Call Me Iron-Woman

INFeD doesn't look like Dr. Pepper being
pumped into my veins, but it's still thick
enough to cause a noticeable burn.

I'm not the average pregnant woman. My version of morning sickness is low-level nausea that lasts for about two weeks, peaks on one day where I can't stand the thought of eating anything and then goes away never to return again.

What hits me like a ton of bricks in my first trimester is fatigue -- extreme fatigue. I'm in bed by 8 p.m. and my body feels leaden when the alarm goes off at 6 a.m. Once I found out that my state of exhaustion was related to pregnancy and not just my post-35 self having a hard time adjusting to the time change, I didn't give my fatigue much thought.

Then it got worse. Not only was I constantly exhausted but I was having a hard time making it through the day. I had a difficult time concentrating on what normally would have been the simplest of conversations. I had difficulty standing for moderate periods of time and would get winded walking short distances. Even talking would take my breath away and leave me gasping for air as if I had just gone for a run.

I mentioned it to my doctor and a quick set of labs showed that what I was experiencing was more than just first-trimester fatigue. I was anemic -- again. But true to form, I wasn't just a little anemic. I never do anything just half-way. In one month, my total iron count had gone from 27 to -1, and my hemoglobin dropped from 11.8 to 9.4. Though 9.4 isn't quite in the danger zone (that's below 9), 11.7 is the lowest of the normal range so dropping that far that fast isn't a good thing.

This is Kim, my infusion nurse. My teeny-tiny
veins still intimidate her after four years, but
we've become friends through the adversity.

Thinking I could get ahead of the curve, I started taking a double dose of Floradix (40 mg iron), which is a food-based liquid iron supplement. It's not cheap and it tastes dreadful, sort of like rust-covered beets with a hint of berry. Oh...and it didn't work well enough to make it worth the investment. After two weeks, my iron went up to 4 and my hemoglobin to 9.5. At that rate, I'd be anemic until my third trimester.

The thing with anemia is that most people think it's no big deal. They tell you to eat steak and spinach or switch to cast-iron pans for cooking. I'm sure those things work for some people but not for me. The reality is that absorbing and storing iron has been a challenge for me every since my bowel obstruction in 2007.  And true anemia (i.e. hemoglobin level below 11.7) is not something to mess with. Anemia robs your blood cells of oxygen, causing them to shrink in size. That means your vital organs are also robbed of oxygen.

As an expectant mom, if I'm not getting the oxygen I need, guess who else isn't? Many anemics suffer heart damage and cardiac disease at a young age. Some suffer neurological disorders from having their brains starved of oxygen. And to add to the fun, there is no cure -- only treatments.

If you think Benadryl knocks you out in pill form, you
should try it in an IV. Instant spinning room and lights
out. Unfortunately, drugged sleep is not quality sleep. The
hoodie helps with the shivers/chills caused by the other meds.

Luckily, iron-deficiency anemia is fairly easy to treat. For most of the population, a diet rich in iron (eggs, beans, dark-green vegetables, etc.) and an oral iron supplement with Vitamin C and B-12 is all that's needed to boost hemoglobin once again.

And then there is me.

The best course of action when I am anemic is iron infusions. My routine of green juices and green smoothies kept me away from iron treatments for almost two years -- a record for me -- but even drinking the equivalent of pounds of greens each day wasn't enough to offset the deficit caused by growing another person in this body.

So back to the infusion center, I have gone. To date, I've had four treatments in what is likely to be a 10-week series. It's not fun, but it beats a sharp stick in the eye. This time, we're using INFeD, which only takes about two hours to administer. I still need the anti-nausea, anti-allergy, anti-rejection companion medications, which turn me into a zombie. The INFeD burns, but not as bad as Venofer did. The side effects of the iron itself are marginal. Some weeks, the night sweats are so bad, I have to change my clothes two or three times. Other weeks, I don't sweat at all. I get nighttime leg cramps, chills, odd nerve/skin sensations and weird short-term bouts of depression after the infusions. The upside is that all of that seems to be gone within 24 hours and I can resume normal life and normal activities.

As a result, I get a little stronger each week and so does the baby.

Growing a Baby is Hard Work

I am amazed by the speed of fetal development. Above, my 8-week
ultrasound. Below, three weeks later.

At 11 weeks, baby looks like a baby.

Like my first pregnancy, the most noticeable early symptoms I have are extreme fatigue. I mean, extreme. When I was pregnant with Lily, I blamed it on recovering from working on a major event at the office. This time, I thought my body was refusing to adjust to the time change. Of course, the further we got from when time changed, the less likely it seemed that was my problem.

Three pregnancy tests later, and it was clear that my exhaustion was due to my body trying to work for two.

A side note about pregnancy tests: I'm cheap. I hate the idea of paying $20 for a name-brand test that's only going to turn up negative. So, I took a friend's advice this time and picked up two tests at the dollar store. The first one was clearly positive. The second was clearly negative. This did not instill confidence in me on either test's accuracy so I broke down and sent my husband to a different store for one of those fancy-schmancy digital tests. $20 and a clear "pregnant" reading later, and I would say that the $2 spent on the first tests was my only true waste of money.

I'm fortunate that nausea isn't much of an issue for me. It's the fatigue, insomnia and constant trips to the bathroom common in the first trimester that get to me. I don't complain because my pregnancies are cakewalks compared to many women I know, but it's still an adjustment for me to realize that my energy is limited.

In hopes of helping my energy levels, I've been on the following supplement protocol since confirming my pregnancy in November:

• Rainbow Light Just Once Prenatal Vitamin (1 a day)
• 800 mcg Folic Acid (1 a day)
• 50,000 IU Vitamin D (1 a week)
• B12 monthly injection
• 60 mg Floradix liquid iron supplement 
• 2,500 mg calcium citrate (taken in 5 doses throughout the day)

My doctor runs full labs on me every month so we can be sure I'm absorbing whatever I'm taking in is being absorbed by my body and making its way to the baby.

On the exercise front, I've decided to hire a personal trainer to ensure that I can maintain my level of fitness during pregnancy without putting myself in danger. I don't think the average person would need to take such precautions but given that my abdominal hernia is still uncorrected, it seems safer to err on the side of caution.

Sequel Makes Big Splash

I can't believe it's been so long since I've posted here. Last year was a whirlwind, and it looks like 2014 is shaping up to be even more eventful. The cat has been out of the bag for some time among family and friends -- it's even Facebook official now, as evidenced by the above cover photo that I copied from my profile. We are expecting a second addition to our little family, and we couldn't be more excited.

I have wanted to be a mom for as long as I can remember, and those of you who have been following Inside Out since the beginning know that desire is what drove me to consider surgical weight loss back in 2004. Doctors told me then my weight was the cause of my infertility. I believed them and made the life-changing decision to slice and dice my insides in order to permanently end my battle with obesity and make my dream of motherhood a reality. I never thought it would take five years, a divorce and a remarriage to make it happen, but it did (All pregnancy posts can be found under the "Oh Baby" tag) . And now four years after the birth of our daughter, we find ourselves eagerly anticipating our second child.

A lot has changed in the past four years. First of all, we're older. That means, I hear the phrase "advanced maternal age" a lot at every doctor's appointment. I'm waiting for them to offer me a walker, because it's obvious the medical community hasn't caught up with the times yet and accepted that women remain fertile long after the age of 30.

That frustration aside, it's been a welcome surprise and we're having so much fun enjoying this pregnancy and Lily's reaction to the idea of being a big sister.

I'm still working out, though my routine looks a bit different. I'm quite surprised at how different this pregnancy has been from my first -- and I think a lot of the differences have to do with being in better shape than the last time around. This time, I started off more than 10 pounds lighter and a whole lot leaner. My pre-pregnancy body-fat percentage was 19.4 percent. That's a far cry from 24 percent when I was first evaluated in early 2013.

My hope is to check in here more regularly. Post-WLS pregnancy is still something that's a curiosity for a lot of pre-ops, and everyone handles it so differently. I have friends whose post-surgery pregnancies are no different than the ones they had before. I have other friends who struggle throughout their pregnancies with weight gain, weight loss, malabsorption issues, nutritional deficiencies and body-image issues. Most bariatric veterans fall somewhere in between but that's a wide spectrum to span.

My journey won't be the same as others, but it will be mine.

Checking in and Progress Pix

When I decided to get stronger in January, I did not plan to lose weight. I just wanted to feel better. Years of battling anemia and other nutritional deficiencies left me feeling frail and I had enough. After six months of focused exercise, plant-based eating, daily green smoothies and fresh juices, I feel better than I have in years.

Along the way, I've dropped a little over 20 pounds and have reshaped my body in ways I didn't think were possible for me without cosmetic surgery. I feel blessed. Few people can say they feel their best ever eight years after WLS. Many gain back the weight they've lost before their fifth post-op year. I'm thrilled to be at a point where my concerns are related to performance and body shape.

Here are my stats compared to where I was in April of this year, when I started tracking my measurements:

Weight: April -- 174.6; Today -- 164.6
BMI: April -- 30.9 (obese); 29.2 (overweight)
Bust: April -- 38.5; Today -- 37
Waist at belly button: 37; Today -- 34.5
Waist above belly button: 36; Today -- 35
Hips: April -- 44; Today -- 41.5
Thigh: April -- 25.5; Today -- 23.5
Upper Arm: April -- 14; Today -- 13.5
Total Inches Lost: 10

The last time I documented myself at this weight was when I celebrated my first WLS anniversary back in 2006. I'm a little lighter now that I was then and all of my measurements are smaller, except for my waist and hips, which both 1 inch bigger right now. I assume I can credit my pregnancy three years ago to that extra inch in the waist and hips.

I've spent a lot of time over the last month thinking about the importance of my body mass index (BMI). I'd have to lose 25 pounds more before I'd get out of the "overweight" category. And though I know I should care about such things, I really don't. I am much more concerned about the function of my body than a label based on an arbitrary formula.

My goal for the next three months is to continue gaining strength by lifting heavier weights more often. I don't worry about the archaic myth of "bulky up." What I do worry about is my bone density and posture, both of which are improved by regular bouts of weight-bearing exercises. And as much as I dislike cardio, I'd like to increase my stamina. Though that's hard to measure, I think running a mile without stopping would be a good gauge of progress for me.

As far as eating goes, I'm content with my progress in that area. I'm doing a small amount of protein supplementation by adding vegan protein powder to my green smoothies. But in general, my focus is on eating whole, plant-based foods. I avoid processed foods, dairy, animal protein, coffee, sugar and alcohol. My meals are filled with an array of fresh vegetables, some fruits, lots of beans/legumes and a smattering of nuts, seeds and fruits for variety.

I can't wait to see the changes that become evident over the next three months. Part of the fun of this journey is the element of surprise -- whether it's finding out I'm capable of physical feats I previously thought were impossible or just observing the evolution of my body shape. It's a fun ride.

Body Fat Update: 22%

In the past eight weeks, I've dropped a little over 4 pounds of fat. I had hoped to drop twice that in this time frame but with the water I'm retaining, I'm not sure how reliable the metrics are. I'll just have to keep my eye on the goal of getting stronger and stay committed to measuring my progress along the way.

Welcome to the Gun Show

I've been busting my backside at the gym since January. I'm up to 4-5 days a week of intense exercise and though I get compliments, I have to say it's hard to see much of a difference. That is until I started doing some side-by-side comparison of progress photos.

My arms are the source of my deepest insecurity, so seeing the photos above have really made an impact on how I see myself. The photos speak for themselves but I have to admit, that picture on the right looks foreign to me. It's not what I see when I look at my arms in the mirror. I suppose I can't trust my own eyes. I need to focus on solid metrics and progress photos for reality checks.

Scale weight is another misleading marker for me right now. I have been fighting some serious water-retention. It's not uncommon for me to gain 8 to 10 pounds in water over the course of a couple of days but clean eating and exercise have helped mitigate that until recently. I've put on 9 pounds over the last week. My legs are so swollen that there is no taper to my legs at all. I have Shrek-size feet. Thank God for flip-flops or I wouldn't be able to wear shoes at all.

I know the water weight will go away at some point. I just wish it would leave sooner rather than later. In the meantime, I'm sucking down a gallon of water with infused with lemon and cucumber in addition to my green juices and smoothies. Something has to give, right?

Clothes Make the Woman

When it comes to exercise, it's crucial to have the right equipment -- right down to what you do and don't wear.

I've learned this firsthand. Shoes that are too wide or too long rub blisters on your feet and can cause ingrown toenails. The only thing worse than shoes that are too big, in my opinion, is clothes that are too big.

Let me explain. When you're sporting a less-than-perfect physique, it's only natural to want to hide that in baggy sweats and shirts at the gym. However, those fabrics aren't usually breathable and all the loose fabric can impede your mobility.

On a WLS post-op, however, loose fabrics can even be dangerous. Unless you've had reconstructive surgery, there is a fair amount of extra skin with which you need to contend. Depending on your rate of loss, starting weight and body type, your excess skin can be concentrated in one area or spread all over. Regardless, you're either going to have loose, floppy skin around the abdomen, thighs, upper arms, buttocks, or back -- or a combination of some or all of those areas.

Loose clothing combined with intense exercises and explosive moves (e.g. jump rope, burpees, etc.) can cause heat rashes, skin tears and even blistering. There is nothing worse than finding yourself increasing in physical stamina only to be hamstrung by a skin injury that sidelines you for a few days.

With that in mind, it's wise to invest in quality workout apparel, particularly compression clothing. Under Armour is known as offering the best compression around. I picked up a pair of the Women's UA Authentic 17" Capris at Sports Authority over the weekend. At first, I wasn't impressed. They don't feel any tighter than the pants I was wearing before. But after one workout, the difference was impossible to ignore. First of all, there was no pain at any point of my workout from skin pulling or tearing. Second, I don't even feel like I've broken a sweat. When I got home to change, my entire lower  body was dry -- that's how good the fabric is at wicking away moisture.

I think UA is a fairly affordable brand and worth the money (my capris were about $38) spent, especially if it's going to save me from visits to the doctor and prescription ointments.

Body Fat Benchmark: 24.2%

I had my body fat measured a couple of weeks ago as a benchmark. It's 24.2 percent. Up until now, I have told two people. Funny thing has been their reaction: "Are we happy or sad about that?"

I just laugh. Given where I've been, I find it amusing that anyone would think I could be emotionally tied to any number. The scale doesn't upset me. Why would I give that control to a skinfold caliper?

I get it. Most women live and die by some number. It may be a number on the scale or even a clothing size. Whatever it is, these numbers tend to hold a lot of power over women. A small number can send a woman jumping for joy, while a large number can be depressing.

Fortunately, I am not one of those women. I use the scale, my clothes and even this most recent skinfold test as nothing more than metrics to help me track my progress. I have to know where I'm at if I'm going to track where I'm going. That's what my numbers are about. To make them mean anything more or less steals my attention from what's truly important, which is my goal.

Upping the Ante Yet Again

I've progressed to four days of weekly exercise and this week, I hope to take it to five. If all goes according to plan, my week will look like this:

• Monday -- Cycle & Strength
• Tuesday -- Bootcamp
• Wednesday -- Interval Training
• Thursday -- OFF
• Friday -- Pilates
• Saturday -- Ultimate Conditioning
• Sunday -- OFF

I'm working out hard enough to be sore every day, some days I'm even hurting in places I didn't know I had. But the results are worth the pain. I am definitely stronger. Lily is easier to lift and carry, especially upstairs. I have more stamina, and I'm sleeping better at night.

None of this is easy, but it becoming more fun.

Worked Out

I added a third day of intense exercise this week, and I am feeling every bit of it. My core muscles are so sore that it hurts to laugh. That's a good thing, right?

I started my week with a combo of cycling and heavy lifting on Monday, then did interval training on Wednesday and a combo of cycling and rowing yesterday. Tomorrow, I'm picking up a yoga class to see how that goes. Hard to believe that six months ago, I had no clue what kettlebells, TRX, burpees, tabata sets or mountain climbers were. Now, I'm doing each of those 2-3 times a week and living to tell the tale.

I don't like exercise, but I like seeing the results of exercise. I like noticing that I did better with jumps on the stationary bike yesterday than I did last week -- and even better than when I first started in January. I also like sleeping through the night -- a lifelong challenge for me. My progress is my motivation, and I need a big motivator to keep getting up at 4:30 a.m.

But again, it's worth it. The best part isn't even how my body is changing, it's who is watching. When I come home from the studio in the morning, my sleepy-eyed daughter gets wide-eyed and animated. She wants to know all about Mommy's exercises and then she wants me to watch her exercise. Her "exercises" are doing jumps and flips on my bed, but it's still cute and it's proof that what I am doing right now is making an impression on her and who she is becoming.

That makes everything I am doing right now worthwhile -- the early mornings, the sore muscles, the failed attempts at advanced exercises. And it's why I look forward to doing it all over again next week.

Anyone experienced with Realize Band?

Though readership of this blog has dwindled over the years due to my lack of activity in keeping it updated, I'm hoping there is someone out there who can help with a reader request.

"A" had a Realize gastric band implanted on March 1. Since then she's lost nine pounds and is increasingly frustrated. She's tracking her eating and consuming about 700 calories a day, which fits her doc's recommendation. Her protein is low -- usually in the mid-50s -- but that is normal for anyone in the early stages of recovery.

We all know weight loss is a staircase, not an elevator. But if you've had gastric banding, what were your results? How fast did you lose weight and how much did you lose at the beginning? Any words of encouragement or advice?

Ready for a New Phase

Tipping the scales over 300 lbs. in 2004. 

Today, at 175 lbs.
after two months of
focused exercise.

It's hard to believe that it's been eight years since I had gastric-bypass surgery. It feels like a lifetime ago when a diagnosis of obesity-related infertility sent me into an emotional tailspin that ended with me tipping the scales at 350 pounds. It was then that the idea of never having children became scarier than the idea of controlling my weight once and for all. I tried losing weight "the old fashioned way" with exercise and a tightly controlled diet, but results just didn't come fast enough to make much of a difference.

That's the short story of what led me to have gastric bypass. It wasn't an easy decision but it was the right one for me. And though I've had my share of ups and downs over the past eight years, I've never once regretted my decision.

Since getting remarried in 2009, I've effortlessly maintained my weight around 180 pounds. By BMI standards, I'm still considered obese, but at least I'm not morbidly obese.

After my bowel obstruction, my weighed dipped in the low 100s. I looked and felt like death warmed over. My skin was so thin that my veins were visible everywhere, giving me a blue hue, especially in photos. My head was bigger than my body, making me look like a bobble head. As I worked to gain my weight back in a healthy way, I chose 180 as my goal. I felt that I needed to have that extra weight as a cushion in case I were to fall ill again. I never wanted to feel weak and emaciated again. It's been a comfortable weight for me -- emotionally and physically -- and one my doctors have all supported.

But now I'm ready for a change. I'm ready to push past that fear and drop a few more pounds. It's not that I think I "need" it. I don't need to be thinner than I am. I am quite content wearing size 14 jeans and medium-size shirts. But I am ready to lead a more active lifestyle, which will naturally lead to a bit of weight loss. It's taken a few years, but I am ready to let my body set itself at a lower point.

So what am I doing? My primary focus is exercise, which is always a challenge for me. I'm working out twice a week at a functional fitness studio, adding a day each month until I'm at 4-5 intense workouts per week. As far as diet, I'm more mindful of what I put in my mouth and pay closer attention to the foods my body doesn't tolerate well. For me, that means minimal animal protein and more raw veggies and fruits in the form of smoothies and fresh juices. I've even started a new blog about it for those who want to follow me as I continue this journey.

As I reflect on the past eight years, I realize I have not yet arrived. There is always another step that can be taken in the pursuit of health and fitness. Success, for me, isn't about numbers on the scale or the clothes rack. It's about feeling my best, and my best is yet to come.

Mango Chicken Salad

I don't usually create posts to merely direct readers elsewhere, but I am making an exception today. Run, don't walk, your mouse over to my good friend Carrie's blog and check out her July 24, 2012, recipe for mango chicken salad. Trust me, you'll be glad you did!

If Not One Thing, Then Another -- Part 1

We treated Lily to a peanut butter cookie
for being so brave when getting her blood
drawn. We had no idea it would be her last.

It's been a busy few weeks in our household. In making good on our New Year's resolutions to focus on health this year, I made appointments for physicals for everyone in the home. You already know the results of mine. To sum up the results of everyone else's, let's start by saying medical insurance is a good thing. The upside of a PPO is that you get to see any doctor you want. The downside is you can pay anywhere between 20 percent and 50 percent of the services rendered. Still, 50 percent is better than 100 percent; and 100 percent is what you pay when you don't have insurance at all.

For our family, the hits in the health department just keep coming. With all we pay out of pocket for health-care expenses, I hope someone somewhere is putting their kids through college.

First, let's be clear on one thing. Our daughter is beautiful and healthy. She had a routine check-up for her second birthday, complete with our doctor's typical assessment of her being "practically perfect in every way."

This time, as we were packing up to leave, I decided to mention food allergies. Here's my sneaky tactic for asking sensitive questions, "Oh, before I forget. Lily has been having some reactions to foods that we can't pin down. That's nothing to worry about, right?" See ... I phrase it like that so the doctor will nod, smile, tell me I am paranoid and send me on my way. Instead, we walked out with a lab slip for blood work.

When the test results arrived by mail, I was not prepared for what we would find. We suspected a milk allergy. Our dairy-loving girl would live on cheese, yogurt and sticks of butter if we allowed it. The half-inch thick document revealed our suspicions to be true. Aside from pineapple, our toddler was indeed allergy to milk and to whey protein. But here's the kicker: She's also allergic to egg whites, potatoes, peanuts, sesame seeds, tomatoes, spinach, cauliflower, and buckwheat. If you're like me, you're looking at that list and thinking, "Potatoes?! Who on Earth is allergic to POTATOES?!" Apparently, our daughter. And from what I read on allergy websites, she's not alone.

The list reads like a who's who of Lily's favorite foods. She devoured eggs daily and eats tomatoes like candy. Her ideal breakfast at the time was egg, banana and a scoop of peanut butter.

My husband and I discussed the results from the perspective of "she's been eating lots of these foods and they haven't killed her yet." But there was one particularly scary restaurant incident where her hand and face blew up like a blow fish that prevented us from being completely lackadaisical about her results. The doctor's advice was simple: Stay away from all listed foods until she's 4; except for peanuts, which is a particularly scary allergy and requires even further precaution.

When we think about it, the allergens make sense. Peanut butter was a recent addition to her diet, and it coincided with the blow fish incident mentioned above. And well, we just aren't fans of Russian Roulette.

The transition hasn't been easy but there have been blessings along the way. Lily has never been a picky eater. She transitioned easily to rice milk. My best friend introduced her to a very tasty brand of soy yogurt. And though she's allergic to a lot, there's a lot Lily can eat. Processed foods have never been a staple in our house, thanks to my post-WLS dietary restrictions, and going dairy-free never killed anyone.

Social eating is difficult. Lily doesn't yet understand that she can't eat certain foods, and other people don't really know what to do with her. So we are all adjusting as best as we can as fast as we can. That's life, right?

Carnie Wilson Has WLS ... Again

I was toying with an "Oops, she did it again," headline but that seemed overly harsh. I've been trying to stay away from this subject for no other reason than everyone else can't seem to leave it alone. I'm not one for jumping on bandwagons, but why not?

In case you missed it, Carnie Wilson has had a second weight-loss surgery and has so far, lost 30 pounds. Since she already had gastric bypass in 1999 (same procedure as me), she didn't have a ton of options to revisit. This time, she chose Lap-Band, an adjustable gastric band that cinches the stomach -- or in Wilson's case, her gastric pouch, to limit the amount of food consumed in one sitting and the speed at which her pouch empties. She says she did it because she needed help; she's publicly struggled to maintain her weight loss, and was on VH1's "Celebrity Fit Club" in 2006. If you're dying to know the details behind her decision to have Lap-Band, you need not wait long. It'll be the topic of the first episode of her upcoming reality show, "Wilson Phillips: Still Holding On," according to USA Today. The episode should air on April 8, on the TV Guide Channel.

So what does this mean? Is this proof gastric-bypass surgery doesn't work? Did it just not work for her? Is it safe? Why would she do it again?

In my opinion, all this means is that Carnie Wilson is a normal human being, and that surgical weight loss (regardless of type) is not a miracle cure for weight loss. It's a tool, and it requires work. And it's proof that no amount of money or fame makes success any easier. We all battle our own demons. Some of us suffer when we eat poorly, and that is enough of a motivator to keep us compliant. Others fall in love with the fitness lifestyle and all it entails. And there are those who seem to effortlessly maintain their weight loss. On the other side of the coin are those who struggle with cross-addictive behavior, depression and even those who regain the weight they lost.

Even when you are going through the process to have bariatric surgery, you don't know where you'll end up. Doctors don't know either. Bariatric programs all over the nation are trying to figure out what makes some post-ops succeed while others flounder.

The fact is that if you need help, you need to get it. That should be a given in all areas of life, but particularly where your health is concerned. If you are morbidly obese and feel you can't do it on your own any more, bariatric surgery may be the tool you need to turn your life around. If you've had bariatric surgery and have not yielded the results you desired, it's not too late. Seek out help in the form of a WLS support group, a psychological professional, a bariatric nutritionist -- whatever help you need, it is out there for you to find.

If all that fails, Carnie Wilson has proven that there are other procedures that can give you a second  chance. It won't be any easier the second time around, though. It will still be work, and the work will still be up to you. But then again, it always was.

One Down, More to Go

After three consecutive iron treatments, I am officially no longer anemic!

My hemoglobin is 11.7 (Normal is 11.7-15.5), up from 11.2 a month ago. My ferritin level has jumped from 3 to 33 (Normal is 10-154). Much better. Not great, but good. I will take good when I can get it.

So this week, I had my fourth treatment in the spirit of a little more couldn't hurt. And now I get a break. Worst-case scenario, it only lasts a month. Best-case scenario, I won't have to worry about it for six months. Either way, I'm excited.

Now that the anemia battle has been won, we're on to other fights...otherwise known as the Battle of the B's (B1, B6 and B12). I'll keep you posted.

Pumping Iron

Ferrlecit is a fast-infusing iron supplement used to combat anemia related
to iron deficiency. Infusions are often done in chemotherapy centers.

Since my WLS "birthday" labs required further review, I went back to the hematologist who did my first round of iron infusions. Dr. Imtiaz Malik is caring, compassionate and thorough -- not always easy to find among specialists in small valley towns.

Dr. Malik is excited that my tests show some stored iron in my body. He had feared that my previous bowel obstruction would prevent my body from storing iron anymore. He is happy to be wrong. But some stored iron is still not enough stored iron and therefore, another round of iron infusions is necessary. This time around is different, though. We're trying a new type of iron that infuses faster. So instead of being tethered to an IV pole for half a day, I'm in and out in a little over an hour. I still get nauseated with the treatments, and the iron stings while it's infusing -- but those side effects are manageable and only last while I'm getting the infusions.

The challenge is dealing with the side effects that come later. Being lethargic and groggy for 24 hours from the Benadryl that is administered with the iron to prevent allergic reactions is annoying but tolerable. A little extra sleep doesn't do much harm. The hard thing for me, though, is night sweats. Yuck. Nothing worse than being awaken from drug-induced sleep to soaked jammies and sheets.

So what is the upside? Ask my friends. I've been told I'm "the old me," happier, more cheerful, more alert and "with it." Acquaintances comment on the change in my color. I suppose I'm not as pasty as before.

But for me, the benefit is much more than cosmetic or even social. The fact that I don't get killer leg cramps when walking up the stairs means I get to be the one to carry my daughter to her room at night. It means I don't have to make excuses not to play with her because I'm not as easily winded anymore.

So, yes. I am happier. I get to exercise and play with my daughter without feeling like I'm 80 years old. And all that extra oxygen that comes from having enough iron means I don't feel like my head is full of cobwebs. I can carry a simple conversation with minimal effort. Sometimes, I can even hold my own in complex conversations. I don't feel stupid. I don't feel drugged. I feel...human. And I really like the return to humanity.

The Ugly Side of Anemia

Anemia is not cool. Sure, it can give you the pasty-pale look that is so trendy in today's vampire-crazed world. But that's really the end of the coolness factor. It doesn't give you super-human strength, and it definitely doesn't make you sparkle. Instead, anemia robs your body of vital oxygen and makes you feel like everything in life takes an extraordinary amount of effort.

Vampires...much sexier than anemics.
We just look blue and gaunt.

Treating anemia can be just as grueling as living without treatment. For most people, anemia is related to low iron. Treating iron-deficiency anemia usually starts with oral supplements. Iron pills work for most people battling anemia. Unfortunately, I am not one of the lucky ones. So instead of taking pills every day, I get to have murky liquid iron injected via IV once a week. Jealous yet? It's about as glamorous as it sounds.

The first time I had infusion therapy was in late 2010. I stopped just short of a 12-week series using Venofer, which looks like Dr. Pepper pumped into your veins. Venofer was not my friend. It takes about four hours to infuse a dose, not including the pre-medication infusion of Benadryl and Zofran -- nor the 45-minute endeavor of trying to find a vein in my arm strong enough to handle the infusion. It felt like hours of my life being sucked away each week.

Then I would go home and deal with side effects. Nausea and fatigue from the drugs would send me straight to bed, where I'd pass out for four to six hours. Then I'd get up, eat a little and remain in a zombie-like state for about 36 hours. In between treatments, I'd suffer night sweats, loss of appetite from the rust-like flavor living in the back of my throat and physical pain from all of the puncture wounds on my arms. That was my life for three months. There were times when my arms were so weak from the punctures that I couldn't even hold my daughter, who was still an infant. The fact that Brian was unemployed at the time was a true blessing.

I had hoped to never go through that again. Unfortunately, my recent labs make it a necessity.

Sufficiently Deficient

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

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

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

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

By the Numbers
Before any of us gets too excited, let me reiterate that I am still deficient in many areas. The good news with this recent set of labs is that it appears that all levels are rising. I'll take whatever good news I can get. Here's where I am at as of Feb. 24, 2012 (date of the bloodwork; bold type indicates levels are within normal range):

• Hemoglobin -- 11.2 (Normal is 11.7-15.5)
• Ferritin -- 3 (Normal is 10-154)
• Total Iron -- 18 (Normal is 40-175)
• PTH -- 116 (Normal is 10-65)
• Vitamin B1 -- 73 (Normal is 87-280)
• Vitamin B6 -- 6 (Normal is 2.1-21.7)
• Vitamin B12 -- 330 (Normal is 200-1100)
• Vitamin D -- 67 (Normal is 18-72)

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

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

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

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

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

Seven Years -- No Itch

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

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

February 2005: Awaiting surgery.

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

Fall 2011: Almost seven years later.

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

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