Bariatric Betty starts 2013 with Reactive Hypoglycemia

Scary.  That's how I can sum up my first (and hopefully last) experience with Reactive Hypoglycemia.  Reactive Hypoglycemia occurs 1 - 2 hours after a meal and is when your blood sugar plummets.  It's a complication some post-bariatric patients get about a year out from surgery, and apparently I am part of that group.  Non-WLS people can have experience R.H. by eating very high carb unbalanced meals, or by diabetics injecting themselves with too much insulin.  Studies have shown that starting 6 months post-op the pancreas of WLS patients (particularly the gastric bypass patients like myself) have a big increase in insulin reactivity.  One study I read said that the reactivity increases 20 times normal (duadenal switch and gastric sleeve WLS patients had a 6 time increase).   It's part of the same mechanism that reverses our diabetes with surgery, but in overdrive.

So, what happened?  Last night I made homemade black bean soup from a bariatric-friendly recipe, and had a bowl with some cheese sprinkled on top for dinner.  I also ate 1/4 of one serving of a baguette, a rare grain "treat".  I had eaten the black bean soup acouple times before as part of a meal - eating 1/4 of a serving along with 3/4 serving of my favorite lentils/onions/ greek yogurt/ cheddar cheese dinner.  Then about 1 1/2 hours later I went to the gym and hopped on the treadmill, because I hadn't gotten my 10,000 steps in for the day yet and it was TOO COLD to go walking outside.

Looking back, my first clue that something was wrong was that about 20 minutes into the walk I realized I was sweating.  Sweating?  From walking?  Ridiculous - I jog 5ks now, why would walking for 20 minutes make me break out in a sweat?  I decided that the gym must have bumped up the thermostat, and since I was on the top floor I was just getting an extra dose of heat.  I was trying reading while I was walking and I started having trouble reading at about the same time.  Of course, that wasn't how I was thinking of it then - I thought "Wow, suddenly the light reflecting off the screen of my Kindle is making it hard to see the words" and "Huh, I'm losing the thread of this chapter - maybe I shouldn't try reading while walking, I'll just turn it off and watch the TV.  Then I started feeling a little clumsy and irritable.  My brain started to signal "Hey, maybe you've done enough" at about 27 minute, but I thought "Nah, just 3 more minutes..."  By the time the 30 minutes was up I was definitely not feeling great. I felt light-headed, sweaty, and when the machine tried to add an additional 5 minutes of cool down walking I got mad.  I got mad at a treadmill.  Yeah, they should list that among symptoms - if you start to fume at inanimate objects, you might want to check yourself for hypoglycemia. 

Compare this to how I usually feel after a 35 minute jog - warm but not sweaty, sharp, and pleased with myself.

So I went down the stairs carefully because I felt a little dizzy.  "Must have not had enough water..." I thought.  So I drank some and headed into the basketball courts where my kids were playing.  I saw my one son, but didn't see my other son.  Then I realized that the other son was standing next to where my first son was sitting - weird, how did I miss that?  My younger son wanted to stay, so I went to sit down.  Then my older son said he wanted to get home and I agreed.  By this time I had decided that I must not have had enough protein that day.  I had only logged my breakfast so far (15 grams of protein), and had a Quest bar for lunch (20 grams) and I knew that the black bean soup wasn't as protein dense as lentils... yeah, that must be it, I was low on protein.

For my non-WLS readers, most adults only need about 45 grams of protein a day.  Post-bariatric surgery we aim for 60 - 80 grams.  Our bodies metabolise things quite differently, and having to live on great reduced calories requires a large protein load to reassure our bodies that we are not - in fact - starving after having been shipwrecked on a deserted island (in which case our bodies would start to consume it's own muscle tissue in addition to fat, BAD). 

So I called my husband as I started the drive home, explained I was low on protein and not feeling great, that my 12 y.o. was complaining of being lightheaded as well (meanwhile he started telling me from the backseat that he wasn't lightheaded and never said that). My younger son backed me up saying that my older son HAD said he was light-headed, but at this point I realized that I wasn't even sure what he had said any more, because I was feeling confused and irritable.  I SHOULD have realized "That means you shouldn't be driving, dummy!" but I didn't.  Luckily we got home safe and sound.  My hubby was waiting in the driveway with some cheese for me.  I ate half of it and started making some popcorn for my son.  I finished the cheese, had 2 cups of popcorn and went online to log the rest of my food for the day. 

Wow!  I hadn't realized that the disparity between the protein in black beans and lentils were so huge.  I always try to eat between 20-23 grams of protein in a meal, and apparently even with the cheese on top, I had only had 11 grams.  I ate another 1 1/2 ounces of cheese to bring me up to 60 for the day.  My overall calories had been low, too.  Good thing I had eaten some popcorn (I had no idea how good until this morning).  OK, everything looked better.  I signed off and went into the other room to sit with my family while they watched TV.  Within 15 minutes I fell sound asleep.  My husband woke me up and walked me upstairs to bed.  I had horrible dreams about feeling confused and thinking I was having a TIA (mini-stroke).  It wasn't that far off.  My brain was being glucose deprived. 

This morning I woke up feeling much better and something clicked.  Reactive Hypoglycemia.  I went online and reviewed studies and articles until I was sure.  It wasn't just lower protein, it was lower protein mixed with higher carbs (although not enough to make me dump) and then working out (even though it was low intensity) two hours afterwords - which is right about when my blood sugar plummetted.  I rushed through the low level and landed in moderate hypoglycemia and luckily had the popcorn and cheese before it got to severe (which includes seizures, unconsciousness, and potentially death).  If I hadn't eaten the popcorn it might have been worse.

To treat hypoglycemia you eat a small amount of carbs paired with protein (in my case, cheese and popcorn).  Non-WLS people might drink juice or eat a small amount of candy to boost up their blood sugar short term until the protein kicks in, but in gastric bypass patient that will cause a potential dump and a larger blood sugar crash shortly after, putting them in greater danger.  In non-WLS someone might have hypoglycemic symptoms after not eating at all for a long time, or about 1-2 hours after eating a huge amount of carbs (like 120 grams) and no/ low protein.  I ate about 30 grams of carbs, but only 11 grams of protein and BAM!  Lessons learned... whew. 

A big thank you to all my WLS friends who have written and talked about their experiences with R.H. - it was remembering your experiences that helped all of this make sense his morning. 

One fun/ funny experience to share - I was on Zappos' Facebook page and saw joint contest with Delivering Happiness and Tout.com where you shared a 15 second video of what or who inspires you for a chance to win a $500 Zappos gift card.  SWEET. I need new waterproof snowboots, and had been wrestling with whether or not I can afford some nice ones...plus heck - that could be several pieces of new clothing!  So, I made the video about how my Weight Loss Support Group inspires me and posted it, checking the box that said "only you" can view this on your timeline.  Imagine my surprise when my friends started commenting on it!  Great comments, too - saying I was cute, adorable, and my favorite "HHHHOTTT!"  What a great reminder that in our internet world, just because it says something will not be seen doesn't make it TRUE!  I'm so grateful for the support of my family and friends, and grateful that the thing that inspired me wasn't embarrassing or "private" in any way.   Here's hoping I win the gift card!
 

Bariatric Betty Breaks down a bit, plus a new pic

I saw my primary care physician for the first time since surgery this week.  She was thrilled with my success and there were a lot of fun "Oh my goodness, I almost don't recognize you!" compliments.  She asked a lot of questions and was thrilled with my exercise routine.  She also seemed surprisingly knowledgeable about blood tests that need to be watched.  But, there were some not fun things as well. 

If you remember my birthday post, I talked about how my birthday was wonderful with the exception of some poison ivy on my face and neck.  I ended up getting both an injection of steroids and later being put on an oral dose pack as well.  About halfway through the itchy mess of that, I noticed a sore itchiness around my waist on my right side.  At first I assumed that I had spread the poison ivy there in my sleep.  Later as it spread around my back, I began to think it might be something different.  It felt uncomfortable for fabric to touch it, and it wasn't as itchy as the poison ivy.  I rubbed some topical cortizone cream on it a couple of times a day.  I started wondering if I was experiencing the skin infections/ rashes that some WLS patients get under the folds of their skin.  My rash seemed to be on top and under the flap of skin, but I thought I would get my primary care physician's opinion.  I haven't thought I would want plastic surgery unless there was a medical necessity.  On the other hand, if my skin was going to itch and sting like this off and on for the rest of my life - that might push me towards it, and I better start getting it documented.

So as I described it, she said she would take a look - we were doing my annual exam, so she was going to be looking at everything anyway.  It only took her a couple seconds of looking for her to inform me that it was not poison ivy.  It was shingles!  In a lucky coincidence, I erupted into shingles while I was being treated for poison ivy, so all the steroids I was taking for the later helped the shingles not be so horrible.    What a strange silver lining!

Next she felt my hips - I had told her about sleeping on my stomach with a pillow under my abdomen to alleviate discomfort from my hip bones on my skin.  She felt them and said "Oh my, you are bony there!"  Bony?  Never in my life would I ever dream I would be called bony ANYWHERE.  But one thing you learn about major weight loss is that you don't lose it evenly, and certainly not in any order of preference of location.  Then she felt my left hip where I have been feeling some pain especially when I'm walking/ jogging and announced that I have some bursitis.  She would have prescribed anti-inflammatories, but knew I can't take them as a WLS patient.  She said if the tylenol stops working, she can prescribe injections of anti-inflammatories, which I can take. They also suggest you stop the repetitive motion that is aggravating the bursa and causing it to be inflamed.  Yeah.  Well, I can't stop walking, and I don't want to stop jogging.  For now the tylenol works fine.  But there might come a time when I will need to change my exercise routine because of it.  Isn't bursitis like an old-person-thing?  I guess it goes with my old-person-loose-skin now.

Last borders on TMI, but she also found that the unusual pressure I have been feeling at times is due to a rectocele.  A rectocele is kind of a hernia of the colon.  In my case it isn't causing actually pain, and returns to it's proper position when there's no straining involved.  She said that there's no risk to my health involved right now but that if the pain or retraction changes we'll have to look into surgery.  Apparently obesity is a big risk factor in rectoceles.  I suspect I might have had it for a while but didn't notice it until my diet changed into 90% protein and therefore made me more prone to constipation.  So I will continue to work on packing fiber in. 

Two weeks into my new workout program results... my dog and I can both now jog North/South Roundhead circle. That means that except for a 5 minute warm up walk and 5 minute cool down walk, we are now jogging his entire walk! Boy, that was quicker that I imagined it would be. There are several advantages to this. First and foremost, I get his walk done in 25 minutes instead of 45. Extra time is a serious advantage. Second, it kicks up my exercise a notch, increasing the intensity and calories burned. I'm still not loving jogging itself, but I'm enjoying the benefits.

I'm doing the alternating walking/ jogging with my son three evenings a week, so on those days I'm just walking Perseus in the morning. Then I'm walking during my monitor shift. Last Thursday I got over 20,000 steps in a day according to my Fitbit! Even cooler, I found out that since I got it on Mother's Day I have walked over 1,000,000 steps. One million.  How wild is that???

Then there is the mental part of my work-in-progress life.  Last weekend I had a scary reminder of how easy it is to get off track.  We were holding a sleepover and I went to go make the traditional post-no-sleep-over breakfast of pancakes.  Out of Heart Healthy Bisquick.  So I got out my cookbook and made some batter from scratch, but it didn't look or cook right.  I tasted it, and realized I had forgotten to put in the melted butter.  Remixed it and tasted it again -ahhh, much better.  I made the pancakes but found myself wiping off the batter drippings with my finger (and then licking the finger).  Yum.  Uh oh.  I love to bake, and have been very good since surgery not to eat anything I bake (which has been pretty easy).  However, for some reason I have always liked the unbaked stuff (cookie dough, batter, etc.) as much or more.  Here I let down my guard and find myself slipping into old habits.  No no no no!  It's a reminder that I need to be vigilant.  I probably tasted less than a tablespoon of batter, so I didn't dump.  I did, however, crave carbs more than usual for the next couple of days.  This weekend we had another sleepover, another pancake breakfast, and I was careful not to let one drop of batter reach my lips. 

I also caught myself chain eating salted cashews when they are left out on the table.  Cashews aren't a bad snack if I haven't gotten all my protein in - but when you find yourself taking three or four nuts every time you pass the table you aren't eating to live.  You're grazing.  Away go the cashews.  Out of site, out of mind.

All of this leads up to my losing it over some innocent choices my husband made for my son and officially inducts me into the food-nazi society, I guess.  After a tough football game that my son played in a soaking rain, my family split up for the trip home.  My husband got my football-player son a bottle of "Gatorade: Recovery".  And a bottle of regular gatorade.  I found out about the first on the phone and was like "Why??? It's only 10am?  He had 20grams of protein at breakfast, he doesn't need the 16 grams of protein now when he's going to come home and eat lunch (and more protein) in one hour!  And it has a lot of sugar, too.  He doesn't need that.  He's going to get high blood sugar and then crash as the insulin kicks in and feel horrible."  The when they got home I saw a second bottle of regular gatorade being consumed on top of the first one and just took it from him and threw it out.  "Did you know that the American Academy of Pediatrics recently said that NO STUDENT ATHLETES WILL BENEFIT FROM SPORTS DRINKS?  That basically it's like giving them sugar water or pop.  The only gatorade they should get is the low cal one, and even then it's unnecessary.  Water is best.  If they want to drink one of these for treat - like instead of an Icee, that's OK, but this is not helping him!"  Add in that they stopped at GameStop on the way home so he could blow his allowance when his brother also wanted to go there, and I was beyond irritable. 

It didn't help that I was tired, having to get up at 6am on Saturday to get him to the pre-game warm-up and meeting.  Or that I hadn't gotten my usual morning walk/ jog in with the resulting endorphins.  But I think mostly it was feeling overwhelmed.  Pushing myself to keep up with my exercise, work, finding out about the shingles/ bursitis/ rectocele, and the normal daily struggling with the kids about homework/ cleaning up/ etc.  I just lost it.  My poor husband. 

So the last couple weeks have been a little shaky, but I'm leaving them behind and climbing back out of that place.  I went to a baby shower yesterday at a beautiful restaurant and drank water through the whole thing.  I really enjoyed seeing a lot of extended family, and really liked most of the compliments I got as well.  The only exception being the one surprised "You look really pretty!" that was then amended to "Oh, not that you weren't pretty before."  Yeah, it's OK, I understand.  And the spirit it was intended in was nice, and they're right I do look a lot better.  I did have to spend about 15 minutes explaining why Visalus would NOT be a good choice post bariatric surgery.  Does anyone else feel like that's a pyramid scheme?  Oi vey.  Anyway, it was fun for the most part, and I brought the take-home goodies back for my boys.  Here's a picture.