And then Michelle Obama visited Merced

When the UC Merced Class of 2009 set its sights on having First Lady Michelle Obama deliver the keynote address at the university's commencement celebration for its inaugural class, I never thought in a million years that it would come to pass.

I stand corrected.

Mrs. Obama delivered an inspirational message to our graduates in May of this year, encouraging them to pay forward the blessings they had received so that others may have the same opportunities afforded to them. She talked about the daunting challenges that lie ahead for those entering the work force but reminded the 500-plus graduates that there were ample opportunities to make a difference in the world.

Her presence led about 12,000 people to brave the sweltering valley heat in order to catch a glimpse of her in person. Close to 20,000 people in all spent that day in Merced, some watching the commencement festivities from locations downtown or in the air-conditioned comfort of the homes of family and friends. Most local media outlets broadcast the event live on their Web sites. It was also broadcast on public-access cable television and on CNN.

As a public information officer for the university, I had the opportunity to coordinate media before the event and help journalists get the access they needed during the event. That meant that I, too, was bravely the 100-plus-degree weather and full sunshine. Anyone who thinks a journalist's job is glamorous hasn't been corralled in a press area without shade for hours.

Though I gave a lot of interviews in the weeks leading up to the First Lady's visit, my favorite interview came in the days after when Sam Matthews, publisher emeritus of the Tracy Press, called me up to see what I had to say about the experience. Never in all my years at the Press did I ever think I'd live to see the day when I was mentioned in Tracing Tracy Territory. I guess that makes me an official Tank Town veteran.

The experience of working with the White House is also one I won't soon forget. Politics aside, nobody can deny the fact that the Obama administration is highly accessible and gracious when it comes to working with others. I learned so much from the six short weeks we had to prepare for the event, and I am so much better for the experience.

And then we got married

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

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

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

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

Showered with shoes and purses galore

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

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

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

And then I got engaged

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

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

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

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

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

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

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

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

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

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

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

Apology and Update

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

For that, I apologize.

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

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

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

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

What happens to cravings after WLS?

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

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

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

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

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

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

UCSD develops new WLS method

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

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

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

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

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

Do Low-Carb Diets Affect Brain Function?

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

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

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

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

AP: Liver Disease Plagues Overweight Kids

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

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

Kaiser Point West Says Goodbye to Gity

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

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

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

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

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

Tales From the Dark Side, Part II

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

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

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

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

Why?

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

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

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

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

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

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

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

But let’s get two things clear:

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

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

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

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

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

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

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

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

Tales From the Dark Side, Part I

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

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

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

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

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

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

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

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

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

It was hard not to roll my eyes.

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

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

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

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

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

The Human Pin Cushion Speaks Again

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.