No Rest for the Weary

A full night of sleep has evaded me lately. I'm sleeping well for the most part. I manage to go to bed at a decent hour and wake up rested, but I'm not sleeping through the night.

I have some of the most vivid and wild baby dreams. The most recent one is that I woke up with a baby girl in my arms. Brian looked like he had just finished a marathon but I couldn't figure out where the baby had come from. Apparently, I had delivered her in my sleep. Brian, on the other hand, had been awake during the whole experience and gave me the play-by-play.

Given what I know about the birth experience, I doubt that was a premonition. Most likely, it was just wishful thinking.

Brian says he's also had vivid, unusual dreams. So it seems we both are up and down throughout various times of the night. Suppose we can count this as practice for when the baby arrives. At least we can't say we don't know what it's like to be up every two hours.

36-Week Update

It's hard to believe that I'm in the home stretch of my pregnancy. It feels like just yesterday when I was bowled over by the news that I was expecting.

Brian and I have had a lot of fun over the past nine months, planning and preparing for our family to grow. Just married in March, we've celebrated a lot of firsts as a married couple and lasts as a childless couple. It's been a great time all around.

Now that I'm officially nine months pregnant, there's a collective sense of relief in our home. Though we both hope Baby Kubo holds out until his/her expected arrival date of Jan. 22, we know that s/he can safely enter the world at any point now.

Our twice-weekly doctor visits have been going well, with lots of visible movement and good variation of heart rate. We had a mild contraction during our last visit, according to the monitor. I didn't feel a thing, but the fetal monitor picked it up. If I could figure out how to make it through labor without noticing my contractions, I think I might have it made.

The most exciting thing for me, however, has been the improvement in my lab results. In just one month, my hemoglobin has jumped from 8.5 to 10.5 -- proof that my anemia was caused by both iron and B12 deficiencies.

It's amazing that it's taken almost five years after having gastric-bypass surgery for me to find a doctor willing to give me B12 injections, but I'm glad I have. Those weekly B12 shots have really turned things around for me, increasing my stamina and energy, in addition to raising my hemoglobin. Double-digit hemoglobin is important. Anemics aren't just at risk for pre-term labor, but many require blood transfusions after childbirth. Not a procedure I'm interested in if I can avoid it.

What is "Ready"?
People keep asking Brian and me if we're ready for the baby yet. We're definitely ready to meet the baby, to learn his/her personality and to have the reality of parenthood fully confront us. But I find that most people aren't really curious about the emotional side of parental readiness. When they ask that question, what they really want to know is whether the nursery is in order and if we have all the baby's stuff washed and ready for action.

The answer to that is short and sweet: Nope. Not even close.

There's a lot we'd love to do in the house before Baby Kubo makes his/her debut. There are a few things we'd still like to buy. But we also know that babies are very simple creatures with simple needs for the first few months of life. They don't need skillfully decorated nurseries or perfectly arranged outfits when they come home from the hospital. They need love, attention, food and warmth. That we have covered -- everything else is just icing on the cake, so to speak.

So from now on, when people ask if we're ready, I think my answer will be short and to the point. We're as ready as we'll ever be -- and we'll adjust as needed. Baby Kubo probably won't know the difference between ready and not, and I'm pretty sure s/he won't remember much about the first year. I think we can safely relax, knowing that as long as we cover the basic needs, we're doing everything Baby Kubo expects and requires.

Feeling Photogenic

Ever since I was a child, I have looked forward to the experience of being pregnant. As I've said before, it can be the most perfect time in a woman's life. When else is it socially acceptable to stick out your belly, eat as much of whatever you want and be treated like Cleopatra by all who surround you?

My pregnancy experience, however, has not matched my childhood predictions. I have enjoyed the experience with minimal unpleasant side effects, but I'm not "big as a house" like I thought I'd be. In fact, most people enjoy telling me that I "don't even look pregnant," which is irritating, because I could swear that my belly doesn't usually extend past my bustline -- but maybe I'm delusional.

For the most part, I've been able to accept that my pregnancy journey is specific to me and enjoy the process. Though I was unable to feel the baby move until much later in my pregnancy than most, I still enjoy the quiet moments in the morning and right before bed when the baby is most active and I can feel the flutters and flips inside my belly. I love guessing which body part is where and seeing how the baby reacts to external stimulus. The baby loves kisses from Daddy and the loud music at church. The baby is not so impressed by the fetal monitor at the doctor's office.

Of course, I realize all of these interpretations are guesswork. I assume the baby enjoys something when s/he is more active in response. I assume the baby doesn't enjoy something when s/he kicks or punches something inside me that hurts. Even if I'm wrong, it's fun to guess.

Where I've had a hard time adjusting, though, has been in the case of photography. Being that I've always envisioned having this ginormous, round pregnant belly, it's been really hard for me to get excited about taking photos. I had always wanted a professional maternity shoot, but I kept holding off on scheduling it because I wanted to wait until I "popped," which moms I knew swore would happen "any day now."

When I looked at the calendar last week and realized that "any day now" could also bring a baby, I accepted that it was now or never. At first, I figured I'd just have a quick photo taken of Brian and me for our Christmas cards and to mark the memory of our first Christmas as a married couple and last Christmas without children.

A brief conversation with one of Brian's former coworkers led us to a Saturday morning photo shoot in a local park. The quantifiable end result is a collection of photos by Donavan Garrison that will serve well to document the upcoming birth of our first child and also ensure friends and family get a Christmas card from us before Valentine's Day.

But the end result that can be seen or measured is my full acceptance that I am who I am, and regardless of how that compares to the others in the world, it's perfect and normal for me. I'm thankful for the experience Donavan gave us that allowed me to embrace my figure for what it is and to truly get excited about meeting the little person growing inside of me.

Showered with Love

Cake made by Mary Reis of Hilmar; lavender-scented bath salts made by the fabulous Amber Tucker.

I have the most incredible bunch of friends and relatives, all of whom have blessed me beyond belief for my entire life. Having them come together for my recent baby shower was so much fun, I can hardly stand it.

Brian's family hosted a shower for us on Thanksgiving, which was a great way to remind us to be so grateful for the blessing we're about to receive in the form of our first child. Then my best friend, Amber, hosted a shower at the beginning of the month that was absolutely perfect. We had an amazing mix of people present: Former coworkers from the Tracy Press, college friends, UC Merced friends and colleagues, Mary Kay friends, family, and just about everyone else I've met along the way in life.

We had amazing food. Amber's spinach quiche (find recipe in Comfort Foods post) was devoured in about a minute. My mother made sure we had an impressive selection of Hilmar cheese with crackers. For those who didn't need to watch their sugar intake, Amber also made a sausage-and-egg casserole, cheesecake bites, macadamia nut coffee cake and baked french toast casserole. We had cake, too!

The best part of the day, though, was being able to see people I hadn't seen in ages. My AXiD little sis Amy Lee was there with her 15-month-old twin boys. I hadn't seen Amy since she got married! Her boys are so adorable. My college roommate, bridesmaid and all-around-amazing friend Allison Buck brought her mom, Claudia, who I hadn't been able to see since Allie married Brook in Riverside close to a decade ago (boy, do I feel old!).

Nothing compares to the feeling of love and joy you get when surrounded by an enclave of women who love and adore you -- and the advice they each shared was invaluable.

I've been too way too many baby showers that have morphed into parenting gripe fests or worse, labor horror story share-a-thons. Mine was far from that. I was surrounded by a room full of women who focused on sharing positive tales with me.

Here's a brief round-up of my fave bits of wisdom:

• Soothies are the best pacifiers ever! -- Amy Lee
• Don't get caught up in perfection; what works for you is perfect for you -- Amber Tucker
• Breastfeeding is cheap and easy; give it a try -- Hannah Chevalier
• When all else fails, just love your baby -- Stacy Escobedo
• Give God thanks daily -- Edna Overstreet
• BumGenius Organic Bamboo Diapers are great -- Wendy Sparks (via Allison Buck)
• Get rid of all the chemicals in your home; they aren't good for you or the baby -- Aunt Bina
• You're going to be the best mom ever -- Debbie Luiz (would you expect anything different from my own mother?)

It's exciting to know that I have such a phenomenal network of women to rely on when my little one makes his/her entrance into the world. We're already so blessed!

33-Week Update

33 Weeks -- Full face shot

I had been feeling great during my pregnancy until a new phenomena developed, which I labeled "Good News Tuesday; Bad News Friday." The doctor had taken to monitoring me twice a week and requesting ultrasounds weekly to monitor the growth of the baby and the maturity of my placenta.

Apparently, us WLS women don't have the nutritional reserves to grow placentas with staying power so the doc wanted to be very careful and watch me closely. No big deal. "Watching closely" involves me seeing the baby more during ultrasounds and spending close to an hour hearing its heart beat while hooked up to a monitor. Sounds like fun to this expectant mom!

But then I realized something aggravating: The schedule I was one for these appointments meant that my doc would see me on Tuesday with no new information and then see me on Friday after receiving the ultrasound results. So, I'd walk in on Tuesday to good news: Everything looks great; you're amazing. And then on Friday, it would be time for bad news: Baby isn't growing; your placenta is getting old; hope you're not attached to working much longer.

I was taken off work at the beginning of the month because the baby was assumed to be super-small. Some women with this problem have seen radical growth once they stop working their office jobs, because stress plays a big role in baby development.

It was unexpected, but I've been able to roll with it for the good of the baby. Then came suggestions that I not drive too far from where we live and that I sleep more. If you know me, you know I'm not much of a sleeper when I'm burning the candle at both ends -- much less when I'm not.

Ultimately, all of this impresses one major fact upon both Brian and me: We are not in control here.

When it comes down to it, you can try to align the planets perfectly in a multitude of ways, but when you are expecting a baby, that little, tiny baby is the world's tiniest dictator -- in control of every minute detail. And if you want to maintain your sanity, you'll realize that, accept that, and move on. So my mantra of late has been to accept that which I can't control and focus on that which I can. Sounds simple enough. Hard to put in practice, though.

The High Cost of Eating Well

A recent conversation with a friend has caused me to revisit the question of whether healthy eating is truly more costly than unhealthy eating. The answer depends greatly on how you define “healthy.”

If “healthy” to you is low calories, high fiber, you can do quite well on a paltry budget budget by dining on meals rich in beans and legumes, whole grains and seasonal fresh/frozen/canned veggies and fruit. Your grocery dollars can go quite far if you’re not buying milk, butter, eggs and cheese. Dried beans and lentils are cheap. Brown rice is cheap. Oatmeal is cheap. Look in any grocery ad, and you’ll find some veggie or fruit on sale for 99 cents a pound or less.

Buying organic can increase your costs, but you’re still saving a hefty chunk of change compared to the carnivores of the world.

If, however, “healthy” for you is a high-protein, low-carb eating plan, adjustments have to be made.

You Get What You Pay For
I remember when I first had gastric bypass that people would often comment that I must save a ton of money on groceries. It sounds like a logical conclusion until you realize that quantity gives way to quality when your capacity for food is limited. The pantry had to be cleared of cereal, bread, crackers, pasta and rice. No more juice, milk or generic yogurt in the fridge. And definitely no ice cream in the freezer.

Instead, my pantry was stocked with protein powder ($40-$60 a canister) and ready-to-drink protein supplements ($3-$4 each). My fridge and freezer housed a combination of cheese ($4-$5/lb.), fish and seafood ($5-$8/lb), Greek-style plain yogurt ($5 for a large carton), chicken ($2/lb) and the like. Surprisingly, not only did my grocery bill not go down – in some cases, it increased.

My friend, who recently adopted a healthier way of eating that involved cutting sugar and refined carbs noticed the same trend at her house. A frequent fast food diner, she was amazed at how much more expensive her daily drive-through visits had become.

“Instead of spending 99 cents on a chicken sandwich, I’m ordering a $4.99 chicken salad – and it’s not even that good,” she lamented.

The flip side, though, is that she feels a lot better and has noticed other positive effect of her new way of eating, such as sleeping better at night, having more energy during the day and just a general sense of wellness.

And (pardon the pun) that’s what makes the juice worth the squeeze.

28-Week Update

Where has the time gone? I realized when I had my OB appointment that we never got around to taking profile photos of me during the second month. Though I still get told I don't look anywhere near seven months pregnant, you can definitely see that my belly has expanded since the last in-home photo shoot!

It's amazing to me to document the changes in my body -- just as amazing as it was when I documented my weight loss back in 2005 when this blog was published as a series of columns in the Tracy Press.

It can be challenging at times to see the scale drift in the opposite direction, especially when I've spent the last 4-plus years focused on losing and maintaining weight loss. However, the knowledge that I am growing and nurturing a baby prevents me from feeling as if I'm just eating my way past the tool of gastric bypass.

Speaking of eating, I've been ravenous for the last week. I can't seem to get enough to eat. I'm learning quickly how to balance that by eating small meals throughout the day. Not only does that help manage my hypoglycemia but it also prevents me from biting the heads off of my coworkers during hunger-induced temper tantrums. Seems everyone benefits from making sure I'm well fed.

I have to say that I am really happy with my choice of medical provider. Not only is she local, but she truly understands the risks associated with my medical history and current pregnancy. She's not an alarmist, but she's definitely thorough. She orders a full metabolic panel every other month to check my nutrient absorption. So far, iron and vitamin D have been my only deficiencies. I'm hoping that my hemoglobin is on the rise, given the two iron supplements and liquid cholorophyll I've been taking for the past 60 days. If there's no sign of improvement, we'll have to figure something else out.

She's also testing my blood sugar level. Because of having gastric bypass and reactive hypoglycemia, I can't have the glucose-tolerance test that most pregnant women go through to test for gestational diabetes. Other doctors I had interviewed felt this minor detail meant I had to be labeled high-risk throughout my pregnancy and put on bed rest (not sure what bed rest can do for blood sugar but it's an interesting concept). Dr. Schill was the only one who didn't consider it that big of a concern and felt that careful monitoring would be sufficient. It feels good to be treated like a normal patient vs. a surgically altered freak.

As I await my lab results, I'm enjoying the feeling of the baby's movements. At 22 weeks, I just felts taps and pokes. Now I can discern the difference between kicks/punches and flips/twists. It's definitely a miraculous experience. And to think that I never thought it would be possible. Boy, am I glad modern medicine doesn't know everything!

Recipe: Pumpkin Pie Protein Smoothie

This is a modified recipe from one I found on a WLS recipe site, combined with tips received from the generous proprietors of Barrista's in Tracy (home of the original pumpkin pie smoothie that I was addicted to in my pre-op days).

Note: You can use any vanilla protein powder or even a vanilla RTD drink (like Oh Yeah!), but I prefer the creaminess of Isopure cannot be duplicated. The recipe makes a 25-gram shake but I like to double the protein and pumpkin in the a.m. so the shake holds me through lunch.

Ingredients:
1/4 c pumpkin puree (NOT pie filling...just pureed pumpkin)
1 scoop vanilla Isopure protein powder
1/4 cup ice-cold water
1 tablespoon frozen Cool Whip Lite
1/4 teaspoon pumpkin pie spice
1/2 teaspoon vanilla
1 tablespoon agave nectar (Brian prefers 3 pkts of Splenda)
Pinch of salt
6 ice cubes

Directions:
Place pumpkin, protein powder and water in blender and blend until smooth. Add whipped topping, pumpkin pie spice, vanilla, salt and sweetener of choice. Blend again, adding more iced water if you like a thinner smoothie. Switch blender to highest setting and add ice cubes one at a time until you reach the texture and consistency. I find six cubes gives me a high-volume end result similar to soft-serve ice cream or a milkshake. Pour into a class and garnish with a slight dusting of nutmeg and even another dollop of the frozen whipped topping, if you like.

Au Naturale: A New Kind of Supplement

One of the many perks of having a doula, or labor assistant, care for you before, during and after the birth of your child is that you become aware of options that exist outside of the mainstream.

Our first meeting with Dawn was a little on the daunting side. As a lay midwife, it’s her job to get a sense of my medical history in order to figure out the best way to support me in the birth experience of my choice and also to be prepared for potential complications that may arise.

I’m not sure if all of Dawn’s consultations are over two hours, but mine was. It took me a solid hour just to explain my medical history and laundry list of current ailments. I felt like one of those retirees who shares their trials and tribulations with anyone who shows the poor judgment of asking, “how are you today?” To her credit, though, Dawn did a great job of keeping a straight face.

We discussed my previous surgeries and the residual effects of each. I explained reactive hypoglycemia and my desire to labor at home for as long as possible because I’m concerned that the hospital’s protocol on limiting birthing women to ice chips and minimal clear liquids will put me at risk of an episode that could lead to an unnecessary C-section. We discussed my anemia, my vitamin D deficiency, my body’s tendency to retain water, my hospital anxiety stemming from my last surgical experience and just about everything in between.

We spent a lot of time discussing how I manage my hypoglycemia and which foods work at which stages. She encouraged us to make sure the fridge is stocked with all of those items by my third trimester so we can be prepared. She also gave us a variety of natural remedies to consider taking during the pregnancy to improve my outcome.

Chlorophyll for Anemia
For my anemia, she recommended liquid chlorophyll. Natural health experts believe chlorophyll to be molecularly identical to hemoglobin with the exception of the center atom. In hemoglobin, the center atom is iron; in chlorophyll, it’s magnesium. The thought is that this means chlorophyll can actually help do the job of hemoglobin (important for women like me who don’t have enough). The side effect of this is more energy and general well-being. Chlorophyll is also known to detoxify blood and increase the number of red blood cells in the body. It’s also known as a natural internal deodorant.

I found a moderately priced liquid chlorophyll supplement at Raley’s in the natural foods section over the weekend. I started taking it on Sunday and have faithfully drank two tablespoons a day ever since.

I expected it to taste similar to wheatgrass juice, which is known to be high in chlorophyll, iron and vitamin K. I like wheatgrass juice a lot, but jaunting to Jamba Juice every morning is neither practical nor cost effective. This bottled supplement from Raley’s seemed like a decent compromise.

I bought the “natural flavor” (mint is also available), and I also bought a bottle of acai juice as a chaser just in case it was dreadful. Initially, the chlorophyll is very sweet and finishes with a flavor I can only describe as “mud.” It’s like you just chowed down on some grass – dirt and all. You’re even left with bright-green lips as a reminder. The acai juice definitely helps afterward. All in all, though, it’s not the worst thing in the world. I have found it tastes better cold than at room temperature, and I’ve survived so far.

I have noticed increased energy during the day and possibly some reduced fluid retention. I feel different enough to continue taking it. We’ll see how my next set of labs come out to determine whether it’s truly effective in improving hemoglobin and red blood cell counts.

Red Raspberry Leaf Tea for Uterine Toning
Vitamin D deficiency is a side effect of the malabsorptive nature of the type of gastric-bypass surgery I had in 2005. Recently, scientists have linked vitamin D deficiency with an increased occurrence of emergency C-sections. Though no research has yet been done into why vitamin D deficiency can result in C-section births, the current hypothesis is that it’s due to muscle weakness.

Vitamin D is known to promote muscle strength. The uterus is one giant muscle that must contract repeatedly in order to bring a baby into the world the ol’ fashioned way. If a woman doesn’t have enough vitamin D, it’s possible she won’t have the uterine strength or stamina to birth a baby naturally.

Red raspberry leaf (commonly consumed as a tea) is known to strengthen the uterus. It’s often found as a primary ingredient in herbal teas marketed to expectant women. I found a box of 24 tea bags at the Vitamin Shoppe for $4.99 – lower than what prenatal teas typically cost (about $6 for 14-16 tea bags). I now drink a mug of red raspberry leaf tea each morning. It doesn’t taste bad, but I wouldn’t call it delectable either. It is what it is.

Dandelion Tea for Liver Health
Detoxifying one’s body is always a good idea, but when you’re pregnant, your body has to handle a lot of extra waste until the baby develops organs stronger enough to supports its own systems. That’s one reason pregnant women retain excess fluid.

Dandelion tea is known to be a strong detoxifier, particularly for the liver. I’m now drinking a cup a day of this (right after the raspberry leaf tea) as well. It’s not pleasant, but I’ve survived so far. I can’t describe the taste other than to say it’s not good. But I found it at the Vitamin Shoppe for an affordable price, and if it truly works, I would say it’s worthwhile.

So far, that’s the extent of the supplements I’ve tried. Dawn also recommended alfalfa, garlic and fish oil, but I can only take so many pills a day before I’m not longer able to fit food in my tummy. And the available pill space is currently taken up by my prenatal vitamins and iron supplements. So we’ll see how the next few weeks go, and then proceed from there.

Seeking Assistance

Brian and I met with a doula last week. We were referred to her by my sister-in-law, who used her services when she had our nephew in April. Walking in, our plan was to take Bradley classes from the doula but pass on her other services.

It may be hard for longtime readers of this blog to believe, but I am typically private when it comes to medical stuff. I don't like people to see me when I am sick or in pain. I don't like an audience when I'm not up to par. I don't like hospital visitors or even visitors to my home when I'm recovering. Given what I have heard about childbirth, it seemed that I wouldn't want more people than absolutely necessary in the delivery room. Truth be told, I wouldn't even have Brian there if I thought I could get away with it. I'd just retreat to a cave and do it all myself.

Brian isn't budging on being in the delivery room so I'm warming up to the idea. Having a doula, or childbirth assistant, on the other hand, seemed to be unnecessary and smothering. But then I met Dawn, and I began to see the benefit of having an experienced professional join us in the delivery room.

Highly Recommended
Dawn Brown is the most experienced doula I have heard of in the Merced area. She comes highly recommended by midwives and former clients. And in her line of work, reputation is everything. Since doulas are lay people, they only have their reputation to support them. They aren't like doctors who can hide behind insurance coverage or hospital contracts. If they don't meet their clients' needs, doulas quickly find themselves out of work.

My sister-in-law describes Dawn as "very earth mother." My best friend would say she's "crunchy," meaning she's a granola muncher. I would describe her as a gentle spirit who seems more concerned with the desires of expectant moms and dads than her own. I like that a lot.

Dawn definitely has her own belief system, and it's apparent with one look around her home. She homeschools her children, practices attachment parenting and I would almost guarantee she still share a bed with her kids from time to time. But in our consultation with her, it was all about us -- and I like that a whole lot.

Dawn's way of working is to ensure that each couple gets the labor experience of their dreams -- whether that means all natural all the way, medicated and artificially assisted, or somewhere in between.

When seeing medical professionals, it's all about them -- all about hospital protocol, insurance requirements, policies and procedures. Only after those bases are covered do you, the consumer (or patient) count. It's a sad fact of life in current society. Sad but true.

Full-Service
After meeting with Dawn for about two hours, both Brian and I saw the value in the service she provides. First and foremost, we get her focused attention. At my OB appointments, I tend to wait for an hour to see my doctor for 10 minutes. With Dawn, we are her only priority at that time. She also makes house calls. I might not be so hesitant to visit doctors if they were all as willing to come to my home as she is. It's a nice benefit.

We'll meet with Dawn at least four times before the baby is born. During visits, she'll do her own basic OB exam to get a sense of what is normal for my body (vital signs, fetal growth, fetal heart beat, etc.) and also for our baby. This will enable her to better assess me when I'm in childbirth.

Dawn, a longtime Bradley Method instructor, will also handle our childbirth preparation classes. Though no longer a certified Bradley instructor, Dawn has years of experience that I think will come in handy as we make our plans for natural childbirth.

Dawn is also available to us 24/7 -- for questions, concerns or even just to talk. Can you imagine calling your doctor in the midst of a hormonal breakdown? Not likely that he/she would even take your call.

When the time comes that I feel I'm in labor, Dawn will come to our home and help me labor in the privacy of my own home until the time comes for me to go to the hospital. More time at home means less anxiety for me. My last hospital experience was not a good one. I don't look forward to being on the receiving end of hospital care again. But I also know that in this instance, it's necessary. I am not a good candidate for home birthing. It's in both mine and the baby's best interests to be in a hospital, but limiting my time in the hospital will enable me to stay calm longer, I think.

Worth Every Penny
Most doulas charge a flat fee for their services. Dawn's is $1,000. Sounds steep at first, but when you think about it, it's not much at all. Bradley classes cost around $350. Though Dawn is not Bradley certified any longer, you can't tell me all that knowledge suddenly fell out of her ear just because she didn't renew a piece of paper. Using her services means we don't need to seek out private childbirth preparation classes. Since she's on call 24/7, we can pick up the phone anytime something doesn't seem right and get immediate answers without having to trudge into the hospital ER on a fact-finding mission that might end in a diagnosis of "it's nothing" or "that's just false labor." ER visits cost about $100 each under my insurance plan if I'm not admitted to the hospital. Just in the final stages of my pregnancy alone, it's easy to see how fast that could add up.

So, though we originally met with Dawn for a small portion of the services she provides, we ended up contracting with her for full care. I'm excited at the prospect of working with her, and so is Brian. I think we're a good match, and I think she's going to enrich our labor and delivery experience -- something that is very important to me.

Recipes: Comfort Foods

About a week ago, I hosted a baby shower for a dear friend and former roommate. D and I have known each other for more than a decade, and it was exciting for me celebrate the upcoming birth of her first child by hosting a shower in her honor.

D told me she had been craving comfort foods, such as pastas and casseroles, so I decided that her shower should feature a collection of traditional family favorites. However, there were also some dietary concerns to consider: One guest was allergic to garlic and a highly sensitive diabetic; another was vegetarian; and then there's me with my WLS-related restrictions. It felt like I was cooking too much food in order to accommodate all of the special needs, but it turned out to be perfect. Considering we didn't have a whole lot left after the event, I would say the menu was a great success. Allow me to share the recipes here. Keep in mind that not all of the recipes are WLS-friendly (such as the pasta dishes), but the entire menu featured something for everyone.

The top picture is of the fruit tray I made. I believe that the key to stress-free entertaining is mixing homemade specialties (preferably ones that can be made ahead or prepared with little fuss) with convenience foods. For this fruit tray, I decided to keep it simple. I bought the melon, apples and pineapple pre-cut and washed from the grocery store and added the grape clusters after giving them a rinse.

As for the fruit dip in the middle, that's just honey-flavored Greek-style yogurt purchased from the natural foods section. It's naturally sweet and creamy without overpowering the flavor of the fruit.

Another successful aspect of the dish is the serving container. I purchased this sectional server from a consultant at a Pampered Chef party this past summer. What sets it apart from other similar pieces is that it has gel inserts under where the fruit is and also in the dip container, which can be frozen ahead of time. This kept the fruit and dip ice-cold throughout the shower, and it made for a much more pleasant eating experience for our guests.


Baked Penne

16 oz wholewheat penne (ziti or rigatoni can also be used)
16 oz. hot Italian sausage, casings removed (or you could get bulk)
1 pkg pepperoni (or as much as you want)
16 oz. fresh ricotta cheese (I use Trader Joe’s brand)
1 round mozzarella, shredded
2/3 parmesan cheese wedge, shredded
1 large jar of red pasta sauce (I use Trader Joe’s Vodka Sauce)

Cook pasta in a pot of salted boiling water until al dente. While that’s going on, brown the sausage, breaking it up with a spoon as it cooks. Put on paper towels when done to drain grease. Mix ricotta with half of the mozzarella and half of the parmesan.

When pasta is done, drain and put back in pot. Mix in cheese mixture. It takes some work, but the heat from the pasta will melt it and make it all gooey. Then add sausage and pepperoni (I use scissors to coarsely chop half the pepperoni and leave the other half whole for variety in texture). Once it’s all combined, mix in the pasta sauce and stir thoroughly. Pour mixture into a 13-by-9-inch casserole dish. Press it down firmly. Top with the remaining mozzarella and parm. Bake at 350 for 30 minutes or until cheese is bubbly and edges start to brown.

Allow to sit at least 15 minutes before serving.



Baked Macaroni and Cheese

This recipe comes from my best friend's mom. It's best made right before serving, but you can cut leftovers into cubes and dip in egg and breadcrumbs for fried mac-and-cheese the next day. Note: I mixed in a little parmesan and mozzarella (leftover from recipe above) to make for a more adult version. It worked well.

2 Cups uncooked elbow macaroni (I used tri-color brown rice radiator pasta)
½ cup butter
½ cup flour
1 ½ cup milk
1 ½ cup sour cream
1 tsp salt
¼ tsp pepper
10oz bar sharp cheddar cheese, grated

Preheat oven to 350

Cook macaroni in salted boiling water according to package directions. Drain and rinse with cold water. Pour into 3qt casserole dish.
In a saucepan, melt butter and stir in flour. Gradually stir in milk and sour cream. Add salt and pepper.
Cook over low heat, stirring constantly, until sauce bubbles and thickens.
Reserve 1 cup grated cheese for the top of the casserole. Toss macaroni with remaining cheese. Pour sauce over macaroni and mix thoroughly. Sprinkle with reserved cheese. Bake for 1 hour, or until bubbly and brown


Spinach Quiche
This recipe comes from my best friend. She made it for my bridal shower, and I was instantly smitten. I will never host an event where I don't serve this! Note: She pours her quiche into a pie crust. I prefer my quiche without crust. Either option is tasty.

1 (10oz) pkg. frozen chopped spinach, thawed
1 bunch green onions, finely chopped (white parts only)
6 eggs, beaten
1 (16oz) package cottage cheese
1 cup shredded cheddar cheese
1 cup Asiago/Parm/Romano blend (shredded)
1/4 cup crushed croutons (plain)

Preheat oven to 325 degrees
Drain all liquid out of spinach, stir together with green onions,eggs, cottage cheese, cheddar cheese and asiago/parm/romano blend. Pour mixture into baking dish coated with nonstick spray.
Bake uncovered in preheated oven for 45 min, remove from oven and sprinkle with crushed croutons. Return to oven and bake for an additional 15 minutes or until eggs are set.



Chile Relleno Quiche
This recipe actually comes from Susan Maria Leach's "Before and After." However, she calls it "green chile cheese puff." I have renamed it when I make it because I have found that here in California, a chile relleno quiche sounds more appetizing to people -- but it's really all the same. The original recipe calls for medium cheddar cheese, but I prefer it with pepper jack.

Nonstick cooking spray
1/4 cup all-purpose flour
3/4 teaspoon salt
1/2 teaspoon baking powder
6 large eggs
2 tablespoons butter, melted
1 cup 2% low-fat cottage cheese
1 cup freshly shredded pepper jack
Two 4-oz cans diced mild green chiles, drained

Preheat the oven to 350. Lightly coat a 9-inch glass pie plate with cooking spray. Sift together flour, salt and baking powder into a small bowl and set aside.Beatthe eggs in a large bowl with an electric mixer until doubled in volume (about 4 minutes). Blend in the flour mixture and melted butter. Stir in cottage cheese, pepper jack, and green chiles.
Pour mixture into prepared pie plate. Bake in the middle of the oven for 30 to 40 minutes, until the top is puffed and golden -- and a sharp knife inserted near the center comes out clean.
Serve with sour cream and salsa.

21 Weeks and Counting

5 months

4 months

3 months

It's hard to believe I'm halfway through my pregnancy already. Seems like only yesterday that I was staring at a digital pregnancy test in disbelief, waiting for "NOT" to appear in front of the word "Pregnant."

Now we're halfway through and talking baby registry, home repairs, childbirth education and everything else under the sun that is baby-related.

I had my 5-month check-up Monday, and the baby seems to be perfectly normal (at least until he/she is born and takes on personality traits from his/her parents -- at least we know we're weird). The baby's heartbeat is strong, and he/she appears to be growing at a perfectly normal weight.

I, on the other hand, have a few pregnancy-related challenges that I'm working to overcome. My doctor is diligent is monitoring my vitamin levels. I'm still deficient in Vitamin D, but my anemia has become more aggressive.

It's funny. Between WLS and the bowel obstruction, I've learned a lot about reading doctors. There's a definite difference between getting a call from the doc's nurse who reports, "Umm...looks like your iron is a little low," and getting a call from the doc herself saying, "Uhh...yeah...I just received your lab results and your iron is quite low. Did you run out of vitamins?"

The silence on the other end of the line was deafening when I said that no, I had plenty of vitamins, was still taking them and didn't realize there was a problem.

So now, I'm on an even bigger cocktail of supplements. I'm combining chewable and tablet prenatal supplements, and combining my SeVate with a standard ferrous sulfate supplement. I'm learning to disperse my doses throughout the day to avoid stomach upset and to improve the opportunity for absorption, but it's a work in progress.

Brian is a great helper when it comes to reminding me. This "prego brain" phenomenon I keep hearing about makes it easy for me to lose track of which pills to take and when. But I'm getting better.

My other no-so-fun pregnancy side effect is water retention. My legs, ankles and feet are swelling to the size of tree trunks! Despite a dear friend's assurances that tree trunks are considered sexy in some countries, it's disturbing to watch one's formerly cute feet get bloated and distorted by excess fluid.

The doctor assures me there is nothing to worry about. My blood pressure is steady around 110/67 so preeclampsia isn't a concern. She says that this is just how my body is reacting to its newest resident. That's the upside. The downside is that there isn't much that can be done about it. Reducing sodium during pregnancy has been proven detrimental to expectant mothers so that's out. Mint Bliss lotion helps the swelling subside overnight, but it never goes away completely.


The doc's best advice? Elevate whenever possible. Lie down whenever possible. Drink lots of fluid. Avoid long car rides or any activity that requires sitting for prolonged periods of time.

Eventually, the swelling is likely to impede mobility, so we're already planning for my medical leave to take place in early December instead of early January.

I'm trying to look at the extra time off as an early Christmas present -- more time to plan/prepare for Baby Kubo's arrival. I imagine by that time, I'll probably relish the break and the excuse to loaf about all day.

We shall see.

Reality vs. Expectation

I have a confession to make: Pregnancy is not what I expected.

I know every pregnancy is different. Some women throw up for nine months straight while others never even feel queasy. Some women get crampy and irritable while others glow and have the best time of their lives. "Normal" is relative to your personal experience.

I have always viewed myself as progressive and modern. In the years that I was dreaming of being pregnant and trying to get pregnant, I had great fantasies of what I would do and how I would act when my dreams came true.

As someone who used to be the size of a small house, I always looked as pregnancy as the one time to be able to let go. I figured I would embrace my curves, the roundness that is supposed to be there. Nobody lectures pregnant women on what or how much they eat. It's the one time in a woman's life when a protruding belly is a good thing and not an object of scorn.

I always envisioned myself to be the girl in the form-fitting clothes, even baring a little taut rotund midriff now and then. Naked preggo bellies are so cute to me!

Alas, my dreams have not matched my reality. Instead of rockin' my baby bump, I feel more like the girl immortalized in the "Rockin' the Beer Gut" song that I hate so much. I don't feel voluptuous and curvaceous. I feel frumpy and awkward.

I have cute maternity clothes, but they are all far from the sexy styles of what celebs like Gwen Stefani and Nicole Ritchie have worn in their prenatal stages.

I'm not miserable by any stretch of the imagination. After all, my only experience with morning sickness was about 10 days of feeling like I was on a boat in stormy waters. I don't have half of the maladies that other pregnant women get. Pregnancy is truly an enjoyable experience for me. I feel like myself -- only better.

I just don't feel like a sex symbol. And that's perfectly OK. It's not what I expected, but it's who I am right now. I might feel differently as the pregnancy progresses or during my next pregnancy. But for right now, I'm just learning to accept the changes my body is undergoing and embracing my form as it emerges.

Strength in Numbers

I am so blessed to have the good fortune of being pregnant at the same time as a handful of other incredible women I know. I have a friend due Oct. 31, three friends due in December, one due in January around the same time as me and another due in February.

A few of us have started a Yahoo Group, where we can connect online and share tips and experiences with one another. We call ourselves belly buddies because we'll be watching our bellies grow together. It's great because we can update everyone at the same time with just a click of the mouse, and it's there for us 24/7 if we can't sleep or have an immediate need.

Having girlfriends is a great thing, but having women along the ride for this journey is even better. I'm not knew to the world of children. I spent over a decade raising other people's babies as babysitter and private nanny. I learned to change diapers long before I ever learned cursive. Kids are nothing new or strange to me.

Pregnancy, on the other hand, is a new experience. Out of all of my belly buddies, I'm the only first-time mom. That means, I have a wealth of knowledge to pull from when it comes to getting my random pregnancy questions answered. I don't have to plow through books or spend hours on the Internet only to freak out about worst-case scenarios. Instead, I post a simple message and within moments (or sometimes, hours), I get answers flooding back. Almost always, they set my mind at ease.

The only thing that could be better is if we had another WLS mom in the mix...that would truly be another woman who is walking my path. But the fact remains that I'm very lucky to have these women to guide me -- we're all lucky to have each other.

Oops...I did it again!

Ever feel like you're king/queen of stupid? That's how I'm feeling this morning. I swear, I'm a bright girl. Ask anybody. I went to school, managed to get decent grades in difficult classes (when I applied myself) and even went on to get one of those highly sought after bachelor's degrees that people proudly display on their walls as proof of their intellectual elitism.

Yet, sometimes, I do the stupidest things. Like most people, I don't typically go around bragging about my stupid behavior. Instead, I favor smacking myself in the head in private and vowing to use my head as more than a hat rack in the future.

But last night's senseless act can't be kept private for many reasons. First off, writing is therapy, and maybe if I commit this one to print where it can confront me in the future, I won't be so stupid again. Second, I know there are others out there in my shoes who are guilty of my same stupidity. I am posting today to give them hope. I'm sure that like misery, stupidity also loves company.

I have reactive hypoglycemia, a somewhat uncommon form of low blood sugar that is now known to be a side effect of certain malabsorptive surgical weight loss procedures. I say "now known" because reactive hypoglycemia didn't have a name or much attention untill 2007 when bariatric researchers started studying patients who had a very odd reaction to consuming certain foods.

Instead of causing their blood sugar to skyrocket, simple carbs and sugars (even natural ones like in fresh fruit and juices) caused their blood sugar to plummet. In the world of blood sugar, 80 to 100 is good; 50 to 79 is when even normal people start feeling shaky or grumpy and need to find something to eat quick; under 50 signals danger with big, red flashing lights. Scientist dubbed this condition "reactive hypoglycemia" to group the patients whose blood sugar fell in reaction to the very foods that should have elevated it.

So, see, I'm special...unique...everything my mommy said I was when growing up. She just apparently left out the other qualifiers to indicate my natural inclination toward senseless behavior.

I rode the reactive hypoglycemia roller coaster for about a year after my emergency intestinal surgery in 2007. Those knotted innards were either slowing nutrient absorption enough to allow my body to react normally to complex carbs and sugars (simple sugars and carbs were always my enemy) or the reactive hypoglycemia was triggered by the trauma of that health crisis. No matter what, 2007 was a nightmare year for me. I didn't understand the rhyme or reason of what my body was doing, and not one of my "expert" docs could help me figure it out.

Then I moved to Merced and met a physician's assistant to whom I owe my life. Not only did she know about and understand reactive hypoglycemia, she taught me to manage it. She even gave me a glucometer to help me monitor my sugar levels at home. It was a newfound freedom to be able to equate my symptoms with one of the glucose zones I listed above. It also helped me figure out my body's rhythm. For example:

On a typical day, I wake up with a blood sugar level of 100. Then I eat breakfast and it drops to 80. If that breakfast is high in protein, I stay at 80 till my next meal. If it is not -- or if it includes sugars like toast, jam, juice or their ilk -- then it drops to 70 and sometimes 60 within 30 minutes. And I find myself forced to eat regardless of hunger just to achieve balance.

In the last 18 months or so, I've learned a lot about my body. I've learned that my hypoglycemic episodes are triggered by stress in addition to food, which means I sometimes suffer severe low episodes during stressful times (like when a deadline looms at work or I'm confronted by a personal crisis) even if I'm eating like I should.

Enough back story, let's talk about last night.

Last night, I had dinner with friends. I'm usually really good when eating in social situations. The conversation and activity provide enough of a distraction to give me time to step back and make wise eating choices. My worst moments are when eating in a rush. We had a family-style dinner that featured lots of chicken, veggies, noodles and rice.

Typically I would serve myself tablespoon-size portions of noodles and rice with four times the amount of chicken and some veggies so that the protein and fiber in my meal could slow the absorption of the carbohydrates. I might feel a little fatigued after that -- what many refer to as "food coma" -- but I would be otherwise fine.

However, I'm four months pregnant. And pregnancy has added nuances to managing my hypoglycemia: I find meat less appealing than usual and I have to share my available blood sugar with the baby growing inside of me. The good news is that the baby will always get what he/she needs. The bad news is that there is not always enough left over for me.

So last night, I go to serve myself what I know I should eat only to realize the chicken is unappetizing to me. I have a mental battle with myself (eat it anyway; no, if you eat that, you're going to throw up in front of everyone, eat it or you'll get sick, don't eat it or you'll get sick...and so on). I tried to compromise by serving myself two small chunks of chicken with a heap of veggies and sauce in hopes I could disguise the texture.

My plan seemed to work. I got through dinner, making sure to eat enough to satisfy me without overeating. After the meal, we sat and socialized for 30 to 40 minutes. I felt that faint feeling of fatigue that told me I would need a protein boost when I got home, but the conversation wasn't lulling to the point that it was clear we'd leave anytime soon. One friend ordered a sweetened beverage. It sounded good, and for a moment, I thought it would give me a needed boost till I could get home.

This beverage is one I've had before and I know that if I order it before my meal, I can sip it super-slowly while eating and suffer no ill effects. I've never tried order it as "dessert" before. I've surely never tried drinking it by itself without some type of protein to balance it out -- and I've never been dumb enough to drink almost half of it in the span of 15 to 20 minutes.

But last night, I was apparently struck stupid and did just that.

By the time I got home, I was feeling queasy. I had a long list of work to do and couldn't be bothered to listen to my body so I drank a glass of water. Thirty minutes later, I was soaked in sweat: That's the first symptom that I'm in the danger zone. I went to the bedroom and tried to undress myself but didn't have the dexterity needed to accomplish the task. I manage to send Brian (who had just gotten home) a text: "C me." When he got to the bedroom, I was lying in the fetal position and tugging at my clothes. He helped me out of them and instantly knew the problem.

True hypoglycemic episodes cause sweating, shivering, shaking, brain fog, impaired speech and hallucinations. And I was in the throes of every symptom at that time. I didn't realize he left but he returned with string cheese and a glass of water. He started prepping my glucometer to test my sugar for a benchmark. I was at 30.

I had trouble wrapping my brain around the situation but I knew that something was missing. In the danger zone, you need 15g of pure sugar -- fruit juice, honey, candy, even cake frosting -- to give your body an immediate boost before consuming something equal in protein and carbs (like cheese) to balance the sugar levels and head toward normal.

I tried to think of what was in the house he could give me, but it was hard to think and harder to articulate. Finally, I muttered something about chocolate and he brought me a small piece -- less than an ounce. I grunted and stuck it in my mouth. It was a good choice because it melted without much chewing. Next was the cheese. Chewing was very difficult. I was having trouble getting my brain to cooperate with my body, but I was managing.

Brian helped me test again. 50. Getting better. Lucidity should have come at any moment, but I found myself still slipping in and out. I was trying to think of my trigger. I remembered my after-dinner drink. Stupid, stupid, stupid. I asked for another cheese stick.

Then I had a brief hallucination of dying and winner the 2009 Darwin Awards for doing society a favor by chlorinating the gene pool. Just my luck.

I tried to stay conscious while Brian soothed me with a cool cloth, but something didn't feel right. I had him help me test again. 40. Brian said 30 minutes had passed since it all started. Crap. Sliding backward...why was that happening?

Struggling to remember my doctor's instructions, I couldn't decide whether to have Brian seek medical help or try to eat more sugar. The backslide didn't last long, the fog lifted a little, and I remembered the final part of my doctor's advice: "As soon as you're stable enough to walk under your own power, get to the kitchen and eat something else...ideally, protein and carb.

I couldn't fathom eating more cheese or touching any meat so I settled on a little nectarine with a few spoons of heavy whipping cream. Small amount of protein, small amount of carb. Besides, I'd rather dump from the dairy in the cream than feel like I felt.

That did the trick, and it wasn't long before recovery fatigue set in. For me, episodes like this are followed by extreme fatigue. My body likes sleep while it heals itself. I can easily sleep 12 hours after an experience like this. Usually, it's a dead sleep. Sometimes, though, it's filled with vivid dreams. Last night was a vivid seven hours of dreams. I woke up as exhausted as when I lied down. I immediately went to the kitchen for more fruit -- just in case -- which I will shortly follow with another cheese stick. Today will have to be a good eating day so I can build up my body's glucose stores.

It's a stiff lesson. It's probably been a year since my last episode of this level of severity. Writing it all out is hard, because nobody likes to admit to being senseless. But it's also necessary. I know what I did last night is standard behavior for others with the same affliction as me. They feel out of control, maybe even desperate. Some may not even understand why their bodies do what they do. They need to read stories like this to know they aren't alone -- and that there is hope.

For me, it drives home the same message I've been telling myself since 2007: I am not anatomically normal, and I probably never will be. But, like most things, this can be managed. I just have to take care to do so. The best news ever, though, is at least I don't have to worry about my stupidity affecting my child -- unless stupidity is genetic. If that's the case, let's hope the baby has Brian's intellect.

It's a ... baby!

Yesterday's ultrasound showed me at 17 weeks and altered my estimated delivery date to be around Jan. 23. It also showed a health-looking baby with two arms, two legs, a brain, spinal cord and beating heart -- with all of the necessary parts to connect each. So far, so good.

We've chosen not to find out the baby's gender. We like surprises.

It was an amazing experience. Seeing the baby swim around, flip and flail was incredible -- especially since the amniotic fluid absorbs the impact at this stage and I don't feel a thing. We were also able to hear the heartbeat, which was a first for Brian but no less thrilling for me the second time around.

It's amazing how each new experience drives home the reality of what's to come in just a few short months!

Obesity and health care

On Sunday, the San Francisco Chronicle published "Obesity a Crushing Weight on U.S. Health Care," which points to the obesity epidemic as a driving force behind the high cost of health care.

Duh.

Seriously, it's taken this long for a reporter to make such a conclusion? And I thought us journalist types were supposed to ahead of the curve.

Obesity is linked to a variety of nasty life-threatening conditions: Type II diabetes, high blood pressure, congestive heart failure, certain types of cancer. Diseases -- especially ones like diabetes and cancer -- are expensive to treat. Therefore, it stands to reason that obesity is linked to high health-care costs.

I remember when I was originally researching surgical weight loss. There was a lot of controversy at the time over the BMI requirement most insurers had for patients to qualify as having a medical necessity to lose weight.

WLS experts and obesity researchers talked about the cost benefit of covering weight-loss surgery for people with BMIs of 35-40 because they thought it was easier for a smaller patient to physically withstand the rigors and trauma of major surgery. They also believed that patients who were able to drop a large amount of weight BEFORE their bodies sustained irreparable damage from excess weight would be more successful in the long run. Insurance companies, on the other hand, viewed weight loss as a vanity measure and didn't want to cover it until it had already caused life-threatening diseases. Only then did the cost of the surgery win out over the cost of managing a long-term disease.

I also remember being very angry back then that WLS was my only option for insurer-covered weight management. I couldn't understand why an insurance company wouldn't pay for a year of intensive nutritional counseling and personal fitness training in an effort to prevent a patient from ever needing surgery.

At that point, I was able to speak to someone in the insurance industry. She was blunt and to the point: Insurance companies could not justify the expense of an obesity treatment that depended too much on an individual's compliance. People are fickle, and they sabotage themselves, she said. Paying for a year of nutritional and fitness counseling offered the insurance company no guarantee. However, surgery did. At least with surgery, there was a higher chance of immediate and long-term results.

My, how the pendulum has swung in the last five years. Now, many insurance companies require potential WLS candidates to undergo six to 12 months of medically supervised weight management before surgery can be approved. Some programs are hosted in hospitals by third-party groups. Others are offered by bariatric surgery centers. And others are semi-private. The motivation behind the programs are as varied as their sponsors. Some are merely there to prepare patients for life after WLS, which is the patient's ultimate goal anyway. Others are focused on getting patients on the track to better health so they abandon their desire for WLS. And others fancy themselves to be objective, saying they don't promote or condone WLS procedures but that they don't discourage their participants from pursuing surgical weight loss either.

One thing is certain, despite the increase in WLS over the last five years, obesity is still an epidemic and those afflicted are getting younger and younger.

Solutions mentioned in the Chronicle article include limiting fast-food establishments, creating public gardens and taxing junk food. Making healthy living more convenient and affordable sounds like an easy answer. I wish it were.

But the reality is that humans are human, and we've created this conveniently unhealthy culture we live in. If there were a public garden in every neighborhood, how many people would truly take the time to tend it so that it reaped a harvest that everyone could benefit from? And would that truly reduce the amount of processed foods each family consumes?

And as far as taxing junk food goes, I think that will have a marginal effect on consumption as well. I remember when cigarettes were first taxed in the 1980s. My mother, a longtime smoker, was not about to pay an extra 25 cents a pack for cigarettes and she quit cold turkey. But you know what? Her friends didn't. They all complained about the tax, but they kept smoking. Some still smoke today, and I don't think they've cut back. I imagine a junk food tax would have the same effect. Some may quit fast food altogether, others might cut back on trips to drive-thrus and soda/candy purchases, but many will cut other expenses just so they don't have to be inconvenienced.

Looking at my own situation, I can honestly say I hope my children never know what fast food is. I don't want a drop of McDonald's, Jack in the Box, Taco Bell, etc., to ever touch their lips. But is that anything more than a pipe dream? Fast-food advertising is everywhere: TV, billboards, radio, vehicles, clothing, the list goes on. How do I shield my children from that when I can't even shield myself?

I don't want my children to suffer my fate. I don't want them plagued by the social stigma and physical limitations of obesity, but I also know I can't raise them in a bubble. I am glad that obesity is back in the spotlight as a public health issue -- because it really does affect the entire population. At the same time, though, I realize that it is my job to ensure my children develop a healthy relationship with food and that they maintain a healthy level of activity. It may not be easy for me to cook dinner every night and take the time to play outside with my children, but if I don't, who will? And if I don't take the time to ensure my children are active, who will I have to blame when they develop sedentary habits?

The sound of a beating heart

I had my four-month OB visit on Friday, and I was very excited to hear the baby's heartbeat for the first time. It's an incredible sound that really brings home the reality of having a little person quickly growing inside of me.

My ultrasound is scheduled for tomorrow morning, and I'm looking forward to another view inside my womb. It's been six weeks since the last one, and I can't wait to see the changes that have happened in that time.

My doctor and I had a great talk about hypoglycemia and pregnancy. I was comforted to know that my hypoglycemic episodes will have no effect on the baby. It's just a matter of trying to ensure there is enough glucose to support me so I'm not always fighting the symptoms of low periods. I have had a handful of moments where my sugar falls between 40 and 60, but I've been better about staying around 80 for the most part.

We redid my labs on Friday to see how my vitamin levels are doing. The results should be in this week, though I may not discuss them with the doctor until my visit in September.

Vitamins, vitamins and more vitamins

The top priority for any women when trying to conceive or upon discovering she is pregnant is to get on a high-quality vitamin program to ensure her growing baby has all of the nutrients necessary for development. Normally, doctors prescribe a brand they prefer. Some docs are OK with patients taking over-the-counter vitamins, but my experience has shown a strong preference for prescription vitamins during pregnancy.

Since my bowel obstruction, I have struggled with ingesting and process pills and tablets. Even though, it's been four years since I had gastric-bypass, my digestive system has retained many sensitivities since the emergency surgery I had in 2007. For that reason, my doctor and I chose to augment my current vitamin routine to ensure I'm getting the necessary amounts of vitamins and minerals without overdosing on any one nutrient.

Here's what I'm taking daily right now:

• 2 Bariatric Advantage high-potency (extra A, D, E, K) chewable multivitamins -- Before pregnancy, I took 1 daily
• 10 Bariatric Advantage Calcium Chewy Bites (250 mg of calcium citrate each) -- Before pregnancy, I took 5 daily
• 1 Bariatric Advantage sublingual B-12 tablet -- Before pregnancy, I took 2 per week
• 1 Se-Vate iron supplement with succinic acid and B12 (generic for Repliva, which has since been taken off the market) -- This is the only tablet I swallow daily.

Obviously, my vitamin expenses have increased during pregnancy. But I figure it's better to be safe than sorry. My doctor's main concern is that I get at least 800 mcg of folic acid daily and that we keep my existing nutrient levels as high as possible. My vitamin D has been very low lately and my iron still runs on the low side of normal.

I have to admit, though, that the daily B12 has really helped with my energy levels.

We're closely monitoring my nutrient levels, but it appears that so far, what we are doing works. The proof, however, will come when I deliver a healthy baby in a few months.

WLS and Pregnancy

Now that the cat is out of the bag, so to speak, about my pregnancy, I find myself hammered with random questions. There are the normal ones: When are you due? When do you find out what you’re having? How are you feeling? Etc.

And then there are the ones that remind me that I’m not normal – at least not in the eyes of others: Can you do that? What has your doctor said? Will you be able to eat enough to nurture your baby? Are you high risk?

I hate feeling like an alien, but sometimes, I think the rest of the world views me as one. Being an expectant mom is stressful enough. Especially as a first-time mom, there are a million things to consider: Medicated or natural? Hospital or home? Breast or formula? Cloth or disposable? Organic or not? Vaccinate or don’t? Co-sleeper or crib? To wear or not to wear?

And let’s not forget all the people out there who feel the need to recount labor horror stories with every pregnant woman they lay eyes on. I think there should be a special place in hell for those people.

As intrusive as they may seem at first, the questions regarding how WLS will affect my pregnancy are fair ones. It’s common knowledge that surgical weight loss affects your insides. What seems to be no-so commonly known is how your uterus is/is not affected by your intestines.

The most common questions I hear are related to my vitamin levels and eating habits. People still think you need to eat for two when you’re pregnant. Not true. You need some extra calories (300 per day to be exact), but the baby will get what it needs – if not from what you eat, then from what you have stored up. All nutrients play a role in growing a healthy baby. Folic acid is key for brain development. Iron ensures healthy blood flow. Protein builds tissue. Carbohydrates offer energy.

I know WLS patients can have healthy babies. I’ve seen it firsthand. But I also know you can have healthy babies while compromising your own health. I don’t want to be Carnie Wilson and gain 75 pounds, but I also don’t want to be so obsessed over the scale that I harm myself either.

So far, I have really enjoyed the experience of being pregnant. I was nauseated and fatigued early on, but that has subsided. I devote a lot of energy on nutrition (more on that later) and try not to devote too much time to second-guessing myself. I figure there are plenty of people out there willing to do that on my behalf.

And now...we're expecting!

The biggest development in my life this past year has also turned out to be the biggest surprise. After we were told it wouldn't happen, couldn't happen, Brian and I found out that I was expecting in early June. This has been the ultimate answer to prayer for both of us. We knew the hows and whens of becoming parents would materialize in God's timing; we just didn't expect God to be so agreeable.

Longtime readers of this column when it first appeared in the Tracy Press (long before I even knew what Blogger was), know that my desire to become a mom is what originally prompted me to consider WLS. Back then, I didn't want to be thin; I thought I was healthy and happy; I just wanted to have a baby. My doctor at the time told me I had obesity-related infertility and that surgical weight loss was my best chance at regaining my ability to get pregnant.

Since that time, I have received conflicting information from medical providers. Visible signs of fertility took a long time to materialize for me. Docs attributed it at first to the trauma of having Roux-en-Y gastric-bypass. Then they attributed it to the rapid weight loss. Then I had a bowel obstruction and yet another traumatic abdominal surgery. I was told my body was in shock, that it had been through a lot and it needed time to heal. After a year of healing, questions of whether I was ever fertile at all began to surface. Lab results were no help. One batch would show normal ovulatory function. Another would show none. It was an emotional roller coaster that I soon grew weary from.

The idea of finding love again after divorce was hard enough, but with questionable fertility, it seemed pointless. It's not exactly first-date appropriate conversation, but it's not fair to string a guy along if you're aware of information that might change his opinion of you. So I didn't date. Avoidance seemed the most painless solution.

And then I met Brian and that all changed. I went from "not dating" to "head over heels" in what seemed like the blink of an eye. We had similar histories, similar backgrounds, similar values and similar priorities. It was like coming home after a long journey through the wilderness. It was warm, safe and reassuring. No surprise that our love blossomed rapidly.

And now we're going to be parents, and we're so excited we can hardly stand ourselves. Our friends are thrilled; our families are thrilled. Did I mention that we are thrilled?

The ultrasound shown above was taken in late June and show the baby as little more than a kidney bean with a flashing pulse. My next ultrasound will be in September. In the meantime, I'm focused on a healthy pregnancy.

We WLS moms are a special sort and have to be particularly attentive to our bodies during pregnancy. My hemoglobin levels are good and I still respond well to my iron supplements, but I can't be caught off-guard. I have other vitamin levels to be mindful of, and reactive hypoglycemia is still a tricky thing to manage.

I'm confident, however, that I'm in good hands. My family doctor has delivered a number of babies from post-WLS moms and has a solid record of successes. My health concerns don't alarm her, which means they don't have to alarm me either. The pregnancy is considered normal by all standards, and I'm enjoying the experience.

And then Michelle Obama visited Merced

When the UC Merced Class of 2009 set its sights on having First Lady Michelle Obama deliver the keynote address at the university's commencement celebration for its inaugural class, I never thought in a million years that it would come to pass.

I stand corrected.

Mrs. Obama delivered an inspirational message to our graduates in May of this year, encouraging them to pay forward the blessings they had received so that others may have the same opportunities afforded to them. She talked about the daunting challenges that lie ahead for those entering the work force but reminded the 500-plus graduates that there were ample opportunities to make a difference in the world.

Her presence led about 12,000 people to brave the sweltering valley heat in order to catch a glimpse of her in person. Close to 20,000 people in all spent that day in Merced, some watching the commencement festivities from locations downtown or in the air-conditioned comfort of the homes of family and friends. Most local media outlets broadcast the event live on their Web sites. It was also broadcast on public-access cable television and on CNN.

As a public information officer for the university, I had the opportunity to coordinate media before the event and help journalists get the access they needed during the event. That meant that I, too, was bravely the 100-plus-degree weather and full sunshine. Anyone who thinks a journalist's job is glamorous hasn't been corralled in a press area without shade for hours.

Though I gave a lot of interviews in the weeks leading up to the First Lady's visit, my favorite interview came in the days after when Sam Matthews, publisher emeritus of the Tracy Press, called me up to see what I had to say about the experience. Never in all my years at the Press did I ever think I'd live to see the day when I was mentioned in Tracing Tracy Territory. I guess that makes me an official Tank Town veteran.

The experience of working with the White House is also one I won't soon forget. Politics aside, nobody can deny the fact that the Obama administration is highly accessible and gracious when it comes to working with others. I learned so much from the six short weeks we had to prepare for the event, and I am so much better for the experience.