Anyone experienced with Realize Band?

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

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

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

Ready for a New Phase

Tipping the scales over 300 lbs. in 2004. 

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

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

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

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

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

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

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

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

Mango Chicken Salad

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

If Not One Thing, Then Another -- Part 1

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

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

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

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

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

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

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

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

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

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

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

Carnie Wilson Has WLS ... Again

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

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

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

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

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

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

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

One Down, More to Go

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

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

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

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

Pumping Iron

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

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

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

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

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

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

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

The Ugly Side of Anemia

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

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

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

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

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

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

Sufficiently Deficient

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

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

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

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

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

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

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

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

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

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

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

Seven Years -- No Itch

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

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

February 2005: Awaiting surgery.

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

Fall 2011: Almost seven years later.

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

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

Review: POM Wonderful

POM Bourbon Marinated Tri-Tip. YUM!

This review is long overdue. Shortly before having Lily (yeah, that would be two years overdue!), I received a nice email from a POM Wonderful representative asking if I would be willing to review the company's pomegranate juice in exchange for a free case. I said yes, adding that I would have to disclose that I received the juice for free when my review was published. The case of juice arrived the week I was to be induced. Suffice it to say, I've had other things on my mind for the last two years. But a promise is a promise, so I'm making good on my word here.

This was not the first time I had tried POM products. The idea of cold pomegranate juice that I didn't have to squeeze myself sounded like the greatest thing since the wheel when it first hit the marketplace, and I bought a few to try. I won't lie, it's the nectar of the gods.

Headquartered in Southern California, POM grows its Wonderful variety pomegranates in the San Joaquin Valley, where I have lived my entire life. POM is the largest grower of pomegranates in the United States and according to its website, supplies the majority of the nation's fresh pomegranates and ships to more than 55 countries. Oh, and they've been generous donors to UC Merced, which already puts them on my short list of favorite corporations.

Now that you know a little about the company, let's talk about what I did with all of that juice. A case of juice goes a long way in the home of a post-WLS woman. As a sugar-sensitive post-op and reactive hypoglycemic, juice is at the top of my long list of banned foods. However, the timing of my gift was perfect. Arriving days before Lily's birth, the juice was like a gift from God. And in the end, it literally saved my life.

Allow me to explain. If you've read Lily's birth story, which you could also call my labor story, you know it didn't all go according to plan. We walked into the situation knowing that a severe hypoglycemic episode had the same symptoms of what people call "transition" in labor. We knew that when (forgive the pun) push came to shove, I would need glucose support. And that's why I had my husband pack four bottles of that delectable POM Wonderful juice in our hospital bag.

At the hospital, I tried my best to be a good patient. They had juice they wanted me to have. Too bad that "juice" wasn't really. Looking at the label (labor hadn't really started yet so I had time and energy for label-reading) left me nonplussed. The box the nurses gleeful offered me was 10 percent juice and 90 percent high-fructose corn syrup and other additives. But I'm a good soldier. I politely accepted the fake juice from the nurse and as soon as she left, ask my husband to instead dilute some of the POM juice into my ice-water cup. One container of POM Wonderful juice lasted throughout my labor experience. It provided the sugar my body needed to get through the marathon of childbirth. Their were some complicating factors along the way, as my loyal readers know. But the complications would have been much more dire had the diluted POM juice not been available to me.

Diluted POM juice was my primary source of glucose support throughout my hospital stay and during my first days home as I was learning to juggle motherhood, breastfeeding and healing.

Even through all of that, I still had six bottles of juice left. No longer needing the juice to keep my blood sugar stable, I found myself wondering what to do. It had been given to me free of charge for personal use so I didn't feel it would be ethical to give it away. However, drinking it no longer was healthy for me.

Around that time, I signed up for a freezer meal exchange group. Created for busy moms, the group focused on each member making multiple batches of the same dinner to freeze. Then once a month, the group got together to exchange meal. You walk into the exchange with five of the same meal and walk out with five different meals. Functional and fun.

Our local grocery happened to have a great sale on beef roast that month and I visited the POM website to see if I could find a way to incorporate the juice into that month's exchange. What I found was an incredible recipe for POM Bourbon Marinated Tri-Tip.  I have since followed the recipe to the letter and must tell you it's even better than the picture above implies.

However, for my freezer meal exchange, some adjustments were needed. I decided to make this as a crock pot meal. So instead of using tri-tip (a California-specific cut of meat only beginning to gain popularity in other states), I used a ball-tip beef roast. I put the raw roast in a giant resealable freezer bag with the marinade contents and froze it. Well, I did this five times, since I was part of the exchange. I gave everyone instructions to thaw the contents in the bag, dump it into a crock pot and cook on low for 8-12 hours. I also included a small baggie of pomegranate arils I had purchased from the store and instructions on boiling down the cooking liquid to make a sauce for serving.

Every single person in my group raved about this dinner dish. The bourbon prevented the marinade from completely freezing and served to continuously tenderize the meat. The pomegranate juice sweetened the marinade enough that even after three months in the freezer, the bourbon flavor didn't overpower the meat. It was a wildly successful experiment and a dish I now make often in my own home because it gives me that wonderful pomegranate flavor without the perils that come from me consuming too much sugar.

The POM site, by the way, is filled with incredible recipes for every taste and time of day. It's worth checking out. But more importantly, if you haven't already, check out a bottle of POM Wonderful pomegranate juice. It's usually found in the refrigerated section of your local grocery store's produce department. It tastes good and is good for you. And if you love pomegranate arils, visit the site today for a coupon. A dollar off makes a big difference.

Unhealthy Food Choices: Privilege or Right?

This photo was featured on the L.A. Times opinion blog referenced below. I'm using it here to illustrate a point.

Today's rant is brought to you courtesy of an L.A. Times opinion blog post that one of my friends shared today on Facebook. For those of you short on time or interest, I'll spare you the details and get to the point: A Florida senator wrote a bill to restrict what recipients of federal aid can buy with that money. By federal aid, the senator means food stamps or what we call "EBT" where I live. The bill would prevent the use of EBT in restaurants or on most foods not found in the meat, dairy and produce aisles. The Times' editorial board has called the bill socialistic. Some Times readers commented that recipients of food stamps are eating on the taxpayers' dime and therefore, don't have the luxury of free will when it comes to what to buy.

The Times hasn't asked what I think, but I have my own blog so I get to share my opinion anyway.
I have never set foot in the state of Florida so I can't speak to its system. But I am a native of California's Central Valley and know a thing or do about how public assistance works here.The food-stamp program has changed a lot over the last few years. Marketing efforts have given it a new image. It's now officially called CalFresh, which complements CalWorks, the new name for cash aid. If you visit the CalFresh website, you'll see the state wants recipients to make good food choices and strives to educate them on how to stretch those free food dollars the furthest. In addition to being able to use your EBT card at Jack in the Box, you can also use it to buy cheap fresh fruits and vegetables at our local farmers' markets. Welfare has come a long way, baby!

Despite all this education and glitzy marketing, obesity still reigns supreme. Local university researchers are amazed at the number of children with obesity-related co-morbidities such as high blood pressure and Type 2 diabetes. Sadly, most of those obese children come from homes with CalFresh assistance. And their obesity is evidence that healthy eating is not the norm. This proves that education (the Times' suggested solution) alone is not the answer. Knowing what to eat and feed to your family and actually taking the time to do it are two different things.

My knee-jerk reaction is to say forget choice and dictate every singe morsel purchased with public funds, if for no other reason than to serve the taxpayers' best interests. Obesity is expensive. Obese children become obese teens and later, morbidly obese adults. Obesity-related illnesses are expensive to manage and treat. But that reaction comes from the perspective of my inner 200-pound child, who still remembers the emotional and physical challenges of growing up poor and obese.

As much as I want to save our future generation from the curse of obesity, I know that children are at the mercy of the adults in their lives. American adults will stop at nothing to get what they want when they want it. I can remember as a child, seeing people in the grocery store parking lot trade food stamps for cigarettes. If this Florida bill were to gain steam and become law, food-stamp recipients wouldn't instantly become Jamie Oliver's newest converts. They would just find a way to trade those EBT dollars for the unpermitted foods they want. Instead of trading food stamps for cigarettes, people would start trading them for jelly doughnuts and potato chips.

So, if I'm saying education isn't the answer, and mandating the purchase of healthy foods isn't the answer, then what IS the answer? I wish I knew. If I did, I could use my public relations background to market it and pat myself on the back all the way to the bank.

Nutrition education and activism must continue, and each of us must lead by example. When we step up to the plate to make better choices for ourselves, we serve as an example to those around us. So the solution lies within each of us and what we buy at the store for our household, because that dictates the food served in our home and to our household guests.

Dinner time at your house may be the first time your child's favorite playmate ever lays eyes on roasted asparagus or green beans that weren't victimized by the canning process. That playmate might bravely try that asparagus, like it and go home and tell his family about it. And who knows? Maybe asparagus will makes its way to their dinner table the following week. You never know. So the next time you have company over for dinner -- whether adult friends or kid friends -- consider making dinner instead of ordering takeout, and watch for the ripple effect.

'Weigh' to Go!

Like a good little post-WLS girl, I went to the doctor today for my annual lab work-up. It's hard for me to believe that the 24th of this month will make seven years since my Roux-En-Y gastric-bypass procedure. But what is harder for me to believe is how my doctors respond to my weight at my check-ups nowadays. The only word I can come up with to describe it is glee. Really...my doctor is filled with glee every time she checks my weight. It's an odd occurrence to observe, considering that I was in the super-size club for so long. You know, the club where you go to the doctor for a sore throat and they find a way to make it about your weight so they can discuss diet and exercise without seeming insensitive. I spent about two decades in that club.

I don't keep a scale in my house anymore and when I go to the doctor, I don't even look at my weight. It's way too easy for me to obsess on the numbers, and I did not have gastric-bypass to have the scale serve as my external source of self-esteem. I did it to give me the opportunity at a healthier life, both physically and emotionally. And in my book, daily weigh-ins and freak-outs over a pound here or there is not healthy.

I'm still about 10 pounds over what I consider my "fighting weight" of 165 pounds -- that sweet spot for me when clothes fit perfectly off the rack and I am able to move through the world with minimal effort. But I'm also about 10 pounds less than I was when I found out I was pregnant with Lily (which followed the most stressful month of my life). I will take the weight I am at right now over where I have been any day of the week.

Merry Christmas and Happy New Year 2012

The Kubo clan in December 2011. Photo courtesy of Donavan Garrison/DMG Photos

Time is precious. That’s all I can think of right now as I write this post. I started this blog seven years ago with a dream in my heart that if successful, I would one day be a mom. I could never have predicted the road on which surgical weight loss would have me travel – rapid weight loss, active lifestyle, near-death experience, divorce, career change, remarriage, etc. – but I am forever grateful for the vehicle.

Lily turned 2 in January. Photo courtesy of
Donavan Garrison/DMG Photos

I remember the first time a doctor mentioned gastric bypass to me. I was 280 pounds and trying to figure out why I couldn’t get pregnant. I had been obese almost as long as I could remember, but I never thought it would interfere with fertility. Docs know so much more now than they did back then but after looking at my charts, the nurse midwife said weight-related infertility was the only logical conclusion.  I left the office insulted that she thought I was big enough for bariatric surgery and then I went home and proceeded to “diet” my way to 350 pounds over the next year.

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

Lily, that child I wasn’t sure I would ever have seven years ago, is now 2. And every day that I look into her eyes, I am reminded of what an incredible gift WLS can be. But it’s a delicate gift that requires careful handling and consideration. I’ve forgotten that a time or two over the years and have paid the price.

But today, I relish hearing the words, “Mommy” and “Mom” from the baby bird lips of my toddler in that soft, high-pitched voice that I know won’t last forever. I share the day-to-day discoveries on Facebook with my friends and I count my blessings even in times of frustration.

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

Breaking the Cycle

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

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

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

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

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

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

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

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

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

The Best-Laid Plans – Labor & Delivery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Best-Laid Plans

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

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

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

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

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

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

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

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

Lily Ann Makes Her Debut

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

40-Week Update

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

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

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

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

The Final Countdown

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

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

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

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

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

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