advice on eating healthy foods as we age in books and magazines, on television and radio and on the Internet. So, where do we begin?
Foods to Put on Your Plate
Let’s get as practical as we possibly can. There are certain foods that should be on your breakfast, lunch and dinner plates every day. Why? These foods are well-known as anti-aging foods. They provide good sources of antioxidants, vitamins, beta-carotene, fiber, protein and Omega 3.
- Eat at least 5 portions of colorful fruits and vegetables daily, including dark leafy greens, blueberries, carrots, and deep red tomatoes. Eat brightly-colored produce such as corn, peppers, oranges and melons. These foods maintain good vision and protect your vision from macular degeneration. Vitamin C helps to keep the skin younger-looking and eating yellow and green vegetables daily can reduce wrinkling and other signs of aging skin.
- Resveratrol is a power anti-oxidant found in grapes and red wine. Scientists have been telling us for years that getting these in our diets can reduce risk of cancer, heart disease and premature aging.
- Whole grains are not only heart-healthy, they can reduce your chance of developing type two diabetes. Oats, quinoa, wheat, barley, and brown rice are grains rich in fiber. Eat at least 3 portions of these daily as a part of your anti-aging diet.
- Two portions of fish per week will provide all of the Omega-3s you need to protect your heart, reduce your risk of having a stroke and minimize the odds of developing Alzheimer’s disease.
- Dairy is a healthy source of calcium and vitamin D, which are important for health bones and preventing osteoporosis in aging women. Eat a minimum of 3 portions daily. Choose low fat dairy options to avoid cholesterol problems. For those who don’t eat dairy products, good alternatives are soy products, almond milk and cereals.
- While you’re at it, throw a few almonds on your plate to add healthy fat, which has been shown to reduce high blood pressure and high cholesterol. Beans also provide great anti-aging benefits, including high fiber and protein, which can reduce risk of heart disease and diabetes. One more piece of advice: reduce your salt and sodium intake due to its association with high blood pressure and kidney disease.
Medical studies show that risk for developing cancer, heart disease, diabetes, and even Alzheimer’s disease can be significantly reduced by maintaining a healthy diet as we age.
Exercise and Aging Well
As we age, exercise becomes more important than ever. It gives us energy, helps to maintain independence, and can benefit already-existing diseases and pain. Exercise is good for both the body and brain. It enhances memory and mood, maintains or helps with weight loss, and strengthens mobility, flexibility and balance. Regular exercise can also help with sleep, reduce the impact of illness, manage pain and build self-confidence. Regardless of your current health condition, there are exercises that can benefit everyone.
Tips to Get Started
Before beginning an exercise routine, consult your physician to see what exercises you should and shouldn’t do. Take into account your current health conditions – it’s better to be safe than sorry. Start low and go slow. This means build your exercise program little by little. Always warm up and listen to your body. Commit to an exercise schedule for around 3 to 4 weeks, so you create a new habit. Find exercises you enjoy and stick with them. If exercising ever makes you dizzy, weak, short of breath or you begin to experience chest pain or joint pain, stop and consult your physician. Become focused and mindful of your body, breathing and movements and make every session count!
Building Your Exercise Plan
A good exercise plan begins with cardio endurance exercises, including walking, swimming, climbing stairs, cycling, tennis and dancing. These exercises will get your heart pumping and prepare you for the next type of exercise – strength and power training.
Strength and power training can be done with the use of free weights, machines or elastic bands. These exercises build muscle, improve balance and help to prevent bone loss with aging. They can also increase your speed and help to avoid falls.
Next, add flexibility exercises, such as stretching and range of motion. Yoga is a good example. Flexibility exercises help keep your body limber, increase range of motion of your muscles and joints, and help with everyday activities, such as driving, showering and playing with your grandchildren.
The last group of exercises to add is those that help with balance, which include standing and stability, while stationary or moving around. Examples of this type of exercise include yoga, Tai Chi and other posture exercises. They improve your balance, posture and your quality of walking.
Aging involves many changes in our bodies and brains that may be outside of our control. Despite this, we can control how we care for ourselves as we age. In particular, diet and exercise are among the most important areas where we do have control. Putting more age-defying foods on your plate and remaining active can only produce positive results as you age, regardless of the condition you are currently in. It is never too late to start! Eat smart, exercise and have fun!
The state’s largest organization representing long-term care facilities has honored a Massillon, Ohio Nurse as its February 2016 “Hero of Long-Term Care.”
Lisa Glick, State Tested Nurse Aide (STNA) at Rose Lane Nursing and Rehabilitation in Massillon, Ohio has been selected by the Ohio Health Care Association (OHCA) as its Hero of Long-Term Care for March 2016. OHCA honors one long-term care employee each month for their service to long-term caregivers, residents and the community.
FOR IMMEDIATE RELEASE
Grande Village Retirement Community, a community of Sprenger Healthcare, achieved a deficiency-free rating during a recent annual Quality Indicator Survey from the Ohio Department of Health (ODH).
A deficiency-free rating signifies Grande Village is in full compliance with all standards in care and service set forth by the Centers of Medicare and Medicaid.
During the survey, a team of representatives from the ODH visits Grande Village for an extended period of time to evaluate the quality of care provided for residents and determine if it meets regulatory standards for long-term care providers. The ODH observes the operations of the facility and reviews organizational procedures.
The Quality Indicator Survey consists of an evaluation of professional care standards, infection control, drug administration and overall quality of health care administration. It also requires observation of food service operations, maintenance, housekeeping and laundry services to ensure they are in compliance with safety policies.
Grande Village Retirement Community, located in Twinsburg, OH, provides a full range of health care services, including 24-hour skilled nursing, long-term care, assisted living, independent living and memory care. It also offers hospice, home health care, and short- and long-term rehabilitation.
About Sprenger Healthcare
Sprenger Healthcare has been family owned and operated since 1959. With 10 facilities throughout Northeast Ohio and Indiana, Sprenger offers the full continuum of aging services including: Short Term Rehabilitation, Skilled Nursing, Memory Care, Assisted Living, Independent Living, Hospice, and Home Health. Our innovative care, excellent customer service, and compassionate, dedicated employees have made Sprenger Healthcare a leader in providing exceptional health care. Sprenger communities have a history of excellent Resident and Family Satisfaction Surveys, 5 Star Ratings, Deficiency Free Surveys, and US News & World Report Rankings. For more information on the programs we offer and to hear more about the Sprenger difference, please visit our website, www.SprengerHealthCare.com or follow us on Twitter and Facebook.
Many people think that all you can do when it comes to Alzheimer’s Disease is pray for the best. However, research suggests you may be able to reduce your risk of Alzheimer’s, slow down the disease or even reverse its effects.
In 2014, an estimated 5.3 million Americans were diagnosed with Alzheimer’s Disease. The average onset of the disease occurs around the age of 65 years or older and 75 percent of those diagnosed are women. Due to increased life expectancy and population growth, it is expected the number of people diagnosed will reach upwards of 7.1 million by the year 2025 unless a preventative cure is found.
Alzheimer’s Disease is the sixth leading cause of death in the United States. While those diagnosed with the disease typically live an average of eight years after their symptoms become noticeable, survival can range from 4 to 20 years depending on age and the interaction of other medical conditions.
It is important to emphasize that although there is currently no known cure for Alzheimer’s Disease, there are things we can do to reduce our risk. It is believed that the majority of Alzheimer’s cases occur due things we cannot control, specifically age, family history and heredity.
The good news is that research has indicated making changes in general lifestyle and wellness choices, as well as proactive management of other health conditions can be beneficial in reducing that risk. The Alzheimer’s Association provides the following research-based guidelines to reduce the risk of developing the disease:
- Avoid head trauma: Studies found there may be a strong link between serious head injury and risk of Alzheimer’s. Avoid head trauma by wearing a helmet when participating in sports, wearing your seatbelt and avoiding falls.
- Monitor heart health: Evidence shows your heart health can directly affect brain health. Your heart nourishes your brain with its network of blood vessels. The risk of Alzheimer’s appears to increase in individuals with conditions that damage the heart blood vessels, such as diabetes, stroke, high blood pressure and heart disease. Work with your doctor to monitor your heart health and treat any problems that arise.
- Live a healthy lifestyle: Using strategies for overall healthy again may also reduce your risk of Alzheimer’s. This includes watching your weight, staying social, exercising your mind, staying fit and avoiding excess alcohol and tobacco.
Improved understanding about this disease and methods to prevent controllable risks can facilitate better health. Should you have concerns related to any of the symptoms described above be sure to contact your doctor. You can also visit the Alzheimer’s Association website for information concerning the disease and how loved ones can provide support.
Author: Nancy Dawkins, SLP
It’s extremely important to take care of your skin – after all, it’s your body’s largest organ. Dr. Ferraro, President and CEO of Comprehensive Surgical Wound Care Consultants (CSWCC), recently shared tips for skin care as you age during an informative talk at Rose Lane Nursing and Rehabilitation. If you missed his presentation, don’t worry – we have the information for you!
Your skin plays a large role in the function of your body, as it offers protection to your internal organs, regulates your body temperature, communicates sensation, and balances your fluids and electrolytes.
As you age, you may notice a difference in the appearance of your skin; however, there’s more going on than cosmetic changes. Underneath the surface, more serious changes take place over time, including:
- Loss of dermal thickness – Your skin gets thinner and is more prone to tears.
- Decrease in fatty layer underneath skin – Your body can’t hold in heat as well.
- A lesser amount of collagen fibers – This affects the elasticity of your skin.
- Decline in the number and function of sweat glands – Not enough sweat causes dry skin.
- Changes in blood vessels – Your skin has a lower blood supply, which causes decreased healing properties.
Skin care tips
How can you take care of your skin and combat these changes as you age? Most people already know to use moisturizing cream and avoid exposure from the sun to keep your skin healthy. However, here are some tips from Dr. Ferraro you may not already know:
- Avoid baths: A prolonged period of soak time is not good for your skin, as it drains your oil glands and causes dry skin.
- Avoid lotions with lanolin for daily use: Lanolin is an ingredient in some lotions that can build up actually cause breakdown of skin, if used daily.
- Do not use band aids: Seniors should avoid using band aids, or any other adhesive on your skin, as this can cause tearing. Consult your doctor on how to properly dress a wound.
Foot care tips
When taking care of your skin, you should pay extra attention to your feet. Your feet are very vulnerable to injury, which can be high risk for seniors. With a decreased blood supply to your feet as you age, the healing properties are diminished and a simple foot ulcer can lead to amputation and even death. Older adults are also at risk of Neuropathy, which can cause loss of feeling or weakness in hands and feet. This is a common cause of foot injury.
We want to help you keep your feet in top shape and injury-free. Follow these tips for taking care of your feet:
- Inspect your feet daily: Everyone should inspect their feet as they get older on a daily basis – especially people diagnosed with diabetes. When inspecting your feet, check for any discoloration. This could mean there is a deep tissue injury from pressure. Consult your doctor if you see any discoloration or any other wounds.
- Choose the correct type of shoes: Choose comfortable shoes made of soft leather or athletic material. You should never wear a new pair of shoes for more than two hours at a time and you should always inspect your feet after wearing a new pair of shoes. Take extra precautions when wearing sandals or open toed shoes.
- Choose the correct socks: You should always wear socks with your shoes. When choosing socks, avoid synthetic materials and wear cotton or nonirritating blends. Additionally, pay attention to the fit of the top of your socks. Tight fitting socks can cause pressure ulcers on your ankles or legs.
Visit your doctor regularly and ask what you can do to care for your skin. Seniors should have their feet checked each time they visit their doctor. See your doctor right away if you develop an area of skin with poor color, a blister, a callus or a sore.
Dr. Ferraro provides wound care at three of our Sprenger Health Care communities: Rose Lane Nursing and Rehabilitation, Grande Village Retirement Village, and Heather Knoll Nursing and Rehabilitation.
Sprenger was a panel member on a recent WNIT public television program Ask An Expert. This program discussed Senior Care options to provide information about the levels of care of aging adults and caregivers.
Take a look at the full program. Take a look at the full program
By Lisa Zook, Registered Dietician
The new dietary guidelines for Americans were released January 7th by the U.S. Department of Agriculture and Health and Human Services. These new recommendations emphasize healthy lifelong eating patterns rather than singling out specific foods to avoid.
The guidelines may seem confusing, but can be broken down into sections to make it easier to implement into your diet.
Fats:
Continue to limit those “bad” fats such as trans-fat and saturated fats (butter, whole milk, cream, animal fats, hydrogenated fats and palm or coconut oil). Instead of going on a low fat diet and thus eating more sugars and carbohydrates, use good fats such as avocados, olive oil, flaxseed oil, fatty fish, nuts, seeds and liquid plant oils in moderation. Protein foods should be low in fat, such as fish, lean chicken and other lean meats, low fat dairy products, yogurt, beans and soy products. This allows for a wider choice of food, which can curb overloading on empty calories.
Cholesterol:
The exclusion of eggs and other high cholesterol foods has been dropped. Science has shown that it is the saturated and trans-fats that needs to be limited, not cholesterol rich foods that have little fat content (shrimp and shellfish).
Added Sugars:
Added sugars are from foods such as desserts, ice cream and soda pop. A specific goal has been set as 10% of your daily calorie intake. For a 2000 calorie diet, this would be 200 calories per day from added sugar. At 4 calories per gram of sugar, the limit would amount to 50 grams of sugar per day. (200 calories divided by 4 calories per gram = 50 grams of sugar). Labeling laws will most likely be changed in the future to identify the number of grams of added sugar in a product. Natural sugars from dairy products and fruit are healthier choices. Water should be substituted for diet drinks sweetened with artificial sweeteners.
Caffeine:
Coffee and caffeine products are now noted to be part of a healthy diet. The upper limit is suggested to be 400 mg daily. Generally coffee has 90-150 mg caffeine per 6 oz. and tea 50-100 mg per cup.
Grains and Fiber:
A diet rich in fruits, vegetables and fiber-rich whole grains is again promoted as part of a healthy diet. Refined white bread, cereals and crackers should be replaced with whole grain breads, whole wheat pastas, brown rice, fiber-rich cereals and whole grain snack bars.
Sodium:
A limit for sodium has been suggested at 2,300 milligrams per day. This is a difficult goal unless you limit canned goods and highly processed foods. Switching out to frozen vegetables, avoiding fast foods and convenience foods will make it easier to reach this goal. Herbs can go a long way in seasoning foods rather than using salt. Reading food labels is a must, as there are many hidden sources of sodium. Good choices should have less than 300 mg sodium per serving.
These guidelines strive to provide suggestions for a healthy all around diet. Balance and moderation is the key.
By: Chris Phillips, Sprenger Dining Services
It’s projected by the year 2030, 22%of the world’s population will be 65 years old or older. You probably don’t need me to tell you, but this is a large amount of people! In fact, according to the U.S. Census Bureau, the same demographic only accounted for 4% of the world’s population at the beginning of the century. Chances are, if you don’t fall into this category, you know someone who does. Someday you’ll fit this category and it’s important to know what you can do to improve not only the number of years in your life, but the quality of those years.
It’s commonly known as we age, we’re more susceptible to disease and disability. Heart disease, cancer, stroke, diabetes and other chronic degenerative conditions all affect the elderly.
There are different techniques and care plans for each condition, but the one thing that can help with all of these conditions is proper nutrition. It will give your body the necessary nutrients to fight any chronic condition and prevent it from becoming worse.
If something like proper nutrition is so important to your health it must be hard to maintain, right? The answer is no!
Older people don’t need to ingest as many calories as younger people due to factors like a slower metabolism, but they do need to make sure they maintain a proper level of minerals and vitamins. This can be done by choosing nutrient dense foods like fruit, fat free cheese and whole wheat crackers instead of sugar filled snacks like cookies and ice cream. Choosing fish, poultry and soy protein foods like tofu will give you your necessary protein. Calcium can come from low-fat milk, calcium fortified orange juice and broccoli. Vitamin B12 can be attained by eating low-fat meat, poultry, fish and fortified cereals. Get your Vitamin D from fortified milk and milk products, and fatty fish. Be sure to include fruits and vegetables for fiber and top it off with 6-8 glasses of water a day.
When preparing food, you should bake your food instead of incorporating other techniques, such as broiling. High heat causes foods to develop toxic compounds called Advanced Glycation End (AGE) products. These AGEs can contribute to hardening of the arteries, wrinkles and stiff joints and should be avoided to achieve optimal health.
Don’t let diminished senses keep you from maintaining healthy nutrition. Add flavor to your food by using low sodium seasonings, such as lemon juice, ground pepper, curry pepper and fresh or dried herbs of all types. Diversity in color and texture of your food can make your food look more appetizing. If you’re having trouble eating, try eating small meals throughout the day instead of three big meals to increase the appetite and stimulate the senses.
One day age catches up with all of us, but it doesn’t have to be all doom and gloom. Adopt these techniques and you can age well while fighting whatever chronic conditions life throws at you.
By: Phyllis J. Molnar, R.D., L.D.
Reducing the pain from osteoarthritis in our knees and preventing falls are two important concerns for seniors. Research indicates that vitamin D may help with both.
Arthritis pain
In a recent study, adults with low blood levels of vitamin D were shown to have significantly more osteoarthritis knee pain than adults with healthy vitamin D levels.
Aging and carrying extra weight are prime factors in knee osteoarthritis pain. When researchers increased the study participants’ vitamin D levels to normal, they experienced significantly less osteoarthritis knee pain—in spite of the fact that they were older and overweight.
Those with higher vitamin D levels were also better able to walk, had better balance and had an easier time getting up from a chair than participants with low vitamin D levels.
Preventing falls
Falls are the major cause of injury mortality in Americans over 65 years of age.
Studies have shown that persons with low serum (blood) levels of vitamin D of less than 30 ng/mL (75nmol/L) have increased balance problems, more muscle weakness and an increased rate of falling.
Whereas, participants having an average vitamin D level greater than 30 ng/mL (75nmol/L) experienced significantly fewer falls and bone fractures.
Source of information: The American Geriatrics Society’s 2014 consensus statement, “Vitamin D for Prevention of Falls and Their Consequence in Older Adults.”
Vitamin D sources
Achieving a vitamin D level greater than 30 ng/mL (75nmol/L) can be difficult without taking a vitamin D supplement –especially for seniors.
Foods alone cannot provide sufficient vitamin D. Sunshine is the best source of vitamin D. Studies have found that persons who spend most of their day indoors have low levels of vitamin D.
And as we age, our skin cannot produce vitamin D as efficiently from the sunlight and our kidneys are less able to convert vitamin D to its active form.
Therefore, most seniors need a vitamin D supplement to achieve optimal vitamin D blood levels.
Vitamin D supplements
Only your doctor can determine the correct dose of vitamin D for you based on your current vitamin D level, daily sun exposure, age, weight, medical conditions and medications.
Obesity increases the amount of vitamin D needed. Persons with malabsorption conditions such as Crohn’s disease, celiac disease, cystic fibrosis and other inflammatory bowel diseases need larger doses of vitamin D. Medications that block fat absorption, such as cholestyramine and others, also increase the need for vitamin D.
Increasing vitamin D absorption
Vitamin D is a fat soluble vitamin, so we need fat to help absorb it. Studies have shown that taking a vitamin D supplement with a meal containing significant fat or oil increases its absorption by 32 percent.
Many people take their vitamins with breakfast. A breakfast of cereal, fruit and milk contains little fat. Thus, little vitamin D will be absorbed. Instead, take a vitamin D supplement with a meal containing more fat such as supper or lunch. Never take vitamin D with water between meals.
Facts about Vitamin D
- In northern Ohio, we can only make vitamin D from the sun during the late spring, summer and early fall.
- Vitamin D is made from the sun’s ultraviolet (UV) B rays.
- Complete cloud cover reduces UVB exposure by 50 percent.
- Shade (including that produced by severe air pollution) reduces it by 60 percent.
- UVB rays do not penetrate through clothing, glass windows or sunscreens with a sun protection of 8 or more.
- The skin may produce approximately 20,000 IU vitamin D in response to 20 to 30 minutes of unobstructed summer sun exposure. The body can store vitamin D.
- You cannot get too much vitamin D from excessive sun exposure. Sustained heat on the skin degrades (breaks down) vitamin D.
- Persons who are obese typically have lower blood vitamin D since vitamin D gets trapped in body fat and is unavailable for use.
- One 8 ounce glass of milk contains only 100 IU of added vitamin D.
- Yogurts and most cheeses are made with milk which is not fortified with vitamin D.
- Few foods naturally contain vitamin D, with the exception of canned salmon (processing with heat removes some water, concentrating the vitamin D).
Salmon Tetrazzini
4 ounces spaghetti
1 can (14.75 ounces) salmon
Low-fat milk (about 1 ½ cups)
2 Tbsp. canola oil
2 Tbsp. flour
¼ tsp. salt
Dash of pepper and nutmeg
2 Tbsp. red wine
Sliced mushrooms (1 small can or 4 fresh), optional
Topping:
2 Tbsp. dry bread crumbs mixed with 2 Tbsp. grated Parmesan cheese
Preheat oven to 350 degrees.
Cook spaghetti according to package directions and drain. Set aside.
Drain canned salmon reserving liquid in a 2 cup measuring cup.
Add enough milk to make 2 cups of liquid.
In a bowl, break up salmon into large pieces and crush bones. (Do not discard bones)
In a large saucepan, heat oil. Using a whisk, stir in flour, salt, pepper and nutmeg.
Add salmon-milk liquid all at once.
Cook over medium heat stirring constantly until mixture thickens and is bubbly.
Add 2 Tbsp. wine. Stir in cooked spaghetti, mushrooms and salmon.
Pour into 1 quart casserole dish. Top with bread crumb-Parmesan cheese mixture.
Bake for 35 to 40 minutes.
Nutrition note: Fresh fish is significantly lower in vitamin D. During the heating process of canning, water is evaporated, concentrating the amount of vitamin D per serving in the fish.
By Phyllis J. Molnar, R.D., L.D.
Registered Dietitian
Elyria City Health District
