The Human Pin Cushion Speaks Again

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

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

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

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

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!

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

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?

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

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

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

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

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.

Recipe adapted from Chocolate and Zucchini: Daily Adventures in a Parisian Kitchen by Clotilde Dusoulier.

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

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

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

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 ...

... 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

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

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

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

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.