Inside Out

Review: POM Wonderful

2012-02-09T16:24:00.000-08:00

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.

Unhealthy Food Choices: Privilege or Right?

2012-02-08T20:10:00.000-08:00

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.

'Weigh' to Go!

2012-02-07T21:56:00.000-08:00

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. Really...my 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.

Merry Christmas and Happy New Year 2012

2012-02-05T06:44:00.000-08:00

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 Iwrite this post. I started this blog seven years ago with a dream in my heartthat if successful, I would one day be a mom. I could never have predicted theroad 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 bypassto me. I was 280 pounds and trying to figure out why I couldn’t get pregnant. Ihad been obese almost as long as I could remember, but I never thought it wouldinterfere with fertility. Docs know so much more now than they did back thenbut after looking at my charts, the nurse midwife said weight-related infertilitywas the only logical conclusion. I leftthe office insulted that she thought I was big enough for bariatric surgery andthen I went home and proceeded to “diet” my way to 350 pounds over the nextyear.

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

Lily, that child I wasn’t sure I would ever have seven yearsago, is now 2. And every day that I look into her eyes, I am reminded of whatan incredible gift WLS can be. But it’s a delicate gift that requires carefulhandling and consideration. I’ve forgotten that a time or two over the yearsand 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 Iknow won’t last forever. I share the day-to-day discoveries on Facebook with myfriends and I count my blessings even in times of frustration.

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

Breaking the Cycle

2011-10-11T11:01:00.000-07:00

After a long hiatus, I’m moved to blog yet again by a comment posted on “Trying to Heal the Inner Child,” which I wrote back in 2005. Not popular among many of my relatives, the post expressed my anger about being a morbidly obese child and what I felt was the gross inaction of the adults around me.

Now I find myself wearing the other shoe, with a daughter who will turn 2 in a few months. There are times that I obsess over ensuring she doesn’t follow in my footsteps but feeling overwhelmed by all the messages to the contrary in society: fast-food restaurants on every corner, growing numbers of obesity from infant to adult, sedentary habits, etc. But I always calm myself with one thought: All I can do is all I can do.

I cannot fight the world all by myself. I can’t control what is served in other homes, but I can control the eating environment in my home. Both my husband and I work very hard to cultivate a healthy perspective on food in our home and in front of our daughter. If we don’t want her to eat it, we don’t eat it and we don’t keep it in the house. Maybe that’s why dropping my baby weight wasn’t an issue.

Seriously, though, we don’t have a “clean your plate” policy in our home, and I won’t allow anyone else to impose one upon our daughter. We offer and serve a wide variety of food and I don’t force the issue if she refuses something. I also refuse to be a short-order cook. If she doesn’t eat much of what she’s served, I know there is a snack or meal just a few hours ahead when we can try again. I will not jump through hoops to get her to eat large quantities at every eating event.

The end result is we have a toddler with a love of exotic cuisine: Thai curries, Indian dals, sushi and sashimi, and tofu are all favorites. She loves anything orange, which means there is a lot of cheddar cheese, pumpkin, winter squash, and carrots served in our home. She seems to enjoy strong flavors; sharp cheeses and spicy salsas rank high on her list.

She’s never laid eyes on a chicken nugget, and she won’t in our home. The world has way too many foods to offer for us to limit her to what can be found at drive-thru. But still, I try not to obsess. I don’t always pack enough of the right foods when we’re on the go. So sometimes we have to stop at a convenient place. She’s had apple slices and milk from McDonald’s and though I can’t tell you exactly when, I’m sure she’s had a bite of hamburger once or twice. When on the go, we try to choose sit-down restaurants or grab takeout from Starbucks, because we feel we have better control. The bento boxes at Starbucks with noodles and tofu are pricey but she sure loves them.

She also doesn’t drink fruit juice. Health professionals are always telling us adults not to drink calories, so why do we push that upon our children? As a bariatric post-op and reactive hypoglycemic, I don’t drink fruit juice. Neither does my husband. There is no reason to have it in our home, and quite I don’t think any child NEEDS it. We get a lot of odd looks from people and questions of “But what does she drink?!” as if she’s in danger of dehydration. She gets plenty of fluid from water and milk, thank you very much.

She's healthy, happy and we have no complaints. Why fix what isn't broken?

So that’s our bird’s-eye view on food in our home. What’s yours?

The Best-Laid Plans – Labor & Delivery

2010-02-02T20:43:00.000-08:00

By my 40th week, stubbornness was no longer an option. My blood pressure, which had averaged 116/64 during my pregnancy, had begun to climb. It was 134/84 at 38 weeks and 140/90 at 39 weeks. Showing no signs of protein in my urine or blood, I didn’t have pre-eclampsia but it seemed like that was the next logical step. The day before I was admitted to the hospital, my blood pressure was 150/94 and I was showing trace amounts of protein in my urine. Official diagnosis: Pregnancy-induced hypertension, referred to by some doctors as “pre-pre-eclampsia.” I wonder if those doctors also work for the Department of Redundancy Department.

Humor aside, my need to compromise wasn’t over. My doctor explained that being induced while still relatively healthy increased my chances of a somewhat natural delivery and reduced my chances of requiring a Caesarean section. Though I come from the school of thought where “natural childbirth” is defined as allowing your body to naturally do its own thing (no induction, no painkillers, no medical intervention, etc.), I found myself compromising yet again.

Hurry up and Wait
I admitted myself into the hospital at 8 a.m. Jan. 21. Since my body was showing all the signs of being ready to deliver on its own, the doctor agreed to be less aggressive and start with prostaglandin gel. The baby’s head was right on the cervix so there was no need for pitocin-induced contractions to bring the baby lower into the pelvic outlet. We just needed to get the cervix opened up so the baby could come out.

The gel did its work on my cervix, and regular contractions began shortly thereafter. The doctor visited me around dinnertime and said that we’d most likely have a baby Friday afternoon. My night-shift nurse decided to administer another dose of gel around 8 p.m., figuring it would cause my cervix to soften overnight while I slept. We called the doula and told her that we wouldn’t need her services until the next day. None of us knew at the time what lie ahead of us.

They Don’t Call it ‘Labor’ for Nothin’
The second dose of gel threw labor into overdrive for me with intense contractions starting at 11 p.m. The most intense contractions alternated between belly and back, indicating the baby was most likely sideways with its shoulder and elbow digging into my spine.

This is when I should have called the doula, but I still believed “hard labor” wouldn’t begin until the following morning and didn’t want to disturb her. Only now do I realize that was the wrong move.

Thinking I should conserve my energy for the hard work ahead the next day, I agreed to the nurse’s offer of a small dose of Stadol to help me sleep. Bad idea. The drug hit me hard and fast, making me just this side of crazy. I swear, I haven’t felt that intoxicated since taking up the challenge of drinking 21 shots on my 21st birthday. I was out of my mind but aware enough to realize I couldn’t articulate a complete sentence and should just stay quiet.

Fear Sets In
Here is where things got a bit hairy. Brian, the doula and I were all prepared for the signs of transition, which has symptoms that mirror severe hypoglycemia. We were also prepared for the possibility that I might have a hypoglycemic episode (blood sugar dipping below 50) during labor. What we didn’t prepare for is that both could occur at the same time, and that none of us would figure it out.

Between the hypoglycemia and the Stadol, I was incoherent. I couldn’t follow simple instructions and kept having flashbacks to my bowel obstruction three years ago. I had a hard time differentiating between past and present. I was terrified and couldn’t effectively communicate.

My blood pressure was escalating, giving readings of 150/99 up to 165/ 104. The nurse suggested an epidural. I fought the idea. I had already compromised my ideal natural birth experience; I didn’t want to compromise further. Yet I couldn’t figure out how I would deliver my baby when I couldn’t even figure out where I was or speak a complete sentence to anyone around me.

Seeking a way to clear my head, I agreed to the epidural. The anesthesiologist arrived at the same time as our doula. But by that point, there was little she could do for me. Instead of giving me a full epidural, the doctor administered a bolus – a temporary dose of medication – with the intention of returning to give me more later. Once the epidural kicked in and the doula began feeding me diluted juice, the fog in my head began to clear. I wasn’t numb from the epidural – just a little tingly. I could feel my contractions but I was no longer in fear. I knew where I was and what I was doing. I was able to put the terror of the bowel obstruction behind me and focus on the task at hand. Once I had enough juice in me, I realized the uncontrollable jitters, nausea and mental fog were due to low blood sugar.

I had a moment of feeling like an epic failure at the birth process since I caved to offers of drugs, but that gave way to excited anticipation that I would soon hold my baby in my arms. The bolus began wearing off after a couple of hours and my contractions got more intense. I felt the full force of each, most concentrated in my back, and my doula and Brian coached me through relaxing as each one came and went.

Getting Down to Business
It soon became apparent that the baby would arrive quickly. The nurse called our doctor and said she was on her way, but the baby had no intention of waiting. The urge to push was overwhelming, and the nurse led me through a practice push to see how effective I would be at it. Apparently, I did a great job because her next instructions were to avoid pushing and to breathe through the contractions. Fat chance, I told her. Her response: “Tonya, I cannot deliver your baby. We have to wait for a doctor.” Then she started paging residents.

I don’t know if I said it out loud, but I didn’t care if she wanted to deliver the baby or not. As far as I was concerned, she could step aside and let Brian and the doula take over. One thing was certain, the baby was coming, and I wasn’t holding back. My doula whispered to me that I could push if I wanted. So I did.

Lily Ann was born in the next push. Her cord was around her neck but the nurse calmly took care of that without much distress. She was in my arms as the OB residents entered the room in time to clamp the cord for Brian to cut. My doctor arrived just in time to handle the cleanup, which was pretty extensive given the speed at which Lily was born. But by that point, I had Lily on my chest and I didn’t care. Brian and I were in awe of her. Such a perfect little being that we created, and I birthed into the world. The achievement -- even though it required compromises on my part -- still boggles my mind.

The Best-Laid Plans

2010-02-01T19:36:00.000-08:00

I have waited my entire life to become a mother. Seriously, having children is something I can vividly recall looking forward to from the time I was about 6 years old. Raised as an only child, I also wanted a really big family, often telling people that I wanted 25 children. I was about 13 before I realized that it would take me about 40 years to reach that goal unless I had a string of multiple births. By the time I was in high school, I had settled on a much more manageable number: 6, and had a plan to start my family at 25.

But as we all know, planning and doing are two entirely separate things. I never planned to have trouble getting pregnant, I never planned to get divorced and I definitely didn’t plan on getting remarried in my early 30s – yet that’s what happened, and what led to me having my very first baby on Jan. 22.

Lily Ann has 10 fingers, 10 toes, and all the necessary parts to connect them. She’s practically perfect in every way. Yet her debut into this world did not come as I had planned.
Having spent my childhood, teens and early 20s as a paid caregiver for other people’s children, I had plenty of time to plan how I would raise my own. I babysat and nannied for a variety of individuals – granola-munching ex-hippies, modern yuppies, welfare moms struggling to get by, military personnel, etc. – and each experience taught me a little about what I did and didn’t want for my own children.

I knew I wanted to exclusively breastfeed, use cloth diapers and wear my baby 24/7. I also wanted natural birth, with my preference being an unassisted home birth but willing to compromise by having a midwife present.

My pre-existing health conditions – gastric bypass, bowel obstruction, abdominal hernia, anemia, reactive hypoglycemia – caused me to “risk out” when it came to a home birth, meaning that no midwife was willing to take on the risk of assisting me with a home delivery.

Thus began my first compromise as an expectant mom: I would give birth in a hospital, attended by a family practitioner and assisted by my husband and a doula (labor assistant) to serve as my advocate.

Then my health conditions took their toll on my body and on my pregnancy, leading me to more compromises: Ultrasounds and fetal monitoring multiple times per week and early maternity leave.

When it came to my 38th week and my doctor began discussing the possibility of induction, I was a bit like a spoiled child and dug in my heels. I felt that I had compromised enough during my pregnancy, and I didn’t want to budge one inch further. I wanted the natural delivery of my dreams, and I was determined to get it. But sometimes, fate forces our hand even when we want to be stubborn.

Lily Ann Makes Her Debut

2010-01-23T05:26:00.000-08:00

Lily Ann was born at 5:12 a.m. Jan. 22, 2010. She weighed 6 pounds, 7 ounces; and measured 18.5 inches. Details to come...

40-Week Update

2010-01-20T12:46:00.000-08:00

As my 40th week of pregnancy winds down, reality and excited anticipation are ramping up. I've been having strong contractions since last night in what seems to be proof that Skipolini's Prego Pizza really does what it promises to do. We'll see how the rest of the day goes.

Speaking of rest, that's tops on my agenda for today. They say it's important to reserve energy as much as possible during the first stage of labor to ensure you have the stamina to make it through to the end. I alternate cat naps with birthing exercises on my yoga ball. I've even managed to do a load of laundry here and there. Both Brian and I are eager to meet our little one and I have to admit that I'm eager to experience childbirth.

Though both Brian and I are techno-savvy folks, we are not planning Twitter or FB play-by-plays in the delivery room. Once we get there, we're on a mission and plan to focus on the serious work ahead of us. But until then, it's fun to text friends back and forth with our progress thus far.

I can't wait to hold our little bundle of joy in my arms!

The Final Countdown

2010-01-19T02:29:00.000-08:00

The last few weeks have been a whirlwind of activity in our home as we make final preparations for Baby Kubo’s welcome into the world. We’ve washed loads and loads of diapers, blankets and other baby-related laundry, taking special care not to go overboard in case we have a closet full of clothes that the baby will never have a chance to wear.

I have completed my newborn diaper stash with a selection of fitteds, diaper wraps, some homemade soakers from a local woman and a variety of cloth diaper wipes. We also have some prefolds and all-in-ones for future use. I’m still waiting on some custom-made pail deodorizer and wipe solution/bum cleaner to arrive in the mail. My rapid research and foray into the world of cloth diapering is worthy of its own post one day, but today isn’t that day.

We have the co-sleeper set up in our room, and the crib was picked up and assembled today. Brian is a great expectant dad, knowing exactly what to do and when. He even made sure the car seat was properly installed today, which is not nearly as easy as it sounds. Luckily, our brother-in-law is a firefighter and father, and therefore, well educated and experienced in that sort of thing.

There’s a misconception among some couples that it’s better to be the parents of the first grandchild, but I have to say that we have benefitted greatly from the fact that Brian’s sister was the first on his side to have children. We’ve been so blessed to learn from them and their experiences over the past few months. We’ve not had to reinvent the wheel, and that’s made for a stress-free pregnancy in so many ways.

I’ve enjoyed practicing swaddle and babywearing techniques on the stuffed animals I’ve kept since childhood. Brian says I’m getting pretty good at it. Of course, we’re both aware that it’s easy to be good on inanimate objects. But at least I’m getting the basics mastered. Next step: Add squirmy newborn.

I’m just beginning my 40th week of pregnancy and am eagerly anticipating signs of labor. As I’ve said before, I’m in no rush to end the experience but I am ready to meet the baby now. We’ve waited a long time to get to this point and it’s exciting to see the end in sight, even if that end is merely the beginning to a whole new experience.

38-Week Update

2010-01-10T07:56:00.000-08:00

It’s official, I am almost 10 months pregnant. It’s not until you’re pregnant that you realize it’s not a nine-month experience. I’m surprised more people don’t do the math and realize that 40 weeks equals 10 months. Then again, it’s not uncommon to deliver a baby between 36 weeks and 41 weeks so everyone’s journey really is relative.

For me, it’s been a fast few months. Even planning our wedding didn’t go this quickly in my mind.

It’s hard to believe that just a few weeks ago, I was at risk of pre-term labor and had to make some major adjustments in that arena. Now it appears, it’s all smooth sailing. My belly has grown. The baby has grown. And I have learned the art of taking it easy, which I would have previously told you was impossible.

As of our latest ultrasound, the baby is over 6 lbs and appears to be in position to make his/her debut. We have gotten some fun photos, thanks to a very patient ultrasound technician. Baby Kubo has never felt photogenic and has made most techs go insane as they attempt in vain to capture cutesy keepsake photos. My favorite photo from our last appointment is that of the baby's foot, which at 3 inches long, looks a lot like Brian's.

I’m not in a rush to end my pregnancy. I really enjoy being pregnant and having this little person moving and growing inside of me. At the same time, I look forward to meeting him or her, learning the baby’s personality and seeing how Brian’s and my genes have meshed. We hope the baby gets the best of both of us instead of the worst, but I imagine he/she will have a little of both. I'm also interested to see how accurate the ultrasounds have been. Does the baby have as much hair as it seems? Are the size estimates true or is that "plus/minus 1 pound" margin of error more true to form?

As I look over the photos I’ve been posting, I’m glad we took the time to document the past few months. It’s hard for me right now to remember life before I had a rotund belly. It’s hard to picture my pre-pregnancy life at all. It feels as if I’ve always been carrying around this little being who has required me to alter my eating and lifestyle habits. I’m going to miss this feeling when it’s gone.

Happy New Year!

2010-01-04T01:35:00.000-08:00

2010 is officially in full swing, and I am in awe of what's ahead of me this year. I know 2009 was a downer for many. The economy affected many I know through the loss of jobs, loss of homes, loss of credit and loss of loved ones.

A good friend of mine who had a pretty rotten 2009 admitted that she had a rough time when writing out her Christmas cards last year, because the only thing that went well for her family that year was in the area of finances.

"Given what's happened to everyone else in 2009, that's just not the sort of thing you can brag about," she said. So her Christmas cards were general and basic with hopes for 2010 to be better all around.

Brian and I were discussing 2009 over the weekend. We know it was a tough year for the nation in general. But even though we faced our own challenges over the year, it's hard for us to deny the incredible blessings we experienced throughout the year:

We were married in a fairytale ceremony in the company of our dearest friends and relatives.
I had the once-in-a-lifetime experience of coordinating media when First Lady Michelle Obama visited UC Merced.
We discovered I was pregnant, despite being told such a feat was impossible without medical intervention.
Brian was cast as Cogsworth in Playhouse Merced's production of "Beauty and the Beast," one of the best shows he's been in.

The year was far from perfect, but we really can't complain. We survived it relatively unscathed. And now we're looking ahead to 2010. This is going to be an equally big year for us, with a baby coming, increased involvement in our church and our first wedding anniversary all in the next few months.

I'm not doing resolutions this year but I do have goals. My primary goal is to enjoy life and my family. I love leading a busy life, but priorities are the key to harmony. When everything is urgent, nothing is important. I want to make sure I spend this year putting first things first. Everything else will fall into place after that.

No Rest for the Weary

2009-12-30T06:29:00.000-08:00

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

2009-12-29T15:07:00.000-08:00

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

2009-12-21T09:05:00.000-08:00

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

2009-12-10T08:30:00.000-08:00

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 Broo k 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

2009-12-07T00:14:00.000-08:00

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

2009-11-11T13:45:00.000-08:00

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

2009-11-01T06:22:00.001-08:00

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

2009-09-24T08:51:00.001-07:00

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

2009-09-23T14:42:00.000-07:00

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

2009-09-21T22:33:00.000-07:00

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

2009-09-19T19:51:00.000-07:00

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

2009-09-16T13:26:00.000-07:00

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

2009-09-14T23:41:00.000-07:00

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

2009-09-14T21:59:00.000-07:00

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!

2009-08-20T05:23:00.000-07:00

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!

2009-08-18T03:28:00.000-07:00

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

2009-08-17T12:36:00.000-07:00

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

2009-08-16T09:58:00.001-07:00

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

2009-08-12T09:27:00.000-07:00

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

2009-08-11T16:44:00.000-07:00

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!

2009-08-10T12:21:00.000-07:00

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

2009-08-09T22:54:00.000-07:00

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.

And then we got married

2009-08-09T22:26:00.000-07:00

Brian and I were married earlier this spring after a brief engagement. Something my health issues have taught me is that life is precious and time waits for no one. And something that Brian has taught me is that when something feels right, there is no reason to put off what is inevitable.

Our wedding was everything I have ever dreamed of -- it was original, fun and true to our personalities. We had a rockabilly-inspired ceremony and reception in my hometown. Aside from committing myself to Brian forevermore, my favorite part of the event was that we were able to support so many small business owners by hiring them to help out with the festivities.

Texas Roadhouse of Tracy catered the event, providing a sumptuous dinner of grilled chicken breast, broiled salmon, mashers and Caesar salad. Christy LoBao of Atwater made our polka-dot wedding cake and Portuguese pastries. Phaedra Rhodes of For Always Photography in Turlock photographed the event. Amber Tucker of Modesto led the style team to make sure our hair and makeup evoked the classic 1940s/50s era. Debby Carper of Denair made the bridal attire, including my oh-so-fun party dress. Lester Knox made Brian's titanium wedding band. Our flowers were provided by the Pitman High School OH Department, which enabled high school agriculture students to get valuable work experience while earning money to support FFA programs in Turlock. Pastor Shawn Marshall of Family Life Center in Stockton officiated the ceremony. Ann Jayne of Tracy designed our tablescapes and served as wedding coordinator.

We had fun, our guests and had fun, and Phae's incredible talent for photography ensured we have every minute documented forever.

Showered with shoes and purses galore

2009-08-09T20:11:00.000-07:00

The best part of getting married the second time around is that you don't have to feel beholden to tradition or societal expectation. That means that wedding planning turned out to be a lot of fun for me.

My bridesmaids decided to host a shoes-and-purses shower on my behalf. It was a complete surprise to me -- and one I really enjoyed. I'm the type of girl who loves to accessorize but enjoy shopping for accessories so I end up with just a handful of staples. Now, thanks to the lovely women in my life, I have a whole collection of shoes and purses to go with just about every possible outfit.

Aside from shoes and purses, though, my maid of honor, Amber, made sure I had plenty of pouch-friendly tidbits to nosh on. Amber made a green salad, chicken salad, quiche and appetizers. She also made a decadent chocolate cake and ordered custom cupcakes for the occasion. A nibble of each was more than enough to satisfy my curiosity. In case you're wondering, those decorative shoes and purses on the cupcakes are edible but not yummy. Better left as decoration.

And then I got engaged

2009-08-09T19:32:00.000-07:00

Last fall was a whirlwind for me. In the span of a week, I earned the free use of a car from Mary Kay, became a director with the company, turned 31 and became engaged.

I'm exhausted just thinking about it. But then again, I don't tend to do anything halfway. I'm either all in or all out; tip-toeing has never been my style.

And that also sums up how I ended up dating and agreeing to marry a man after swearing off romance for all time.

I met Brian through a coworker when I went to a production at the local playhouse. Brian was in the cast, and I was instantly captivated. Pride wouldn't allow me to admit at the time, though. After all, I was the "never girl." I swore I would never date again, love again and marry again. I was wrong. I've learned to never say never again.

Brian swept me off my feet, and our story is a remarkable one, but it's not one I'm sharing right now. Suffice it to say that I found my soul mate and am enjoying my own version of "happily ever after."

She did what?! Yes, I'm a Mary Kay director!

2009-08-06T18:40:00.000-07:00

The catalyst for all the changes I've encountered in the last year was my decision in June 2007 to join Mary Kay. Surprised? Not nearly as much as I was when I signed my consultant agreement.

I did not go to college to peddle lipsticks, but facts were facts. I needed extra money and I didn't have a whole lot of extra time to earn it. So, I followed the advice of a good friend a took a chance that something I would have never considered might just be the opportunity of a lifetime. Turns out that my friend is pretty good in the advice department. I spent most of 2007 enjoying the extra money my Mary Kay business brought in, which allowed me to re-evaluate my priorities at the time.

But the big change came in Summer 2008. That's when I decided that I wanted more out of my Mary Kay business, and I was ready to do the work necessary to get more. So I began the process of qualifying for the position, debuting as the newest director in the Future Munguia National Area in October 2008 -- and I even earned the free use of a brand-new Pontiac Vibe along the way.

I haven't looked back since, as I enjoy working full-time at my day job and building my Mary Kay business in about 15 hours a week. It's a fun way to make money, and it's a career I can feel passionate and optimistic about building.

Along the way from consultant to director, I learned a lot about priorities and what truly motivates me. I have learned that short-term sacrifices pave the way for long-term rewards and that I deserve to seek out the things in life that bring me joy and personal fulfillment. It wasn't an easy road for me to travel. I had to give up a lot of resentment and negativity that was holding me back, but in the end, that freed me for the good things to come.

Apology and Update

2009-08-06T15:04:00.001-07:00

This blog has gone neglected for some time – long enough to be kicked out of its Web rings and probably long enough to fall off the radar of most readers.

For that, I apologize.

It’s hard to take the time to write about life when you’re so busy living it. And I have been living it up this past year. Rather than recap in brief bullets what’s kept me so busy over the last year or so, I’d rather just take a little time to post on the major events.

We’ll call this one the “I’m sorry” post. It’s where I publicly apologize to all of the people who have felt neglected by my blogging absence, but consider that absence a nice, clean break that hints at something new on the horizon.

I’ve grown weary of looking back, of living in the past, and of being looked at as nothing more than this woman who writes about gastric-bypass. Believe it or not, there is move to me than how much I have weighed, do weigh or will weigh. I think it’s important to remember from where you’ve come so you can avoid the pitfalls that might lead you there again, but dwelling on the past is an exercise in futility. And I hate futile efforts.

So, look forward to a new angle on this blog from here on out. There will be lots of familiar aspects to it. I’m still going to post recipes, I’m still going to talk about what I love and don’t, and I’m still going to talk about issues related to obesity and surgical correction. But I am also going to celebrate. I want to celebrate what’s new, what’s different and choose to live life on the sunny side for awhile.

What happens to cravings after WLS?

2009-08-06T14:13:00.001-07:00

A reader recently posted a comment about her insatiable craving for chocolate and her hope to be delivered of it after WLS. Without knowing which procedure she's having, I can't do anything more than guess. Then again, so much of life after WLS is guesswork. We never know exactly how our bodies will adjust to surgery, do we?

Assuming this reader has some type of bypass or even Lap-Band, I can say that just the trauma of surgery will alter taste buds long enough to eliminate cravings for some time. But cravings eventually return, though not always how we'd expect them.

Though I still crave ice cream, it makes me too sick for me to be tempted to give in that often. Usually a bite or two is plenty. I still have a sweet tooth, but I find foods often to be "too sweet," even if artificially sweet. A half-packet of Splenda is usually plenty to sweeten anything I might want to try. Gone are the days when I would need four or five packets in my coffee or tea.

I still enjoy chocolate from time to time, but I prefer darker varieties and favor bitter flavors.

That's just my experience. I'm sure others have different tales to tell.

The one thing I can say is that worrying about it now won't help or change anything. Your body will do whatever it is it wants to do. All we can do as patients is obey our tool as best as we can.

UCSD develops new WLS method

2009-08-06T14:10:00.000-07:00

It appears that researchers at UC San Diego have figured out a new way reduce the size of the stomach, without cutting patients open or creating an intestinal bypass.

It's only been tried on a handful of patients, but this new method involves inserting an instrument through the oral cavity and down the esophagus to fold the stomach into a smaller size, which would reduce food capacity without causing nutrient malabsorption. That means post-ops wouldn't be at risk of nutrient deficiency, reactive hypoglycemia, dumping syndrome or any of the other potential complications linked to gastric-bypass procedures.

The article also states that the procedure is meant for patients who are not yet morbidly obese. This reminds me of a conversation I had with a surgeon some years ago at an ObesityHelp conference. He said that as surgical weight loss was growing in popularity, there was increasing talk in the industry about how to reverse obesity before it became a life-threatening condition.

I understood his point at the time. It's easier to operate on someone with a BMI of 35 than 55. The smaller you are, the better your body tends to handle the trauma of surgery.

But surgical weight loss shouldn't be a Band-Aid for people who need to lose a few pounds. I have always believed that it needs to be a weight-loss method of last resort. Because only when it's your last resort are you willing to make the lifestyle changes necessary for long-term success. Then again, if this procedure eliminates many of the problematic side effects associated with gastric-bypass procedures, maybe the lifestyle changes aren't as necessary. But then if you don't change your lifestyle, how do you keep the weight off?

Do Low-Carb Diets Affect Brain Function?

2008-12-15T11:49:00.000-08:00

Web MD has an article today, stating that low-carb diets may impair brain function. Read it here.

The article is as interesting as the study, which only followed participants for three weeks. Participants were tested on short- and long-term memory and attention three times during the study. I'm not sure you can come to any firm conclusions on anything after only three weeks, but these scientists have tried.

To me, the study's results are in line with what I know of how carbohydrates affect the human body. Read the fine print on any program recommending low-carb living, and you will see that advocates believe it takes 10 to 14 days to wean the body from reliance on simple carbohydrates. Withdrawal symptoms include irritability, sluggishness, lethargy and difficulty concentrating. Once the body has recovered from its withdrawal, usually people find themselves more alert, energetic and able to multi-task.

So if participants in this study only limited their carb intake for a week, it would stand to reason that they'd be in the midst of withdrawal symptoms when researchers tested their brain function. A week later, after resuming carbohydrate consumption, those symptoms would be gone.

AP: Liver Disease Plagues Overweight Kids

2008-09-08T06:20:00.000-07:00

This story from the Associated Press is sobering. Docs are finding the need for children to have liver transplants is increasing, thanks to obesity. As a fat kid, I knew the mantra of the time that I would grow out of it, that I was just big-boned or my personal favorite, that I may be big but at least I was healthy, was a gigantic load of crap.

Too bad it's taken 20 years for medical professionals to put two and two together on that one.

Kaiser Point West Says Goodbye to Gity

2008-07-25T11:46:00.000-07:00

I will be in Sacramento tomorrow at Kaiser’s Point West facility to bid farewell to Gity Tabriztchi Baxter, who is retiring from Kaiser. Those of you who are Kaiser members may know Gity from the bariatric programs in South San Francisco and Richmond.

Gity has been special to me from the moment I met her at my bariatric orientation in October 2004, when she asked the assembled group why there was so much guilt among the obese.

“Does anyone ever blame the cancer patient for their disease? Or the bypass patient for their heart problems? No. Why? Because we all understand that diseases are out of our control.”

Gity is the first person I recall seeing when I awoke from surgery. She wished me a happy birthday, since Feb. 24, 2005 was the first day of the rest of my life. And she was right, it was a happy birthday – and my life has never been the same.

I will miss her, though I know we’ll keep in touch. I just wonder if Kaiser has any idea at what they are losing.

Tales From the Dark Side, Part II

2008-07-18T06:12:00.000-07:00

In following up to yesterday’s post, I want to address my answer to the question, “Given the chance, would you have RNY again?”

WLS blogger Melting Mama, has a nine-minute YouTube video that explains why she wouldn’t. If you haven’t already, please watch the video (at the top of yesterday’s entry) before reading this. It’s not that MM wouldn’t have WLS, it’s just that given the choice, she would have picked an alternate procedure.

MM’s WLS journey is similar to mine in that we both went under the knife when we were in our 20s, both were over 300 pounds at the time, both had RNY and both now suffer from anemia and hypoglycemia as a direct result of that surgical procedure.

Yet now, more than three years later – four for her – we have very different views on what path we’d take if we could go back in time.

Why?

Because of one very key difference: MM was a very healthy 20-something who just happened to tip the scales at more than 300 pounds. I, on the other hand, was slowly dying in a 27-year-old fortress of fat. That’s the difference that makes our post-op experiences worlds apart.

Here’s my laundry list of pre-op concerns:

Chronic joint and back pain (I popped Darvocet and ibuprofen like candy);
High blood pressure (filled my first prescription for the condition at 21);
Debilitating migraines;
Infertility;
Chronic swelling;
Difficulty breathing;
Lack of mobility;

At 27, I felt like I was 80. I worked so hard to pretend the above conditions weren’t a problem and that I was “healthy” despite my weight, that I was exhausted by the end of the day. I had been morbidly obese since childhood, and my body was ready to collapse under its own weight.

After a long talk with a compassionate, yet direct, medical provider, I realized that I was on the cusp; my obesity was just beginning to catch up with me. I could continue down the path I was on and face increasingly severe co-morbidities or I could do something drastic to lose weight in an attempt to drastically reverse my course.

I chose the latter, and I haven’t had a single regret since.

Even when writhing in pain from a life-threatening bowel obstruction, I said with confidence that I would do it all over again because one day of life in a normal-size body is sweeter to me than any number in my pre-operative form.

But let’s get two things clear:

I DO NOT feel that way, because I’m “thin.” Go back and read my early posts – from before I had surgery – and you will see that I was terrified of being thin. It was a foreign concept to me at the time, something I could not wrap my brain around.
Surgery wasn't a cure-all for me. I still suffer from some of my pre-operative health concerns; they are just easier to manage at this size.

At the end of the day, my life is truly better now than it was in 2004 when I started my journey.

In my opinion, MM is not a whiner. Every word she says is true. We just have a different perspective on our situations. MM is right on the money when she calls WLS a trade-off. You give up obesity in exchange for other concerns or issues. In her case, the juice isn't worth the squeeze. In mine, it is.

She may not have had a bowel obstruction, but her hypoglycemia and nutritional deficiencies are much more severe than mine; I don’t suffer seizures nor do I need round-the-clock glucose monitoring. I also think that I’ve gotten more diligent after-care than she has – even when that bowel obstruction went misdiagnosed for six freaking months.

And I will say one thing very plainly: Reactive hypoglycemia is a nightmare.

MM says it best with the succinct comment, “Yeah, I look good. But what does that matter if I’m dead?”

If I ever came close to regretting bariatric surgery, it was when I became hypoglycemic. It’s difficult to articulate what it’s like other than to say it feels like your body is your enemy. Between that and the anemia presenting themselves at the same time, I felt like I was at the brink of insanity. The emotional and physical toll of hypoglycemic episodes were debilitating for me until brought them under control with the help of a caring, knowledgeable doctor a few months ago.

This last year has really been tough. I won’t lie. But in my situation, morbid obesity was still tougher.

Tales From the Dark Side, Part I

2008-07-17T14:58:00.000-07:00

This video, courtesy of WLS blogger Melting Mama, is a must-see for anyone considering bariatric surgery. The picture she paints is grim reality that more pre-ops need to be exposed to. It’s a nine-minute video but it’s worth the time.

It’s been almost 3½ years since I had gastric-bypass – roughly about six months after Melting Mama. Our stories are similar in many ways: we were both over 300 pounds before WLS, we both were under 30, we both had roux-en-Y procedures, and we both suffer from anemia and hypoglycemia as a result of our surgical procedures.

Despite those similarities, though, we have different perspectives on our surgeries. Melting Mama would not have RNY all over again; I would.

I don’t want to steal the video’s thunder but it addresses the biggest issue I have with the popularity of surgical weight loss: LACK OF EDUCATION.

I remember my WLS orientation like it was yesterday. After six months of waiting, I was finally at Kaiser SSF to get more information on bariatric surgery. Like Melting Mama, I wanted the LapBand; it was less-invasive than gastric bypass, had no malabsorption and led to more gradual weight loss. I was also talked out of it when the surgeon at orientation informed me it was not covered by Kaiser and then gave me his laundry list of reasons why it was a bad idea anyway.

Beside that, there was one thing that struck me as odd about orientation – my fellow pre-ops didn’t seem to have a clue about bariatric surgery or what they were getting themselves into.

At this point, I had spent months poring over articles and research about WLS. I had interviewed people who had various procedures at various times. I talked to people with life-threatening complications and ones whose post-op journey was smooth sailing. I was armed and dangerous with more knowledge than my own physician when I marched into his office and asked to be considered for Kaiser’s program.

My cohorts at orientation, however, seemed to know little more than RNY made Al Roker and Carnie Wilson lose lots of weight and that they looked thin and beautiful. I remember one man who was downright outraged when he was told he’d have to limit his intake of sugar.

“But Al Roker says he can eat whatever he wants; he just eats less.”

It was hard not to roll my eyes.

I sat through three similar group classes before making a big decision: I would document my journey in writing and share it with the world.

Up to that point, I had intended to keep my surgery private. Like many of my friends, I was merely going to have “abdominal surgery” and let people think I was having my gall bladder removed or whatever. I didn’t want to make myself a spectacle. I didn’t want to open myself up to negative comments. I wasn’t even going to tell my family.

But the reactions and comments of the pre-ops I encountered in my journey showed me there was a dearth of reliable information on the subject of WLS that was easy to access. It also showed me that when it comes to losing weight, few people read the fine print. They are so intoxicated by the idea of being thin, they don’t pay any attention to the price they may have to pay. In short, they hear what they want.

So, my mission was simple: I would write a column dedicated to the subject with the goal of educating those who wanted or needed bariatric surgery and the general public. I wanted people to understand the seriousness of the decision, the dangers of the surgery and the fact that it requires a complete change in attitude and habits. I figured that since I had already done all the research, I could make it easier on others who followed in my footsteps to be as educated as I was when it came time to go under the knife.

Sadly, I overestimated my peers. Since I started this journey in 2004, I have only come across a handful of pre-ops truly willing to weigh the pros and cons of surgery. Even more sad are the number of post-ops who actually go on to make the changes necessary for success.

The Human Pin Cushion Speaks Again

2008-07-16T12:24:00.000-07:00

My latest set of lab results just came in, and the news is mostly good.

After three rounds of iron therapy with Repliva, my hemoglobin has risen to 10.2 -- a small increase, but we're taking it as a good sign and continuing my current dosage of 150mg.

My B-12 levels are on the low side of normal at 232 with normal being considered any amount over 200. Doc isn't worried yet.

Parathyroid hormone (PTH) is elevated to 87 instead of being below 65, which -- combined with normal calcium levels -- indicates hyperparathyroidism. Don't you just love big words? Long story short, I'm not absorbing the calcium I'm taking in. I'm switching to UpCal D, which is a powdered form of calcium that mixes easily in liquid. I have a few friends who credit it with rapidly decreasing their PTH levels. I found it online for about $20 for a 16-oz canister. If you know of a cheaper source, e-mail me.

With my body having a difficult time still recovering from last year's bowel obstruction, my doctor has recommended keeping close tabs on my labs this year. We'll retest iron, B-12 and PTH in two months to see if my modifications have improved matters at all.

Maybe We're Doomed Before Birth

2008-07-15T16:08:00.000-07:00

An LA Times article suggests we may be predisposed to obesity in utero, depending on our mothers' eating habits and health concerns during pregnancy.

What do you think?

Time Flies

2008-07-10T12:47:00.000-07:00

Hard to believe it's been so long since I've posted. I was thinking about it the other day. I'm always thinking of posting on here or reminding myself to remember to post something I think is profound or would be worthwhile to others with interest in obesity or weight loss. But then I get side-tracked and it slips my mind.

I think that's what happens to most of us.

I remember a couple of years ago -- shortly after my first post-op anniversary -- that a similar subject came up with a WLS friend of mine. I had recently returned from a conference and was relaying to her how many surgeons and bariatric coordinators complained that attendance at support groups and bariatric events drastically dwindled after the first post-op year. Docs were looking for answers as to how to retain their patients' interests.

The consensus at the time was that as pre-ops, patients will jump through any hoop necessary to get doctor and insurance approval. But once they go under the knife, they become less compliant. After all, it's not like anyone can take your surgery away after the fact, right?

My friend, however, posed another explanation. She had missed her support group's last three monthly meetings at the time. Her reason? "I'm too busy living life," she said.

Hmmm...

She went on to explain: "I worked too hard in having surgery and losing weight to live my entire life according to support group schedules. I am making the most out of my new life, and if that means I can't sit through two hours at a support meeting because I'm in Shasta or Disneyland or on a cruise with my husband, then so be it. I refuse to apologize for that."

Interesting...

At the time, I thought, "good for her." She was out living life. I didn't feel like I was sitting on the sidelines, but I did make a concerted effort to organize my playtime around support group meetings and events whenever possible. Then again, I was leading a WLS support group, writing on the subject of WLS regularly in print and online and dipping my toes into the waters of private consulting. I was eating, sleeping and breathing the world of surgical weight loss.

Then another year passed and I got knocked on my backside with a bowel obstruction. The months between my second and third WLS anniversaries trickled by at an unbearably slow pace as I struggled to regain my health and vitality. It wasn't until March of this year that I started to feel some resemblance to the upbeat ball of energy I had been in my first post-op year.

Since then, life has been too good to stand. And like my friend, I'm so busy living it that there doesn't seem to be much time left over to sit down and document it. All I can say is that it's an amazing adventure -- and given the choice, I'd do it all over again.

Pumping Iron

2008-03-21T14:16:00.000-07:00

I'm just wrapping up week three of my Repliva regimen. A word of warning to anyone interested in the prescription iron supplement: The pills are HUGE! The Web site, I think, makes the pills appear to be the size of birth control pills when in reality, they are the size of prenatal vitamins.

I wish I could say I feel differently now than before I started Repliva, but I don't. It still takes me 30 to 45 minutes to get out of bed in the morning. I still feel as if I'm walking underwater as I go about my day. Every little thing feels like it requires great effort. To say I'm dragging is a bit of an understatement.

Regardless, I'm still confident the Repliva will work in time, and I have yet to miss a dose.

Annual Lab Results: The Human Pin Cushion Speaks

2008-02-28T22:03:00.000-08:00

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy Birthday to Me!

2008-02-24T18:06:00.000-08:00

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

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

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

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

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

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

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

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

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

Fast, not Furious

2008-02-15T10:40:00.000-08:00

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

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

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

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

What Price Vanity?

2008-01-27T19:17:00.000-08:00

I was just finishing up the most amazing lunch yesterday at a restaurant in Fresno when I encountered a fun group of women sitting in the booth behind me. I had overheard one woman talking of sugar-free chocolate. I turned around to tell her of my favorite brand and we started talking about diabetes, hypoglycemia and eventually bariatric surgery. One woman in the group had gastric-bypass. She told me she had dropped 85 pounds, adding that she wasn't "very big" to begin with.

Knowing that there is some elitism in the bariatric community regarding pre-op size, I shrugged and said their was nothing wrong with being a lightweight. After all, better to take control of obesity before its long-term effects take control of you.

"Oh...I had it purely out of vanity," she said.

That stopped me dead in my tracks.

Since having weight-loss surgery almost three years ago, I've encountered a variety of pre- and post-ops with varying reasons for wanting/having surgery. Though every person has given the same party line about "health concerns," I know more than a few really didn't care about their health -- they just wanted to be thin.

It was those people who I originally wanted to help when I started writing this column (now blog) in 2004. I thought educating them on the risks associated with surgery would drive home the point that this is truly a drastic solution to what should be a very drastic health condition. There are days when I feel like I've accomplished that goal, and other days when I feel like I'm hitting myself in the head with a hammer to no avail. But one thing I can say is that nobody I've encountered over the years has had the either the self-awareness or the gumption of the woman I met in the restaurant.

I applauded her for her honesty. There are many who might not agree with her decision to have surgery for reasons of vanity, but I have to give her credit for being open and honest about her motivation. At the same time, there's a part of me that worries about the implications of such decisions. Having been morbidly obese most of my life, I would never wish that fate on anyone. But I would hate to see this surgery be used as "cosmetic surgery" for anyone wishing to drop 20 or 30 pounds without having to "work at it." That, to me, would be an abuse of this marvelous tool.

Is such thinking naive?

The Long Way Around

2008-01-21T09:32:00.000-08:00

I've been making little changes since the first in an effort to increase my daily activity level beyond what I do at the gym.

My first order of business was to park farther away from my office. Though I still prefer not to park in the lot that's a half-mile downhill from my office, I don't spend 15 minutes anymore milling around and around looking for an empty spot near the building's entrance.

The next step was to stop using interoffice mail. The campus is not nearly big enough to warrant me dropping paperwork in the office and waiting three days for it to arrive at its destination. Such a decision is even sillier when it only takes about 20 minutes to walk from one end of the campus to the other.

Last week, I decided to stop using the elevator to my third-floor office. To be honest, the elevator is so slow that it's not much of a convenience feature anyway. I take the elevator because I favor high heels (at my height, you take all the extra help you can get), and my klutzy natures makes stairs not so easy to negotiate.

I would probably still be taking the elevator had I not realized last week that I'm not wearing high heels as often to the office. Why the change in fashion? Simple, because on Week 1, I started parking farther from the office. I realized a need to change my footwear by the second day of that habit. I still can't believe it took me two weeks to realize that switch also meant my excuse for using the elevator was null. Then again, I never said I was the brightest bulb in the drawer.

Industry Secrets

2008-01-03T10:08:00.000-08:00

Bankrate.com has a great article on Secrets of the Weight Loss Industry. Definitely worth checking out for those who are looking for non-surgical options.

Day 2

2008-01-02T11:54:00.000-08:00

It's the second day of the new year, and I'm just posting to see how everyone is doing with their resolutions. Has anyone already given up? Has anyone decided to postpone their resolutions? Have any of you woken up to realize that your resolution wasn't the right choice for you?

I've never been the typical resolution maker, so I don't have a history of failed ones to nag at me. I always resolve to make the new year better than the last. I know I will make mistakes, but I try my best to make different mistakes from year to year so I can at least say I'm experiencing growth.

So this year has been a little different since I've made specific pledges. So far, so good. I've really been enjoying water and tea for the last two days. Seems I was drinking more caloric beverages than I had realized, because water has tasted like a sweet treat. My weekend of cooking madness has ensured I have more than enough leftovers to keep me away from temptation, and I don't have to worry about having the time or energy for a healthy dinner each night. So all in all, I'd say I'm off to a good start.

How about you?

I (heart) food blogs and Web sites

2008-01-01T13:58:00.000-08:00

I'm not sure what foodies did for new recipes before the advent of the Internet. I suppose they kibbutzed with friends for new ideas, pored over newspapers and magazines and bought up fundraiser cookbooks. All great methods. In fact, I will still buy up any fundraiser cookbook found at yard sales (the Tracy Fire Department Auxiliary's cookbook is a definite asset to any collection, as are any of the editions put out by the Hilmar Covenant Church or YLI). And I will always be a sucker for any newsstand magazine that advertises slow-cooker recipes (the slow cooker is a must have for any bariatric patient).

Since moving out on my own, I've been able to be more adventurous in my kitchen experiments. After all, I only have to worry about myself and my tastes. Trust me, I didn't get to weigh 335 pounds by being a picky eater. However, the Internet has really helped me broaden my cooking horizons.

For a while, I subscribed to a local food co-op. Getting produce boxes from food co-ops can be a little scary. You never know what your box might hold or what to do with it. That's where the Internet comes in. When I opened my box one week to find fennel, which I had only glanced at on the food network, I only needed to type in "fennel recipes" into Google before finding a pasta sauce recipe that not only used the fennel bulbs I had, but also leftover sweet potatoes from Thanksgiving. Instead of pasta, though, I served the sauce over spaghetti squash, another gift from the co-op box.

For my church potluck last night, I decided I couldn't just go with gobs of cookies and candy made from the bulging baking shelf of my pantry. I needed to have some "good food" to go along with it. I opted for a chicken stew from SimplyRecipes.com, which just might be the best food blog in existence. What I love most about SimplyRecipes.com is that the author resides in Sacramento, which means whatever is in easy and available for her is also in season and available to me. Realizing (thanks to the feedback of a few well-meaning friends) that the recipe I chose might be a little "out there" for church folk, I decided to also take a tried-and-true casserole in the form of Paula Deen's (of the Food Network's Paula's Home Cooking") shrimp and wild rice casserole. It was a favorite of my ex-husband's (though he always had me omit the bell pepper and onion), especially when I doubled the cheese.

The chicken stew, though, was my favorite. Chock-full of onions, tomatoes and super tender and moist chicken, it was every bariatric patient's dream. I would challenge any gastric-bypass patient who says he/she can't tolerate chicken to stick by his/her story after trying this dish. The chicken literally melts into the sauce, leaving a warm, hearty meal.

I should stop there, but I won't. I can't sign off without leaving you the recipes I'm speaking of.

Chicken Stew with Onions, Tomatoes and Dijon
(from SimplyRecipes.com)

I rarely ever make a recipe exactly how it's written. I put my own spin on just about everything. So, for this recipe, I used six chicken thighs and two bone-in chicken breasts. I also omitted the roasted garlic, though it sounds divine! The key, to me, is in the browning of the chicken. Get it good and crispy, because that adds complexity to the final product. (My favorite olive oil is Lost Dogs Farm of Tracy, Calif.) Though the recipe calls for it to be served with rice, I think it would be incredible over savory polenta, such as what Alton Brown recently made on an episode of "Good Eats" on the Food Network. For myself, I just mixed in some steamed zucchini.

1 whole head garlic
Olive oil
Salt and freshly ground pepper
One 3-4 pound whole chicken, cut into 8 serving pieces (2 breasts, wings, thighs, legs)
6 medium red onions (about 2 pounds)
One 28 to 32 ounce can good quality whole peeled tomatoes, drained
1 Tbsp fresh thyme or 1 1/2 teaspoons dried thyme
2 bay leaves
A pinch of chile powder
1/3 cup dry white wine
3 Tbsp old-fashioned whole seed Dijon mustard (or 1/4 cup regular Dijon mustard)

1 Preheat oven to 400°F.

2 Peel away the outer layers of the garlic bulb skin, leaving the skins of the individual cloves intact. Using a knife, cut off 1/4 to a 1/2 inch of the top of cloves, exposing the individual cloves of garlic. Place garlic head on a piece of aluminum foil. Drizzle olive oil over the garlic, and sprinkle with salt and pepper. Wrap the garlic head with the foil and place in the oven. Bake for 45 minutes or until the flesh of the cloves are light brown feel very soft when pressed with the tip of a knife. Set aside to cool. (See how to roast garlic.)

3 While the garlic is roasting, heat a tablespoon of olive oil in a large, heavy-bottomed pot (with lid) or Dutch oven, on medium high heat. Rinse the chicken pieces in cold water then pat dry with paper towels. Season liberally with salt and pepper.

Brown the chicken pieces, starting them skin-side down, cooking them a few minutes on each side, working in batches so that you don't crowd the pan.

4 While the chicken is browning, peel and quarter the onions. Remove chicken from pan when nicely golden with tongs or a slotted spoon and set aside on a plate. Discard any fat and oil beyond about 1 Tbsp left in the pan. Put the onions in the pot and cook them until softened, stirring frequently, about 5 minutes.

5 Add the tomatoes to the pot, the thyme, bay leaves, and ground chile powder. Put the chicken pieces on top of the tomatoes. Pour in the wine and bring to a simmer. Cover and cook on medium-low heat for 40 minutes, stirring from time to time so that the vegetables don't stick.

6 After the garlic has cooled enough to handle, squeeze out the roasted garlic from the cloves into a small bowl and crush with a fork. Sprinkle with salt and pepper to taste. Set aside to serve with the chicken stew.

7 When the chicken has cooked, add the mustard to the pot and stir to blend. Increase the heat to medium-high and cook uncovered for 10 more minutes, or until the sauce is thick enough to cling to the meat. Remove bay leaves. Salt and pepper to taste.

Serve stew over rice or pasta, with the garlic paste on the side.

Serves 4 to 6.

Shrimp and Wild Rice Casserole
(from Paula's Home Cooking)

1 (8-ounce) package wild rice
1 pound medium shrimp, peeled and deveined
2 tablespoons butter
1/2 green bell pepper, seeded and chopped
1/2 onion, chopped
1 (10 3/4-ounce can) condensed cream of mushroom soup
2 cups grated sharp Cheddar
Salt and pepperCook the rice according to package directions minus 1/4 cup water. Drain and cool.

Bring 2 cups water and 1/2 tablespoon salt to a boil in a medium saucepan and cook the shrimp for 1 minute. Drain immediately and set aside.

Heat the butter in saucepan and saute the pepper and onion until soft, about 5 minutes.

Preheat oven to 325 degrees F.

In a large bowl, combine the rice, soup, 1 1/2 cups of cheese, shrimp and vegetables. Add salt and pepper, to taste. Mix well. Spray a 9-inch square aluminum cake pan or an 11 by 7-inch glass casserole dish with vegetable spray. Place the mixture in the pan and top with remaining 1/2 cup cheese. Bake for 30 minutes, until bubbly.

Penne with Sweet Potatoes and Fennel
(from Quick Fix Meals with Robin Miller)

For this dish, I left out the pasta and used roasted spaghetti squash instead.

2 ounces uncooked penne pasta
1 tablespoon unsalted butter
2 teaspoons olive oil
1 fennel bulb, sliced crosswise into 1/4-inch thick slices
1 tablespoon chopped fresh rosemary leaves, or 1 teaspoon dried
1 tablespoon sugar
1 cup reduced-sodium chicken broth
1 cup milk (regular or lowfat)
2 tablespoons all-purpose flour
2 cups leftover roasted sweet potatoes, cut into 1-inch cubes
2 tablespoons grated Parmesan
2 tablespoons chopped fresh parsley leaves
1/2 teaspoon salt
1/4 teaspoon ground black pepperCook pasta according to package directions. Drain and set aside. Keep warm.

Meanwhile, melt butter and olive oil together in a large skillet over medium heat. Add fennel, rosemary and sugar and cook 10 minutes, until fennel is tender and golden brown. Stir in the sweet potatoes.

Whisk together chicken broth, milk, and flour. Gradually add to skillet and simmer 3 minutes, until mixture thickens, stirring constantly. Add the pasta and stir to coat. Stir in Parmesan, parsley, salt, and pepper and cook until heated through, stirring constantly, about 3 minutes.

New beginnings for a new year

2007-12-31T06:11:00.000-08:00

As 2007 winds to a close, I’m looking ahead. This past year was a busy one for me. I started it off with a bowel obstruction that almost missed getting diagnosed, leading to emergency abdominal surgery and a long, arduous recovery. My husband and I separated in June; a very dear childhood friend and her unborn daughter were killed in July; I switched careers in September; and I moved 75 miles southeast of Tracy in October to be closer to my new job.

There is not one event that has occurred over the past year that I would change if given the chance, not even the death of my friend. After all, it was her death that led me reexamine my priorities in life and make the changes required to be where I’m at now.

However, during the course of it all, I’ve succumbed to some old habits that I need to relinquish yet again. In times of stress, I think it’s normal to revert back to old coping mechanisms. My most comfortable coping mechanism has always been eating. More accurately, it’s been the abuse of food or using food to feed my emotions rather than hunger. Feeding has always been easier than feeling for me.

Luckily for me, weight gain hasn’t been an issue. I dropped enough weight while sick from January through March that the weight I’ve put on makes me look healthy not out of control. But for a food addict, “out of control” can be just one bite away. And that’s not a place I want to visit, much less stay. So I will take advantage of the new beginnings associated with a new year and get myself back on track before I veer too far off my desired path.

Getting back on track won’t be easy, but the gift of gastric-bypass surgery and the tool it provides still make it easier for me to adopt healthy habits once again than if I didn’t have surgery at all. The key for me will be to draw some very deep lines in the sand and not let anyone or anything cross them.

Here are my top 5 rules for 2008 that will help me make sure my health goes back to being my top priority:

My house is a junk-free zone
No, I will not become a better housekeeper. Ha! That’ll have to wait until 2010 to make the resolution list, if ever. Instead, I’m referring to junk food. “Junk food” is different for everyone. For a gastric-bypass patient, simple carbohydrates and sugar are our main enemies but junk food can be any trigger food, even ones considered “healthy” (like sugar-free desserts).
I used to believe I had to have these things for those who didn’t have the dietary restrictions I did. Now I realize that as a single woman, there is no reason to have stuff in the house that I should not be eating. I've tossed out all the crackers, rice, pasta and chips that have wormed their way into my pantry, in addition to the sugar and baking ingredients I collected to make holiday treats. I don’t need the temptation. I’ve baked a few things for my end-of-the-year church potluck, and the rest will go out with the trash. Better that it fill the trash bin than my backside.

I will respect my pouch
One of the greatest gifts bariatric surgery offers is the ability to control the amount of food one needs to eat to feel full and/or satisfied. That gift can be abused by non-compliance. Non-compliance comes in a variety of forms but the most common are overfilling the pouch at meal times, grazing throughout the day and consuming liquids with meals. Rather than eat until I’m full, I will focus on eating until I’m no longer hungry. Though it sounds like a minor difference, the difference can add up to quite a few hundred calories by the end of a day. Hypoglycemia requires that I eat more often than most bariatric patients, but I don’t have to eat huge amounts at each sitting.

I will not drink my calories
This one will be tough. I really love mochas and caramel macchiatos from Starbucks and the Acai Super-Antioxidant from Jamba Juice. Even with two scoops of protein powder, Jamba Juice smoothies aren’t good choices for bariatric patients. The sugar content in them outweighs any benefits of the protein. Alcohol also fits into this category. I love a good vodka martini, but calories add up. I spent my first two post-op years drinking nothing more than water and unsweetened tea. I was quite content and am confident I can be equally content doing so yet again.

I will exercise five times a week
I have to stop kidding myself. Parking a half-mile from the office is a nice way to incorporate more movement into my daily routine, but it does not replace the need for honest exercise. Like all gastric-bypass patients, I have the metabolism of a sea cow. Our drastically reduced intake, coupled with nutritional malabsorption, puts our bodies into starvation mode. The only way to kick start the metabolic standstill is by incorporating vigorous exercise each day.

I will say no to sabotage
This one is easier said than done, but it’s high time I put my foot down. I’m tired of well-meaning people encouraging me to “treat” myself and assuring me that “a little bite” or “sip” won’t hurt, as if they had any clue what it’s like to walk in my shoes. The fact is that for some of us, there is really no such thing as “just one bite,” and I’m tired of pretending it’s not an issue. So rather than give in to temptation in a misguided attempt at politeness, I will offer a firm rejection and not lose sleep over potential hurt feelings. After all, I’m the only one who has to live with the consequences of eating foods my body doesn’t tolerate well.

Merry Christmas

2007-12-25T17:45:00.000-08:00

I'm not sure I'll ever stop being amazed at how much more I enjoy holidays now that I'm no longer a slave to food.

Today was such a great day. Woke up early, had some chicken and veggies for breakfast, a couple of homemade mochas and gallons of iced tea. Lunch was turkey, a bit of ham, cranberry sauce, some potato and corn. Dinner will likely just be turkey, cranberry and veggies. Oh, I did splurge on a slice of cherry pie, but just a slice -- not the whole pie, nor a slice of every pie and cake available.

We watched a movie, we hung out, we relaxed. It was amazing. No uncomfortable over-stuffed feeling, no wanting to puke, no food coma. Who would have thought a holiday could be so pleasant?

Dinner of Champions

2007-11-29T20:56:00.000-08:00

I'm back to my old tricks of cooking up a storm. Here's what I made for dinner:

Chicken Stew

Recipe courtesy Giada De Laurentiis
Show:	Everyday Italian
Episode:	One Pot Meals

2 tablespoons olive oil
2 stalks celery, cut into bite-size pieces
1 carrot, peeled, cut into bite-size pieces
1 small onion, chopped
Salt and freshly ground black pepper
1 (14 1/2-ounce) can chopped tomatoes
1 (14-ounce) can low-salt chicken broth
1/2 cup fresh basil leaves, torn into pieces
1 tablespoon tomato paste
1 bay leaf
1/2 teaspoon dried thyme leaves
2 chicken breast with ribs (about 1 1/2 pounds total)
1 (15-ounce) can organic kidney beans, drained (rinsed if not organic)

Serving suggestion: crusty bread

Heat the oil in a heavy 5 1/2-quart saucepan over medium heat. Add the celery, carrot, and onion. Saute the vegetables until the onion is translucent, about 5 minutes. Season with salt and pepper, to taste. Stir in the tomatoes with their juices, chicken broth, basil, tomato paste, bay leaf, and thyme. Add the chicken breasts; press to submerge.

Bring the cooking liquid to a simmer. Reduce the heat to medium-low and simmer gently uncovered until the chicken is almost cooked through, turning the chicken breasts over and stirring the mixture occasionally, about 25 minutes. Using tongs, transfer the chicken breasts to a work surface and cool for 5 minutes. Discard the bay leaf. Add the kidney beans to the pot and simmer until the liquid has reduced into a stew consistency, about 10 minutes.

Discard the skin and bones from the chicken breasts. Shred or cut the chicken into bite- size pieces. Return the chicken meat to the stew. Bring the stew just to a simmer. Season with salt and pepper, to taste.

Ladle the stew into serving bowls and serve with the bread.

I've Said it Before ...

2007-11-28T14:18:00.000-08:00

... But the following bear repeating:

I love AchievOne Cappuccino RTD protein supps.
Using RTD protein supps (like Micellar Milk) as creamer in your coffee is a great way to get your protein and caffeine boost in one convenient dose.
Sugar-free syrups and flavorings are a great, low-cal way to add variety to your protein shakes and beverages. They also help you get through a huge tub of protein powder without wanting to yak from boredom.

Some of my faves: Add peppermint syrup to a chocolate protein supp with a little coffee for your own peppermint protein mocha; add caramel and hazelnut syrups to a vanilla shake for a little decadence; fruit-flavored syrups are great additions to vanilla shakes in the summertime.

You can use Micellar Milk in lieu of fluid milk in recipes. Just be sure to adjust the amount of sweetener added. I love using vanilla MM in custard recipes.
You are worth every dime you spend on protein supps, vitamins, gym memberships, personal training, etc. Remember, these are not luxuries; they are investments in your health.

The Ugly Side of the Holiday Season

2007-11-27T19:17:00.000-08:00

Now is the time of year when people are decking the halls and spreading holiday cheer to everyone and their brother. But there is an ugly side to holiday cheer. It's also the time of year when decadent treats and desserts seem to multiply like caged rabbits. For those of us who struggle or have struggled with controlling our body weight, the holiday season can feel a lot like a Cambodian minefield. It feels like everyone we turn, there are cookies, cakes, pies, candies -- and a million and one reasons why it's OK to indulge.

But the worst part of the holiday season are the food pushers. The name is self-explanatory. Food pushers are those who push food at you. They tell you that you deserve to treat yourself, that just one bite won't hurt, that we all need to splurge now and then. Food pushers are a year-round hazard, but the holiday season seems to be when they are in rare form.

I try to see the good in people, to assume that they mean well and don't understand the ramifications of their actions. After all, that's a much more pleasing thought than to believe they are intentionally trying to sabotage your efforts to maintain a healthy way of eating.

Shock and Awe

2007-11-07T00:07:00.000-08:00

When I accepted this new job, I was excited at the prospect of a new start in a new town where I had no expectation to live up to. Following a dear friend's advice, I considered not sharing my past with my new coworkers and acquaintances.

My friend suggested I keep mum about my past because he felt I deserved to make impressions based on who I am now, not on who I used to be. He's always thought my column, blog and transparency on my history with obesity was unfair to me. I understand where he's coming from. He's seen firsthand how people treat me differently once they find out I used to be morbidly obese or that I had weight-loss surgery. They scrutinize my body to gauge whether I've had cosmetic surgery or if I was ever big enough to "truly need it." They talk to me differently; the watch everything I eat. It's like living in a fishbowl, and it loses its charm quickly.

My attempt to follow his advice didn't last long, though. After all, I can't change that fact that I used to be morbidly obese and how it has shaped my character. I can't change my dietary restrictions, and I refuse to let people assume I'm one of those healthy-looking women who hates herself and is perpetually on a diet.

I don't broadcast my past or my surgery, but I don't shy away from the subject when it comes up. I've showed my before pictures to a couple of people and the reaction is always the same: shock and awe. I'm told I look like a different person, that they never would have guessed I had a history of obesity. I know I should be flattered, but it's hard. It's been 2.5 years since I had WLS; I'm at home in this new body. At the same time, I can't blame people for how they react -- especially if I'm openly sharing my history.

Happy Trails

2007-11-05T22:56:00.000-08:00

The Livermore Walk From Obesity was Oct. 6 at LifeStyleRx in Livermore. The walk was a fundraiser for the American Society of Bariatric Surgery Foundation and Obesity Action Coalition. The ASBS Foundation raises money for the study and treatment of morbid obesity. OAC is an activism group dedicated to fighting discrimination against the obese and encouraging insurance companies to cover medical treatments for the disease.

I won't deny that I was a bit disappointed by the walk's turnout. I had lofty goals when I signed on as a team leader for the walk. I thought I could amass a Tracy team of at least 20 people who would raise $5,000. After all, I know how much this town raises in the American Cancer Society's annual Relay For Life. So I knew it could be done. But it just didn't happen for us.

Instead of 20 people, my team -- One Step at a Time -- had four members who raised less than $1,000. But as walk organizer Julie Rooney of LifeStyleRx said, "every little bit counts." And other walkers raised similar amounts of money, which added up to a decent sum of money for the charities involved.

Personally, I want to thank my generous sponsors: Dagny of Sassy Ladies of WLS; Kenny Luiz (my uncle); Lorraine Cardoza (my aunt); and Ben van der Meer (former colleague). Their support has meant more to me than words could ever articulate.

Those who didn't participate missed out on a fun day and a leisurely three-mile stroll down the Arroyo Mocho Trail. Walkers enjoyed a goodie bag and free breakfast, courtesy of ValleyCare Health Systems, and AchievOne protein lattes (a personal fave).

More than one person questioned why there wasn't more participation. Each of us talked about how we had difficulty getting people to join our team and the challenge of fundraising. The conversation reminded me of a friend of mine, Heather Maes. Heather is a 30-year-old single mom battling colon cancer. She's documented her fight on MySpace, in a blog she calls My Cancer Chronicles. The Tracy Press occasionally prints entries from her blog, which is how we first met.

Heather is a calendar model. Well, to be precise, she's actually Miss December on this year's Colondar. The Colondar is a fundraiser for the Colon Club, which is an organization that raises awareness of colon cancer among those younger than the stereotypical over-50 crowd. In September, Heather blogged about online encounters with people who did not agree with Colondar concept. Some called it disgusting; others lamented what they considered preferential treatment of cancer patients. One person even said that the limelight on cancer made others suffering from chronic illness feel "left out of the fun." I'm sure Heather can tell you all about the fun she's having as she undergoes her second round of aggressive chemotherapy.

But I digress. My reason for mentioning Heather and her Colondar (BTW: they are on sale for $15; you should buy one) is that I found myself walking three miles on an early October morning wondering why thousands of people get so passionate each year about fundraisers benefiting cancer societies, Special Olympics, and even the American Heart Association, but it was like pulling teeth to drum up any interest in a Walk From Obesity. I don't want to sound like the ignorant idiots who told Heather and other cancer patients that they didn't deserve to raise money for their causes. At the same time, I'm curious at why obesity doesn't get the same attention as other diseases.

Cancer, special needs and heart disease are relatively random afflictions caused by a combination of family history, lifestyle and luck -- or more correctly, a lack thereof. Obesity, on the other hand, affects a majority of our society. About 60 percent of our nation suffers from obesity (BMI of 35 or more); morbid obesity (BMI of 40 or more) affects about 35 percent of all Americans. Obesity is preventable, treatable and deadly. We all know how the disease comes about; and assuming you subscribe to the "calories in vs. calories out" theory of nutrition, we all know how to overcome it.

So why is it so hard to get support for a Walk From Obesity? I think because obesity is preventable and curable, people don't view it as a disease. And that includes those who suffer from it. If I had a nickel for every time I heard an obese or morbidly obese person say, "I know what I need to do; I just have to do it," I'd be a very rich woman. If the obese don't realize they are diseased, why should anyone else?

When I participate in Relay For Life each year, I am surrounded by those who are fighting cancer, have beaten cancer, have loved ones who fit into the previous categories or have been touched by cancer in other ways. At the Livermore Walk From Obesity, I was surrounded by bariatric medical professionals, post-ops and their loved ones. I even tried to drum up interest among my non-op friends, regardless of size. To me, this walk was about silencing a killer (just like any other fundraiser walk); nothing else.

But I realized that it's impossible to silence a killer when its victims refuse to come forward and defend themselves. I haven't given up, though. I hope the Dr. Mary Estakhri, the bariatric surgeon who has sponsored the Livermore Walk From Obesity for the past two years, will continue to support this event; and I also hope that, in time, the walk will gain steam as more and more people realize the how tight of a grip obesity has on this nation.

Crawling Out From Under My Rock

2007-10-27T13:09:00.001-07:00

Just a quick post to let you all know that I have not fallen from the face of the Earth. I've been juggling lots of changes, and this blog has fallen through the cracks for a short time. I'm newly single, have taken a new job in a new town, which has prompted me to move away from Tracy but also enabled me to adopt a new focus on serenity in my life.

I'm having lots of fun and can't wait to share it all with the rest of you. As planned, I took part in the Livermore Walk From Obesity earlier this month. Once I get photos from the event, I'll post an entry on the event. It didn't have the huge turnout I anticipated, but those of us who were there enjoyed ourselves. I think I've finally gotten a handle on my blood-sugar issues. Hypoglycemia is a lot easier to manage when you cut out carbs. It's not a perfect science, but it's getting easier to manage.

And we wonder why we're fat

2007-09-14T22:30:00.000-07:00

Calories underestimated in "healthy" restaurants

By Anne Harding
Fri Sep 14, 3:24 PM ET

People who opt for a meal at a "healthy" restaurant often consume more calories than they would dining at fast food joints that make no health claims, a new study shows.
The researchers found that individuals underestimate the calorie content of foods served at restaurants they see as healthier, to a degree that could easily lead to weight gain.
For example, "People think that the same 1,000-calorie meal has 159 fewer calories if it comes from Subway than if it comes from McDonalds," Dr. Pierre Chandon, at INSEAD in Fontainebleau, France, told Reuters Health. "If they choose to consume this fictitious 'calorie credit' on other food, and it they eat at Subway twice a week, they could gain an extra 4.9 pounds a year."
While restaurants presenting themselves as healthy have grown at a much faster rate over the past five years than traditional fast food restaurants, Americans' waistlines have not been shrinking; in fact, the nation's population is fatter than ever, note Chandon and his colleague Dr. Brian Wansink of Cornell University in Ithaca in their report in the Journal of Consumer Research.
The researchers theorized that people might take in more calories when they eat in "healthy" restaurants, and conducted a series of studies to test this notion.
In the first, they asked people who had just finished eating at Subway or McDonalds to estimate how many calories they had just consumed. On average, Subway patrons rated their meals as having 151 fewer calories than did McDonalds patrons. In fact, for a meal at either restaurant containing 1,000 calories, people would estimate it to contain 744 calories if they'd eaten at McDonalds and 585 calories if they'd dined at Subway.
In the second experiment, they asked people to estimate the calorie content of four different sandwiches: a six-inch ham and cheese sandwich (330 calories) and a 12-inch turkey sandwich (600 calories) from Subway; and a McDonalds cheeseburger (330 calories) and a Big Mac (600 calories). Study participants consistently rated the Subway sandwich as having fewer calories than the McDonalds sandwich with the same calorie content.
Next, the researchers offered people a coupon for a Big Mac (600 calories) or a Subway 12-inch Italian BMT sandwich (900 calories), and asked them whether they would like to order a drink or cookies with their sandwich. People eating the Subway sandwich were more likely to choose a large drink, less likely to opt for diet soda, and more likely to get cookies. This meant that, on average, they wound up consuming 1,011 calories, compared to 648 calories for the people given a McDonalds coupon.
People who want to control their weight or trim down need to think objectively about calorie content, and not let their perceptions be clouded by whether a food is supposed to be good or bad for them, Chandon said. "We have to move away from thinking of food in 'good food / bad food' (terms) and think also about 'how much food.' In France, for example, people enjoy relatively fat diets but are less overweight simply because portion sizes in restaurants and at home are smaller."
Chandon suggested one technique to help people judge calorie counts more accurately: "Instead of estimating the number of calories of the whole meal (which leads to undercounting) look at the sandwich, the side, the beverages, and the drink and add that up. Our research showed that this 'piecemeal' method is very effective."
SOURCE: Journal of Consumer Research, October 2007.

2007 Livermore Walk From Obesity nears

2007-09-13T18:42:00.001-07:00

The 2007 Livermore Walk From Obesity needs your help. Please do what you can to volunteer, join a team or donate to the cause. If you want to join my team or donate to it, visit my page here. Registration is $25 and includes a shirt, all-day pass to LifeStyleRx in Livermore (where the walk starts) and other goodies. The walk is from 8:30 to 10:30 a.m. Saturday, Oct. 6, at LifeStyleRx, 1119 Stanley Blvd., in Livermore. You can walk anywhere from a quarter-mile to three miles.

A family affair

2007-08-23T10:46:00.000-07:00

http://www.sacbee.com/101/story/339981.html

Cooled off...sorta

2007-08-12T09:35:00.000-07:00

It's taken a couple of days but I think I can finally address the topic of the 12-year-old who had Lap-Band surgery in Mexico with some measure of civility. At least, I hope I can.

What disturbs me most about the case is this girl's mom and the apparent lack of accountability on the part of both of them. Mom has a fat kid, so her first step is cosmetic surgery (tummy tuck and lipo). When that fails, Mom takes daughter (now 12) to Mexico for bariatric surgery.

Now everyone is happy. Mom says daughter is a compulsive eater and she likes the band because whenever she overeats, she throws up (nice way to train for bulimia, I suupose). Mom likes that her daughter is finally thin and fashionable.

My personal favorite of all the comments Mom made were those related to why she didn't have her daughter go through the process in the states: Money. Nutritional and psychological counseling were too expensive. Really? Compared to a tummy tuck ($3K-$6K), lipo ($1K) and Lap-Band ($9K in Mexico)? Why do I have a hard time buying that story?

I was a fat kid -- not a chubby kid, a FAT kid. I understand how cruel children and adults can be to obese children. It's not a fun life, but is cosmetic and bariatric surgery the answer? I don't think so. A 12-year-old is not mature enough to understand the dangers/consequences of such decisions. The key to long-term weight-loss success is developing a healthy relationship with food and learning to balance consumption with exercise. What has this little girl learned about that? And how is she supposed to learn when Mom's answer to everything is surgery?

12-year-old gets Lap-Band in Mexico

2007-08-10T16:01:00.000-07:00

I need a moment to gain my composure on this one...but until then, watch the clip and leave your opinion:

http://www.cnn.com/video/#/video/us/2007/08/07/ochoa.tx.lap.band.kvue

The skinny on Star Jones

2007-07-31T08:24:00.000-07:00

Star Jones has finally admitted to having bariatric surgery.

Click here to read more.

Changes are a comin'

2007-07-29T08:22:00.000-07:00

I am in the process of negotiating with the Tracy Press to take over sole ownership of Inside Out, both in print and online. My work in the field of bariatrics and as the writer of this column/blog has begun to overshadow my actual full-time job as managing editor of the Tracy Press in the eyes of some.

What the general public has not realized is that I have never been paid by the Press for my work on Inside Out. I write all postings and attend all bariatric- and obesity-related events on my own time, either using paid or unpaid time off, depending on the situation. This has worked just fine for the last 2.5 years. However, demands on my time have increased exponentially this year, leading me to request more time off work and leading the public to think that Inside Out is my full-time job.

The Tracy Press and I have agreed that it would be best for everyone involved if I were to formally make Inside Out a personal endeavor. This is exciting news for me, because it means from this point on, I truly own my own words. Even with free columnists, the Press assumes the rights over everything it prints. It also means I get more freedom over my postings. The Press has never told me what I can and cannot write, but since I know that many readers consider this blog the property of the Press, I have stayed away from certain topics.

The only downside to this arrangement is that I no longer get media clearance into events as a representative of the Tracy Press. If an organization extends media credentials to bloggers and freelance writers, I will be able to obtain press passes under that umbrella but I can no longer use the Tracy Press' name or resources to gain entrance. Truthfully, though, I don't foresee that being a problem. It's not a privilege I took advantage of much anyway.

To better facilitate this division, I have created a consulting company with a business associate for my work in the field of bariatrics. We call our company Bariatric Network Associates, and we specialize in the education and support of those interested in surgical weight loss and the medical professionals who serve them.

We have our first Introduction to Weight Loss Surgery seminar tomorrow (Monday, July 30) at Sutter Tracy Community Hospital. Thanks to the generosity of the hospital, we are able to offer the seminar at no charge but we do request that those interested let us know they will attend ahead of time. The company's contact information is on the Web site.

Living and eating well after all these years

2007-06-30T12:32:00.000-07:00

Originally published Saturday, July 30, in Our Town for the Tracy Press.

This week marked the launch of the revised edition of “Before & After: Living and Eating Well After Weight-Loss Surgery” by Susan Maria Leach.

Leach’s first edition, affectionately known by many in bariatric circles as “the pink book,” has gotten a lot of coverage in this column as I’ve traveled on my journey toward a healthy weight.
I first discovered Leach through her Web site, www.bariatriceating.com, an online superstore of all things a bariatric patient could want or need. It didn’t take me long to find out that her promise of “great taste and good nutrition” was more than just mere words.

The pink book was waiting for me, along with a shipment of protein supplements from her company, when I got home from the hospital after having Roux-en-Y gastric-bypass surgery in 2005.

To this day, I credit Leach’s book and products for helping me to achieve my weight-loss goals without sacrificing my health, appearance or energy.

The revised edition, packaged in a light-blue paperback for convenience, is everything its predecessor was and so much more.

The hybrid of diary, no-nonsense advice and cookbook features 35 more recipes and updated information based on research and discoveries in the bariatric field since the original printing in 2004.

“I have a better perspective as a six-year post-op,” Leach said in an interview this week. “I now understand that people don’t do the right thing automatically. I see so many who give it all up for fast food and sugar, and begin a downward spiral again.”

Leach said she’s realized that many people who have suffered from morbid obesity have a difficult time figuring out how to deal with food. She hopes the new edition’s inclusion of meal plans for every stage of post-op eating will help those people adopt healthier eating habits.

“I offer different good food choices for each meal and simple recipes to combine their grocery list items,” Leach said. “My meal plans train people to create new food patterns that they will enjoy eating and will stick to long term.”

The book’s new recipes reflect Leach’s travels and constant quest for food that is fabulous and healthy. One of her favorite additions is the creamy Tuscan white bean soup, featured on Page 132. She said it’s a replica of a soup she enjoyed with her aunt in Tuscany last year.

“It’s a wonderful reminder of a fantastic trip,” she said. “Plus, it’s a 15-minute recipe that can be used in the earliest stages after surgery but will be a family favorite for years!”
In addition to new recipes, the book also features updated versions of previous favorites, like Leach’s light banana bread.

The new banana bread recipe is a perfect example of what is possible when the marketplace broadens its offerings. She replaces the Splenda (sucralose) and protein powder used in her original recipe with Nature Sweet Crystals (maltitol) and California almond flour.

“This superb sugar replacer makes a delicious, healthy loaf that is indistinguishable from a full-sugar, full-fat version,” Leach writes in the recipe’s introduction on Page 263.

Though the original edition of “Before & After” was a financial success for Leach, she hopes readers feel they get something for their money with the second edition.

“Weight loss surgery was not my first choice; it was my last choice,” she said. “It is so important that people understand it is not a diet that ends at a goal weight; it is a new way of life.”

Product Review: Better Balance Protein Cereal

2007-06-17T08:21:00.000-07:00

The folks at Kay's Naturals sure do know their stuff when it comes to protein snacks. I was lucky enough during ASBS to sample a variety of their products, but the Better Balance Protein Cereal exceeds expectation. During the conference, I snacked on the Honey Almond and French Vanilla flavors right out of the bag. This morning for breakfast, I enjoyed the Apple Cinnamon variety mixed with my Fage 0% greek-style yogurt.

Though I like all of the varieties, Honey Almond is my favorite. It reminds me a bit of Smart Start, which was a cereal I regularly enjoyed as a pre-op. Apple Cinnamon tastes like Apple Jacks, and French Vanilla has a great vanilla flavor.

The O-shaped cereal comes in 1 oz. packages, providing 9 grams of soy protein in 100 calories with 1.5 grams of fat and 15 grams of carbohydrate (3g dietary fiber; 3g sugar). The cereal is sweetened with inulin.

Hit or Miss? A definite hit. The Kazemzadehs, who own the company, were nice enough to let me try almost all of their products at the convention tradeshow. Awesome product!

From the "duh" files...

2007-06-16T02:07:00.001-07:00

SAN DIEGO -- Though I appreciate the time and effort taken in researching obesity and bariatric procedures and outcomes, some studies make me shake my head in wonder.

For instance, comparing the success rate of bariatric surgery to commercial weight loss programs seems ridiculous. After all, does anybody really think counting POINTS! can hold a candle to rerouting one's digestive tract to reduce capacity and nutrient absorption? That doesn't even seem logical to me, much less a wise use of funding.

Here are two of what I'd call "duh" studies that were presented at the convention this week:

* Bariatric surgery makes people more sensitive to alcohol -- I don't think any of us with gastric bypass needed Stanford researchers to tell us that our rerouted intestinal tract makes us cheap dates when it comes to running a bar tab.
Dr. John Morton, assistant professor of surgery and senior author of the study, was quoted in today's Science Daily as saying, "I've heard the anecdotes of a patient who will drink one glass of wine and get a DUI, but I wanted to know if there is really a difference before and after the surgery."
Dr. Morton later says in the article that most patients aren't aware of this and that Oprah has done the field a favor by pointing it out on her show about the dangers of cross-addiction. I don't know about the rest of the post-ops in the world, but I discovered that fact the first time I tried wine after surgery. I didn't need Oprah or a study to enlighten me. Furthermore, I had been warned by other post-ops about the phenomena long before I ever had surgery, so I don't think it's as big of a mystery as Dr. Morton professes.

* Binge eating and a sweet tooth lead to gastric-band failures -- Just to make sure we're all on the same page here, a team of Swiss researchers reported that those post-ops who binged on food or indulged in sweets experienced a higher incidence of band failure than those who did not. The conclusion? The best candidates for banding are highly motivated patients who don't binge or eat sweets. Wouldn't you say the same thing for any type of bariatric procedure?

Candelas San Diego

2007-06-14T23:00:00.000-07:00

SAN DIEGO -- Words cannot describe the dinner I experienced this evening. We visited Candelas on Third Avenue. And I say visited, because it was so much more than just a place to eat; it was an all-encompassing environment with an amazing atmosphere, above-par staff and cuisine that was out of this world.

Our party decided on a collection of appetizers and one entree to share, because making a decision was so difficult. We all giggled a bit when our server, Tony, went over his recommendations on the menu. He said everything was "amazing" but suggested the duck, poblano soup and the avocado salad. We thought he was just angling for a good tip -- until we were presented with the incredible dishes we ordered.

The Carpaccio Franco ($12) had fan of paper-thin raw ahi drizzled with a lemon-cilantro mustard sauce served around a salad of marinated bell peppers, baby greens and tequila-marinated pear. The ahi was so tender that it melted on my tongue, but I would have liked a little more of the sauce to enhance its flavor.

Taking Tony's suggestions to heart, we ordered the Estructura de Aguacate ($11.50), which was a stacked salad of avocado, scallops, crap, shrimp, parsely and mild jalapeno with a light drizzle of mango-basil vinaigrette. The presentation was awe-inspiring. The salad was molded into a cylinder in the center of the plate with ribbons of dressing poured around the edges. It had a delicate flavor, with each ingredient complementing one another instead of competing for attention.

The Crema Fabiola ($14.50) is a stellar puree of poblano chile and cream with a half of a lobster tail poised in the center. The color contrast between the pink and white lobster and the sage-green soup was eye-catching but nothing prepared me for the taste of the soup. It was an explosion of flavor that led a few of us to consider licking the bowl when we were finished.

The only entree we ordered, the Pechuga de Pato Lucrecia ($25.50) was another sight to behold. The duck breast was cooked in its own juices until medium rare and then fanned around vegetables and mashed potato with a light passionfruit sauce. The duck barely required a knife to cut and its buttery texture dissolved easily on the tongue. Our only regret was that our pouches forced us to leave one succulent piece on the plate along with the potato. Even Tony remarked it was a crime.

We had planned to pass on dessert until Tony mentioned crepes covered in a goats milk caramel that sounded heavenly. The presentation was simple, two crepes swimming in thick, rich caramel with pecans sprinkled over the top. We each took only one bite, knowing that a second would leave us sick all night. But that one bite was all that was needed for an instant trip to nirvana. It was the type of dessert that makes you not want to put anything else in your mouth so you can savor the flavor as long as humanly possible and then burst into tears once it diminishes.

I could not even imagine a better way to end the most hectic day of the convention.

A whirlwind of a day

2007-06-14T17:00:00.000-07:00

SAN DIEGO -- Thursday was such a crazy day that it took me until Friday to realize that I didn't publish this post. I'm back-dating it so it's chronological:

I sat in today on an interesting session for primary clinicians. The opening speaker was Dr. Sasha Stiles of Kaiser South San Francisco, where I had my bariatric surgery two years ago. Dr. Stiles is the program's medical director, creating Kaiser's Northern California program with Dr. Prithvi Legha (my surgeon). During my time with Kaiser, I grew to know Dr. Stiles more than Dr. Legha because she is the one who handled my pre-operative screenings and post-operative follow-up. I was very sad when my employer switched from Kaiser coverage, because she is such an amazing doctor. At least I'm still able to be in Dr. Legha's capable hands.

Dr. Stiles provided a brief introduction to the Primary Clinicians Tract that was an overview of the advancements made in the treatment of obesity. For a rail-thin woman, she knows a lot about obesity. She sees 6,000 patients a year through Kaiser's bariatric program, and the South San Francisco facility treats about 200 patients a month.

She didn't report anything that was new or earth-shattering but did pose some interesting questions for the audience to ponder. Her over-arching theme regarding the success of bariatric surgery was that it provides hope for the morbidly obese. Hope, she said, is what motivates patients to make the lifestyle changes required for long-term success.

She called the physicians collectively on the carpet for not doing a good enough job in following up with their patients to ensure long-term success. Studies show that dieting is stressful and that even the most successful weight loss programs have followers who fall off the wagon and start over. Dr. Stiles said anticipating this aspect of human nature can make bariatric programs more successfull, too. After all, if you anticipate that after two years, post-ops will stop attending after-care programs and possibly begin to gain back weight, doctors could then build services into their programs to bring those patients back to the fold in a supportive manner.

Makes sense to me. What do the rest of you think?

Food, fabulous food

2007-06-14T06:34:00.000-07:00

SAN DIEGO -- It occurred to me last night after signing off that I've yet to post about food. One of the reasons I promote Susan Maria Leach's book, "Before and After: Living and Eating Well After Weight Loss Surgery," (revised edition goes on sale in two weeks) is because it proves that enjoying great food does not end when you go under the knife.

A lot of non- and pre-ops I meet fear gastric-bypass surgery means a life without taste, texture and gastronomical pleasure, but nothing could be further from the truth. If anything, most of us become food snobs after weight loss surgery. I ate fast food at least twice a week as a pre-op. Now, I could hardly be paid to eat at McDonalds or Carl's Jr. -- the food doesn't even taste good enough to be pouch-worthy. I can find something to eat just about anywhere, but I'd rather not waste valuable space in my gastric pouch on mediocre food.

So, what does the American Society of Bariatric Surgery have served at its annual conference? Last year, I made the mistake of thinking that because it was an event about bariatrics, the catering would reflect the needs of bariatric patients. Wrong. What I forgot in my naivete is that the conference is geared toward bariatric health care providers -- not patients -- so the food did not match what my pouch could tolerate. If it hadn't been for the BariatricEating.com booth last year, I would have surgery fainted for lack of protein. That's part of the reason I agreed to help Susan at her booth this year -- I owe her a debt of gratitude for saving my pouch last year.

So far this year, I've been pleasantly surprised. Yesterday's breakfast was the obligatory continental convention fare: pastries, muffins, bagels, fruit, juice and coffee. The BE.com gang picked up coffees and went to the booth to make protein lattes and cappuchinos. I enjoyed a delicious latte made up of Nectar Cappuccino, Matrix Chocolate, Micellar Milk and hot water (12 oz offers about 25 grams of protein). For my mid-morning snack, I sipped coffee mixed with vanilla Micellar Milk and a shot of Davinci sugar-free Englis Toffee syrup and Cinnamon Bliss (a sugar-free caramel replacement that tastes just like a spicy cinnamon roll). OK, I'll be honest: I had two of those for about 20 grams of protein combined.

Lunch, however, offered something for everyone. The buffet featured a selection of salads and build your own sandwiches. I enjoyed a small green salad with tomato-basil vinaigrette and swiss cheese rolled up with deli ham and grainy mustard -- fast, filling and delicious. I was wise and steered clear of the decadent desserts.

Back at the booth, we were serving Revial soy chips (I'll have to review those at a later time), parmesan cheese crisps, AchievOne, Nectar Twisted Cherry mixed with Cherry-Pomegranate Crystal Light, ThinkThin bars and New Whey protein bullets in addition to the Micellar Milk lattes. Again, my body has never been so happy. My blood sugar only dipped once all day.

For dinner, we attended the conference's welcome reception. Again, I didn't know what to expect. Imagine my delight when I spied appetizer tables overflowing with oysters on the half shell, succulent shrimp, snow crab claws, cheese trays, canapes and beef and turkey carving stations. I didn't even glance in the direction of the pasta and dessert areas, though I did spy a few people enjoying chocolate-covered strawberries and baklava. But personally, those are treats in which I could never eat just one. Instead, I helped myself to oysters with Tobasco and fresh lemon, shrimp and crab sans cocktail sauce, green olive tapenade eaten with a spoon, Jarlsberg cubes, and melon-wrapped proscuitto and brie with a dab of cream cheese and mandarin orange (it was easy to set aside the little squares of toast atop which the melon and brie canapes were served).

Heavenly food aside, the best part of the cocktail party was that you couldn't easily tell the post-ops from the non-ops. We were mostly all enjoying the same delicious cuisine combined with excellent conversation. And like I told a couple of very handsome Australian surgeons yesterday, that -- to me -- is what the gift of surgical weight loss is all about: looking, acting and living a normal life. I could have kissed just about every doctor there for that blessing.

New key studies on morbid obesity and bariatric surgery

2007-06-13T21:38:00.000-07:00

SAN DIEGO -- The following studies will be released Wednesday at the American Society of Bariatric Surgery annual meeting in San Diego:

The Impact of Bariatric Surgery on Health Care Costs
Date/Time: 8:45 a.m. Wednesday
Lead Author: Anita P. Courcoulas, MD, University of Pittsburgh Medical Center
Key finding: Bariatric surgery reduces health care costs over time, especially those related to medication usage.

Bariatric Surgery in Adolescents: Analysis of 309 Cases
Date/Time: 9 a.m. Wednesday
Lead Author: Esteban Varela, MD, MPH, VA North Texas Health Care System and University of Texas Southwestern
Key finding: Bariatric surgery outcomes in adolescents appear to be as safe as for adults.

Preoperative Weight Gain Does Not Predict Failure of Weight Loss or Co-morbidity Resolution of Gastric Bypass for Morbid Obesity
Date/Time: 10:30 a.m. Wednesday
Lead Author: Michael C. Harnisch, MD, Duke University
Key finding: Gastric bypass surgery can be performed safely with improvements in co-morbidity and extended weight loss regardless of preoperative weight gain or loss.

Presurgery Psychiatric Disorders are Associated with Smaller Reductions in BMI at 6 Months After Gastric Bypass
Date/Time: 10:45 a.m. Wednesday
Lead Author: Melissa A. Kalarchian, Ph.D., Assistant Professor of Psychiatry and Psychology, Western Psychiatric institute and Clinic University of Pittsburgh Medical Center
Key finding: Preliminary analyses suggest pre-surgery psychiatric disorders are related to poorer weight outcome at six months after gastric bypass. Results suggest that intervention to improve psychosocial functioning, especially anxiety and depression, may improve surgery outcomes.

Laparoscopic Adjustable Gastric Banding in Patients >65 Years of Age
Date/Time: 2 p.m. Wednesday
Lead Author: David A. Provost, MD, University of Texas Southwestern Medical Center, UT Southwestern Medical Center
Key finding: Laparoscopic gastric banding provides a safe and effective weight loss option in patients 65 years and older

Dinner at Henry's

2007-06-12T20:56:00.000-07:00

SAN DIEGO -- We ate dinner tonight at Henry's, an Irish Pub near the intersection of Market and Fifth. Though Henry's definitely has a pub atmosphere, the food choices were superb. No bangers and mash on the menu at this place.

Eating among post-ops is such a refreshing change from what I'm used to. Five of us are post-ops -- from two to six years out from surgery -- and discussing what to have for dinner is a fun experience in itself. No mention of pizza or fried foods.

The biggest decision we had was whether to order our own entrees or share. We all decided that we hadn't eaten enough during the day so we opted not to share. Us post-ops were copy cats; we each ordered the salmon with dill cream sauce and a double portion of veggies instead of mashed potatoes. Being the "youngest" post-op in terms of when I had my surgery, I ate the smallest amount but I held my own with the veterans.

What I loved most was watching each of them following the rules even at their stage: No drinking with meals, protein first, eating slowly and chewing each bite thoroughly. We had incredible conversation on topics ranging from WLS issues to work topics to just life in general. It was like a night out with my best girlfriends, except that these girlfriends eat the same way as me.

Gringas like to party

2007-06-12T18:03:00.001-07:00

SAN DIEGO -- Popping in for a second after helping to set up the BE.com booth at the ASBS convention center. I've learned many skills in my short time here. For instance, there is a lot of skill behind the building of a trade show booth, particularly when the shipping company crushes most of your boxes and leaves you to make do with damaged products. You'd never guess we had any trouble by looking at it, though.

Susan Maria Leach's new edition of "Before and After: Living and Eating Well after Weight Loss Surgery" hits bookstore shelves at the end of the month. The new version of the "pink book," as its known by many fans, is now a teal blue paperback that features updated information on the various types of surgeries, meal plans and even more recipes than its predecessor. Presale orders are now being taken at BE.com.

The best part of hanging out with the BE.com crew is that I never go hungry. We were all famished at light-headed while working on the booth, but that wasn't a problem because we had plenty of Revival soy chips, Power Crunch and Oh Yeah! bars and Protein DeLite Protein on the Go (chocolate coconut is soooo tasty!). My blood sugar hasn't been as level as it is today in weeks -- and I've been traveling -- not too bad, if you ask me.

Flying Southwest

2007-06-12T12:25:00.000-07:00

Even after two years, the novelty of flying at a normal size has not worn off. Though I still feel like a world-class klutz when trying to negotiate my suitcase and carry-ons throughout the maze of airport lines and security checkpoints, I'm amazed at how effortless it is to move around -- even when loaded down with all my luggage.
This was my first time flying Southwest. I can see why people enjoy it. The lines weren't overly long, the staff was nice and the peanuts were yummy. I love that the seat belt fits me now, but the best part is still the tray table. Not only does it drop down completely, but I can also cross my legs beneath it!
Off to the convention center...more later

Look out, San Diego

2007-06-11T12:30:00.000-07:00

I'm leaving tomorrow morning for the American Society of Bariatric Surgery annual conference in San Diego. My goal is to blog daily from the event but if this year is anything like last year, I'll be lucky to eek out a posting or two each day. The conference is jam-packed with educational sessions, events and an overwhelming trade show.

Open mouth; insert foot

2007-05-29T23:11:00.001-07:00

I attended tonight's meeting of the Tracy Express Network (a local chapter of the American Businesswomen's Association).

During the networking portion of the evening, I was chatting with an engaging woman from New York Life. We were talking about all the illnesses that seemed to be going around this spring, which both of our husbands caught with gusto. I told her that I get very worried when my husband is ill, because he's such a thin guy, adding that I don't have the same concern for myself. She chuckled a bit and looked me up and down. I realized then that this woman had no idea I have ever looked contrary to the way I do today. I let the subject drop and we parted ways to mingle further.

We caught up again a few moments later when another member, a woman I know rather well, greeted me by calling me "Skinny." She made a comment to the New York Life agent about how great I looked. Finally, I let the agent in on the secret.

"You have no way of knowing this, but I used to be almost 200 pounds heavier than I am today. That's why calling me 'skinny' is humorous."

She was obviously shocked and after congratulating me, said she never would have guessed. I told her that I realized she had no idea based on her reaction to my earlier comment about my husband.

"Truly," I told her, "I have to be careful. I often forget I'm no longer a big girl and will make comments that come off as insensitive or rude."

It's not that I'm a narcisist who thinks the world revolves around her. It's just that I've chronicled my weight-loss experience for so long and so many people approach me in public about it that I forget it's not common knowledge. And then there are times like tonight that jolt me back into reality. I assume that the further out I get from surgery, the more common it will become to meet people who assume I've always been thin. I'm not sure I'll ever get used to it. I want to say that it'll become old had after a while, but that's hard for me to picture. I guess time will tell.

Too skinny?

2007-05-28T22:21:00.000-07:00

I met a woman over the weekend who said something I consider interesting. Her husband had gastric bypass a handful of years ago. She said he's since gained about 40 pounds or so. I nodded, letting her know that's a common occurrence for veteran post-ops. Her response gave me pause for a moment.
"I think most people get too skinny after WLS," she said. "Your body has to put on an extra 20 to 40 pounds just to look normal."
I said nothing.
Then she added, "Then again, maybe it's just that the rest of us are used to seeing our loved ones be so big that we have trouble adjusting to their new size."
Hmmm...that was profound.
I get told I'm too thin all the time now. My favorite is when people inform me that it's time for me to stop losing weight -- as if I'm blind to my own size. I always let people know that I could lose another 20 pounds and still be within a normal weight range for my height, but I'm also clear that I'm happy at my present size. Though anything is better than carrying 335 pounds on a 5-foot, 3-inch frame, 138 pounds seems to be my body's preferred weight.
I don't understand why people feel obligated to tell me their opinion of my size. I assume it's because in our society, it's considered appropriate to tell someone when they are too skinny in your eyes even though you'd get a dirty look or backhanded if you pointed out an obese friend should lose a few pounds. I'm guessing that woman I met over the weekend has a clearer view into the average person's psyche than I do. If what she says is true, it's a matter of comfort. We know obesity is unhealthy but we're not comfortable with those close to us changing their appearance too much.
I wonder if this phenomenon will change down the line. Maybe in three years, people will be so accustomed to my size that they don't think twice about it. Then again, maybe well-meaning acquaintances and relatives will continue adding their two cents.

Who am I?

2007-05-27T17:39:00.001-07:00

My husband and I just got back from a wedding on his side of the family. Though I feel at home at my present size, there are still many in his family -- and even a few in mine -- who haven't seen me in a year or more.

The funny thing is that few people assume I've lost a drastic amount of weight. Instead, they just figure I'm a different wife than the one my husband had the last time they saw him. Even better are those who think my husband is having an affair and dared to take his mistress to a family function.

I suppose this would offend some women, but I find it amusing. So long as they think I look fabulous, I won't complain about who they assume I am.

WLS not right for everyone

2007-05-26T16:14:00.000-07:00

Melting Mama has a thought-provoking post on her blog about surgical weight loss. Instead of trying to restate what she says -- truly, she articulates the point way better than I ever could -- I suggest you click over to her site and read her words for yourself.

FYI

2007-05-25T15:15:00.000-07:00

I'm noshing on a creamy peanut butter Think Thin protein bar, and it tastes a bazillion times better than the sugar-free peanut butter meltaway I blogged about yesterday. And a half-bar adds 10 grams of protein to my day.

When chocolate goes bad

2007-05-24T22:40:00.000-07:00

There was a time in my life when I could say with confidence that I had never met chocolate I didn't like. That time was from about five seconds after I was born until about an hour ago.

To be honest, chocolate hasn't impressed me as much as it used to since I had WLS. I still love it, but a protein shake or bar can curb a chocolate craving better than a cookie. But every now and then, I still get a hankering for rich, delicious chocolate candy. Today was one of those days.

I was strolling around the mall this evening with my husband when the urge to have chocolate overwhelmed me outside of the Sweet Factory. I went inside to peruse the sugar-free section. I walked out with a bag of chocolate-covered pretzels, almonds, raisins, peanut clusters and something called a peanut butter meltaway. All together, I had about an eighth of a pound of candy in my bag.

Upon getting home, I couldn't wait to try some. I had a yummy dinner of Asian-style chicken and veggies and decided an hour later to treat myself to some of that sugar-free chocolate deliciousness I had purchased at the mall.

I opened up the bag and took a whiff. Hmm...not the intoxicating aroma I had envisioned. Oh well. I shrugged my shoulders and dove in for one of those oh-so-dreamy sounding peanut butter meltaways. I took a bite, crinkled up my nose and promptly spit it out. It was bland and chalky and not worth the 10 calories I probably ingested during my brief taste.

Next I tried a pretzel. I was smarter this time, though, and just tried a tiny bit. The salty pretzel was stale and the cholate disapointing. It was waxy and again, lacking in flavor. It reminded me of a less-sweet version of Flicks, the "chocolate-flavored" candy wafers I abhorred as a child. Next I tried a peanut cluster. It was, by far, the best thing in the bag but that still didn't make it good.

Disappointed, I tossed the rest of the candy in the trash. Chocolate or not, the taste wasn't worth the effort it took to chew it. I never would have guessed that chocolate existed that was bad enough that I would throw it away, but I found it. Then again, maybe the chocolate wasn't that bad after all. Maybe chocolate just lost its hold over me. Or maybe, the change in my taste that makes fast food no longer palatable to me has crossed over into desserts. If it's not fabulous, it's just not worth my time.

Ghengis Khan

2007-05-23T22:22:00.000-07:00

My husband and I tried out Ghengis Khan on Grant Line Road today (in the new shopping center by Costco). He loves Mongolian barbecue. Before I had surgery, we'd visit the Ghengis Khan in Stockton a few times a year. Since surgery, though, we've shied away from all buffets. It just doesn't make sense to shell out the money when I'm not going to eat much, nor does it seem smart to surround myself with the temptation of an all-you-can-eat event. But my husband really wanted to try it, and Ghengis Khan is affordable as far as buffet restaurants go.

The best thing about Ghengis Khan is its location. It's in a small strip mall along with Kinder's Meats, Kitchen Angel, a coupld of salons and a check-cashing store. It's remote location makes it the prime dinner spot on a weeknight. The manager said the place is packed on weekends but it's not a weekday destination yet.

If you're unfamiliar with Mongolian barbecue restaurants, they all work the same. You walk in, grab a bowl at the buffet that you stuff with thin slices of frozen raw meat (turkey, chicken, beef or pork), noodles, and a variety of vegetables and cooking sauces. At the end of a counter, you turn over your bowl to one of the cooks who dumps it out on a hot metal cooking surface. He uses two long sticks to move the food around the cooking surface until it's done. He puts your food into a clean bowl and then hands it back to you, piping hot.

While your food is cooking, a server is busy setting up your table. When you get to your table, there is soup, rice, an appetizer (fried wontons with sweet & sour sauce) and a sesame biscuit. You order your drinks and enjoy your food.

I had fun creating my bowl tonight. I added turkey, chicken, a heaping pile of spinach and cabbage, a little bit of corn, onions, mushrooms, broccoli, zucchini, cilantro, jalapenos and peanuts. I added one scoop of each sauce, three scoops of garlic sauce and a scoop of sesame oil.

My overflowing bowl cooked down into a scant bowlful, but it was so tasty that I didn't care I would leave most of it behind. After about 30 minutes of eating, I looked down to realize that I didn't even make a dent in the bowl. The server came by and asked if I wanted to box it up. That was shocking. Most all-you-can-eat places do not allow you to take food home with you. But the server said that anyone who only makes one trip gets to take home their leftovers.

That was exciting for me, because I now have at least two more yummy meals waiting for me in my fridge. And it's nice to know that there is a buffet in town I can visit without feeling like I'm the weirdo who doesn't make trip after trip.

I know many post-ops carry around a card that tells restaurateurs that they've had gastric-bypass surgery and asking that they be allowed to eat off the children's or seniors' menu. That's not something I've ever done because I don't find things on those menus to be that healthy. Besides that, I just don't think it's a restaurant's job to bend its rules for me because I decided to alter my body's biology. So, I would never ask for such things, but it's nice when a restaurant offers. And for that reason, I'll be back to Ghengis Khan.

Off Topic: Call Me Miss Green Thumb

2007-05-21T21:44:00.000-07:00

I just have to share about my weekend endeavor. I planted a container garden on my patio. I'm now the proud owner of a tomato plant, Thai chile plant, basil, nasturtiums and marigolds. This could be as addictive as chocolate. I'm now eyeing a three-tiered plant stand to grow more herbs.

Can't wait till harvest time.

Things that make me go "hmm ..."

2007-05-20T23:45:00.000-07:00

Took a quick trip to Kohl's today to check out the clearance ranks. I had fun trying stuff on, especially now that I'm a solid medium/size 8 almost everywhere. At JC Penney two weeks ago, I discovered that I fit 8 petites to a T.

I was excited today to see the awesome selection Kohl's had in its petite clearance section. Found a beautiful kimono-style blouse for $4 that I thought would be perfect for ASBS in San Diego. I took the medium into the dressing room, unzipped it and slipped it on. Looked great except for one teensy-weensy problem: I couldn't get it zipped up past my rib cage. Hmm ... OK, Plan B kicked in and I went in search of a large. I found one in a different color that I liked just the same as the first. Took that one in the dressing room, held my breath and tried it on. Again, no luck. No matter how much sucking in I did, I couldn't get the zipper past my ribs.

Before I had gastric bypass, this occurrence would have broken my heart. It would have ruined my day and I would have gone home mopey. But today, I just laughed. All I could think was, "Well, ribs are bones ... can't suck those in no matter what." My feelings weren't hurt; I didn't have any feeling of failure. I just figured that explained why such a cute blouse made it to the clearance rack in the first place.

And now, as I get ready for bed, I think of how far I've come in the last two years.

Product Review: Micellar Milk

2007-05-19T10:04:00.000-07:00

Photo courtesy of BariatricEating.com

Nature's Best Micellar Milk is a relatively new addition to the ready-to-drink proteing supplement market. I had heard of it from other post-ops on the BariatricEating.com (which sells it) message board last year but hadn't gotten around to ordering any before getting sick in January.

While I was in the hospital, a member of my local support group, Tammy Coursey, smuggled a container of vanilla and chocolate into the hospital for me. She swears by it as helping her get in her required protein since having surgery last Thanksgiving. She enjoys the vanilla poured over ice, saying its thin milk-like texture is perfect for her pouch -- not too heavy like blended supplements can be.

Aside from being thin and easy to drink, Micellar Milk is also nutrient-rich. A 17-ounce container provides 40 grams of protein with 220 calories, 2 grams of fat and 4 grams of sugar.

My favorite flavor is vanilla, which reminds me of rice pudding in taste. My husband is in love with the newest flavor, strawberries & cream. He says it's just like Strawberry Quik. Micellar Milk also comes in chocolate.

Having the consistency of milk makes Micellar Milk a perfect protein-rich substitue for milk in many recipes. When I was recovering from my bowel obstruction and restricted to a full-liquid diet, I used it in lieu of milk to make Sans Sucre instant chocolate mousse. I also used it in vanilla custard (with a dash of sugar-free Torani syrup). It was a tasty way to make sure I met my protein needs without overtaxing my digestive system.

If you visit the BE.com message board's recipe thread, you'll find all sorts of recipes that incorporate what members affectionately call Mice Milk. One favorite is Mice Cream, a protein-rich version of ice cream.

Personally, I enjoy Mice Milk by itself or with a few variations. One of my favorite ways to serve it is to make ice cubes out of leftover coffee and pour either chocolate or vanilla Mice Milk over the cubes for a cool treat at the office. One weekends, I'll use vanilla Mice Milk as creamer in my coffee with a shot of Torani sugar-free Irish Cream syrup for an Irish Cream protein latte that puts Starbucks to shame.

Hit or Miss: Definitely a hit. I have two cases at home right now, but they are going fast.

Somerville supports kids

2007-05-18T13:17:00.000-07:00

An entire town went on a diet for a year in an effort to help the children in the community adopt healthier habits, according to an Associated Press article.

Thanks to financial support from a couple of grants, educational programs emphasized the importance of increasing activity and making food choices that included more fruits and vegetables and less fat. School lunches featured more fruits and vegetables, and children were encouraged to eat as much of them as they desired. Restaurants even joined the effort by offering healthier options and smaller portions. At the end of the program, researchers say the town's children avoided gaining one pound of body weight, compared to children in neighboring communities -- making the program a success.

Read the article yourself and tell me what you think.

The difference that makes it

2007-05-17T10:52:00.000-07:00

Katie Jay of the National Association of Weight Loss Surgery has just published an article by me on the free portion of her Web site.

The article is a basic retelling of my personal story, one that readers of this blog know all too well. However, I hope that having it published on the NAWLS site opens me up to a wider audience. Bookmark the site, because Katie has already asked me to write another article for NAWLS and to record an audio interview with her.

ASBS conference

2007-05-16T21:55:00.000-07:00

The American Society of Bariatric Surgeons will hosts its annual meeting and conference next month in San Diego. The weeklong event will begin June 11 at the San Diego Convention Center.

ASBS is the only national governing body for bariatric surgeons. It's the group behind the Centers of Excellence distinction that surgical centers strive to achieve. The organization Web site offers a list of Centers of Excellence by state for patients to peruse.

The conference is a big deal. Not only does it allow medical professionals to congregate and network, it provides continuing education courses and panel discussions of interest to those who work with the obese. Surgeons and other bariatric health-care providers will learn the latest surgical techniques and discuss research data on topics such as how access to nutritional supplementation affects compliance in patients and whether preoperative weight loss makes a difference in surgical outcomes.

The conference also features an extensive trade show with vendors showcasing everything from super-size furniture that is comfortable for morbidly obese patients to compression garmets that hold in excess skin so post-ops can achieve a more normal appearance under clothes. There are also vitamin and supplement vendors galore, in addition to advocacy groups. Carnie Wilson was a featured guest at a vendor's booth last year. No word whether she'll attend again this year.

I attended one day of last year's trade show in San Francisco. This year, I'm fortunate enough to spend most of the week at the event. I'll be blogging on the various workshops and educational sessions I attend.

Point to ponder: Childhood obesity

2007-05-15T21:22:00.000-07:00

I was thumbing through a copy of Bariatric Times at a friend's house earlier today when an article on childhood obesity caught my eye. The article itself wasn't that earth-shattering but there was a profound quote from a source that hit home with me.

Loosely paraphrased, it read, "The key to treating childhood obesity is to understand that the afflicted come from homes where overeating and inactivity are allowed or encouraged."

Interesting perspective. I read those words and find them logical and succint. A lot of efforts toward reducing childhood obesity focus on educating and motivating the children but don't seem to target changing the environment at home. I wonder how effective it is to teach little Johnny the importance of making wise food choices and exercise if he goes home each day to a harried household where dinner is from the nearest drive-through and served in front of the Nintendo Xbox.

Any thoughts?

Recipes wanted

2007-05-14T19:12:00.000-07:00

Summer is almost upon us, and that has me thinking of warm-weather meal options. Anybody have any recipes to share that include seasonal produce or are quick and easy and don't heat up the kitchen? Andrea, care to share some of your vegan favorites? Anyone else?

Vegetarian heaven

2007-05-13T20:28:00.000-07:00

The downtown farmers market started today, and there was a vendor selling Afghan food who has stolen my heart. I'm serious -- we are new best friends. First off, he fed me lunch by giving me half a dozen different samples. I walked away with a low-carb pumpkin bolani, lentil curry, eggplant pesto, hummus, sweet-and-sour carrot chutney and whole wheat pita bread.

If you haven't tried Afghan food, I highly recommend it. To me, it tastes "cleaner" than Indian food but still has the complexity of flavor and spiciness that I love. All the stuff I bought today either was made with olive oil or had no added fat. Most of the breads offerred are made with lentil flour. That means no gluten and
lower carbs. The spinach bolani was super-yummy, too.

For those who don't know, bolani is almost like a cheeseless quesadilla. It's a folded piece of flatbread filled with spices and veggies. This vendor had low-carb pumpkin, low-carb spinach, then a veggie and potato version.

If you're in town next weekend, check it out. The farmers market will be open from 9 a.m. to 1 p.m. every Saturday until November. The market is on 10th Street, between Central Avenue and B Street.

If you don't live near the Tracy area, check out the company's Web site by clicking here.