Immediate Gratification (The Good Kind!)

Well, that was a short delay with the insurance denial! My surgeon talked to the medical administrator at my insurance company (aetna), and my gastric sleeve procedure has been approved for 1/11/11! Yahooooo!!

I was hoping, hoping, hoping it would turn out this way. It seemed like a small technicality to delay the approval for, and one that would just add cost and time delays for all parties (more appointments with the surgeon, the nutritionist, the physical therapist while we were biding time until my surgery date).

Yay! I am very happy and excited! Glad I kept those big-girl panties on and stuck to the liquid diet today, haha.

Disappointment Turned into a (Small) Win

My precertification for the surgery was denied. :( I was supposed to see the surgeon monthly for three months before the surgery. I saw him 9/30, 10/28...12/10 and 12/30. I missed my November appointment because:

1. It snowed and the city shut down for three days the Mon-Wed before Thanksgiving;
2. The Thanksgiving holiday (Thu/Fri); and
3. My surgeon's wife had a baby on 11/19 and he was in and out of the office for several weeks.

Pure carelessness on my part. I should have had a crystal-clear understanding that "under the surgeon's care for three months" meant "seeing the surgeon at least once every calendar month." Not having an appointment that was date-stamped "NOVEMBER" has temporarily sidelined my plans! Hope is not lost, however. My surgeon is talking to the medical director for the insurance today and will plead my case RE: the missed appointment.

Ah well. It will work out somehow. The surgeon said they will approve the gastric sleeve, once I satisfy this calendar-month requirement. That was my big concern: being forced to choose between an approval of the RNY after I had already made the decision to have the sleeve. I just wasn't sure what I would do in such a scenario.

Possibilities are:

1. The insurance has a change of heart and approves my 1/11 date;
2. I am given a "make-up" month where I see the surgeon in January and can have a February surgery; or
3. I have to see the surgeon for three consecutive calendar months, starting with December - thus, a March surgery date. We'll see.

But! I promised you a small win. I am a TOTAL emotional eater. So you know after leaving my surgeon's office, bitterly disappointed and without a surgery date, I was ready to scrap this liquid diet in a big way. "I am going to stop for lunch on my way to the office," I told myself.

I'd actually be okay with that, in theory. I don't know how this will play out, it is not unreasonable to put the liquid diet on hold temporarily, etc.

However. I was not thinking, "Gosh, I'm a little hungry and I can have a small healthy meal in lieu of a protein shake." I was thinking, "SOMEONE JUST TOLD ME SOMETHING I DID NOT WANT TO HEAR AND I AM VERY UPSET ABOUT IT AND NEED COMFORT. NOW."

I did not stop for lunch. I got a protein shake out of my purse and drank it. This type of challenge is what will NOT go away with the surgery. For months now, in preparation of the surgery, I have been asking myself how I will handle my emotional eating/head hunger issues. What will I do when I'm bored? What will I do when the kids stress me out? What will I do when I am sad? Stressed? Lonely?

What will I do when I am very disappointed? Will I scrap two+ days of effort on a liquid diet? How will I feel if I get "the call" from the surgeon saying my surgery is back on for 1/11? Do I trust myself to eat a healthy meal in this emotional state of mind? If so, I could use it for my day's meal and have a protein shake for dinner. Do I really trust myself to have a protein shake for dinner, when my habit is to have a big dinner?

No. I decided that when I had my big girl panties back on, after I've heard a definitive "no" on the 1/11 surgery date, if I would like to discontinue the liquid diet, it will be a conscious, well-thought out decision. Not a "you hurt my feelings so I am going to eat myself into a stupor" decision.

Oh, Ask Me How Much I Love a Liquid Diet - GRR.

I am doing this to help myself, I am doing this to save myself, I am doing this for me, I am doing this for my children, IamdoingthistohelpmyselfIamdoingthistosavemyselfIamdoingthisformeIamdoingthisformychildren...

Gack, but that doesn't mean I like it! Yesterday was rough. I was Starvin' Marvin all day! I went overboard with my "small meal" at night, but all in all, a very good day. Today, it's 10:15 and I am happy to report that I am not consumed by hunger as I was yesterday (hmmm, suggests Dr. Freud - do you suppose the hunger could be mental? Und do you think perhaps you were not as hungry as you thought, but instead were suffering from childish feelings of deprivation?) Hrumph. I don't care what you say, Dr., I was damn hungry yesterday. Today I am off to a much better start. Good times!

A friend has invited me to lunch to watch her eat. Umm, this is funny but maybe not such a good idea today. I'm going, but if I come back cranky and mean, you'll know why. ;)

Last Iron Infusion?

I am scheduled for my fourth IV infusion on Monday. Thus far, my ferritin levels have been 3 (when first tested), then 40, 28 and now 48 following each infusion. (I have a feeling I'm goofing up those numbers a bit, but am too lazy to check the facts. It's pretty close, though: a spike following first infusion, a drop, then a good climb. The goal is to get my levels above 50 and holding. I know I'm close! Yesterday, I called and asked for my lab results and was told to come in for another IV on Monday. Then today, in a miscommunication, a nurse called and said the doctor said my levels were fine and to come back in eight weeks for a re-check. It turns out he initially said I could come back in eight weeks, but when I called for my lab results, he happened to be right there, so he asked me about my sleep patterns, etc and decided to do another IV. Today's nurse was calling in response to an old message.

Anyway - I'm close! This will be my last infusion before the surgery, and I'll probably go back in eight weeks for a re-check. I'll have to remember to ask about an oral supplement, as this was something he mentioned he was going to have me do before, but today's nurse knew nothing of it.

I'm ready to be done with these, too! I am feeling better - although I did read something today about anemia causing hair loss - this is me!! I've been losing hair like crazy this year! I will confirm this symptom with my doctor on Monday, as it would be nice to have an answer. LAUGH - right before I have weight loss surgery and start losing hair as a side effect of that, haha. Oh well. Forewarned is forearmed, right?

Also, I found out that the iron IVs are costing me $200/each out of pocket. Gulp. Last I checked: not made of money. Thank goodness for insurance, though! My 10% copay of $200 means that each IV costs...well, millions and millions of dollars, anyway. ;)

What Protein Looks Like

I made a trip to Costco last night. Truly, I should have prepared in advance for this pre-surgery period. I have been busy, and procrastination is one of my strong points! Anyway, $80 later, I left with two boxes of protein shakes, and one each of fruit-flavored protein-y concoctions.

My philosophy today is "get through the day." Thus far, I've taken in 714 calories: that's three of the shakes and one each of the fruity concoctions. This isn't in the range of the 400-600 calories I'll have per day in the two weeks following surgery, but I think we can all agree that it is much less than my normal caloric intake.

First impressions of the fruity conconctions: ugh. The "test tube" one is vile. It must be the green tea flavoring that doesn't really taste like green tea to me. They are both sickly sweet: the gray bottle one is much sweeter but doesn't have any weird after (or during) taste to it. It tastes good, actually, in a can't-hardly-handle-the-sweetness way. I'm not a big sweets person. Both were greatly improved by putting over ice. I will chug them down, but won't buy the test tubes again unless I have a radical change of heart. The packaging is so cute! :) I wish they weren't gross. I have been trying to think of how I can re-use these adorable little tubes.

For my birthday, my friend Nancy, bless her heart, has ordered me chicken-flavored protein powder from unjury.com. Every girl wants protein powder for her birthday! We had lunch today (she is also having protein shakes for lunch for the next two weeks, in a show of solidarity, haha) and the topic du jour was protein. She decided to order me the sample pack from Unjury, as well as the chicken-flavor. Love her! Can't wait until they come in the mail.

I won't bore you with pictures of my protein shakes for the next two weeks. When I begin to drone on endlessly about how many shakes or concoctions I had in a day, as I'm sure to do, you can reference this picture. ;)

Helllloooo, two week liquid diet!

Oh dear, really? It's time? Well, maybe. I'm still waiting on that insurance approval, see. But wouldn't it suck to blow off the liquid diet, only to have the insurance approved at the last minute? Wouldn't I feel foolish then?

It's time. Hopefully I'll be having my surgery in just TWO WEEKS FROM TODAY! Maybe not, but hopefully. I'll keep you posted, for sure. In the meantime, protein drinks are my friends. Uhhh, I'm hungry. I've read and heard that by day five, it's just a new way of life. Today, however, I see hunger in my future. :) Hunger, but EXCITEMENT! This is really happening! Even if my surgery doesn't happen 1/11, I will stop the wheels of weight gain and start building my positive momentum down the hill. I am ten weeks smoke free, I am starting a new chapter in life. Wow, thus far my forties have been all about REBIRTH.

You go, girl. I am proud of you. Err, me.

Surgery Date is Not Working Out as I Had Hoped!

I'm still keeping my fingers crossed, but the precertification process is proving to be slow to take off! On Monday, I spoke with my surgeon's office and was told the notes they'd received from the physical therapist were not signed or dated. Thus, they were waiting for signed notes before submitting for precertification. After talking to them, they agreed to submit the precert request without the signature/date for the second PT appointment.

This afternoon I called my insurance company: no pre-cert request has been logged. Called the surgeon's office. Request faxed over 12/20. Called insurance: prefers that doctor's phone in request. Fax takes forever to work through the system. Called surgeon's office: they will phone in request.

ARGH.

My hoped for surgery date of 1/11 is seeming quite unlikely. The insurance company has 72 business hours (approx nine business days) to review the request after receipt. Let's see: we'll start the clock at tomorrow AM since the insurance company is on the east coast.

Nine business days gives them through 1/5/11 to decide. The surgery would be in less than a week.

I am still hopefully, but not holding my breath. :)

Pre-Holiday Silliness

From: Julie


To: ALL_EMPLOYEES

Subject: *REWARD* Missing Rubbermaid cart *REWARD*

Hello, all! We are missing a beige double-decker Rubbermaid cart that is clearly labeled in black Sharpie: (department/division/floor) (uh, it was clearly labeled like a week before the re-org, unfortunately…) A photo of a similar cart is attached, although there is no way to represent in film the love and affection we bestowed upon this cart. Truly, it’s like one of our dear coworkers has gone missing! (Although we would probably have launched the manhunt sooner, in that case.)

This cart has untold sentimental value to our project managers, as it is the Motivational Cart, which inspires us all to quickly review heavy plan sets and contract specifications, specifically by using the cart to block access (or occupy a large percentage of square footage of) to cubicles and offices.

Reward offered! Good karma abounds! Please look around your work areas and see if the cart is hiding in a nook or cranny.

No questions asked on how or why you had a cart in your cube for months that is clearly marked as belonging to another work unit…I’m just sayin. ;) I am willing to arrange an anonymous exchange of the cart and the reward in a discreet location so as to protect your cart-hoarding identity!

Call me. Start 2011 knowing that you returned a loved one to its family. We’ll never, ever, ever let anyone borrow it again it out from under our loving gaze.

JULIE
__________________________________
From: P
 
To: Julie

Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

I don’t know where it is, but this is pretty funny and that will prompt me to keep an eye out for it.

____________________
 
From: D


Sent: Wednesday, December 22, 2010 9:58 AM

To: Julie
Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

Hello Julie,

I checked (outlying work area) and did not see your cart.

D
_____________________________
From: R
To: Julie
Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

Is that the same one I saw for sale on Craig’s List??
______________________________


From: Julie
To: P, D, R
Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

That’s all I can ask, guys – “someone, somewhere, knows something.” ;)

Have a great day!
____________________________________
From: B

To: Julie

Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

This looks suspiciously like my lovely wife's garden tool cart in our garage…I was wondering what the (department/division/floor) meant!

__________________________
From: B


To: Julie
Subject: RE: *REWARD* Missing Rubbermaid cart *REWARD*

*UPDATE* The missing cart has just been spotted northbound on 8th Ave at Madison loaded with groceries and being pushed by an elderly lady with a shawl.
______________________________
From: Julie


To: ALL_EMPLOYEES

Subject: **UPDATE**FOUND (sort of)** Missing Rubbermaid cart **FOUND (sort of)**UPDATE**

Friends, a monster walks among us. Or, even worse, a clutch of monsters! A work unit so devious, so sneaky, that they have not only kept a cart from its loving family, they have kept it bound in chains and ropes, and what I believe may be an extension cord?? ARE YOU EVEN FEEDING IT AND GIVING IT WATER?? Look at this picture I received in an unmarked envelope!

**UPDATE (WITHIN AN UPDATE)**

The culprit has called and identified himself. I will protect his “good” name in hopes that he actually delivers the cart, as promised! And get this…he’s blaming a RETIREE, a good wholesome man who worked hard his whole career and is no longer here to defend his honor! Really, do we believe this story?? And (really, really outlying work area you would never suspect), I can promise you, I would have never, ever thought to look there. :)

Hi Julie,

Your cart, which Eric commonly referred to as “the dim sum cart” arrived at (really, really outlying work area) approximately seven months ago. It’s been well-cared for.

There’s a fine line between a ransom and a reward… I could either arrange to have someone meet you down at the docks for the exchange, or I will have it brought downtown to you tomorrow.

-S

(oops, I “forgot” to protect his good name, just like he “forgot” to tell me for seven months that he’s been hoarding my cart!)

 Thanks all! I appreciate the department rallying to find the cart, identify suspect coworkers, and offer empathy, support and candlelight vigils.

As you were…

Julie (I’M BUYING A BIKE LOCK FOR THAT CART THIS WEEKEND)
_____________________________________________

From: K
To: Julie

Subject: RE: **UPDATE**FOUND (sort of)** Missing Rubbermaid cart **FOUND (sort of)**UPDATE**

If food, water and shelter was not provided, we could investigate. Our officers are Humane Law Enforcement officers after all.
______________________________

From: C
To: Julie

Subject: RE: **UPDATE**FOUND (sort of)** Missing Rubbermaid cart **FOUND (sort of)**UPDATE**

Julie, we enjoyed your comments over here at (a place where lots of calls are received) (of course we also “feel your pain…”). We’d like to encourage you in exploring a sideline career in standup comedy or writing! C
_____________________________________________
From: J


To: Julie

Subject: RE: **UPDATE**FOUND (sort of)** Missing Rubbermaid cart **FOUND (sort of)**UPDATE**

GOOD News!!!

I’ll call off Homeland Security and the FBI!!!
______________________________
From: J
To: Julie

Subject: RE: **UPDATE**FOUND (sort of)** Missing Rubbermaid cart **FOUND (sort of)**UPDATE**

Julie, I haven’t met you yet, but I wanted to tell you that you made my day with this e-mail exchange. The next time I have to write a department-wide e-mail, I’m going to enlist your amazing writing skills!

Thank you,

J

This has nothing to do with anything...

But a friend linked me to this blog, and I am rolling with laughter this morning. Truly, tears rolling down my cheeks. I highly recommend you check it out! Silly captions to catalog photos...

Catalog Living - "A look into the exciting lives of the people who live in your catalogs."

Nighttime is the right time…

Waking up to a freshly ironed dress and a half-eaten watermelon, Gary suspected Elaine was back on Ambien.

What to Expect

I have some lingering concerns about how life will be post-operation. At this point, it's just time to take the plunge and figure it all out as I go along. But it is a little stressful, wondering, wondering, wondering...

- I have a big appetite. With the VSG, I have learned, "The sleeve gastrectomy and hunger is quite interesting because the sleeve gastrectomy works, in one of its mechanisms, by removing a hormone named ghrelin, which is produced in that portion of the stomach, which is removed and sent to the pathologist. So, initially we know that the hunger is eliminated because that hormone is eliminated, but with time, we notice that patients re-develop hunger." That quote is taken from this site, but it is consistent with what I've read and heard from my own surgeon. I just needed a nice sound byte. :)

• Will my hunger go away with the surgery? A woman in my WLS support group said that two months post-op, she needs to remind herself to eat. If she doesn't, she crashes, but she doesn't feel hungry. She's done better since getting on a routine of meals and snacks throughout the day, even relying on an alarm to remind herself. She had the same procedure I'm hoping for by my same surgeon, so it's interesting to hear her feedback. On a happy note, she has lost 50 pounds since the surgery!! The last time (the only time, actually) I saw her was two weeks before her surgery - I barely recognized her at the support group this weekend, and had to wait until after she introduced herself to the group to make sure it was her. :)
• What will I do without food? I will have to be very careful to avoid cross-addictions. I don't know what particular addictions I'm worried about, really. I'm not much of a drinker and I'm not likely to turn to drugs, haha. But I do worry about how I'll spend my free time without food! Will I be rattling around restlessly?
• How will it feel to have energy? Will weight loss give me energy? I confess, I'm a terrible slug. I am feeling much better with my iron IV supplements and the vitamin D mega-dosing. However, given my druthers, I pretty much just veg out. For instance, I am the slowest housekeeper in the free world. It will take me literally all weekend to clean my tiny condo, and generally I don't even remotely finish it. How much of this is obesity, and how much is just I'm-a-lazy-sloth-and-that's-why-I'm-obese?? The causation versus correlation argument can drive me insane in this regard. Which came first, the chicken or the egg?
• How long until things stop hurting? My feet have really been hurting this fall. Not just hurting like they used to hurt when I do yoga. Not just hurting like while I'm walking. We're on to full, long-lasting foot hurt. I want this to stop!! Yesterday, I took my 11 year old daughter downtown Seattle. We had a blast! We walked and shopped and finally saw a concert and had dinner at a yummy dinner theater. What a great day! And oh. my. goodness. did my feet ever hurt. They are still very sore today.
• What if I change my body, but not myself?? I confess, I am very disappointed in myself in my pre-surgery behavior. I am not only not losing weight, I am gaining weight. Yes, it's the holidays, and yes, I did quit smoking NINE WEEKS AGO (yay!!) as my pre-surgery gift and commitment to myself. But I am feeling more physically uncomfortable than ever as I lead up to my surgery.

1/11/11 Looking Unlikely

Well, I just called my insurance company and my surgeon has not yet submitted the precertication request. Grr. I left a message with the surgeon, but there is even a possibility his office is closed this week (purely my speculation, since no one answered the phone at 10:00 a.m.).

Oh well. The insurance company has nine business days to review a request. Eek! With the holidays, it practically is only nine business days until my planned surgery! I don't mind a change in date, terribly, anyway. It will just be nice to be able to make plans. Right now my biggest complication is scheduling my ex- to take the kids for two weeks. It's only fair to him to be able to have a date set as soon as possible. (He is a massage therapist with crazy stupid hours and ridiculous part-time jobs cobbled together...and ouch, look, the anger/irritation of our marriage is burbling up again, ack!) Anyway, he is more than willing to take the kids for a couple weeks but I really do need to make sure he has enough time to plan for it as he frequently works evenings and alternate shifts and blah, blah, blah.

You Make a Grown Man Blush!

Today's WLS support group was fun. I got good information about my quandry over whether to have RNY or sleeve surgery. The people there are nice, and it's an enjoyable couple hours.

Most fun, though, was during the introductions. A rather attractive couple had wandered in late, and I was trying to guess which one had weight loss surgery. Turns out it was the husband. He introduced himself, saying he had lost well over 100 pounds since early spring, I believe. Something astonishing. I leaned over and whispered to my neighbor, then thought, what the hell, I'll just say it out loud: "It must be great fun for your wife to see her husband turn HOT." Oh my! The wife was roaring with laughter, the husband turned beet red, the whole room was laughing and having fun.

But seriously. :)

Surgery Date! (Hopefully) 1/11/11

Isn't that a nice date? It's also the day after my 41st birthday, so my year will get off with a bang and hopefully by summer I'll be rockin' my hot new body. :)

The date is contingent upon insurance approval, however. I believe my surgeon submitted for pre-certification this Monday (that was the plan, anyway). The insurance company has nine business days to make a decision.

I have been really struggling with the decision to have VSG (sleeve) or RNY (bypass). I want the sleeve. I am concerned about RNY: you cannot take NSAIDS (Aleve, ibuprofen, a prescription med, Celebrex, that worked wonders for me with back pain). I worry about digestive issues with RNY - gassiness and stinky poop. Not that my poo smells like roses, mind you! It's more the gassiness. I lean this way anyway (more and more I am realizing it is because I am much, much more lactose intolerant than I am willing to admit, and my body deals with it as best it can). I don't want to opt in to additional problems with gas. And, for that matter, I should be more proactively addressing my current issues. It's the dairy, dummy.

I'm more comfortable with VSG. I'm a quantity eater, not a particular foods eater. I don't gravitate toward sweets or fats in particular, I just overeat. I have a good, varied diet and the only foods I really balk at eating are olives and mushrooms. :) But I will tolerate them if I am out with my olive and mushroom-eating friends.

SO...you see, I want the gastric sleeve. But...what if my insurance doesn't approve it? I have read the policy on their approval of gastric sleeve. I do not technically meet the requirements. I do meet the requirements for RNY. I have decided that if my insurance only approves RNY, I will move forward with that procedure. So, if that's my bottom line - why not just choose the RNY? This is my surgeon's preference, I believe. He maintains that I will lose more weight with the RNY, and have a better likelihood of keeping it off.

Lots of people don't have complications with RNY. I do not tend to have complications with medical procedures. I am a "pretty typical to best results" sort of person with surgeries and medical treatments I've had. My back surgeon (fusion in 2004) said I am a poster child for the procedure. :) So I tend to look at it all pretty optimistically: I don't have any higher degree of likelihood to have complications.

I think I'll stay on my current course: have the VSG if approved by insurance, have RNY if not. This morning, I have my WLS support group and I may do some more interrogating questioning of the people there. Most have had RNY, a few have had VSG, and a couple have had the band (which is not even on the table for me).

Overhunger Rectified

Oh dear, I should have made it back to the blog to post my photo update! And here I went to great pains to photograph my lunch before eating, haha. As you can see, I did pretty well. I chose the smallest container, I went heavy on the protein. Threw in a piece of fried zucchini, because, well, it's yummy. :)

Why Do You Do the Things that You Do?

I'm doing it again - one of those silly things that keep me on the path to ruin. I'm s-t-a-r-v-i-n-g. It's 1:45 p.m. and I have not eaten today. So, I am trying to talk myself down Hunger Hill. No, I do not need to have yummy pizza for lunch. I do not need a giant meal that will have me nodding off at my desk in an hour, writhing around with a bloated belly ache.

Silly Julie. This is one of the many problems I need to address. Over-hunger = bad news. I've long since passed the point of hunger, then famished, then starving. Nope, I'm on to full-blown shaky hands, nothing sounds good, perilously low blood sugar.

And this, ladies and gentlemen, is reason #503 that I am obese. Err, morbidly obese. Overcompensation for going too long between meals, or eyes-bigger-than-my-stomach syndrome.

Let's see how I can rectify the situation and come back to blog. :)

New Connections!

Today at lunch, one of my bestest buddies mentioned I should talk to a friend of his (and fellow coworker of ours) about her experience with gastric bypass surgery. I jumped on it! I haven't gotten much chance to grill people in person about their experiences with WLS, haha. We work in the same building (it's a biggun, that building of ours) and were able to meet for a break this afternoon. Wonderful! Best yet, my new friend has blogged her experiences, which is the most inspirational and motivational tool for me right now. I love seeing before and after pictures, reading about ups and downs, personal struggles and triumphs. More later!

3rd Iron IV Infusion

Ok! I'm done with my third iron IV. Let's hope that my iron levels improve and stabilize, because the novelty of this procedure has worn off. :) Today I had to get stuck with the needle twice, and the second time was on the outside of my wrist. I have had three IVs in my hand/wrist before, and all of them have been extremely painful mo'fos. This one is no exception! Ouch. I must have more nerves in that area.

I'll go back on 12/20 for another ferritin level check. They will also be testing my B-12 levels with some advanced test. My overall B-12 is 300, with the range being 250 - 900 or thereabouts. If the advanced screening comes back with certain indicators, they'll start me on B-12 injections. I almost hope they do, as I'm really pretty intrigued with how these levels affect how I feel on a day to day basis. I find it so cool that I am actually waking up before the alarm clock every morning. Iron = good!

On the bad side, my feet and knees are really bugging me lately. Why? Winter? Weight gain from quitting smoking? Old age? My forty-first birthday draws nigh, after all. Anyway, I don't like that one bit.

I have a follow-up appointment with my surgeon on Friday morning. I will have to face my weight gain, which I think has at least stabilized. Oh well, I'm so very, very glad that I quit smoking! Tomorrow, I will miss the WLS support group, unfortunately. They are sampling a bunch of protein products. I would love to be there! That stuff is expensive, and any opportunity to try it for free would be wonderful. But instead, I will be at my daughter's cello concert - an extremely worthy reason to miss the support group meeting, I believe.

Follow-up: Iron IV Infusions

I just booked an appointment for my third IV iron infusion. I am so surprised! I had my blood work done yesterday, and my ferritin level was 28. This is down from my level of 48 at the time they did the second infusion (before the infusion, of course). I can't help but feel disappointed, but that's kind of a silly reaction. :) Bear with me. Since I'm coming up from an initial level of three - well, we're making leaps and bounds of progress. The nurse said my dwindling numbers aren't a reflection on any mischief my body is up to instead of making iron like it's supposed to. It can just sometimes take longer than expected to get the levels up and stabilized.

We are shooting for a level of 50. After I'm stabilized here, they'll put me on an oral iron supplement and continue to monitor my levels, as needed. On the plus side, at my current levels, I notice that I am feeling better and have a bit more energy. The most marked difference I've noticed is that I wake up before the alarm clock in the morning. This is a new thing, believe me!

I'm having the third IV infusion tomorrow afternoon. The hematologist did not test my vitamin D levels yesterday. Instead, they will have me take the higher dose of vitamin D once a week for two months and then re-test.

$45 for a Gallon of Milk

The gallon of milk I bought today cost me over $45. On Friday and Saturday, I took the kids to McDonald's for breakfast for no other reason than we were out of milk. On Friday morning, I realized my foolishness, but had to scramble to get the kids off to school. By Saturday morning, there was nothing I could offer in terms of an excuse: just add another $25 to the cost of the milk.

No, by this morning, I still had not bought milk. And to think that I had held off sending one of the kids to the gas station to buy the $6 gallon of milk in order to "save money." And that's awfully good milk, too, although the price is o.u.t.r.a.g.e.o.u.s. Our gas station sells the brand of dairy products the milk man brings to you door: local, hormone-free, antibiotic free, etc, etc.

But don't let me turn my ample skills in diversion and distraction change the topic from a bazillion dollars in fast-food over a lack of desire to go to the grocery store. And...it's Christmas...and I am a single mom...and my ex and I are not sharing cost on Christmas prezzies for the kids this year...and, did I mention there are three of them...and, let me just say wasting money on McDonald's is one of the stupider things I can do right now!

Something I'm hoping to gain from the surgery, and it's not weight, haha: endurance. Stamina. I confess, I usually shop when the kids are with their dad. This week, they are with me, and so...no grocery shopping. I hate taking my children into a store. My 11yo daughter is no problem. It's my boys, 9.5 and 5. Argh. So, when I am exhausted from work, which is not going well, exhausted from dealing with my 5yo, who is raising hell at school and daycare, and just physically and mentally exhausted, in general...well, you can see it in my household management. Messy house, out of staple foods.

By taking off weight, I'm hoping to capitalize on some energy. I know that my physical pain will lessen: feet and knees won't ache as much, etc. That will be good. But I'm hoping that life won't be such a damn chore. I tell you, after a long day volunteering yesterday and then taking the boys to a fun event, I am beat down today. The boys were horrible at Target (where I did pick up all our staple foods, haha). Horrible. We are going to a Christmas pageant of sorts tonight, and I am dreading it. The house is a mess, the kids are hungry, and I am just draggggggginnnngggg trying to get back on task.

Deep Breaths

Looking at protein and diet as objectively as possible. Tonight, I checked my daughter's BMI: it's 39.8. Much better than how I had guesstimated it, but still pretty shocking, especially for such a young girl. She and I have agreed that she can continue a vegetarian diet, but will be held accountable for increasing protein intake. We will be finding more tofu recipes that she enjoys, finding ways to jazz up our soft tacos at home, she is going to try one of my favorite combos - pineapple and cottage cheese. She will continue to have a protein shake for breakfast in the morning, and we will work on her bringing lunch from home. When she doesn't, she will have the yogurt/cheese stick/muffin lunch combo on most days.

We are both going to work on keeping a food diary. Hers will be so I can track her protein intake and double-check that she is taking her vitamins. After my low iron level scare, I became pretty vigilant about her taking a daily multi-vitamin with iron. It's hard to stay on top of that every day (harder still because I am so awful at remembering to take medications and supplements, myself).

I'm feeling less stressed about it this evening, but definitely feeling an urgent need to get this family on track. Being a single parent is so darn difficult sometimes. I've got great kids, but there are three of them, and they are young, and my boys have been particularly time consuming with their own issues lately. I feel like I'm struggling to keep everything moving forward. I'll continue to work on my organization and family schedules to try to lighten the demand on myself.

Daily Protein Requirements

The plot thickens! My surgeon says to plan on a goal of 60 grams of protein per day following surgery. In the short-term liquid diet phase following the operation, this will be accomplished with protein shakes. My favorite brand has 30 grams of protein per shake. That will take care of at least the first two weeks following my GSV. But what's a girl to do after that? I am really hoping not to rely on protein shakes: I like food, and I want to be able to enjoy it for the rest of my life. But I will take the recommendations on how to make the most of my surgery and weight loss/maintenance very seriously, too.

Your body needs a lot of protein! This page on about.com says that "the standard method used by nutritionists to estimate our minimum daily protein requirement is to multiply the body weight in kilograms by .8, or weight in pounds by .37." Uhhh, according to that formula, I should be taking in upwards of 90 grams of protein a day.

Ninety grams of protein is:
- 39 oz, or 2.5 bricks of tofu; or
- 4.5 cups of beans; or
- 15 eggs; or
- 2.25 cans of tuna; or
- 14 oz of fish; or
- you get the idea.

Funny, I have never really thought about how much protein I take in during a given day. As we saw from yesterday's lunch, my meal selection naturally tends to be a mix of a little of everything, including good sources of protein.

However - when you think about the "meal the size of the palm of your hand" and "60+ grams of protein a day," I can see it will get a little complicated! Protein shakes, protein powder and protein bullets are going to have to round out my diet, I believe.

Where I'm a little concerned right now is with my daughter. She's eleven, and has a BMI of probably 61. OMG. That brought tears to my eyes just typing it. My family's health is in crisis mode. Plus, she insists on being vegetarian, so getting protein into her...well, it's hard. She won't eat fish, she isn't wild about tofu, eggs or beans...

Ahh, I'm kind of having a reality crisis just writing this post. Wow. Thinking about my protein needs and how I'm going to manage them pre- and post- surgery has led to a real bucket of cold water on my head about just how terribly I'm managing this whole issue for my family.

And you were here, live, to see it. Now back to our regular programming, already in progress. Yikes.

Much thinking to do. This is why I write - it is therapeutic, cathartic, and seems to be the only way I can think. Doh.

The Size of My Palm x How High?

Bahaha, I am thinking about lunch. I've decided to focus my efforts on eliminating gluten from my diet and limiting meal size to roughly the size of the palm of my hand.

What to eat, what to eat? No, I did not transform into Super Organized Woman and bring my lunch from home today. So I'll be wandering over to the local food court with a friend of mine. I was thinking about rice with peanut sauce, or what she and I call the "Two dollar lunch." It's not on the menu, but the thai place will sell you a scoop of rice and a ladle of peanut sauce for about $1.60. The "One dollar sixty cent lunch" doesn't roll off the tongue, though, hence the "two dollar lunch."

So, the two dollar lunch actually comes pretty close to fitting on the palm of my hand. But it's a pretty tall pile. :) And there's no protein in it, either. Or is there? Peanut sauce - hmm, peanut butter = protein. Not much, though, I'd say. Here's a recipe from cooks.com:

2 tablespoons smooth peanut butter

2 tablespoons soy sauce
1-2 cloves garlic, minced or chopped
1/4 cup water
1 tablespoon brown sugar
juice from half a lemon (can be less, depending on your tastes)

I say this needs some chili oil for kick. Google tells me there's about 8 grams of protein in 2T of peanut butter. I'm supposed to be shooting for 60 grams of protein per day. This isn't going to cut it! This amazingly cool website http://www.wolframalpha.com/ says there's 8 grams of protein in 3 ounces of tofu.
 
Clearly, I'm going to have to spend a lot more time thinking about how to up my protein intake...

Why Am I Fat? And Broke?

Hmm, another lunch purchased instead of brought from home. And while it is pretty - I was thinking about it on the way back up to my office. It weighed a damn bit more than the 2-4 oz my surgically-altered stomach will be able to hold!

Well, on the good side, it's got plenty of protein. That's fried tofu in teriyaki-type sauce, tuna salad and a few pieces of salmon hiding under the bok choy. I am aware of the fact that if your lunch plate is hiding other items on the plate, well, there is too much food on the plate. You see that I have lapsed in my no-soy, no-dairy, no-gluten experiment. There's a little bit of macaroni and cheese (can you hear it screaming "comfort food!" from there, I wonder?), some breaded and fried zucchini, some veggie fried rice, broccoli in soy sauce, and the baby bok choy. Uh, I think that's all that was hidden there.

This combo, plus a bottle of Diet Dr. Pepper, was $11.25. Ok. Maybe we could play a little "What's Wrong with this Picture?" game!

1. Fried, really? Tofu and zucchini?
2. Pasta and breading on the zucchini = not gluten free.
3. Tofu = soy. I'm not too concerned about that one, really. I know I am lactose intolerant, I know I am probably gluten intolerant, but I have no reason to believe I am soy intolerant. Jeez.
4. Mac n Cheese = dairy
5. Where in the heck do I think I've got $$ for an $11.25 lunch hiding??
6. The principle behind gastric sleeve surgery is that you can live on 2-4 oz at a meal. This lunch was that amount, many times over. With or without surgery, I can live on 2-4 oz. The surgeon said basically, after recovery, it's the amount of food that would fit in the palm of your hand. Fingers excluded, haha.
7. As an example of the mindset I need to correct. There was one more piece of tofu and one more piece of zucchini in the lunch before I took the picture. I got back to my desk and realized I had misplaced my iPhone! I got a little panicky. I was already hungry to the point of being out of sorts, not being able to find my phone pushed me even farther. So I sat down and ate a little bit before looking for (and finding) my phone.
1. Don't let yourself get so hungry that you are physically goofed up from it.
2. Uhh, watch the stress eating and eating to calm down, haha.
3. This whole meal and experience sort of sums up many problems I've got going in my life. PeeWee's word of the day is OVERCONSUMPTION.

Link to VSG / Gastric Sleeve Surgery

Hmm, this isn't for the faint of heart, but I did find a link to an excellent overview of a VSG surgery - and an actual surgery being performed, eep!

Gastric Sleeve Surgery video

Marry Me!

ROFLMAO, I have just re-read through a few blog entries and I realize what a catch I am! Divorced, over 40 (well, I *am* 40, but that changes soon enough), 3 young kids, morbidly obese, herpes, and, in my own words "am bloaty and gassy all the time."

Yes, marry me! I am your heart's one true desire. ;) I guess I can just cut and paste this blog over to my match.com profile, haha!

Phhhblllttt. Hey, come next summer I'll be rocking my new hot body, and will be so busy putting it through its paces! Just like a new car, you've got to get it running and see what it can do. I am greatly looking forward to it. I have a feeling life is going to take many turns for the positive in 2011.

CPAP = Claustrophobia, Pester, Aggravate, Peeve

I feel ashamed of such a lame acronym, but that's all I have for you tonight. I've been attempting to bond with my CPAP for a little over a month now. I hate it.

It doesn't help that I know I have very mild sleep problems and won't need the machine for long after my surgery, or after I lose any amount of weight. That makes it even more of an annoying invasion of my nights.

When I first put it on, it seems good. Ahh, yes, I think, that seems good. A little push of air. Not disruptive, not bothersome. Mask fits well, hose doesn't get in my way. All is well.

At some point during the night, it becomes INTENSELY annoying to me. I don't think I've slept through the night once since I got the darned thing. Not on the nights I've used it, anyway. There have been several nights that I have not used it.

I have a history of this sort of thing. I'm a terrible jaw-clencher and teeth-grinder. I have a nightguard, and I can humor myself and put it in before bed. I rarely will wake up with it in, however. My subconscious self decides at some point during the night to do away with it: tucking it in the medicine cabinet, throwing it on the floor, hiding it under my pillow.

Same with the CPAP. I generally find I am getting up to go to the bathroom (something I do not normally do) and "forgetting" to put it back on. Then awaking in the morning a little surprised that I'm not wearing it.

Oh, I hate that thing. I know it's supposed to be good for me, but it is good for me in a terribly unpleasant way. I will be so happy to bid it adieu!

Spell Checker

Oh my goodness, I had no idea that I've been spelling 'acupuncture' and 'acupuncturist' wrong all this time! I guess I was going a little overboard with my Cs! And I was just arrogant enough to think that the highlighted 'accupuncturist,' signifying a spelling error, was some sort of mistake on blogger.com's part, not mine, haha. But it finally puzzled me enough to check into it - and wah-lah! Poor spelling on my part.

Not that it's the first or last time you'll see a) mistakes or b) foolish arrogance on this blog. Bear with me. :)

Goofball

My accupuncturist reaaalllllllyyyy wants me to stop eating gluten. I am a stubborn one, though, and have not yet taken the plunge. Her reasons make sense, and I would be well-served to give it a try.

- My low levels of iron, vitamin D and vitamin B. She says this is exactly what you'd expect to see in someone with malabsorption problems, likely due to gluten intolerance.
- My ethnicity as 1/4 Alaskan Native (here, I always say "eskimo" but I am told that it is now an offensive term. Not to me or my family, haha, but I'll yield to the PC-gods, nonetheless.) My accupuncturist says "Alaska Natives" are notoriously gluten-intolerant because it simply was not part of their natural diet.
- She's been gluten-free for several years and swears by it. She's a big nutrition/healthy eating fan.

Okay, I already know I am lactose intolerant. That in itself makes me cranky. :) Give up wheat and dairy?? (This statement implies that I've actually given up dairy, which I have not. I've simply learned not to overindulge quite as often, and when I do, while I am retching into the wastebasket whilst sitting on the toilet with horrificly painful diarrea - well, at least I understand that I did it to myself. Dope.)

Years ago, I did have my doctor do a celiac blood work panel on me. It came back fine. However, my accupuncturist says the initial panel they usually do has a high false negative rate: there is some more involved test that yields better results. Now, I trust my doctor, but I have to say - after my initial iron test was "fine" and my follow-up panel ordered by the sleep doctor was so miserable...well, let's just say I'm open to the follow-up testing.

The reason I requested the celiac panel was because of the Starbucks Eight-Grain Roll. I'm not much for sweets in the morning, and I had taken to eating these rolls. And it took me a little while to figure out that I was getting a miserable stomach ache and being gassy and bloaty after "enjoying" them. Oh! It was when I made the rolls at home that I really made the connection. I found a similar recipe, made delicious rolls at home, and paid the price. I started wondering if I was gluten-intolerant, or even had celiac disease.

My doctor poo-poo'd me right from the start. As a morbidly obese woman, he said I obviously was not having troubles absorbing food. (He didn't say it that callously, but I'm just cutting to the chase.) My accupuncturist says the opposite is true - obesity can indicate poor nutrient absorption, too.

The easy thing to do would be to stop eating gluten, even temporarily. However, I'm spoiled. Without a diagnose, some professional confirmation that I am gluten intolerant...well, it's easier to keep eating it. Doh.

And I'm intolerant, I can tell you for sure. I am always gassy and bloated feeling! This is real! I used to think it was because I drank so much pop: but when I didn't drink pop, I felt the same way.

Give. up. the. gluten. I have done this for a short time in the past. It is not hard, it is just not fun. I have read online resources and borrowed books from the library on the subject.

As my accupuncturist says, now it's just on me to make the decision.

Ex-Smoker

Happy six weeks smoke free to me! Hurray! I am happy to say that I feel confident in my non-smoking status. Generally, I don't think too much about it. When I quit smoking (twice) earlier this year for three weeks each time, I started up again when I was having a hard time with the kids. The stress just got to me. I think I've been doing much better wrangling my three young'uns, and I haven't wanted to turn back to cigarettes. On Thanksgiving, I went to my parents' house. They both smoke - the elusive "light smokers" who have no more than a few cigarettes a day. Anyway, they went outside after dinner to smoke...and that was the first time that I thought, "yes, I'd like one, too." I didn't even go outside with them to chat: I found something to keep myself busy, and the urge was fleeting, anyway.

I will have to be careful, though. Cigarettes sound good when I drink, and they have always been a crutch for me when I am stressed. When I quit in 1998 or thereabouts, I did well as a non-smoker. However, I was getting ready to have children, so I was very committed to it and had finite goal(s) in mind.

I started smoking again, briefly, in 2004. I had to have an MRI for an upcoming back surgery. In the MRI machine, I had a complete and utter claustrophobic meltdown! Oh man, did I ever hate that. I left the lab in tears and went across the street and bought a pack of cigarettes. I sat on the stairs of the store and cried and smoked. Eep. MRIs = nasty. Anyway, I was a basket case over the impending surgery, and I smoked for several months leading up to the surgery, then quit right before it.

Also, this week I had a couple dreams about smoking. This isn't unusual - I've had dreams about smoking every time I've quit. These dreams were humorous, though. In the first, I found a half-pack of cigarettes and lit one, without thinking. After I had smoked it, I chastised myself for "forgetting" that I am a non-smoker. Then I realized it was a dream, and I felt relieved that it wasn't really happening. I laughed about it when I woke up. However, the next time I fell asleep, I dreamed I was smoking: this time I was pissed off because I *knew* I wasn't dreaming (of course, I really was)! Oh, I was so mad at myself in that dream...and still a happy non-smoker when I woke up. Oh, crazy psyche...

So...I will always have to watch myself with cigarettes. They are a big time stress "go to" for me. But today, I am six weeks smoke free, I am proud of myself and have no urge to pick up the habit again. Yay, me!

The original quit smoking meter I was using on the blog doesn't seem to be working. This one is okay - but shows some odd currency sign instead of the $ sign. However, the math still checks out. Over 600 cigarettes foregone! And over $300 saved! (Where in the heck is this money, though??)

Bariatric Surgery Support Group

I went to my second support group meeting today. I'm so glad I went! A couple observations on the makeup of the group:

- most of the people there are significantly older than me (55+, I'd say). There was one girl there who is 20 - she had lap-band surgery two years ago.

- most of the people there had gastric bypass, roux-en-y surgery. Two had lap band, two or three had gastric sleeve, as I plan to have.

- more women than men.

All are so nice. Two of the women strike me as a little kooky. Interestingly, both of them were also the ones who seemed overly stressed about the amount of food they are only able to eat. One spoke of being molested frequently in the past, of not trusting men, etc. These topics were not par for the course for the meeting.

Lap band surgery is not nearly as effective as gastric bypass or gastric sleeve. The two people there: the 20-year-old girl and the 50-something man, have not lost very much weight. She has lost 37 pounds in two years, he has lost about that in the 10 months since his surgery. They both have quite a bit more weight to lose, but not so much that you would think they need gastric bypass surgery. She expressed some disappointment in her weight loss, but acknowledged it has not been a priority for her. I pointed out that at least she wasn't gaining weight. I was about as overweight as she is at her age, and if I had been able to curb the weight gain, life would be very different for me now, perhaps.

There were three people there, two women and a man, who were eleven days post-op for gastric bypass surgery. That was primarily why I was so glad I went! They all looked wonderful. Good color, healthy, happy. All said they experienced no pain from the surgery, only discomfort. All said they stopped using pain meds in the hospital. I was very pleased to see how well they looked so soon after the operation. It has been one of my biggest concerns with the operation. Post-surgery, my life will continue at its normal fast pace. My kids' dad will take them for a couple weeks following surgery, and I will take a couple weeks off work. But I want, and need, to be back on my game as soon as possible. Seeing these three made me feel good.

One of the recent surgery patients was one of the women who was stressed about how much she could only eat. She is eleven days post-op and she wanted to be eating more variety, eating regular foods. She said that she did eat a small portion of regular Thanksgiving dinner. It was a little disconcerting: it illustrated how the food addiction does not disappear with surgery. However, most people report that immediately after surgery, the hunger disappears, for the most part. I am wondering if the two women who seemed a little more...hmm...what is the word I'm looking for? A little less mentally stable (although they weren't *unstable* by any means) were also the ones who seemed to struggle with the loss of food more.

One man has lost 132 pounds since his bypass surgery in February. He was really quite inspirational. He talked about the emotional difficulties following surgery. He said for the first couple months after surgery, he was pleased with his weight loss but could only described his emotional state as feeling deprived. He said it was hard, but he focused his energy on all the many benefits of the surgery and weight loss. He said, again, at Thanksgiving - such a food-based holiday, it was a little hard. But he has so much more going on for himself than a year ago, it was only a feeling of minor loss. He is really cool. His wife was there (not obese) and they talked about changing priorities: he used as an example milestones he set for himself post-op. He said it was very hard at first to think of non-food celebrations to look forward to when he met his milestones. :) I liked them both immensely. He works out regularly now: twice a week with the physical therapist, more at home.

For my part, I shared that I am planning the gastric sleeve operation in January. I quit smoking about a month and a half ago, and have struggled with weight gain since. I am nervous, but excited about the surgery. I loved seeing people look so healthy immediately after the surgery, and I loved hearing their success stories. I am stressed about missing time from work, since I have exhausted all my paid leave. They are such a nice, supportive group, it really boosted my spirits.

I've got another post or two in mind, I've got some errands to run but will be back later!

Iron-y

I'm a couple weeks out from my second iron infusion, and I have to say...wow! I think I am feeling much better! I have noticed that I am waking up before the alarm in the morning, and actually getting up. Pre-iron, I would hit the snooze button a million times and finally drag myself out of bed at the last possible minute.

Also, I'm not so tired in the evening. I'm getting more things done and not collapsing into bed at the earliest possible moment.

Finally - I am not so irritable. This is really quite remarkable, as it's hard for me to recognize irritability as a valid side effect of low iron. But also, I haven't understood why I'm so damn irritable without good reason. And lately...well, I'm just not. Sure, I'm still bitchy and overwhelmed sometimes, but largely, I think the difference in my mood is pretty darn noticeable.

I've also taken three of my weekly 50,000 IUI vitamin D capsules. Three? Hmm, I'll have to check. I got the prescription a week and a half or so ago...maybe I've only taken it twice. Anyway, between the iron and the vitamin D...well, I daresay I am feeling human again!!

I get my blood levels checked on Wednesday afternoon. I am very interested to see where everything stands. Also, I find it interesting that I stopped taking antidepressants in late July. I have to say that all these months later...I don't miss them. I would say I feel the same or better as I did when I was on the antidepressants. When my moods are blue or even bleak, they are the same blueness or bleakness as when I was on the antidepressant. When I am feeling good, which is generally most times...I feel as good or better as when I was taking the antidepressant. And I don't have to deal with all the yucky side effects.

Costco's Protein Drink and More Thoughts on the Surgery

Really, that's the best one of the bunch, I suppose. It looks like the brand is "Premier Nutrition," but mostly, it just says "Protein" in big letters down the front of the box. It's 3 grams of fat and 30 grams of protein. Tastes yummy. Sells for pretty cheap at Costco.

My ranty post yesterday about deciding to have the surgery was purely for my benefit. I am blessed with friends who support my decision, but not blindly: asking the same questions I am asking myself, coaxing me to think through the things I need to resolve. I don't want to second guess my decision after the surgery, so I need to make my peace with it before the big day! And it is a struggle for me. By nature, I am very, very hard on myself and my perceived failings. My weight, my body, my health - I have a lot of regrets and recriminations about it. So, the last thing I want to be doing after the surgery is kicking myself for having it. I know me: I have to work through all my feelings, so when I'm recovering and need my gallbladder out, while I'm standing there holding fistfuls of my own hair...well, I need to know that I thought it all through and made peace with my decision.

(Hopefully, this scenario won't play out! Instead, I'll be rocking my ever-shrinking body and bouncing off the walls with all my newfound freedom and energy.)

Biggest Loser Previous Winners

I borrowed this picture from another site. I haven't followed the Biggest Loser (see future posts RE: self-loathing, what-I-hate-about-you-is-what-I-hate-most-about-myself). Clearly, though, the photo demonstrates that weight challenges continue to be a very personal, very difficult struggle, even with all the resources and media spotlights. But Oprah would be the first to admit that, too.

Thoughts on Obesity and Aging

This isn't the sort of blog where I ruminate deeply over posts, drafting and editing and revising and finally publishing. Nope, these are my actual thoughts as I have them, haha.

I was thinking about WLS last week. Really, it's all I think about. I am reluctant to have it. I don't want to introduce new side effects into my life: hair loss, heartburn, gallbladder problems, etc.

But...what's the trade-off? And really, what am I adding? Several months ago, I *did* have to go to the doctor for gallbladder pain. I had an ultrasound that did not show any stones, but I didn't have the more conclusive follow-up test. We skipped that, because by then I was no longer having the pain (and haven't had it since).

But the reality is that I am female, fat and forty. It is not out of the realm of possibilities - heck, it is even *likely* that I'll have gallbladder problems. And post-surgery, my doctor puts you on some gallstone resistance medication for a few months. Maybe I won't have problems. And if I did? Really, it's not the end of the world.

As far as hair loss goes, well, one of the reasons I dread that potential side effect is because I already suffer from it. Twice over recent years, I've taken a migraine medication (Topamax) that can cause hair loss. For me, both times, it did. And it takes MONTHS after stopping the medication to stop the hair loss. It's creepy. I have been off that medication for quite awhile now, and I am still losing a lot of hair. I don't know if it's from the med, or stress, or the Natural Instincts hair color I'm using. But, I'm surviving. It is annoying, and it creeps me out, but it is not the end of the world.

Pain. Pain is another side effect. Uh, hello, I had three babies without a bit of pain medication. Sure, I cheated on that third guy and adopted him - but I was there when he was born and his delivery did not hurt me one bit! But with my second, he was in there sunny side up (WHAT IS THE MEDICAL TERM FOR THIS) and crooked, and at one point in the delivery I got up and said I was going home, so tired and frustrated I was...but no pain medication. Sure, I was at the midwife's house and the most she had on hand was probably Tylenol, but I did it!

I also had an L5-S1 spinal fusion in 2004, and you don't know pain until you've had a spinal fusion, I think. Ouch. So I can handle five little laproscopic incisions and some stomach pain.

But what I was really thinking about was getting old. I was telling a friend that I *want* to believe I can take the weight off without surgery. But I am forty, and I don't want to spend the rest of my life in a life and death battle with my weight. And life and death is exactly what it's become.

You don't see elderly obese people. I told my friend I finally realized it is not because they all figure out how to beat the weight as they age. It's because they die. And I'm not even talking "elderly" as 70 or above: you don't see many 60 year old obese people.

There is a woman I worked with in the building here. She was super morbidly obese. She ended up in one of those motorized scooters. When our employer started covering WLS surgery a couple years ago, she said she was the first person to sign up. First, she had to do something - maybe it was lose a little weight. We're not close, and I don't see her often, so I don't know the details. All I know was that I continued to see her around the building in that motorized scooter...until I didn't.

Now, it is possible that she had the surgery and lost so much weight, I just don't even recognize her when I pass her in the building. But I think it's just as likely that she died. I don't know, and it's not important, because this is about me and *my* struggles with obesity, not hers. I don't want to die of obesity. As a single mom to young kids, I can't say that I am always completely enamored of my life. It's exhausting. But eating myself to death is not a road I'd like to take.

I get inspired by these women who take off tremendous amounts of weight without surgery. Their discoveries, struggles and victories are very inspiring and thought-provoking. But I always wonder about their future. Do they keep it off? Once all the challenge of losing it is gone - do they maintain it? I am as competitive as hell, so I can get engaged in a good battle to lose. But, then? When the challenge is gone, so am I. What about all these Biggest Loser contestants? I think there's good reason they don't do many "Where are they now?" stories. My guess is most of them are right back where they started. I know this game. I've played it my entire life. In the past, I've been a "pull yourself up by your bootstraps" success story, too. I've lost 70 pounds more than once through sheer willpower and determination alone. And even 70 pounds lighter - I faced all the same struggles and challenges I do now. But I repeatedly gained the weight back, and more.

I don't have room in my life for "more." If I keep pushing my weight upwards, as I've done this month with quitting smoking, I will kill myself. I've reached maximum capacity, I'm afraid.

So, while I'm not thrilled at the prospect of surgery to overcome my weaknesses...well, I can live with it. *Want* to live with it.

I've got a new perspective on "taking the easy way out" with surgery. I've never been one to take the easy way out. I got my first "real" job the moment I was legally able, I worked full-time during my senior year, I earned my associates, then bachelor's, then master's degrees while I worked full-time. I had three kids without pain medication, I fought hard to save my marriage and threw my husband out on his butt in the middle of the night when I realized I was the only one fighting for it.

I don't cop out, I don't take the easy road. It's ridiculous that I would continue to be so hard on myself over this decision. I am trying to save my life. I am trying to HAVE a life. I'm having that freaking surgery and I don't give a damn what anyone thinks or says about it, or me.

ROAR!!!

Going in the Wrong Direction

My little web counter at the top of the page says it's been over four weeks since I quit smoking. Yay, me!! However, I can really feel it in my clothing. The jeans that had gotten so baggy they were really pretty inappropriate for work? Well, they're snug now. :(

On the good side, I have played "Just Dance 2" several times, including for a good 4-5 songs last night. It may not be a strict exercise regime, but it is a work out, and it is something, anyway.

Also, did I mention I'm a NON-SMOKER?? This, in itself, is very good news. And except for those first couple days, I didn't even really struggle much with it. It was time. However, as usual, when I've quit, my sweet tooth comes roaring to life with a vengeance.

Now that I'll be one month smoke-free tomorrow, it's time to reign that monster in. If I continue to gain weight, my insurance company may decide that I am not a good candidate for weight loss surgery (WLS). And it's mid-November! The new year is creeping up on me quickly - and so is the potential surgery date.

IV Iron Infusion - Good News Follow-Up!

Happy news! Unexpected, too. I have a voice mail on my phone from the hematologist: my ferritin levels are normal! This, before my second IV infusion, even, as they took the blood to test when they got my infusion going on Wednesday. I've got a call into their office, I'm not sure what my number is (nor exactly what it would mean if I *did* know, haha). I know that per his testing, my ferritin level was 3 before the first infusion, and he wanted to get it above 50.

They had scheduled me for a third IV for next week, but the message was to cancel that appointment. Instead, I'll go back during Thanksgiving week to have my blood drawn again to see where the level has stabilized after the second infusion.

I heard back from the doctor's office: my ferritin level is at 48, as tested on Wednesday before my second infusion. So, my level is probably even higher now. The target was to get it above 50, so we're in like Flynn! (was going to say, 'so Bob's your uncle!' here, but decided to go with a slightly less obscure exclamation.)

This is very interesting, because it means my blood is getting back to where it should be, and I should be reaping the rewards!

Also, the hematologist called in a prescription for Vitamin D for me. He does not like those levels, either, and wants to get them boosted. I will be taking 50,000 IUI once a week, indefinitely, just like a certain awesome runner friend of mine. My GP, who is opposed to high dosages of Vitamin D, is just going to have to stuff it on this one. I'd like to get my iron, VitD and B-12 levels to normal-people levels and see how that affects my day to day life for a change.

Cost of Care

As I'm starting the process for my weight loss surgery, it's obvious how quickly the cost of everything is going to add up! I'm looking at my insurance website to date. Thank goodness for a wonderful insurance plan! Even the copays I have now will be the death of me around the holidays - I can't begin to imagine what I'd do without great coverage.

9/30 - first appointment with surgeon (my share) $15 / (insurance payment) $236

10/6 - X-rays and labs (me) $23 / (insurance) $204

10/6 - X-rays and labs (me) $19 / (insurance) $175

10/6 - X-rays and labs (me) $2 / (insurance) $18

10/7 - Hospital incidentals ?? (me) $20 / (insurance) $184

10/8 - Physical therapist (me) $32 / (insurance) $285 (SERIOUSLY????)

10/14 - Sleep doctor, first appt (me) $15 / (insurance) $355

10/15 - Overnight sleep study (me) $142 / (insurance) $1279

10/20 - Lab (me) $2 / (insurance) $17

10/25 - Sleep doctor, second appt (me) $15 / (insurance) $123

10/27 - Overnight sleep study (me) $155 / (insurance) $1398

10/28 - General practictioner (me) $15 / (insurance) $75

10/28 - Surgeon, second appointment (me) $15 / (insurance) $71

11/3 - CPAP set-up appt at home (me) $15 / (insurance) $62

You can see this is going to get very expensive, very quickly. Thus far, my actual out of pocket costs are $500, and my insurance has paid $4482. Gulp. You know what's missing here? The appointments for my iron infusions. They have not been submitted to my insurance yet, so I don't know what the cost will be.

For next year, I set aside $5,000 in my flexible spending account. This is money that I have immediate access to at the beginning of the year. It is tax-free and can be used to pay medical expenses. If I don't use it by the end of the year, I lose it. With three kids, and this surgery planned - well, I'll use it. But if I don't have the surgery?? I may be in a bit of trouble. Next year, you can no longer use your flexible spending account for over the counter medications! This has been the saving grace of "leftover" money at the end of the year: just go buy a bunch of Tylenol. No more! Although, truth be told, I haven't had leftover money at the end of the year in any year since I've been using the FSA.

The biggest appeal to me with the FSA is that I have full access to the $5K at the beginning of the year. It is then taken in equal installments from my paychecks throughout the whole year. For people like me who suck at money management, it's a good way to be able to cover expenses up front.

Prick Me, Baby

I love accupuncture. I've been doing it for many years, off and on. I can't remember how I got started, but my first accupuncturist, Gloria, was really wonderful. She was a nurse, and she wanted to start a program with the hospital for end of life care. It was her passion and it quickly became difficult to get an appointment with her for accupuncture, because she was moving on to different things. She was wonderful, though, and if I had a headache, she could stick that pin in and slowly twist and my headache was gone like magic.

It does matter what sort of practitioner you get. I started accupuncture again this fall because I wanted to treat my super-tight ligament on one of my calves that tightens horribly while I sleep and sometimes wakes me with incredibly painful cramps. There was a provider across the street from my office, so I saw him...once. What a hack. I should have known: I had seen the chiropractor in the same office off and on for years, and he is all. about. the. money. I have never been driven so crazy by a health care provider as by this chiropractor's office. Calling me to remind me of appointments, to remind me to schedule appointments, blah blah blah. I finally told them NO MORE PHONE CALLS...EVER. But foolishly, I went to the accupuncturist in the same office. He jabbed a few pins in and billed my insurance about $300. Then came after me for the difference when the insurance company only paid about $65. HELLO -- here's my Explanation of Benefits stating that I only have to pay my $15 copay and you've agreed to waive the rest. Really slimy business practices.

Oh, also: I asked that accupuncturist to put in pins for quitting smoking (as if it's a button that must be pushed, haha). Well, he couldn't do that, but he has a special 10-session program that is not covered by insurance that involves treatments and aromatherapy and blah, blah, blah.

Forgettaboutit.

I decided my next accupuncturist must be an authentic practitioner of eastern medicine. I specifically searched my insurance company website for names I could not pronounce, I'll admit. But then I happened to ask my chiropractor if he knew an accupuncturist...and he referred me to someone wonderful. She is an authentic-ish practitioner of eastern medicine with a strictly Biff-and-Muffy sounding name. But I adore her, positively adore her. I saw her for the first time on 10/16, the day I stopped smoking. She sticks me full of needles and pins and gets them zinging the way I like, while we laugh and chat. Then I get to zone out under the heat lamp and warm blankies for half an hour or so. I've probably seen her or her coworker eight or ten times in the last month. I'm tapering off, now, my next appointment is the 27th.

So...accupuncture for the newbie. Don't be afraid, it doesn't hurt. The needles are super skinny. Some of them sting a bit going in: the most painful I've had are for the cravings/detox for smoking. Those are the five pins that go in each ear. They're the worst, but they aren't bad at all.

Accupuncture is all about energy flow through your body. I can't speak to the meaning of it all, but I do know I like it and it works for me. I've mentioned that accupuncture can make a headache disappear for me. And if the needle goes into the wrong spot, or not deep enough, you notice it. It just feels like nothing. But a needle to a good spot gives you a little "zing," a little something that tells you it's working. And while I can't say that accupuncture made me quit smoking, I can certainly say that it helped. My first visit was on the day I quit, and I've had several follow up appointments and I am nearly a month smoke-free. The relationship between correlation and causation? I dunno. It worked. I don't question it. :)

If you're at all interested, give it a try. I am a proponent of any self-care treatments involving heated massage tables, warm blankies and quiet time spent by oneself.

Bah-ha-ha-ha! To Dream, the Impossible Dream

I've been playing with this BMI calculator. Would you believe my "normal weight range" is 103 - 138 pounds? This, if I give myself the extra 1/2" of height that I seem to have grown at all these doctor appointments. Who knew? A growth spurt at 40!

Well, the last time I was 103 pounds was 5th grade. And I probably passed by that particular milestone pretty quickly, too! I've been trying to think of how much I've weighed at various times as an adult. I was 275 when I was 40 weeks pregnant with my second child in 2001. I was 167 when I had taken off 69 pounds at Weight Watchers, but before I quit smoking - so probably 1996. Up and down, up and down, for many, many years.

A couple things on the iron infusions. I had my second this week, and will have my third on Tuesday. This morning, I woke up early and had nothing pressing to do before work (e.g. the kids are at their dad's). I gave myself permission to fall back asleep. But I didn't want to! Wasn't tired at all. Instead, I got up and got some stuff done around the house. A sign of improvement on the horizon? I hope!

That little anecdote needs a disclaimer, though, as I think I also pretty much went to bed at 3:30 yesterday afternoon. The kids were with their dad, I had gotten a one-hour foot massage, 15-minute chair massage and a 30 minute sauna treatment...oh, how hard it is to be a lady of luxury! Bahaha. No, I'm not a lady of luxury, but I did treat myself yesterday. My accupuncturist (more later!) recommended the foot massage place. It was $25 for an hour long massage, plus $10 for the 15 minute chair massage. And it was worth every penny, 100 times over. Wow! $25 for an hour massage! The accupuncturist's recommendation stemmed from the coupon placed in her office for a $5 sauna treatment at a nearby spa. I said I was going to go check it out - she said if I did, I must visit the foot massage place. The sauna was okay, the foot massage was to die for!

Anyway, after my spa day, it was pouring down rain, and the traffic was miserable on the way home. I opted to curl up under a blankie and watch t.v., which of course led to napping. I dozed off and on, visited with 2/3 of my kids when they stopped by to get something (Part III was asleep in daddy's car), and watched the NBC Thursday night tv. It was not a grueling afternoon and evening, haha.

I did feel pretty vexed by my laziness this morning when I realized I completely spaced off the bariatric surgery support group meeting last night. I am very disappointed about missing it, especially since the next one takes place on the Saturday after Thanksgiving and I have my kids all that weekend and may have to miss it. D'oh! What price, laziness?

I have been using the CPAP machine at night. I can't say I love it. Maybe I'm getting better quality sleep, maybe it's worse. I do know it is affecting my dreams and stirring up my sleepwalking tendencies. A couple times I have woken up and thought it was morning, took the thing off and went to bathroom, then realized hours later that it is still the middle of the night. It is making my nose break out in pimples. Many mornings, I have mask-imprint-face. Sometimes, I feel like the thing is actually trying to suffocate me: I'll find that breathing deeply into the mask through my nose is not giving me enough air, and I'll end up breathing through my mouth - which creates this bizarre vacuum sensation. No, I do not love it.

But, I'll continue to wear it. Why? Am I glutton for punishment? No! But, for my insurance to pay for it, I have to wear it 21 days out of a 30-day period. And you won't believe how Big Brothery it is, either. The machine has a removable disk I will take to my follow-up appointment with the sleep doctor on 12/21. There, he will be able to see when I've worn it, and for how long, and all sorts of information about my sleep patterns. FREAKY SHIT, MAN!!*

(*Oh, I am so torn about my language on this blog. I am truly a trash mouth. Thankfully, my bosses and coworkers are also trashmouths, so this doesn't get me in trouble at work. No, we are not longshoremen. Anyway, I try to keep my language clean here, because I don't want to offend anyone who may one day be helped in some small way by my experience. But...I gotta be me, too. And I'm not a FIDDLYSTICKS! kind of girl.)

Okay, so on 12/21, the sleep doctor will examine my sleep patterns and have altogether too much information about my nocturnal habits. And I believe the supplier of the CPAP machine will actually come calling at some point to take data off this disk, specifically related to how much I use it so the insurance company will pay him. Funny how I post my whole life on the blog, but am UP IN ARMS about this little disk. Sheesh.

The sleep doctor and surgeon will want me to take the CPAP with me to the hospital to wear after surgery. I've already been given pep talks about this: I will be recovering on my back, the CPAP is most helpful for sleeping on your back, etc. I am a good girl. I don't want to disappoint and tell them to take their obnoxious machine and shove it.

Oh, I guess I have stronger feelings about the CPAP than I was willing to admit. Yes, I hate the damn thing. If it is making me sleep better, I haven't noticed it. It's not like when my ex used to wear one: pre-CPAP, I could lay in bed next to him and listen to him stop breathing for five, ten seconds even, before GASPING back to life. Had I known then we were going to get divorced...mwahahaha. (Without a doubt, I get better sleep than when I was in the bed with him, just because of the snoring and gasping disruptions that probably killed the quality of my sleep, as well as his.)

Self-Doubt, Dismay...Determination and Optimism

It's an interesting state of limbo, this pre-surgical waiting period. Besides all the health-related stuff: blood tests and sleep studies, corrective measures to adjust various levels of nutrients and such...it's a deeply reflective time, too.

Oh heck, who am I kidding? Everything with me is a deeply reflective time. :) But the topic of WLS (remember, that's "weight loss surgery" - I'm really going to use that acronym here!) is front and center at the forefront of my mind.

Feelings range from dismay - "oh, look at the mess I made for myself," to complete optimism, "Imagine! Me, taking care of *ME*!" I struggle with WLS as a cop-out. I'm a pretty determined and strong person, and it is painful for me to continue "losing" (in every sense of the word except for the way I want it!) in regard to my weight. There isn't a lot that I haven't "won" at in my life. In many ways, that's what put me in the condition I'm in. With career, education, family, etc. I've been able to go all out: setting goals and meeting them. But with eating...it's always been my self-care. Tired? Stressed? Burned out? Worried? Sad? Food can soothe all these feelings. Years and years of self-medicating with carbs and other yummy goodness has taken its toll on my body.

When I think of WLS as a cop-out, I realize it's all part of the way I torture myself for not being *enough.* Not good enough, not disciplined enough, not strong enough. Enough. I don't let myself have anything easily. I don't celebrate my victories, I don't give myself credit where credit is due. I've gotten better about that over the last couple years, I think. Personal drama, e.g. divorce and all its ugly fall-out, has led me to examine and ruminate over every facet of my being. I've come to know myself a lot better in this time: the good, the bad, and the ugly.

So I know when I stress out about WLS as a copout, I also know that any path I take from here, I'll be pretty judge-y about my success, or lack of it. Nobody beats up me as well as I beat up me:

Lose the weight "on my own"?(<--I am beginning to hate this term more and more) Good for you - you should have never allowed yourself to get so fat in the first place! How much of your life did you waste? Yes, you lost it, but it sure took you a long time to do it!

Have the surgery?
Good for you! Now, how much of your life did you waste before you had the surgery? But, if you would have only had the (fill in the blank) surgery instead of the type you chose, you wouldn't be stuck with this (fill in the blank) symptom!

I'm looking for peace. Self-acceptance. Forgiveness. Yes, this is rather a bad spot I'm in, but I can find a way out of it and feel better. Feel good, even. I'm not a terrible person: I've made mistakes, I've damaged and been damaged. But I deserve to turn things around, and all the benefits (and challenges) that come from it.

I could take the phrase "on my own" and print it out, wad it up, stomp it on the ground and grind it into shreds. I read the phrase everywhere, I say it to myself all the time. "If I could lose the weight on my own instead..." WLS is not a magic fairy who will make it all better with the wave of a wand. Not at all. It will be a difficult recovery and it will present its own new challenges. And even with all that? It won't take away all my extra weight! Depending on which option I choose (I am planning gastric sleeve), my surgeon says it will take away about 75 pounds of my 125 pounds or so I want to lose. There will be a lot of work for me to do "on my own." Additionally, it's on me to solve the issues that led to the obesity in the first place. Where am I going to channel this extra energy that currently goes toward eating? How do I make sure I don't give up compulsive eating in favor of another addiction?

Either way, surgery or not, it's all on my own. I'm not sure exactly how I see or feel about the surgery, but I always at least see it as a tool to get me on the right road. And as far as the permanency of the smaller stomach - well, it's the guardrails along that road.

Much more on this later, at various times, because it's pretty much all I think about right now. ;)

The Waiting Game and Protein Drinks

I have been doing some reading about others' experience with weight loss surgery (WLS) and musing about the many pros and cons of such an approach for myself. I'm still planning to go through with it, but it is a tough decision. Right now, I'm just focusing on taking care of myself: getting my blood work in order, taking vitamins, trying to get my body as it is now in its best condition. I am looking forward to another iron infusion tomorrow: will this one bring about noticeable changes in how I feel? I hope so! I can be reasonably patient, however, if I don't feel an improvement from this one, perhaps the next. I'm just glad to be on the road to feeling better!

I'm happy - I've started finding some blogs out there related to bariatric surgery. I *knew* they must be out there! It's why I started this blog: it's the sort of anecdotal information that I find helpful, and I figured others must be looking for it, as well. I've stumbled on a few that I really like and will link to here sometime, when I get my blog logistics worked out. I also found a couple non-surgery weight loss blogs that I am enjoying, as well.

Yesterday, I did a trial run of the protein shake diet I'll have to do for two weeks before surgery. Protein shakes all day (I had three) and a reasonable dinner. I was *hungry* during the day! Funny, because I will quite often skip lunch and not be so terribly put out about it as I was yesterday. It's mostly a mental game, I'm sure.

Today, I had a breakfast quesadilla from the cafe in my building. I am full. Too full, really. Actually, it feels better to be a little hungry than a little too full. What a revolutionary life lesson, haha.

This morning, I also had a Slim Fast protein drink. Hey - I just realized I doubled up!! No wonder I'm extra full! I bought this last night - Bartell's seems to have stopped selling Muscle Milk powder, so I picked up a can of this. They all taste the same to me, frankly.

The sundries shop in my building sells Atkins Advantage Milk Chocolate Delight Shakes. I was surprised to see it has 10 grams of fat in an 11-oz serving. No wonder it is my favorite pre-made shake to date! Only 15 grams of protein, as well.

A comparable shake that I've bought is the pre-made Muscle Milk Light, which has 4.5 grams of fat in a 14 oz serving, as well as 20 grams of protein. I like it in the larger bottles, but I have had the Muscle Milk Light in the aseptic boxes and did not like it at all.

Now, the Muscle Milk Light powder prepared with non-fat milk is yummy. I can really drink this without problem or complaint. Except, of course, that I can't seem to find it locally right now, haha. Bartell's sold it and had the best price, but they've stopped selling it. My local Super Supplements sells regular Muscle Milk in powder, but not light. I'll have to order some online.

The Slim Fast Protein Shake is okay - really, the powders taste the same to me and the pre-mades taste the same (although Atkins is noticeably yummiest). Four grams of fat, 15 grams of protein in an 8 oz serving made with non-fat milk.

The Muscle Milk Light powder is really the best way to go, it seems. It would be interesting to plug all these variables into a calculator: serving size, grams of fat, grams of protein. It says to mix the Muscle Milk Light powder with water, which I would never do. Ew!! With water, a 12-oz serving has six grams of fat and 25 grams of protein. Add in the non-fat milk and your protein intake is boosted considerably. What a difference over the Slim Fast with milk!

Iron and CPAP Machine...Restful Bliss? I Think Not!

So, yesterday I had my first IV iron infusion. It was uneventful, except that I had to get poked twice for the IV needle. No side effects, no rash, no constricted breathing. Just me and a recliner and a heated blankie, kicking back reading a book for an hour. Niiiiiiiiicccceee.

Originally, I was scheduled to go back next week for another blood test, but this morning they called and changed the appointment to another transfusion. Apparently, my levels are so low, they've decided I can have three infusions before they even begin to wonder what level I'm at, haha.

Now, foolishly or not, I was hoping - praying - that I would wake up this morning feeling like a BRAND NEW WOMAN!! Sadly, I do not. I actually feel pretty awful. Not sure if it is from the infusion, or from the first night sleeping with a CPAP machine for my mild sleep apnea.

See, last night, the medical supply company brought over my CPAP and taught me how to use it. I had a pretty rough night's sleep with it, waking up a few times, not getting comfortable, etc.

But I feel worse than just *tired,* so we will say that it is from a combination of the infusion and the CPAP. Regardless, I am pouty and whiny this morning, and I am eating a turkey pot pie for lunch along with a side of mashed potatoes and gravy, and this proves a couple things:

- There is a reason I am obese. Duh.
- Comfort food = gold.

Hopefully tonight will go better. I was pretty tyrannical to my kids this morning, and, uh, last night. Mommy needs some good, high quality sleep.

Insurance Approval?

Hmm, I was looking at my insurance company's requirements for obesity surgery this afternoon. I know that they will cover the standard "gastric bypass surgery" and that they also cover the vertical banded gastroplasty (VBG), the type of surgery I want to have. However, it looks like, from the criteria, that I may have a hard time getting approval for the VBG. In addition to their standard criteria (e.g. BMI, co-morbidity or other conditions that affect your health such as high blood pressure or diabetes), for VBG you must have:

- complications from extensive adhesions
- liver disease
- Chrohn's disease or ulcerative colitis
- some poorly controlled disease (such as renal/kidney failure)
- Readiation enteritis (??)

Now, I see online that my insurance does actually approve VBG for people, and my surgeon does this type of surgery for people with aetna insurance. He hasn't raised a red flag about it, but I definitely need to follow up. I am less interested in the more invasive gastric bypass surgery, although I am not prepared to rule it out at this time.

Iron Infusion

Yesterday, I saw the hematologist for the first time. He reviewed my lab results and said I should have an IV iron infusion to boost my iron levels. With the infusion, I can expect my energy levels to increase and the quality of my sleep to improve dramatically! I AM SO EXCITED!

The doctor thinks that several things drove down my iron levels over the course of time: two pregnancies, six months of heavy periods after I had one five-year Mirena IUD removed and then six weeks of heavy flow after I had another Mirena IUD inserted. The biggest culprit, however? Years of regular blood donations, but over the last two years, I've donated pretty consistently every 56 days or so. Whenever the blood drive showed up at work, I made an appointment and donated.

Since I don't eat a lot of meat, and don't take iron supplements, the doctor thinks I ran down my iron supplies and never replenished them. Our new plan is an IV infusion this afternoon, followed by new blood tests in 10 days. We'll keep doing the IVs until my iron levels are holding at a respectable number, then he'll give me prescription iron supplements.

I. am. so. excited!! I have been feeling like C-R-A-P for months and months now, and it has been a driving force in my decision to have the gastric sleeve operation. I figured I had reached maximum density: the point where I was so obese that there was no saving myself from myself. Blech. Too tired to work out, too tired to improve my life. I'm still committed to the gastric sleeve, but *NOW* I can get my blood levels fixed and go into the procedure with some momentuum! Energy - exercise - strength. Much, much better place to be!

The doctor said he wants to get my ferritin level to 50. I am currently at zero. He says I have a long way to go, probably will take several IVs, but I should start feeling a noticeable improvement very soon. YAY!

More on this following my first IV this afternoon.

Muscle Milk Light

I've been experimenting with protein drinks, because for two weeks prior to my surgery and two weeks after, I have to drink primarily protein drinks.

I already know I really like chocolate Muscle Milk Light. But mostly in the powdered form, added to skim milk. Refrigerated bottles are ok - aseptic boxes are my least favorite. Yesterday, I stopped at Bartell's for more powdered mix, and was told they are no longer selling it, at least at that location!

A quick online search tells me that Muscle Milk Light comes in these flavors. I've only tried Chocolate Milk, thus far.

Dark Chocolate
Cake Batter
Chocolate Mint
Chocolate Peanut Butter
Cookies n Crème
Banana Crème
Strawberries n' Crème
Chocolate Milk
Vanilla Crème

Mixed Reviews

I saw the surgeon yesterday for one of my monthly appointments before the surgery. He was very impressed with my nearly two weeks of quitting smoking. He was not impressed with my four pound weight gain. It's true: I quit smoking and discovered "New York Cupcakes" in Bellevue. Oops.

It's funny, the pendulum of my eating issues. My eating at night has gotten much better, but my snacking on sweets since giving up cigarettes has gotten worse. I will need to monitor this all closely, figure out how to walk the delicate balance of taking care of myself.

My biggest challenge in writing a blog that I hope people might actually read is, well, not what I was originally going to say. I guess my *biggest* challenge will continue to be consistency. It is difficult for me to make time to blog daily. My second biggest challenge will be organization of thought. On my personal blog, I am very self-indulgent with my thoughts and how I put them out there. Here, as I'm trying to document my experiences with my health...I'll have to be careful to present information chronologically so it makes sense. Regular blogging would help in this regard. Oh, snap!

So...before I tell you about my appointments with my general practitioner and my bariatric surgeon yesterday, I need to back things up. In preparation for the surgery, I've had a barrage of tests done. Lots of lab work, x-rays, EKG, psychological screening, etc. In time, I'll work my way back to describing each of these experiences.

For now - I'll focus on the blood work. My original blood work came back low in two major areas: iron (hematocrit) and vitamin D. The vitamin D wasn't a surprise to me; I had started taking supplements early this year when my levels tested low at my GPs. It was rather surprising, though, that these levels had not improved one iota even after taking the supplements. More on this later.

The hematocrit levels were bad enough that I was sent for additional testing. Here, my ferritin levels were below testable range. Wikipedia, the source of all things true and accurate on the internet (snort!) says, "Ferritin serves to store iron in a non-toxic form, to deposit it in a safe form, and to transport it to areas that it is required."

Because of these low levels, I was referred to a hematologist, whom I will see next week. Interestingly, my GP, who has been my primary physician since I was 12 or so, said he would not have referred me to the hematologist. Here is where I get some conflicting information. The doctor who referred me to the hematologist said it would take upwards of seven months of iron supplements to get my levels within the normal range. My GP said my levels would improve quickly with iron supplements. However, since I do have a long history of being a whiny baby intolerant of iron supplements, my GP thinks the hematologist is a good idea. When I was pregnant, I took prescription pre-natal vitamins because they were the only ones in which I could tolerate the iron. I get sick, stomach aches, yucky iron burps and constipation with OTC iron supplements. My GP said he would not be able to convince my insurance company to pay for an IV iron supplement without a months-long trial period to demonstrate my intolerance. However, he said if the hematologist wants me to have an IV iron supplement, it will be approved without question.

None of the doctors, thus far, have thought that my low iron levels would preclude me from having the gastric sleeve in January. I, on the other hand, think it would be an unnecessary risk to have the surgery without fixing it. My appointment with the hematologist is on Monday, and in the meantime, I get to smear poop on a card on three separate occasions to bring in to him as an introductory gift: their way of making sure I'm not losing blood in my stool due to an ulcer or polyps or other nefarious means.

In talking with my GP yesterday, he said my initial iron levels were not low enough that he would have sent me for additional testing. Wikipedia, again the most truthful and incontrovertible* online source, says "The hematocrit (Ht or HCT) or packed cell volume (PCV) or erythrocyte volume fraction (EVF) is the proportion of blood volume that is occupied by red blood cells. It is normally about 48% for men and 38% for women." My level is one number below the listed range: this is good enough for my GP, but had my other doctor sending me off to a lab, garnering a test result that said ABNORMAL for ferritin. I think I'm having a crisis of faith with my GP right now. He is unconcerned that my vitamin D levels are just below the acceptable range, unconcerned that my iron levels are just below the acceptable range, and unconcerned that my vitamin B-12 levels are at the low end of the acceptable range. These three things are big indices of how much energy you have, and I have NO ENERGY. I don't want to be just outside the range, or even at the bottom of the range. Grr.

(*incontrovertible. I first typed this as "incontrofutable," but copied and pasted it into bing because it didn't look right. Note to self: when the *only* hit bing returns on your word is to www.saltshakers.com, who says, "It has been argued with triumphant certainty as established with incontrofutable evidence that the whole story of chapter 2, with all its pathetic and romantic incidents, is a ..." then you are making words up. Along with someone at saltshakers.com. I have decided that my word invention is a combination of incontrovertible and indisputable.)