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Monday, February 27, 2012

Sufficiently Deficient

Rather than buy myself flowers or take a trip for my WLS birthday, I did what I've done for the last seven years: get a complete blood panel. And this year, like every year since my bowel obstruction in 2007, I find that I lack the necessary vitamins and minerals for good health and general wellness.

On the bright side, my levels are better this year than they were in 2008 when I last discussed them here. My lowest year ever was 2010, when my body was recovering from having Lily. Come to think of it, 2010 was one of my most challenging post-op years, marked by minimal communication simply because I had a hard enough time facing my deficiencies as an individual, much less in a public setting like this where readers can offer their two cents. At that time, my ferritin (stored iron) was -1 and my hemoglobin was 7.8. My B12 dipped dangerously close to 200. I was also seriously deficient in vitamins B1, B6 and D.

To put it lightly, I was miserable. I felt like I was wading through cobwebs. Simple conversations were exhausting because it took every ounce of my energy just to follow along. Exercise was out of the question because the lack of B12 caused coordination issues, and the anemia (caused by low iron and low B12) caused severe muscle cramping and general fatigue. Lacking B1 and B6 meant issues with memory, cognitive thought and mood. Getting out of bed was a feat in and of itself.

We aggressively tackled the deficiencies that year with iron infusions, B12 injections and fistfuls of pills. There were days when managing my health felt like my career. But looking over my most recent set of labs, it seems like the effort paid off.

By the Numbers
Before any of us gets too excited, let me reiterate that I am still deficient in many areas. The good news with this recent set of labs is that it appears that all levels are rising. I'll take whatever good news I can get. Here's where I am at as of Feb. 24, 2012 (date of the bloodwork; bold type indicates levels are within normal range):
  • Hemoglobin -- 11.2 (Normal is 11.7-15.5)
  • Ferritin -- 3 (Normal is 10-154)
  • Total Iron -- 18 (Normal is 40-175)
  • PTH -- 116 (Normal is 10-65)
  • Vitamin B1 -- 73 (Normal is 87-280)
  • Vitamin B6 -- 6 (Normal is 2.1-21.7)
  • Vitamin B12 -- 330 (Normal is 200-1100)
  • Vitamin D -- 67 (Normal is 18-72)

To clarify, anemia is defined by the amount of hemoglobin. Not enough hemoglobin mean not enough (or small) red blood cells, which means muscles and organs don't get the oxygen they need. Though I am still technically anemic, I'm considerably less so than I was two years ago. And this is the first time that my ferritin level has been a positive number.

PTH is an indicator of whether my body is leaching calcium from my bones. My level indicates I still haven't found the right oral supplement to prevent that from happening.

The B vitamins are all much higher than they were on my last round of labs, but B1 is still lacking. Also, I seem to be among the 10 percent who have brain/blood issues with a B12 level between 200 and 400.

Plan of Action
Lab results alone aren't enough to create a treatment plan, but they are a powerful tool. I will continue my high-dose B-complex oral supplements to boost B1, and I will start monthly B12 injections again to get that number closer to 1000. My Vitamin D level is the best news yet. It means I can go from taking my 50,000 IU supplement twice a week to once a month to maintain.

I have a referral to see a hematologist to discuss the best treatment for my lack of stored iron. He will be the best person to help me determine what's needed in that arena.

Friday, February 24, 2012

Seven Years -- No Itch

They say time flies when you're having fun, but I find it flies right by just when you're living life. At least, that's been my experience in the seven years since I had gastric-bypass surgery. My head spins when I think of all the changes I've gone through over the years. Though the physical changes are most noticeable, I think it's the emotional changes that have made the biggest difference.

I remember sitting at Kaiser South San Francisco during bariatric orientation with my first husband. Part of the program involved patients at various post-op stages describing their experiences. More than one mentioned being frustrated because they were treated differently at a new size. When I think on that now, I can't help but laugh. I am treated dramatically different than I was before, but I am not bitter about it. How can I be? I AM DIFFERENT. I think differently, talk differently and interact with the world differently than I did at 350 pounds.  I am truly half the person I used to be. I don't think it's possible to undergo that big of a physical change and not be internally affected.
February 2005: Awaiting surgery.

I used to be a great observer. I think that's why I did so well in the newspaper field. I knew how to blend into the background (not easy when you're that big) until people forgot I was there. I watched. I listened. But I didn't participate. Ask anyone, that wallflower of years past is long gone. I won't lie. I think there are many people who miss her, but most have removed themselves from my present life. I grieved for the loss of some, but others are barely a memory as I have moved on. Those who are still present in my life get limited influence. I don't have the time, nor the energy, to live in the past.

Fall 2011: Almost seven years later.
I have no regrets, and there is nothing from my old life that I miss. I don't miss only being able to shop at Lane Bryant or Torrid for clothing. I don't miss my knees hurting every day. I don't miss the amount of time or effort it took me to move throughout the world. I don't even miss chocolate cream pie, which used to be my favorite dessert in the entire world. I love my life as it is right now. I love being a wife and mother. I love being an active volunteer. I love the fact that I have the energy necessary to do do all of those things and still run my own business.

When I think about it, there isn't much about my current reality that I don't relish. I feel fortunate that the tool of surgical weight loss gave me the freedom that I enjoy today. I am grateful for the changes it has forced me to make and maintain. Experts say any weight loss maintained after two years is a credit to the patient's hard work and commitment to permanent lifestyle change. If that's true, then I deserve a pat on the back. If it's not, then I owe a debt of gratitude to Kaiser, Dr. P. Legha, and the surgical team that made it all possible. Regardless, I have a deep sense of appreciation for the life I lead today, and the physical ease at which I live it.

Thursday, February 09, 2012

Review: POM Wonderful

POM Bourbon Marinated Tri-Tip. YUM!
This review is long overdue. Shortly before having Lily (yeah, that would be two years overdue!), I received a nice email from a POM Wonderful representative asking if I would be willing to review the company's pomegranate juice in exchange for a free case. I said yes, adding that I would have to disclose that I received the juice for free when my review was published. The case of juice arrived the week I was to be induced. Suffice it to say, I've had other things on my mind for the last two years. But a promise is a promise, so I'm making good on my word here.

This was not the first time I had tried POM products. The idea of cold pomegranate juice that I didn't have to squeeze myself sounded like the greatest thing since the wheel when it first hit the marketplace, and I bought a few to try. I won't lie, it's the nectar of the gods.

Headquartered in Southern California, POM grows its Wonderful variety pomegranates in the San Joaquin Valley, where I have lived my entire life. POM is the largest grower of pomegranates in the United States and according to its website, supplies the majority of the nation's fresh pomegranates and ships to more than 55 countries. Oh, and they've been generous donors to UC Merced, which already puts them on my short list of favorite corporations.

Now that you know a little about the company, let's talk about what I did with all of that juice. A case of juice goes a long way in the home of a post-WLS woman. As a sugar-sensitive post-op and reactive hypoglycemic, juice is at the top of my long list of banned foods. However, the timing of my gift was perfect. Arriving days before Lily's birth, the juice was like a gift from God. And in the end, it literally saved my life.

Allow me to explain. If you've read Lily's birth story, which you could also call my labor story, you know it didn't all go according to plan. We walked into the situation knowing that a severe hypoglycemic episode had the same symptoms of what people call "transition" in labor. We knew that when (forgive the pun) push came to shove, I would need glucose support. And that's why I had my husband pack four bottles of that delectable POM Wonderful juice in our hospital bag.

At the hospital, I tried my best to be a good patient. They had juice they wanted me to have. Too bad that "juice" wasn't really. Looking at the label (labor hadn't really started yet so I had time and energy for label-reading) left me nonplussed. The box the nurses gleeful offered me was 10 percent juice and 90 percent high-fructose corn syrup and other additives. But I'm a good soldier. I politely accepted the fake juice from the nurse and as soon as she left, ask my husband to instead dilute some of the POM juice into my ice-water cup. One container of POM Wonderful juice lasted throughout my labor experience. It provided the sugar my body needed to get through the marathon of childbirth. Their were some complicating factors along the way, as my loyal readers know. But the complications would have been much more dire had the diluted POM juice not been available to me.

Diluted POM juice was my primary source of glucose support throughout my hospital stay and during my first days home as I was learning to juggle motherhood, breastfeeding and healing.

Even through all of that, I still had six bottles of juice left. No longer needing the juice to keep my blood sugar stable, I found myself wondering what to do. It had been given to me free of charge for personal use so I didn't feel it would be ethical to give it away. However, drinking it no longer was healthy for me.

Around that time, I signed up for a freezer meal exchange group. Created for busy moms, the group focused on each member making multiple batches of the same dinner to freeze. Then once a month, the group got together to exchange meal. You walk into the exchange with five of the same meal and walk out with five different meals. Functional and fun.

Our local grocery happened to have a great sale on beef roast that month and I visited the POM website to see if I could find a way to incorporate the juice into that month's exchange. What I found was an incredible recipe for POM Bourbon Marinated Tri-Tip.  I have since followed the recipe to the letter and must tell you it's even better than the picture above implies.

However, for my freezer meal exchange, some adjustments were needed. I decided to make this as a crock pot meal. So instead of using tri-tip (a California-specific cut of meat only beginning to gain popularity in other states), I used a ball-tip beef roast. I put the raw roast in a giant resealable freezer bag with the marinade contents and froze it. Well, I did this five times, since I was part of the exchange. I gave everyone instructions to thaw the contents in the bag, dump it into a crock pot and cook on low for 8-12 hours. I also included a small baggie of pomegranate arils I had purchased from the store and instructions on boiling down the cooking liquid to make a sauce for serving.

Every single person in my group raved about this dinner dish. The bourbon prevented the marinade from completely freezing and served to continuously tenderize the meat. The pomegranate juice sweetened the marinade enough that even after three months in the freezer, the bourbon flavor didn't overpower the meat. It was a wildly successful experiment and a dish I now make often in my own home because it gives me that wonderful pomegranate flavor without the perils that come from me consuming too much sugar.

The POM site, by the way, is filled with incredible recipes for every taste and time of day. It's worth checking out. But more importantly, if you haven't already, check out a bottle of POM Wonderful pomegranate juice. It's usually found in the refrigerated section of your local grocery store's produce department. It tastes good and is good for you. And if you love pomegranate arils, visit the site today for a coupon. A dollar off makes a big difference.

Wednesday, February 08, 2012

Unhealthy Food Choices: Privilege or Right?

This photo was featured on the L.A. Times opinion blog referenced below. I'm using it here to illustrate a point.
Today's rant is brought to you courtesy of an L.A. Times opinion blog post that one of my friends shared today on Facebook. For those of you short on time or interest, I'll spare you the details and get to the point: A Florida senator wrote a bill to restrict what recipients of federal aid can buy with that money. By federal aid, the senator means food stamps or what we call "EBT" where I live. The bill would prevent the use of EBT in restaurants or on most foods not found in the meat, dairy and produce aisles. The Times' editorial board has called the bill socialistic. Some Times readers commented that recipients of food stamps are eating on the taxpayers' dime and therefore, don't have the luxury of free will when it comes to what to buy.

The Times hasn't asked what I think, but I have my own blog so I get to share my opinion anyway.
I have never set foot in the state of Florida so I can't speak to its system. But I am a native of California's Central Valley and know a thing or do about how public assistance works here.The food-stamp program has changed a lot over the last few years. Marketing efforts have given it a new image. It's now officially called CalFresh, which complements CalWorks, the new name for cash aid. If you visit the CalFresh website, you'll see the state wants recipients to make good food choices and strives to educate them on how to stretch those free food dollars the furthest. In addition to being able to use your EBT card at Jack in the Box, you can also use it to buy cheap fresh fruits and vegetables at our local farmers' markets. Welfare has come a long way, baby!

Despite all this education and glitzy marketing, obesity still reigns supreme. Local university researchers are amazed at the number of children with obesity-related co-morbidities such as high blood pressure and Type 2 diabetes. Sadly, most of those obese children come from homes with CalFresh assistance. And their obesity is evidence that healthy eating is not the norm. This proves that education (the Times' suggested solution) alone is not the answer. Knowing what to eat and feed to your family and actually taking the time to do it are two different things.

My knee-jerk reaction is to say forget choice and dictate every singe morsel purchased with public funds, if for no other reason than to serve the taxpayers' best interests. Obesity is expensive. Obese children become obese teens and later, morbidly obese adults. Obesity-related illnesses are expensive to manage and treat. But that reaction comes from the perspective of my inner 200-pound child, who still remembers the emotional and physical challenges of growing up poor and obese.

As much as I want to save our future generation from the curse of obesity, I know that children are at the mercy of the adults in their lives. American adults will stop at nothing to get what they want when they want it. I can remember as a child, seeing people in the grocery store parking lot trade food stamps for cigarettes. If this Florida bill were to gain steam and become law, food-stamp recipients wouldn't instantly become Jamie Oliver's newest converts. They would just find a way to trade those EBT dollars for the unpermitted foods they want. Instead of trading food stamps for cigarettes, people would start trading them for jelly doughnuts and potato chips.

So, if I'm saying education isn't the answer, and mandating the purchase of healthy foods isn't the answer, then what IS the answer? I wish I knew. If I did, I could use my public relations background to market it and pat myself on the back all the way to the bank.

Nutrition education and activism must continue, and each of us must lead by example. When we step up to the plate to make better choices for ourselves, we serve as an example to those around us. So the solution lies within each of us and what we buy at the store for our household, because that dictates the food served in our home and to our household guests.

Dinner time at your house may be the first time your child's favorite playmate ever lays eyes on roasted asparagus or green beans that weren't victimized by the canning process. That playmate might bravely try that asparagus, like it and go home and tell his family about it. And who knows? Maybe asparagus will makes its way to their dinner table the following week. You never know. So the next time you have company over for dinner -- whether adult friends or kid friends -- consider making dinner instead of ordering takeout, and watch for the ripple effect.

Tuesday, February 07, 2012

'Weigh' to Go!

Like a good little post-WLS girl, I went to the doctor today for my annual lab work-up. It's hard for me to believe that the 24th of this month will make seven years since my Roux-En-Y gastric-bypass procedure. But what is harder for me to believe is how my doctors respond to my weight at my check-ups nowadays. The only word I can come up with to describe it is glee. doctor is filled with glee every time she checks my weight. It's an odd occurrence to observe, considering that I was in the super-size club for so long. You know, the club where you go to the doctor for a sore throat and they find a way to make it about your weight so they can discuss diet and exercise without seeming insensitive. I spent about two decades in that club.

I don't keep a scale in my house anymore and when I go to the doctor, I don't even look at my weight. It's way too easy for me to obsess on the numbers, and I did not have gastric-bypass to have the scale serve as my external source of self-esteem. I did it to give me the opportunity at a healthier life, both physically and emotionally. And in my book, daily weigh-ins and freak-outs over a pound here or there is not healthy.

I'm still about 10 pounds over what I consider my "fighting weight" of 165 pounds -- that sweet spot for me when clothes fit perfectly off the rack and I am able to move through the world with minimal effort. But I'm also about 10 pounds less than I was when I found out I was pregnant with Lily (which followed the most stressful month of my life). I will take the weight I am at right now over where I have been any day of the week.

Sunday, February 05, 2012

Merry Christmas and Happy New Year 2012

The Kubo clan in December 2011. Photo courtesy of Donavan Garrison/DMG Photos
Time is precious. That’s all I can think of right now as I write this post. I started this blog seven years ago with a dream in my heart that if successful, I would one day be a mom. I could never have predicted the road on which surgical weight loss would have me travel – rapid weight loss, active lifestyle, near-death experience, divorce, career change, remarriage, etc. – but I am forever grateful for the vehicle.

Lily turned 2 in January. Photo courtesy of
Donavan Garrison/DMG Photos
I remember the first time a doctor mentioned gastric bypass to me. I was 280 pounds and trying to figure out why I couldn’t get pregnant. I had been obese almost as long as I could remember, but I never thought it would interfere with fertility. Docs know so much more now than they did back then but after looking at my charts, the nurse midwife said weight-related infertility was the only logical conclusion.  I left the office insulted that she thought I was big enough for bariatric surgery and then I went home and proceeded to “diet” my way to 350 pounds over the next year.

I had no interest in being thin at the time; that was such a foreign concept. But I desperately wanted a baby, and that desperation won out in 2004 when I began the process to have Roux-en-Y gastric-bypass surgery through Kaiser South San Francisco. The rest, as they say, is history.

Lily, that child I wasn’t sure I would ever have seven years ago, is now 2. And every day that I look into her eyes, I am reminded of what an incredible gift WLS can be. But it’s a delicate gift that requires careful handling and consideration. I’ve forgotten that a time or two over the years and have paid the price.

But today, I relish hearing the words, “Mommy” and “Mom” from the baby bird lips of my toddler in that soft, high-pitched voice that I know won’t last forever. I share the day-to-day discoveries on Facebook with my friends and I count my blessings even in times of frustration.

I have yet to mail out my Christmas cards but I would love to share a couple of my favorite photos from our holiday session, courtesy of Donavan Garrison at DMG Photos. I hope you enjoy them as much as I do.