Call Me Iron-Woman

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

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

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

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

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

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

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

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

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

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

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

And then there is me.

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

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

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

Growing a Baby is Hard Work

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

At 11 weeks, baby looks like a baby.

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

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

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

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

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

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

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

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

Sequel Makes Big Splash

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

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

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

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

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

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

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

Checking in and Progress Pix

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

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

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

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

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

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

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

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

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

Body Fat Update: 22%

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

Welcome to the Gun Show

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

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

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

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

Clothes Make the Woman

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

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

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

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

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

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

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