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.