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.

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.

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.