Lots of pics! Starting my first 5-day pouch test/ My 2nd Surgiversary/ My 2nd Triathalon

I haven't posted a new entry in a long time!  I started this one in February and finally am posting in April.  I think that I have been have a lot of negative old-way-of-thinking thoughts - things like "I'll write a post when I have something cool to write about".  But, that's not why I started this blog.  I started it to motivate myself.  I started it to explore what was going on in my head on this journey.  And I've learned that you can't wait for life to hand something to you, you have to go out and make things happen.  So, I did my second triathalon in spite of the negative self-talk that was spinning around in my head, and it helped turn me back around.  Without further ado, here's a long delayed update.

I can't believe I've just celebrated my second surgiversary!  It seems to have gone so quickly, but at the same time it feels like I've been living this new life forever (and that's a good thing).  I celebrated with my family, and having a date night with my husband :)  And, I decided to splurge and bought myself a Fitbit Flex.

This year has been harder than the first - when they say that honeymoon period ends and it gets harder, they're right!  Your cravings come back stronger - that head hunger that you've been battling is still there AND you actually can tolerate more food (and probably more carbs without dumping, but I'm trying not to find that out).  My weight has fluctuated a lot more in the last year.  I was at 142.8 the morning of my surgiversary, which is 0.2 pounds less than I was on my 1st surgiversary and seems to be a stable point (also below my original goal of 150 so it feels great).  However, I have been lighter (down to 140.6) and I have been heavier (up to 148).  What has changed?  1) I'm not jogging right now, although I just signed up for my favorite 5k - The Color Run in May!  2) Part has been the weather/ deep freeze in Ohio and getting a tiny little dog that can't handle the speed and distance of jogging, and part has been dealing with the physical symptoms of pelvic organ prolapse.  But, part of it is 3) being lazy, being at my goal, and not trying as hard.  I have lost some muscle tone, although my size has stayed pretty much the same.  This is due to decreased intake to balance the decrease in calories burned.

My eating has stayed very good for the most part. I usually eat the exact same breakfast, lunch, and dinner every day.  It is boring, but it helps me remember that I'm eating for fuel not fun and it makes sure that I'm eating things my pouch tolerates well.  Being vegetarian and post-WLS, there aren't that many appropriate entrees that my pouch tolerates. Sometimes I find myself eating something I shouldn't as I'm preparing food for my boys (a bite or two of pasta, a pretzel, etc).  And, when I see the scale heading up north of 144 I have a "eat CLEAN d*** it!" moment.  Sure enough, as soon as I start catching myself, the scale starts to head back down.  I have also recently started rewarding myself with my favorite water flavoring drops (Dasani pineapple coconut) in my evening water if I have done a good job staying clean for the day.  That's been a good incentive.

My labs have continued to come back wonderful.  My hemoglobin A1C (blood glucose over an extended period of time) = 5.1  Anything 6 or below is considered normal for non-diabetics, and below 7 is normal for diabetics, so I am definitely still in remission and plan on keeping it that way.  Getting rid of my diabetes was my #1 motivation for having the surgery, and I was blessed to be part of the 75% to go into remission.  It doesn't mean it can't come back though - so I must remain vigilant.

In general I feel great - lots of energy, lower needed doses of anti-depressants, enjoying my job and (most of the time) my kids.  I love having the feeling of control over my health.  It used to feel like my weight controlled me.  Now it feels like I can us my brain to control my health - although it still has moments of poor judgement.  It's very empowering.

I've got the Color Run 5k coming up! I'm going to do a refresher course of Couch 2 5k to get my race legs on.

I just completed my second indoor triathalon, and that felt great.  I almost bailed on it - I haven't been jogging and didn't know the date for it until 2 weeks before hand.  I was worried that I haven't been jogging, and didn't want to injure myself.  But you know what - that was all negative thinking.  The fact is, nobody was going to force me to jog if I wasn't able to.  Nobody was going to make me finish it if I didn't want to.  Plenty of people just walk the track instead of jogging.  In other words, I needed to stop making excuses and just do my best.

I had a little bug a week before hand, and my husband was very nervous about me doing the race, but I reassured him I was back to normal and wouldn't push too hard.  To me, I realized that I can not let myself make excuses that allow me to be sedentary.  Races are motivating for me, and I enjoy the social aspects.

Here are some pics from the day:

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Last year I won the gold medal for my age group - but that was only because I was THE ONLY WOMAN 40-49!!!  I enjoyed the medal, don't get me wrong, but I would rather lose and have competition.  This year my age group was the most competitive - I had 4 other women in my age group!  I'm proud to say I came in second!

So this is a great reminder to all of us not to let our own self doubts, or negative self-talk stop us from trying to do our best.  Did I run as far in 20 minutes as last year?  No, but it was very close.  And, it turns out I was able to swim, bike, and run farther than a lot of other people so I got a medal!  Most of all, I got a reminder that I am fit, and have good abilities from my daily living, even without really training.

As a psychological reboot, I'm starting my first ever 5-day pouch test tonight with the beginning of Passover.  The idea of a 5-day pouch test is that you re-boot your mind and your pouch sensitivity by reproducing the eating plan you went through right after surgery, only compressed to 5 days.  For the first 2 days, you drink fluids only.  Protein shakes, water, crystal light... The third and fourth day you eat pureed soft foods.  And the fifth day you eat regular food again.  It's to help you remember how to use your pouch as a tool, to think of food as fuel, and reconnect you to your commitment that you've made.  I had been thinking of doing it every year on my surgiversary but a family crisis made that difficult this year.  So I thought that Passover would be a good time - after all, I should be unleavened all year round, but the idea of making a sacrifice, much as people do for lent, seemed to align with the concepts of Passover.  Pushing through, doing what you need to do, walking towards freedom and your future, finding strength and renewing faith...  I'll let you know how it goes!

The Honeymoon's Over - Bariatric Betty's Uphill Climb

How many of you have heard someone actually call getting weight loss surgery "the easy way out"?  WLS patients wince every time we hear it, and many of us will actually address the ignorant person who says it.  Chris Christie just "came out" about having lap band surgery 2 months ago, and I can't blame him for keeping it quiet so long.  The judgment that so many people make about someone having weight loss surgery can be vicious.  And that's on top of the judgment people have already made about those of us who are morbidly obese.

In an interview Christ Christie gave with Brian Williams, he recounts his conversation with his doctor when he asked if he should really get the surgery.  He said his doctor said "If you came into my office with cancer and I knew that there was a 40 minute surgery that would give you a 90% chance of a cure, should you get it?"  Here's the thing - the surgery IS simple for most of us. 

The surgery itself (without complications) can have you in and out of the hospital in a couple of days, put Type 2 Diabetes into remission immediately, and start a rapid weight loss that can lead to a healthy weight and lifestyle.  But, what the typical person doesn't understand is that the real work starts before surgery, and continues for the rest of our lives. 

One of the WLS patients on a Facebook support group was preparing for her surgery with a multiple week liquid diet that the surgeon prescribed.  Weight loss just before surgery will shrink a fatty liver and reduce risks of complications.  A week before surgery she had a small bowl of oatmeal, just wanting something "solid" one more time before surgery and the post-op weeks of liquids and then pureed diet restrictions.  Worried that this might put her in danger during surgery, her husband put a call into the surgeon.  The surgeon cancelled the surgery - NOT because of the oatmeal causing any risks - it wouldn't.  Because the woman feeling such a strong need to eat something she had been told she couldn't have (even though it was a healthy food) indicated that she might not be ready for the lifetime commitment to dietary restrictions that a successful WLS patient must have.  She has to meet with a social worker now, and who knows how long her surgery will delayed until she is really mentally ready.

What happens if we don't make those right choices after surgery?  The obvious result - that we won't lose the weight we need to lose, or will quickly gain it back.  Yes, people go through the surgery and then sabotage themselves soon after - whether pureeing the unhealthy food they crave so they can eat it again (cheeseburgers, french fries, etc) or by consuming liquid calories - a big NO in the rules for post-ops.  Eating ice cream, drinking milkshakes, drinking alcohol - they are all forbidden (although some doctors will say you can have a small amount of alcohol occasionally after 1 year post-op). 

What are other outcomes of bad post-op choices?  If your Type 2 diabetes went into remission and you go off plan and gain the weight back, it will come back WITH AN ATTITUDE.  There is a high risk of alcohol abuse/ alcoholism, even if the patient was never a drinker before.  A patient who had RNY bypass will now absorb more of the alcohol quicker than a typical person.  They will get a bigger buzz/ drunker and it will happen more quickly with less alcohol.  Given that many of us were "using" food in an addictive manner, it isn't hard to imagine that we would look to fill that need in other ways.  Increases in alcohol use, drug abuse, compulsive gambling and other addictive behaviors have all been seen in post-ops.  Big hard rule - whatever your problems were before surgery, they will still be here after surgery.  So you have to work on the underlying issues every day, and continue to face up to them.

My honeymoon period (usually seen as the first 12-15 months post-op when you aren't hungry) is over.  I get hungry now.  I also still get "head hunger" - where I crave something but my body doesn't need the nutrition -  that never went away, I just became better at identifying it.  I have found myself eating things for the wrong reasons before and caught myself before it showed up on the scale.  My caramel calcium chews - that I started eating twice as much of as I should - a nice way to get kidney stones!  Threw them out after a week.  The cashews I had gotten to eat as a protein packed snack occasionally - but found myself snacking on multiple times a day (at 200 calories a pop!).  Got them out of the house and kept them out for over 2 months until I was sure I could see them and not be tempted.  The glaze on the peppermint candy cane cookies that I licked off my fingers and then started scooping off the drip tray - I confessed to my husband that I had a real weakness there and he said that the next time I want to make them for the holidays, he and the kids will do the glazing for me. 

This last one snuck up on me.  I was eating homemade popcorn in the evening once in a while if I was hungry, making a big bowl for the family and having a serving size myself.  Then my serving size grew.  Then I was making it every night.  I still didn't realize I was in trouble until I saw the scale change.  I gained 3 pounds.  From popcorn.  Do you realize how much (unbuttered) popcorn I must have been eating?  OK, that's not the only reason I gained weight - I had been doing more walking than jogging.  While I am still very active (12,000 - 14,000 average steps a day) I went from jogging 3-4 times a week to jogging 3 times a month.  Add to that the salt I put on the popcorn, and Voila!  3 more pounds. 

Don't get me wrong, it isn't unreasonable to expect a little regain.  18 - 24 months out the average patient gains 5 - 10% of their weight back, mostly because their stomach has expanded enough that they can eat more/ get hungry again.  Some people never have any regain - and I really want to be one of them.  I told my husband I needed to "go off" popcorn for the forseeable future and from then on whenever my son requests it he says "Mommy's not going to make it, you can make a small amount just for yourself and throw out whatever you don't eat".  Awesome hubby, isn't he?  Sure enough, just 3 days after no popcorn, and my weight was already back down 2 pounds just getting the excess salt out of my system.  I also started jogging twice a week again.

The scary thing is how I didn't realize my new night-time snack was a problem until it showed up on the scale.  First of all - I shouldn't need a snack every night!  First thing I should do if I think I'm hungry is drink, because I'm probably just thirsty.   And if I am hungry, most of the time it should be satisfied by protein.  And I had gotten lazy with my exercise.  I feel embarrassed to have fallen off the wagon - lured back into an addictive eating pattern (eating more, more often).  It will take conscious choices and deliberate actions for me to stay healthy.  I must stay more active than the average person, and I can't think I can snack like an average person.  "Within moderation" is a loaded phrase and WAY too subjective for me.  In the case of popcorn, I've decided it means 2 cups of popcorn once every 3-4 weeks, max.  It means get out of the freakin' house in the evening, when I start to have the head hunger, so I am distracted from it.  Luckily, I've got my kids baseball and soccer practices and games to help with that! 

Finally, to end on a good note - I had a BLAST doing the Akron Color Vibe Run 2013.  I ran 5k in 30 minutes flat - my new best time.  That might have been because it was cross-country - up slopes, down slopes, across the gravel, sliding on the wet grass, splashing through the puddles.  There was NO BOREDOM there, on the contrary - I was terrified I was going to fall and take some layers of skin off, so that adrenaline probably helped my time.  Also, four times along the run we were liberally doused with colored cornstarch, which made it really fun.  Here are some pics (the tutu is a common accessory in these races)

 

If you want to try a fun 5k, I highly suggest Color Vibe and The Color Run!  Lots of fun for the whole family - one of my sons ran it with me, and the other is seen above tossing a lot of magenta cornstarch!

So, to sum up my original thought, getting weight loss surgery may be simple for most of us, but being a WLS patient for life is not.  Running a 5k feels simple now - it's a short amount of time, and a reasonable amount of effort for that time and you're done.  Making the right choices all day every day, pushing yourself to stay active, reminding yourself to stay away from your triggers and deal with your issues instead of eating to deaden them - that's the hard part.  It's part of the reason I eat the same things almost every day - it removes the temptation.  It's like an alcoholic realizing that it might never be a good idea to eat in a bar if there is another option.  Unlike the alcoholic, we can't just stop eating.  We have to choose to eat healthy things that won't trigger overeating, which can rule out a lot of things for each of us.  We have to choose the proteins that will fill us and meet our new body's needs.  We have to avoid the carbs that are likely to make us ill/ get dumping syndrome.  And we need to take our supplements regularly to make up for the vitamins and minerals we can't get absorbed through our food.  And when we do that, we are healthy.  That's how I plan to stay. 

 

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!
 

Lost and found, Bariatric Betty embraces hard stuff

The fitbit is lost, long live the fitbit!  Yes, I lost my second fitbit, and have been trying to manually calculate my steps and calories burned all week - boy did it have me spoiled!  My clip/holder had broken the week before and I had contacted the customer service for a free replacement.  For that week I was clipping the fitbit directly on to my belt loops, bra straps, etc.  And on that last fateful day - I jogged with my dog after clipping it on, and came home to find it gone.  I traveled my path again twice, trying to find it to no avail.  Fitbit had already given me a replacement once for free - it wasn't reasonable to expect them to do it again.  And then a ray of light - they have a new (cheaper!) fitbit - the Fitbit Zip.  It does everything but counting flights of stairs and sleep monitoring.  That's not bad - I don't even use the sleep monitoring function.  And instead of $99 it's only $59.  OK!

So I sent an email to customer support reporting the loss of my fitbit, and on the next business day... it happened.  "We would be happy to send you a complementary replacement..."  No way.   OK, I will once again rave: Fitbit - BEST CUSTOMER SERVICE EVER.  So here is my unsolicited ad - in addition to the newer cheaper Zip, the Fitbit One (which should be out for the holidays) will have all the initial capabilities as the Fitbit Ultra - but it and the Zip will be able to interact wirelessly with Apple devices and soon select Android devices.  No more base with a cord.  Woo-hoo!  I'm just getting a replacement Ultra, but for those of you who might be considering a splurge (or who want to whisper a wish to Santa) - this will be even more amazing.   Here's a link http://www.fitbit.com/one

OK, so my scale is hovering around the same number it has been on for the past 4 weeks; we are in a stall, Houston, we are in a stall.  But, I'm not worried.  I have continued to lower my Body Fat Percentage a little at a time, so I know I'm replacing fat with muscle.   I also got my test results back from my primary care physician and they were ALL NORMAL.  All my supplements are doing their jobs, no deficiancies, no diabetes, nothing wrong :) 

I'm enjoying my job, I really get a lot out of being an elementary school monitor.  Other than basically functioning as a lifeguard/ babysitter in the lunchroom and playground, I get a chance to impact the lives some of the kids.  The kid who are bored and need a challenge - have you tried running around the track - see how fast you can get around it!  Wow - you went around the whole monkey bars by yourself look how strong you have gotten by trying every day!  Watching the girl who just lost a parent find solace in helping a special needs student.  The student that told me his "heart hurt" and the resulting conversation that ended up with a referral to child protection services.  The daily boo-boos that give me a chance to talk about how amazing and strong the human body is, that it's already working on healing itself while we walk to get a band-aid.  Explaining to the children who are sad or mad that their friend doesn't want to be their friend anymore that even friends can have disagreements - that real friends will forgive each other and play together another day.  Talking about being fair and sportsmanlike, about including others, and watching the kids grow.  It's very rewarding.  In another life I think I would love to be a guidance counselor - but in this one I appreciate the chance to help when I can and refer them to someone better qualified when it's beyond my level.  One of my NSV's (non-scale victories) this week was that I was able to run around the playground track with my 1st graders when they asked me to join them - without breaking a sweat.

Dealing with stress seems to be going better - in addition to talking with my husband, I'm choosing to walk or jog more than any other coping mechanism.  Of course, last night I had a mega-wave of PMS hormones triggering some huge irritability.  It was late, and since I was finding myself getting ticked about things that I could see weren't worth getting upset about, I elected to send myself to bed early.  I just announced that I was worn out, and asked my hubby to take over - which he graciously did.  This morning I explained why, and he actually thanked me! 

Earlier this week I realized I was starting to eat progressively more of the delicious caramel calcium chew supplements than I needed every day.  Not good.  After chatting with a reader who was asking MY advice about staying away from temptation I recognized it for what it was - an addictive behavior.  Enjoying something, turning to craving something, turning to increased consumption/ usage... That might sound extreme labeling to those of you who haven't been morbidly obese, but most of us recognize that are our overeating could be classified as addiction.  So, I threw the caramel supplements out.  Bought boring tablets.  Did I overreact?  Not in this case - I know because 1) late that day I thought about pulling them out of the trash (they were in a sealed bag) and 2) because I craved those caramel supplements for the next three days.  Were they going to make me fat again?  No.  They might have led to kidney stones because of the large doses of calcium - that wouldn't be good.  But it's more the fact that I recognize that I can't allow myself to have something that I'm going to "crave" because it grows out of control too easily with me.  Will I ever let myself have treats again?  Yes, but definitely not in my first year, and then it will be a small amount, rare, and not keeping it in my house.   Eating too much of anything is unhealthy.  Even calcium.

Yes, my head is a constant work-in-progress.  But I didn't get morbidly obese because of stellar mental health, and I am definitely earning my improved health.  By making good choices over and over again, I look forward to it not being so difficult some day.  It's not difficult every day now, and I am so grateful I have my pouch to help me! 

 

Bariatric Betty Faces the Inevitable

So I knew this time would come - the Stall.  When anyone loses weight, they go through periods of time when they don't see much progress.  The first couple weeks/ months are usually full of rewards like watching the numbers on the scale go down steadily, fitting into new sizes of clothes.  It's great!  But at some point your body say "Hold on, let me adjust." and your numbers stop going down. 

In the past, this was very hard for me.  I would be following the plan, eating healthy, working out, and want to see results.  One way to get out of a stall is to eat less, another is to workout more.  When I was a teenager I did both those things repeatedly until I wasn't eating for days and started passing out.  Not good.

In my adult life I have understood that stalls happen, and yes - you can shake up your exercise routine and sometimes it will start the losing again.  But once you're on a healthy low calorie diet, eating less will not help weight loss, it will start a process where you body will go into starvation mode and hold onto weight in an effort to "save" you.  And if you increase your exercise, you have to be prepared to keep the same level of exercise.  So when I was on weight watchers and started biking 5-6 miles a day it helped me earn points and lose more weight - but when I couldn't bike that much any more I gained it back - because my body adjusted to mega exercise and when I went down to just being active the weight stopped coming off, and eventually started to come back on.

Imagine swearing off your favorite foods, working out over an hour a day, eating less and feeling hungry most of time, and then the weight stopped coming off and you were STILL OBESE.  Still not fitting into regular sizes and still getting the looks and comments from rude people who thought you were lazy and lacked self control, and still having major health issues.  After months of dieting - 6 months, 9 months, a year.  Still being obese.  After a while, you start thinking "Why am I doing this if I'm still going to be obese???"

So here is the change - I have hit a stall, and been warned it can last weeks to months, but this time, I am already NOT OBESE.  I am already NOT DIABETIC.   I already have a lot more energy and abilities - thanks to the surgery I was able to change enough things before this stall to be prepared to stick it out.  I already know it's worth it, even if I don't lose another pound.  But I do want to lose more!

I also prepared for this in another way - I have been measuring my body to see the changes in inches as well as pounds, and monitoring my body fat percentage.  I have not lost weight and my body measurements haven't changed for almost two weeks, but my body fat percentage has gone down 1.2%!  That means that I lost over 2 pounds of fat and gained that much muscle.  So I am making progress, this isn't a stopping point, it just means my progress isn't as easily measured or observed.


I am also continuing to up my physical fitness with the couch25k program.  Yesterday we started Week 3, where we doubled the longest time we had jogged so far.  I have to say, I really like this program and would encourage other non-runners to try it.  You can find it at www.coolrunning.com.   I keep waiting to get to a point where I say "Oh my gosh, this is too much!" but it really keeps you progressing at a good pace.  Was I tired after the longer runs?  Yes.  Was I happy to see the time was up and slow down to a walk - you bet.  But I'm not scared of doing it again tomorrow.  My boys are continuing to do really well on it, too.  My older son finally got sweaty yesterday at week 3 - yay, we caught up with his physical fitness level!  My younger son handled the bump up yesterday incredibly well.  He doesn't want to talk about how well he's doing while we're doing it, but at the end he says "it wasn't that bad".  For him and running - that's high praise. 

Day 75 and Bariatric Betty has a bumpy ride

So today I've been on my medically monitored diet for 75 days.  Depending on whose scale you're using, I've lost between 13.5 - 19 pounds.  When I met with Drew, the P.A. supervising my diet, he was pleased to see that I had lost 6 pounds in just the last four weeks.  Plus, he was really excited about my latest test results.  My Hemaglobin A1C has gone from 6.8 (really good for a diabetic) to 6.4 (GREAT for a diabetic) in the last three months and my insulin doses have been cut in half.  Then, he said - the next step is that you're going to go off your Novolog (insulin I take with my meals) altogether ."  I'm already down to 3 units with meals.  The next comment was "6.4, that's barely diabetic."  Ouch.  I said I was lucky that my insurance company wasn't making me diet for 6 months, or I might have a hard time qualifying.  He said "Well, for now you're still on three medications, and still diabetic..."  Whew.  No more labs before my case is submitted to the insurance company, and I will consider my self lucky.

A couple of days ago I got an email from my trainer.  She's left her job, and is no longer working as a trainer, but following her other love - photography.  As much as I'd like to be happy for her, she hasn't written up a summary of our work together, so I'm scrambling to print emails that I hadn't deleted yet and a couple comments she made while following my training on myfitnesspal.com.  My three month diet only satisfies the insurance company requirements if there is documentation of consults (at least three), behavioral modification sessions, nutritionist sessions (at least three), psych eval, and working with a trainer.  It specifically says "work with trainer may not be entirely remote (i.e. - online)".  And what I have proof of is from online.  My PA says that he talked to her before she left and is aware that we met in person once, and that he will write it up.  Just to be sure I'm covered, though, I'm meeting with another trainer this Friday.  He works at the same gym - I asked if he had access to her stuff or if I should bring copies of the program she designed.  He said "Oh, please bring it" - just like I thought, she left nothing....  

Oh, and if for some reason the insurance company doesn't think I've satisfied their requirements, I can continue to diet and have consults for three more months - but at that point I probably won't qualify because my diabetes would probably be diet controlled and have a BMI under 40. 

On a totally different note, I feel very blessed today.  Yesterday my father in law called.  He had gone to his doctor about pain in one leg and was sent to the hospital to get an ultrasound immediately, because the doctor suspected a blood clot.  He's 87 and in marvelous health for his age - very active and health conscious.  We just lost my mother in law this summer, and the thought of the chance of losing him so soon after was just crushing.  I sent a message out to my friends on facebook asking for prayers and was touched by how many responded so quickly.  Two hours later we found out that the ultrasound showed it WASN'T a blood clot after all!  So he still has to find out why it hurts, and we're a little worried about that - but the chance of a stroke has been pushed far down the list and we're so grateful for that. 

I have to remind myself each day; I have great faith in God.  I believe that God will see me through my journey in the best way.  I think that will include weight loss surgery, but maybe God knows something better.  I will keep reminding myself of this while I go through the last couple weeks of my supervised diet and the weeks waiting for the insurance company to make their decision. 

Bariatric Betty is happy to still be diabetic, but faces a sad reality.

Today I went for my 3 month check-up with my primary care doctor.  She hadn't seen me since I started the medically supervised diet (this is day 67 of 90).  She was thrilled with how I'm doing.  She agreed that I was right to lower my nighttime (long-acting) insulin when my morning numbers hit the 70's.  According to her scale I was 17 pounds lighter than 3 months ago!  I love her scale.  But, it lies.  I weighed myself three times at home before the 9:30 appointment this morning.  Once before I ate of drank anything and I was still in my pajamas.  Once after I drank 12 oz. of water and 12 oz. of diet coke (I will miss you, caffeine) and scrambled egg beaters with whole wheat bread.  And a third time after I was fully dressed.  Either her scale is off or I lost three pounds during the 1/2 hour drive to her office.  My scale is weighs me 1.5 pounds lighter than the one at the bariatric surgeon's office.  I'm not normally one to weigh myself numerous times in a day - just was wondering how much my weight fluctuated between eating / dressing/ etc. 

Anyway, she was really proud of me, and said she couldn't imagine how the insurance company would turn me down as a surgical candidate.  From her lips to God's ears!  I stayed and waited to hear my Hemaglobin A1C number... 6.4!  That is wonderful in many ways - first, it's the lowest it's ever been since I've been a diabetic.  Second,  while it shows my diabetes is marvelously controlled, it also shows I am still definitely considered a diabetic.  If it was under 6, my insulin would have been reduced (possibly discontinued) and then the question of my qualifying with the insurance company would have come into play.  Since I now have  a BMI under 40, I need to have at least one co-morbidity to qualify.  Diabetes is my only one.  Now I'm breathing easier, because my last set of labs before sumbission for approval from the insurance company show I'm still diabetic as well as compliant.  Yay!!!

Last night I got to go to my second local support group meeting.  It was just as fascinating as the first time.  Bunches of new people to meet, each with their own story.  Two women had lap-bands and one just a revision to the vertical gastric sleeve 6 weeks ago.  The other had hers a year ago and hasn't lost much weight or noticed it helping. Everyone was very encouraging and positive with her, suggesting that she talk to her new doctor about running some tests to see if the band is functioning.  One woman was a "lightweight" (BMI under 40) like me 15 months ago but has lost 90 pounds!  Another accidentally got pregnant just two months after her surgery.  Whoa.  Not recommended, but she and the baby are both fine.  She lost all the weight (including not gaining any during the pregnancy) she wanted to, and shared some great recipes with us.  She also recommended a latte machine at Bed Bath & Beyond for $30 - she said it reheats and reblends the latte during the day, and has a great recipie book with it that included a mocha latter with egg whites (it heats it enough that there's no samonela risk).  If I liked chocolate or coffee I would have been all over that.   Another woman who had just had plastic surgery to remove excess skin (and looked FABULOUS) and shared this recipe:
Kate'a Frozen Protein Treat
2 cups skim milk
1/2 cup greek yogurt
3 scoops unflavored whey protein powder
6 packets of splenda (or other sweetner)
1 1/2 cups of frozed strawberries

Blend and then pour in a sealable container and freeze.  She eats it as a high protein snack and said it's super.  THAT one I'm trying for sure.

On the topic of recipes, I came to a realization.  I may not be able to handle baking next year.  This may sound funny, but it's a huge tradition in my family.  We decorate our christmas trees with gingerbread, have a new year's eve cookie party for our kids and their friends, and after 3 years of practice I've finally gotten down the art of slovenian potica (a nut roll) making.  I'm very good at controlling my consumption of baked goods - it's before the baking that I am tempted.  Licking fingers and taste testing can sabotage a diet.  I've found a good way to handle it is to have other members of the family join me in the baking and to chew gum while I do it.  That works well for this year, but next year chewing gum will be a no-no (too much air being swallowed and the possibility of gum blocking my stoma) so I'm considering things like wearing a mouth guard, sucking on sugar free mints, etc.  Several of the members of the support group last night said that they can bake for their families without temptation now, so that gives me hope.  However, I have realized that if I find myself tempted, it would be better to give up this part of my identity than foil my brain re-training next year.  So I'll try; with company, mints, and mouthguards.  But if I taste one thing, that's it.  No more baking.  It's not worth ruining my tool.  And my friends and family would rather I was around than a plate of cookies.

For now I'm hopeful.  Hopeful I will qualify for surgery.  Hopeful I will make healthy choices and succeed.  Hopeful that I'm setting up good habits and supports that will help me in my new life.  And just having had Thanksgiving, I'm thankful that I not only have such a supportive family but that I found a way to work through all of this by blogging.  My thanks to you for reading.

2/3 of the way there and things are changing... maybe too much

Today is day 60 out of 90.  I've stayed adherant to my diet and exercise plan, and been under my calorie goal every day except for one (my sweet neighbor brought over delicious, warm, homemade rosemary bread - I am human!).  Depending on the scale and time of day, I have lost between 11 and 14.5 pounds, and my BMI may be as low as 39!  Coming down from 42, that's awesome. 

Here's a weird thing - my insurance wouldn't pay anything towards my RNY if I went below a BMI of 40 if I wasn't diabetic.  So in this strange case, being diabetic is a good thing.  My next change - wait for it - my diabetes is improving.  Yup.  I've been lighter than this weight before (right after I was diagnosed with diabetes 17 months ago) and my blood sugar was out of control.  About two weeks ago I had a morning fasting blood glucose level under 100.  That was only perhaps maybe the 4th time it's been that good.  Then this last week, every reading has been in the 80s.  This morning, at 7:30 am my level was 78.  That was actually a little scary, because I wasn't symptomatic for hypoglycemia, and I don't normally take my levels or eat that early in the morning.  They both usually happen an hour later.  This morning, if I had waited another hour, I could have had my blood sugar levels crashing. 

So my levels have been stable since then, and tonight I'm going to take less long acting insulin (10 units instead of 15).  I see my doctor and get labwork in 7 days, and with Thanksgiving this week, I don't think I could get in any sooner.  She and I had discussed adjusting my insulin if my numbers were low, so I feel comfortable with doing this change now.  Here's what I'm not comfortable with...

What if I am no longer considered diabetic in the next 30 days???  

On one hand - it's a wonderful possibility.  It's the major reason I wanted the surgery - to not be diabetic any more or have to worry about those co-morbidities.  I would live longer, be healthier, etc.  There's no reason I couldn't keep on my current diet. 

On the other hand, if I'm not diabetic, my insurance will no longer approve the surgery.  As it is, I will already have to pay about $5000 for the surgery.  Paying the whole $22,000 is not a possibility right now.  So I could have done all of this work for 90 days just to disqualify myself. 

Why do I need the surgery if I'm losing weight so well now?  Because I've always been successful at losing 20-30 pounds over 6 months or so.  It's when it gets to 9 months and out and I'm still not losing any more weight.  I get frustrated, and feel like being on the diet isn't worth it if I'm still obese with all the co-morbidities that come with it.  I have stopped dieting, and eventually gained it back. 

Having been through that cycle several times on my own, with Nutrisystem, and with Weight Watchers, I just don't know how I could handle it if it happened again.  I really want the tool of my new stomach - with a tiny appetite (at least in my honeymoon period) so I can train myself for my relationship with food for the rest of my life.  I want to dump if I eat too much carbs - to me the RNY is like implanting antabuse in an alcoholic; if you eat (or drink) the wrong thing you get sick, so you reinforce good behavior.   I want my pancreas to start making more insulin the day of the surgery.  I want the reset button to get pushed on my stomach so I know what it feels like to feel full (and not WANT to feel full). 

Well, I won't know what's going to happen until it does.  And just because I'm lowering my insulin dose doesn't mean I'll be off it soon, or off the glucofage.  So I shouldn't worry.  But it's like a little itch saying "what if..." in the back of my head.  On the positive side - being stressed raises blood sugar, so maybe just stressing about my lower levels will be enough to keep me diabetic for sure?  It's a twisted world we live in, and with insurance requirements it's no reason we all go a little crazy.  And right now I'm queen of Looney Land.