Ever since Namine’s physical therapist came over last week, she (Namine, not the PT) has been craving pizza. Normally this wouldn’t be an issue, since we all love to eat pizza. (Seriously, it’s probably our favorite food.) But Namine has been on a mandatory low-fat diet since the Fontan, and do you know how hard it is to get a low-fat pizza? Seriously. Seriously.

It’s kind of funny, actually. Namine has this counting game called Pizza Mania. It’s really fun, but it’s been awhile since she’s played it. Well, the PT was going through games we have, looking for something that Namine can play with her somewhat limited mobility and range of motion. So she and Namine played a few rounds of Pizza Mania, and ever since, Namine has been asking and asking for pizza.

I’ve talked a little bit before about this low-fat diet Namine’s on, but I don’t think I’ve talked about why. Remember the drainage tubes? Well, even though they’ve been long removed, the danger they helped prevent is still there: protein losing enteropathy (PLE). This is simply a term that means the body is losing protein; to be specific, the condition manifested itself in Namine as edema. The drainage tubes were in place so that the draining fluid would be able to leave Namine’s body, not build up inside. The tubes were eventually able to be removed because the drainage tapered to a minimal amount, but not zero. It was a small enough amount that her body should be able to handle it on its own. (Note the use of the word “should,” not “will.” And so far, it has.)

How does this all pertain to Namine’s low-fat diet? Well, foods high in fat have a likelier chance of increasing the edema, and thus the drainage, still going on in her body. (And believe you me, you do not want to look up the complications that can occur post-Fontan.) So it is recommended now of nearly all Fontan patients that they go on a low-fat diet for a minimum of six weeks after surgery. Anything with a total fat per serving greater than three is off-limits. (Just for fun, take a look at some of the food you eat to see how it compares. Trust me, pizza is not on the list.)

So, pizza. Obviously all the delivery places are out. (Even Papa Murphy’s, which has some purportedly healthy pizzas, has a minimum of eight grams of fat per serving. So, what, “here Namine, have a quarter slice of pizza”? I don’t think so.) So are the frozen pizzas; some of those are just as bad as delivery. The only solution, then, is to roll our own, so to speak.

Tomato sauce, tomatoes, and mushrooms have no fat, so those are easy enough. I never really thought of bread (or crust, in this case) as having fat, but when you think about the fact that it’s made with oil, I guess that makes sense. We were originally going to go with these large soft tortillas we found – giant burrito-size things with only 1.5 grams of fat each – but we happened upon some low-fat pizza crusts with 2.5 grams of fat each. (Lucky us!) Cheese is the worst, and there’s really not a whole lot you can do about that. It’s basically down to math: you know how much fat is in each serving, and you just have to measure carefully, so that she doesn’t get more than the equivalent of three grams of fat.

Do you see what appears to be a flaw in my math? Note that the crust has 2.5, and we gave Namine 3 grams of fat (at most) in cheese. Didn’t I say she could only have 3 grams of fat? But according to Namine’s nutritionist, it’s not the fat in the total food, but rather the total fat in each serving of each food. So even though Namine’s pizza had a total of 5.5 grams of fat, it was okay for her to eat because the ingredients never added up to anything more than 3 grams of fat per ingredient.

And did Namine enjoy her pizza? Oh man, did she ever. She finished hers before mine was even half gone.

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