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Thursday, February 28, 2008

Annual Lab Results: The Human Pin Cushion Speaks

It's that time of year again. You post-ops all know what time I'm referring to. The time when we head to the doctor a leave with a handy-dandy lab request form in hand that has more boxes marked on it than unmarked, leaving us to wonder whether it would have just been easier for the doctor to write a note saying, "Check for everything but ... "

My lab results weren't that great last year. Both my blood sugar and iron levels were low. But with my employer changing insurance providers and then me taking a new job that offered other types of insurance plans, I had a hard time keeping track of things.

I met my PCP last week and instantly liked him. Merced may have a shortage of physicians, but so far, I think the ones we do have are top notch. He ordered a full course of lab tests for me and referred me to a nutritionist to discuss my hypoglycemia.

At the lab, I struggled not fall asleep as the technician drew eight vials of blood. I made a bee-line from the lab to a food source when it was all said and done.

My results came in early this week. I wish I could say I was surprised by them, but they only served to confirm what I already knew: I'm a bit out of whack.

First the good news: My cholesterol is 167. My risk level for cholesterol-related heart disease is 0.67. Average risk is 2.34-4.13. My doc is very happy. The nutritionist says I can eat all the cheese I want. Must be why I like her so much ;-)

Now for the not-so-good news: I have mytocytic anemia, most commonly referred to as iron-deficiency anemia. Most common, most easy to treat. The main concern is that I've been supplementing daily yet my iron levels are half of what they were a year ago, and my organs are not getting the oxygen they need. This is why I'm so tired and why I can't sustain physical activity for very long.

Here are my results for perspective:
Ferritin -- 1 (normal is 10-154)
Total Iron -- 22 (normal is 40-175)
Hemoglobin --- 10 (normal is 12-15)

Thought my ferritin level is in the toilet, the nutritionist I saw today said she doesn't recommend infusion therapy unless total iron is 10 or less, or hemoglobin is 7 or less. It's her opinion (she's also a family practitioner) that I can afford to try a higher dose of oral therapy for six weeks to see if that improves my levels. If it doesn't, then she'll combine oral therapy with weekly injections. Transfusion will be her last course of action. We will continue to monitor my iron levels every six weeks until I get in the normal range.

I've been taking 20mg of chewable iron daily. She's prescribing a new type of iron supplement that's supposed to be really good for women in general, but has also shown great results in bariatric patients. It's called Repliva. It's set up like birth control pills, where you take one active pill a day for 21 days and then an inactive pill for 7 days. Apparently, the body absorbs iron better when it gets a little break in between supplement cycles. Repliva is said to be more bioavailable than other forms of iron, because it contains B12, Vitamin C and Succinic Acid, which all act as binders to improve absorption. So, in theory, my body will absorb all 150mg of my daily dose. It's available by prescription only, and there is a chance that my insurance company won't cover it. But if it's not covered, I will figure something out. I can't afford not to supplement my iron intake. I'm not the type of person to cut corners when it comes to my health.

I really like my nutritionist. She gave me a glucometer so I can test my blood sugar levels daily and also gave me a plan of action on how to better control my hypoglycemia. I feel like she really took her time explaining reactive hypoglycemia to me and giving me additional tools to manage it. For instance, she told me that reactive hypoglycemia is much more common in the morning, which explains why I have such issues after breakfast that can lead to me ping-ponging all day to achieve balance. The solution may be as easy as eating only protein for breakfast. Following the same logic, that would mean that if I do want to indulge in a carbohydrate, dinner is the best time to do so.

Aside from logging my meals and testing regularly to find patterns, my immediate goal is to figure out how much carbohydrate my body can handle at one time and then ensuring I get a steady dose of that level throughout the day. This should alleviate my problems with fluid retention and bloating. I'm starting with 100 grams of carbs a day, split equally (20g) through my five meals. She prepared me for the need to juggle as my glucose monitoring reveals a pattern. For example, she said I might find that I have to limit my morning meals to only 10 grams of carbs but can boost my afternoon and evening meals to 30 grams.

Long story short, she did a lot to make me feel that all is not lost. That my hypoglycemia can be managed. And though it will take patience and discipline, I feel like she's willing to partner with me in figuring out my specific needs.

Sunday, February 24, 2008

Happy Birthday to Me!

It's hard to believe, but it's been three years since I went under the knife and changed my innards and my life. Gastric-bypass surgery, and the subsequent weight loss it caused, has led to a whirlwind of changes. Sometimes, I feel like it was just yesterday that it all occurred, and other times, it feels like I've been in this new body forever.

I can now admit my top weight was closer to 350, even though my highest recorded was 335. I do remember registering 350 on the scale at Curves once, but denial is a beautiful thing and kept me sane at the time.

The last year has been an interesting one -- bowel obstruction, surgery, hypoglycemia, anemia, divorce, job change, location change. Come to think of it, not much hasn't changed. But when it comes to my re-birthday, as the Kaiser staff called it, or my surgi-versary, as other post-ops call it, I like to reflect on how bariatric surgery has changed me as a whole.

Year after year, I am amazed at how far I have come.

In February 2005, I was 27 years old but I felt 80. At 310 (Had to lose weight to meet Kaiser's requirements for surgery), I was bigger around than I was tall; I was tired all the time but suffered from insomnia. I had trouble breathing, though I wouldn't admit it to anyone. My knees constantly hurt; my feet would swell up to the point of distortion; just moving about my daily life was chore.

Today, I fluctuate between 140 and 15o. Fluid retention will boost me up to 160 from time to time, but I'm working on that. I weigh myself once a month or so, just to keep things in check. Like many gastric-bypass patients, I still fear waking up one day with all the weight piled back on me. Silly, yes, but it's a real fear. Rather than suffer from joint pain, I deal with my tailbone hurting from lack of cushion. I won't lie to you. It's a nice problem to have. I have been called skinny and scrawny, and I'm not the least bit insulted. I'm not as active as I would like to be, but I am more active than I ever thought possible.

My biggest internal struggle is fear of complete assimilation. Having moved away from Tracy, nobody I meet knows I used to be morbidly obese unless I tell them. It's nice to be judged on who I am now, rather than who I used to be or people's perception of bariatric surgery or massive weight loss. But I don't ever want to forget the old me. A lifetime of morbid obesity shaped my character. It gave me a different type of compassion for others, but it also made me strong. I always felt like I had to work extra hard compared to those around me to combat the stereotype that fat people are lazy or stupid. I was a high-achiever. I still am. And that's not necessarily a bad thing. More people should aspire to more than mediocrity.

I am not ashamed of my past, but I don't want it to define me in the eyes of others. Then again, I'm not sure I can make that choice. After all, we all get to choose how we define others, regardless of what they want.

Three years ago, I thought I was happy. And maybe I was. I had a good life and a healthy level of confidence in myself. I thought I had more blessings than I had a right to expect. But today, I'm so stinking happy I can barely stand myself. It's a different type of happiness. I'm content not complacent. I think there is a big difference between the two. Though I'm not dissatisfied with my life, I know it can only get better -- because every single day since having surgery Feb. 24, 2005, has been better than the one before it. And that, my friends, is what reaffirms that I made the right decision for me when I chose gastric-bypass.

Friday, February 15, 2008

Fast, not Furious

I'm in the midst of a 10-day liquid fast in honor of the Lenten season. Actually, my church is involved in a PUSH initiative, which stands for Pray Until Something Happens. The initiative is built around revolving fasts: For the first 10 days, everyone consumes liquids only and prays five full minutes a day; the next 10 days are a media fast, during which time, everyone abstains from TV, newspapers, movies, video games, texting, e-mail, Internet usage, etc., unless it glorifies God or is required for work; the following 10 days are devoted to random acts of kindness; and the final 10 days require everyone to devote 1 hour each day to prayer.

The fast excites me greatly, particularly this first set. I have needed to do a liquid-protein fast for quite some time. My digestive system has been wonky ever since my bowel obstruction last year, and it seems that I just can't get my body into any kind of symbiosis. There's a question of whether I've developed food allergies or sensitivities, or if something more acute is amiss. Though there is a laundry list of tests that can be run, one efficient way to figure out a problem is to go on an elimination diet.

This church-wide fast has given me the motivation I need to limit my diet to liquid protein supplements, and I have to be honest...I have felt better in the last week than I have in the last year. I'm not terribly hungry, I have oodles of energy, and my intestines seem to be a lot happier. I may extend the fast to four weeks before slowly reintroducing foods into my diet under doctor supervision to see if we can pinpoint exactly which foods my body can't/won't process.

Micellar Milk lattes are still among my favorite protein treats, but I have to say that Met-Rx's 51-gram RTD in cookies and cream makes a very yummy mocha-like drink. That kept me quite happy all day yesterday. Lean Body's RTDs in ice cream flavors are also tasty, but I don't think they taste anything like ice cream. Then again, it's been a long time since I've had ice cream. Maybe I've forgotten what it tastes like.