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Thursday, September 24, 2009

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.

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

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.

Wednesday, September 23, 2009

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.

Monday, September 21, 2009

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.

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.

Saturday, September 19, 2009

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 wa
s 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 hon
ey-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 un
til 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 casser
ole 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.

Wednesday, September 16, 2009

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.

Monday, September 14, 2009

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.