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Tasteful Memories

Apple growing was the main livelihood for generations in my mother’s family, whose farm was in the Blue Ridge Mountains of Virginia. My mother loved to tell about the many trips her ‘Papa’ made by horse and wagon packed to the brim with large, plump apples to sell at the city market. He would leave before daybreak in order to obtain a good spot for sales. As a four-year-old she would wait up into the night to hear the squeak of the wagon wheels as he drove through the gate to the homeplace. Now, driving a horse and wagon through the mountains after dark was not an easy thing to do. ‘Papa’ followed the creek bed.

The family didn’t just grow apples to sell. Apples were a staple in the family diet. There would be apple butter spread on homemade hot biscuits at breakfast, there would be skillet-fried apples, baked apples, and apple sauce always available for a snack. As a child I remember watching ‘Papa’ (my grandpa) even top his cereal with applesauce at breakfast.

For most of us, whether we are aware of it or not, the sense of taste and smell can trigger memories. Thinking ahead to the holidays makes me want to bring out a time-worn family recipes for baked apples. As you might imagine, my mother and her two sisters each had their own twists for making the best baked apples.

To this day a big part of my joy, particularly at Thanksgiving, is digging out my mom’s recipe for apple muffins. They are so good, I want to share them with you:

Apple Muffins

Peel and finely dice 4 cups apples. Sprinkle over them 2 tablespoons fresh lemon juice. Thoroughly combine the apples with 3 and 1/2 cups all purpose flour, 2 cups granulated sugar, 1 teaspoon salt, 1 teaspoon soda, and 1 teaspoon cinnamon.

Stir in 1 and 1/2 cups Crisco oil, 1 teaspoon vanilla, and 1 cup walnut pieces.

Add 2 beaten eggs along with 1/3 cup water. Half fill muffin cups. Bake at 350 degrees for 20 minutes, or until toothpick comes out clean. As muffins come out of oven, let them rest for 5-10 minutes before gently removing to serving plate.

Back when our mom was healthy, she would pack a box full of those muffins along with a baked ham and her angel biscuits on trips to visit us in Ohio.

Gift Idea in Dementia

To my readers, I am sharing a second article written by Dr. Cheryl Achterberg, Ph. D. I invite you to visit Dr. Achterberg’s blog: “About Caregiving and Dementia. Mostly.” which can be accessed by going to cherylachterberg.net.

Her article follows:

Gift ideas for loved ones with dementia are few and far between. It usually boils down to slippers, pajamas, maybe a shawl to keep warm. Gift ideas that are therapeutic are rarer. But my friend, Pat White, has something special to offer.

As a carer herself and volunteer for more than 10 years in assisted living homes, Pat knows the power of pictures to elicit fond memories from the past. She began showing family pictures to various residents to encourage them to talk. She also reviewed the literature and found that “reminiscence therapy” is real and more powerful than simply chatting or socializing among individuals with dementia. What would most of us give to create warm fuzzy feelings in our loved ones? It has become an important and urgent need in this COVID era when many of us are not even allowed to visit our loved ones in person. Thus, the seeds were planted for the start-up of a compassionate business of making posters for families who have loved ones with dementia.

The idea is that each poster is unique to each person it is made for. The posters are meant to capture special happenings in a life and/or to remind a person of their past and the special people in it. Long term memories are held longer than nearer time memories in dementia, especially those memories associated with adolescence and the early 20s. Seeing these pictures can provide comfort to a person with dementia even if no one else is present. They can also be a conversation starter with any visitors, family or staff who are present. The research indicates that individuals who have Alzheimer’s and memories elicited and talked about in this way are happier and healthier than those who merely socialize.

I’m guessing that personalized posters would make a terrific gift for the holidays. Pat provides choices as to size and the number of pictures displayed. There were five pictures for my husband’s poster because he is advanced in his disease and I didn’t think he could process more than that at a given time. I chose a picture of himself, a picture of his family growing up, a picture of our wedding, one of his children, and a picture of the plane he flew into Antarctica on. Up to 20 photos can be accommodated in posters ranging from 16 x 20 inches to 27 x 40 inches in size.

Pat’s products and website are clean and colorful. The instructions are clear, the order is built online, and the posters take about a week to produce. A proof is sent to you before finalization too.

Wrap-Up

I didn’t mean for my blog to be an advertisement site, but I was so impressed with Pat’s work that I wanted to share it with you too. And again, I think it might be a perfect gift idea for the upcoming holiday season.

For More Information:

For more information, see Patricia White’s site, www.MemoriesfromMyLife.com

Pat also keeps a blog about caregiving and Alzheimer’s that you can check out at: https://memoriesfrommylife.wordpress.com


With permission from Dr. Cheryl Achterberg, Ph.D., I am sharing her informative article with you:

Why is there no cure for dementia? It is a common lament, especially among family members and caregivers. There are three main reasons that I can tell. First, dementia research is underfunded. Second, the science is hard. And third, the brain does not regenerate. Let me explain.

Dementia Research is Underfunded

Dementia research is underfunded, receiving only 5% or less of what cancer or heart disease research receives. Even though dementia, and Alzheimer’s Disease in particular, has been identified for more than 100 years, it has not had much public attention until recently. We have an aging population and the aged are living longer. So, there are more cases of Alzheimer’s and dementia now, and many more people are afraid of the disease. Sadly, it is not viewed as an urgent problem.

Dementia is slippery. It sneaks up slowly and is often dismissed or hidden until it can’t be brushed aside anymore. There is also a stigma attached to this disease that curbs attention broadly. Other more urgent issues tend to dominate. Today, for example, COVID-19 has taken up all our attention. However, public pressure could help change policy and win more funding for dementia-related research.

That said, I am pleased to share with you a new initiative starting September 30, 2020. The Centers for Disease Control and Prevention funded the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406). Three recipients will establish dementia-focused Public Health Centers of Excellence and Public Health Programs. The University of Minnesota is one of the recipients and they will focus on dementia caregiving. The national Alzheimer’s Association will focus on dissemination of public health strategies and resources aimed at reducing risk of cognitive decline and dementia.

The Science is Hard

The science is hard. Money isn’t the only issue. Dementia presents an especially difficult problem set. I say “set” because there are many kinds of dementia with different causes and different courses, but the same end or outcome. A common saying is, “It’s not rocket science” when confronting a challenge. But brain science is more challenging than a dozen different rockets. The brain is far more complicated with an estimated trillion cells, and trillions upon trillions of reactions happening constantly. It is, of course, nearly inaccessible despite new imaging technologies. We can’t just open people’s skulls for study without very good reasons. Yet, we know the brain is “plastic.” That is, changing or adjusting with time but constantly organizing and coordinating its own and all the body’s other reactions as well.

Since Alzheimer’s disease and other dementias take so long to develop, they are extraordinarily costly to study. Participants should be followed for 20 years or more, to observe the “before and after” along with what happens in-between. Animal models are limited for dementia too. Finally, recruiting human subjects into research studies about dementia is difficult, especially in diverse communities. People are reluctant to sign up, in part due to the stigma attached to the disease. It will take dozens, hundreds, perhaps thousands of scientists to figure these diseases out.

The Brain Does Not Regenerate

The brain does not regenerate. Dementia in all its forms causes the brain to self-destruct. A “cure” would rebuild or replace the tissue that was lost. We can rebuild muscle therapeutically and joints mechanically, and we can replace kidneys or livers by transplant. These options are impossible with the brain. When brain cells die, they are gone forever. If relatively few cells are injured or killed, the brain will often compensate. Other cells will take over that function inside an individual. But the lost cells are never replaced. In Alzheimer’s disease, it is typical to lose 1/3 of the brain’s volume. Compensation can’t cover for that loss.

The hope for more research is to find a drug or combination of drugs that will halt the destruction. That is the best we can hope for along with diagnostics that will identify the disease before symptoms become obvious. Then, some of the new therapies might have a better chance of working.

What Can You Do?

September is World Alzheimer’s Month and YOU can help.

You can donate to Alzheimer’s research at:

You can participate in Alzheimer’s and related dementia research studies by contacting:

  • Alzheimer’s Association Trial Match (for individuals diagnosed and not diagnosed with Alzheimer’s Disease at tmatch@alz.org or 1-800-272-3900

And you can learn more about funding and research at:


For my mother, her own personal identity seemed to slip away with her memory. 

According to Dr. Esther Oh, an associate professor in the division of geriatric medicine at Johns Hopkins University School of Medicine, people like my mother suffering from dementia tend to withdraw from social engagements, conversations, and everyday activities.  But reminiscence therapy “really draws them out of their shells, because they’re able to tap into their past and things they’re very familiar with.”

My mom found a way to tap into her past by slipping a few framed pictures of herself with her family into her suitcase when she would be traveling from our home in Ohio to visit my brother.  Photos provided that connection for my mother; but, actually, reminiscence can use all the five senses – – not just sight but touch, taste, smell, and sound – – to help folks with dementia remember events, people, and places from their past lives.  

Gerontologist Robert Butler, author of the Pulitzer prize-winning 1975 book, Why Survive?  Being Old in America, and founding director of the National Institute on Aging, established Alzheimer’s disease research as a priority.  Dr. Butler is credited with pioneering Reminiscence Therapy in the 1960s.

How reminiscence therapy works:

As we age, we have an increased tendency to remember things that happened to us between the ages of 10 and 30 years, with events from the late teens and early twenties remaining most prominent.  Psychologists call this ‘the reminiscence bump.  For people with dementia ‘reminiscence bump’ memories usually remain vivid (until their illness is very advanced) and can often be recalled quite easily with the use of some simple triggers.

Memory triggers:

Photos may include pictures of close family members, a special life event such as a graduation or wedding, a special athletic skill, or a special trip of a lifetime.  Perhaps placing a hand in a well-worn ball glove might bring back a few glory days of Little League stardom.  Biting into a cold slice of watermelon might conjure up family summer outings.  Pipe tobacco smoke may bring back memories of quality time spent with a dad – – and on and on. 

Reminiscence therapy can occur in a group or individually.  At Western Reserve Masonic Community’s Pathways Memory Care a unique program of reminiscence was instituted in recent years, using volunteers who met individually with Pathways residents once a week using meaningful photos supplied by family to encourage the sharing of memories about special people, places and events from a lifetime.  The review of data recorded from these sessions over a period of months showed marked changes in mood and the ability to verbalize a simple story, the goal being to share a few recorded stories with family.  Due to the onset of the covid virus, this program is now on hold.     

Benefits to reminiscencing:

  • Encourages communication skills  As Pathways residents began sharing a few memories from their past, their ability to communicate increased.  When they talked about their past, sometimes they might laugh in delight and emotion got involved.
  •  Reduces symptoms of depression  As with my own mother, elders often become isolated from their identities as their memories begin to falter.  A re-connection with their past may increase feelings of self worth.
  • Promotes physical health  Something as simple as recalling past experiences can also improve one’s body.  According to the book, I Remember When:  Activity to Help People Reminisce by Howard Thorsheim and Bruce Roberts, seniors who reminisced showed lowered blood pressure and heart rates.  At Western Reserve Masonic Community Pathways Memory Care, caregivers recorded fewer instances of falls.
  • Reduces stress  The simple activity of reviewing a few pictures from a photo album can be soothing for an elder.
  • Helps eliminate boredom  Reliving a happy experience from the past can offer relief, especially for seniors who are less mobile.  It can take them out of their current situation and help them relive more active days.
  • Preserves family history  This author volunteered  in a Central Ohio nursing home a few years ago and had the special privilege of interviewing a young mother who had suffered severe burns at the hands of an abuser.  Over several weekly visits she was able to share some precious family stories using earlier photos that were recorded for her children.
  • Increases caregiver regard  When a caregiver can view a few pictures of an elder at a younger, healthier time and hear him or her talk a bit about life as it used to be, they may regard that elder in a new way.
  • Increases self-esteem  Reminiscing may help seniors feel heard.  This author recalls hearing another senior who had been a gymnast taking such pride in a picture of himself as a young athlete.     
  • Promotes new pathways in the brain  Often when we watch someone retell a story, we watch them come alive with memory and emotion.  Research has shown new pathways in the brain form as a patient remembers the past.

Dr. Gregory Quirk quotes from his research done at University of Puerto Rico School of Medicine (taken from NIH Research Matters 2/2/15) that “while our memories feel constant across time, neural pathways supporting them actually change with time.”

In terms of Reminiscence Therapy for seniors with dementia, one important question has been whether it is the therapy itself or simply the increase in social interaction that leads to cognitive and behavioral improvement.

Two studies in 2007 and 2008 tested a group of elders treated with Reminiscence Therapy and a control group that discussed everyday topics.  Both reached the same conclusion:  the seniors with dementia who received Reminiscence Therapy had stronger verbal skills, were happier, with improved quality of life, compared with their pretreatment and with the control groups.

Sources:

Reminiscence Therapy – US News & World Report 2019

Reminiscence Therapy for Alzheimer’s and Dementia Care, The Kensington at Redondo Beach

Effect of Activity Reminiscence Therapy as Brain Activating Rehabilitation for Elderly People with and Without Dementia – Psychogeriatrics, 6/3/2007 as reported by T. Yamagami, M. Osawa, S. Ito, and H. Yamaguchi

Effects of Short-term Reminiscence Therapy on Elderly with Dementia:  A Comparison with Everyday Conversation Approaches – Psychogeriatrics 2008; Y Okumura, S. Tanimukai, T. Asada

Does Prevagen Do Anything?

A concern of many of us family members who have a parent or blood relative with dementia is our own futures – whether we are more susceptible to contracting dementia through inheritance. I had begun paying more attention to the TV ads for Prevagen.

However, I have reconsidered after reading the following article, well documented, by Dr. Cheryl Achterberg who is a caregiver. With Dr. Achterberg’s permission I am sharing it with you today:

Does Prevagen Do Anything?

Does Prevagen do anything? According to the company, it is the #1 brain health or memory supplement on the market today. You can’t miss the advertising for it if you watch the evening news. Prevagen is made by Quincy Biosci in Wisconsin. It has been on the market for about ten years. Consumers have spent over $165 million dollars on it according to the Center for Science in the Public Interest (CSPI).

Locally, it costs $59.99 for a 30-day supply of “Extra Strength.”

Prevagen is unique on the market. It is made of a protein extracted from jellyfish called apoaequorin. Jellyfish are not known as big-brained creatures, nor highly functioning creatures. There isn’t any science to suggest that this protein will hurt you, but there isn’t any good science that it will benefit you either, brain or otherwise.

What happens when you take Prevagen? The body does the job it always does when confronted with content in the stomach. It breaks down the stuff into its constituent parts. Simply put in this case, protein is broken into amino acids and some waste. That’s what digestion does. The body reassembles the amino acids it needs into human proteins for use when and where needed. So, you don’t have any beef, quinoa, or rhino protein anywhere in your body. You wouldn’t have any jellyfish protein either if you took Prevagen.

Magic!

Nootropics

Prevagen is sold as a supplement, not a drug. The company gets away with their marketing claims because they do not mention any specific disease in their advertising.  This practice skirts the Food and Drug Agency (FDA) rules. In plain language, Quincy Biosci is not regulated. They say it helps with “mild memory loss,” thereby distancing themselves from any form of dementia. You suffer mild memory loss after a bad night’s sleep for instance. But that’s temporary! If you check out the official website below, the company lists an important caveat in fine print at the bottom: “This product is not intended to diagnose, treat, cure or prevent any disease.”  

Brain and memory health supplements, like Prevagen, have become such a lucrative market that a new category and name has been given to them. They are called nootropics.

There are two types of nootropics. One group is pharmaceutical. These are manufactured substances, usually combinations of different vitamins and stimulants. Some have a fatty acid thrown in. The other type is herbal. These are “natural” substances which are supposed to increase blood flow to the brain and/or decrease inflammation. Both types tend to be over-hyped with little science behind them.

For A Healthy Brain

The bottom line for a healthy brain is what is good for the heart, is good for the head too. Increasing blood flow to the brain is good. You can do that with a good cup of coffee. Decreasing blood flow to the brain is bad. You do that over time with a poor diet and lack of exercise. Certain nutrients, such as Vitamin D or Vitamin B12 will enhance brain function and brain health if you are deficient in them. Both vitamins are often low in older Americans. Ask your doctor; they are easy to check on a routine blood panel. You might also consider a fish oil supplement (for omega 3 fatty acids) and turmeric (as an anti-inflammatory). One caution: Too much of anything is bad.

Wrap-Up

If you are bound and determined to waste your money, there are literally hundreds of nootropic supplements on the market that are purported to enhance brain health or memory. I hope you don’t buy them. Each will take you for hundreds of dollars per year.

References

https://www.brainreference.com/prevagen-review/

https://www.ncbi.nlm.nih.gov/books/NBK552157/

https://cspinet.org/news/prevagen-how-can-memory-supplement-flunk-its-one-trial-and-still-be-advertised-effective

www.buyprevagen.com/shop/?gclid=CjwKCAjwkJj6BRA-EiwA0ZVPVmzRXhwXM8-IQNS3HMm9D725f2yoJ8tYq4kWmobqfNnU-zZt5pQj9RoCYY4QAvD_BwE   

Dr. Achterberg is the dean of The Ohio State University College of Education and Human Ecology.


Identify Your Team

I have had the special privilege of sitting in with an Alzheimer’s caregiver support group for their past two monthly meetings. I thought I knew most everything there is to know about caregiving – – – well, almost everything!

Last night I was blown away by a point made by one of the caregivers in our intimate group of eight: Making the best use of offers to help involves knowing your team!

Each of us as caregivers, over time, have been overcome by the generosity of some friends and family. And at other times when we have been let down when others did not or could not come through has been rather devastating.

After that revelation from the caregiver at the support group meeting last evening, I began reflecting back over 50 years to when my dad’s dementia set in and remembering the mixed feedback our family received from his minister friends. (My dad was a United Methodist minister.)

The majority of his friends, perhaps not knowing what or how to respond to the word that my dad was very mentally ill, avoided our family and my dad.

But two minister friends stand out in my mind to this day as I recall how they reacted. The one, when he found out our family would have nowhere to live after my dad’s forced medical retirement from his church appointment, set about finding us at least temporary housing.

He also knew that I was entering college in the fall. Through a foundation of which he was a board member, he engineered a most generous educational stipend for me that covered all expenses after the initial scholarship I had been awarded by my university. My parents then had no financial worries about me.

The second minister friend extended his friendship to my dad by calling him and sending him regular, personal, handwritten letters over my dad’s remaining lifetime. I believe that close friendship helped him make it through many hospitalizations and times of deep loneliness caused by the frontal temporal dementia. That minister’s daughter remains my friend to this day.

So here, we had friends of two types: 1) those who helped us through by physical actions; and, 2) those who provided emotional support.

Looking back over the 40 years of my dad’s extended illness, my family could have saved ourselves much disappointment by identifying those friends and family members who we could count on, whether it be through loving, helpful acts of kindness or through emotional support through letters, phone calls, or visits.

A fortunate few caregivers may be blessed with a family member or friend who is able to provide both as a doer and as a listener. And those folks are a kind to angels!

Wanting to respond to our loved ones in a helpful way when they are looking for our understanding and affirmation of their thinking can be very challenging at times for us as caregivers.

I am glad to share this article written by Annie Tobey for Seniors Guide for their readership in Central Ohio. Click here to view the article.

My friend and colleague Dennis Stack, Co-Founder of LegacyStories.org, recently shared this poem with me.  And I am passing it along to you.   The poem is introduced as follows: 

When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was felt that she had nothing left of any value. Later, when the nurses were going through her meager possessions, they found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital. One nurse took her copy to Ireland. The old lady’s sole bequest to posterity gradually found its way to a number of Irish publications.

… And now this little old Scottish lady, with nothing left to give to the world, is the author of this simple, yet eloquent, poem traveling the world by Internet.   We all leave “SOME footprints in time”…..

An Old Lady’s Poem

What do you see, nurses, what do you see?
What are you thinking when you’re looking at me?
A crabby old woman, not very wise,
Uncertain of habit, with faraway eyes?
Who dribbles her food and makes no reply
When you say in a loud voice, “I do wish you’d try!”
Who seems not to notice the things that you do,
And forever is losing a stocking or shoe…..
Who, resisting or not, lets you do as you will,
With bathing and feeding, the long day to fill….
Is that what you’re thinking? Is that what you see?
Then open your eyes, nurse; you’re not looking at me.

I’ll tell you who I am as I sit here so still,
As I do at your bidding, as I eat at your will.
I’m a small child of ten …with a father and mother,
Brothers and sisters, who love one another.
A young girl of sixteen, with wings on her feet,
Dreaming that soon now a lover she’ll meet.
A bride soon at twenty — my heart gives a leap,
Remembering the vows that I promised to keep.
At twenty-five now, I have young of my own,
Who need me to guide and a secure happy home.
A woman of thirty, my young now grown fast,
Bound to each other with ties that should last.

At forty, my young sons have grown and are gone,
But my man’s beside me to see I don’t mourn.
At fifty once more, babies play round my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead;
I look at the future, I shudder with dread.
For my young are all rearing young of their own,
And I think of the years and the love that I’ve known.

I’m now an old woman …and nature is cruel;
‘Tis jest to make old age look like a fool.
The body, it crumbles, grace and vigor depart,
There is now a stone where I once had a heart.
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.
I remember the joys, I remember the pain,
And I’m loving and living life over again.
I think of the years ….all too few, gone too fast,
And accept the stark fact that nothing can last.
So open your eyes, nurses, open and see,
…Not a crabby old woman; look closer …see ME!!

May we recognize that young soul within our loved one!


Dear readers,

A good half year has passed since I have written. We are all painfully aware that much has changed in our world since December 2019.

For those of you who are actively care giving, I cannot imagine what the past five months have been like for you and your loved one with the stay-at-home-orders and the no visits inside care facilities.  Video calls, social media and window visits do help of course, but we know that they cannot replace the benefits that come with in-person communication – – especially touch.

For your loved one who is dealing with dementia, the situation has probably been complicated by their not being able to understand why you cannot be with them.

The bottom line is, loneliness directly impacts health and can intensify cognitive decline, depression, and anxiety, said Dan Blazer, a longtime psychiatry professor at Duke University. The question becomes what can we do to help our loved one feel more more secure and connected to us as a family in a time like this.

I am remembering my experiences with my own mother, remembering how she quietly packed a few framed pictures in her suitcase each time when she would be traveling from Ohio back to Virginia to visit my brother. It took a while for me to realize that those pictures were helping her remember the person she had been and the people who were special in her life.

After I got it, what was really going on, I took a few of her pictures to a graphics firm and had them made into a poster with descriptive captions. I will never forget the afternoon I brought that first poster home. At first she just stared at each picture, incredulous. Then came her broad smile of recognition! Ever after, the poster followed her wherever she was staying.

My brother and I got rather used to the back and forth of sharing our mom; and, thankfully, she was a real trooper about making those long trips between Ohio and Central Virginia. But then one night in Virginia, trying to make her way to the bathroom, she fell, fracturing her hip. While she was recovering in the hospital following surgery, I brought that poster to her room, positioning it where she could view it whenever she chose. Amazing things began happening!

Nurses, doctors, and aides began noticing a pretty lady dressed in a red blazer who vaguely resembled their patient. When audible remarks were made, my mother answered with the practiced response of one who knew about whom she spoke. Our mom became more talkative, enjoying being asked questions and telling about her life. And her caregivers began treating her in a different way, seeming to regard her as more than merely a patient but as Christine, a person who had enjoyed a full, active life, someone whose family regarded her.

That poster made a difference for us family members too. Being reminded of how our mom used to look gave us confidence to encourage her recovery, expectant that she was going to heal and regain strength!

When my mother’s dementia had deepened to the point where her caregivers were concerned that she might be having trouble swallowing, the dietary staff suggested to me that my mom needed to have her food pureed.  How I resisted that idea!  I would visit the dining room and purchase foods I thought would be easier for my mom to chew and swallow.  But things did not improve.

I well remember the day when the order went through – CHRISTINE’S FOOD IS TO BE PUREED – it happened to be strawberry shortcake that was the first to be served pureed.  I felt like crying, thinking my mother would probably stop wanting to eat.  So much of her likes and dislikes foodwise were determined by appearances.  In fact she gradually did lose her desire for solid food.

Fast forward 10 years and I am visiting with the daughter of an elder who resides in Memory Care in Northeast Ohio.  This daughter passed along to me how she has encouraged her mom to continue to eat and enjoy her pureed food — She makes the puree into a filler for sandwiches!

This daughter tries to be with her mom for at least one of her daily meals.  The sandwiches are being enjoyed by her mom; and the daughter is encouraged, knowing that her mother is getting some nourishing food — not just peanut butter and jelly sandwiches.