Living the DS Life

It's just not working out...

2009-07-21T08:43:00.000-07:00

It’s time for a parting of ways…

Remember when I converged my blogs into one? The goal was to live a less fragmented life and so I was combining a couple of my more active blogs into one – this one!

Here’s the thing…

It’s just not working out.

When I feel the desire/need/thought to post about my weight loss surgery – or the technical stuff that goes with being a WLS post-op – or pre-op who is still researching – I feel myself go through this jumble of emotions…

…is it appropriate? I mean, how does it mesh with the garden? The chickens? The other stuff? Yeah, some of it works… some of it not so much.

…if I get too technical – well, there are a bunch of people who will wonder what the heck I’m talking about!

…if I post too many posts about WLS or the DS – it’ll seem kinda weird and out of balance…
So I’ve made a decision.

I’m keeping the DS-related stuff at Known by Name, I won't delete it or anything – but I’ve created a NEW Living the DS Life on WordPress (cause it so kicks butt) – right here.
I’ll copy over posts from here that pertain to my DS – but all new DS- and WLS-related posts – they’re going over to the new blog:

http://livingthedslife.wordpress.com/

In case you didn’t know – a really easy and great way to stay current on topics – on ANY blog – is to subscribe. I use the RSS feed subscription (that’s the funky little orange block up there) – and I love it. I have it set up to actually download new posts from blogs that I’ve subscribed to into a content specific folder in Microsoft Outlook. It’s so easy to manage that way!

Anyway – thanks! Thanks for putting up with my little experiment. Thanks for the congrats when I had my 7 year anniversary. It’s been a great ride so far – I’m looking forward to decades more posts about Living the DS Life.

Just a reminder...

2009-06-25T22:07:00.000-07:00

I've moved!

You can find current content at my new blog.

Here's the link: http://knownbyname.wordpress.com/

Hope to see you there!

It's Moving Day!

2009-06-01T20:56:00.000-07:00

No... no... we're not moving houses! Phew! Can you imagine? No - our blog is moving!

Here's the thing... I've got several blogs. I've got shortcuts to them on my desktop - and I'm always thinking about updating one or the other of them. But it just makes my life feel so fragmented.

I don't like a fragmented feeling life.

So, a month or so ago (maybe longer...) I started thinking, "What if I move - and merge! - all of my blogs into one location?" At first it seemed like a crazy idea. But the more I investigated, the more I thought about it, the more I brainstormed... well, it seemed less and less crazy.

So I've started a new blog - moved all of the posts from my other two most invested in blogs there, too, and well - today is the day. It's time to move. So - you can now find me over at: http://knownbyname.wordpress.com/

It's still a work in motion. I'm trying hard to get stuff categorized - if you look on the upper right hand corner there's a drop down with categories. There's a category for Living the DS Life with subcategories. There's a category for the Hip Chick Chronicles (more of my day to day life blog) and subcategories. And then there are some new categories where life kinda intersected.

So I hope you'll follow over there. If you're new to RSS subscription - look on your browser toolbar - it's a little orange button with a dropdown. When you click on that you can subscribe to a blog. Then, when updates are made, you can be notified. It's a very cool thing to know how to do!

Anyway - I've got some blog housekeeping to do. Hope to see you over at http://knownbyname.wordpress.com/

Phew! What a week.... okay - more!

2009-05-13T14:42:00.000-07:00

I can't believe I haven't posted here since March 3rd! I thought for sure I had! I'd thought through posts I wanted to post! But oh yeah - there was that non-weightbearing bit... the "keep the toes above the nose" thing for all of those weeks. Dang - it's amazing how an ankle reconstruction can really cramp your style!

So - I've had some interesting revelations of late...

First - was in Denver last week (with my son at National Jewish Health - honestly, if you have poorly controlled allergies, asthma, immunology issues - these people need to be your best friends!). Wierd thing happened. I was getting in an elevator and as I turned to press the button for our floor, I caught - out of the corner of my eye - view of a fairly slim lady, and I thought, "Gosh, she's nicely proportioned!"

Okay - if you've been morbidly obese - do you do that, too? Do you think those kinds of thoughts? I do - all of the time! Most of the time it's doing a mental calculation trying to figure out if I'm larger (which I typically assume) or smaller, than the other person. Not a competition type of thing - but more a still trying to figure out what my shape really IS kind of a thing!

...back to my story... then, I realized - THAT'S ME!

WIERD!

Then, remembering that I recently had the ankle reconstruction surgery and I use a walker for the most part still....

I was walking through a building and came to one of those heavy double doors with the bar across the middle that you push against to get the door to open. With the walker, I typically turn around, plant my back against it, and shove for all I'm worth. Know what?

I didn't weigh enough to open the stinking door!

WIERD!

According to my scale, I weigh 149 now. My weight hasn't started with a 14 anything since something like the 4th grade.

WIERD!

Oh - and I had to buy a dress for a court date (long story - won't go there) - and I tried on quite a few. One of them was a VERY fitted little number - quite pretty - and know what? Size 12 fit very nicely.

So - let me just say. Yes, I'm liking my revision!

And that's the scoop.

Later, I'll come back and tell you the sordid tale of what my Mother's Day weekend was like!

Surgery tomorrow...

2009-03-03T23:44:00.000-08:00

Yes, again.

This time - left ankle reconstruction. You see there's this necrotic bone - kinda like your bone getting a cavity, and they've gotta take the bad part out, and then fill it... Then there's the whole alignment thing - nothing aligns the way it's supposed to... Then there's the fix the ligament thing... And the possible add a tendon thing... And the release some of the muscle (?) from the back of my calf thing....

I typically can tell you in very exacting medical language exactly what an upcoming surgery will entail and give fairly detailed specifics. Not so much this time!

Dang, this complex orthopedics stuff is a little hard to keep straight.

But these things I do know:

1. I've got a 10:30 am surgery time.

2. I'll probably be in the hospital 2 or 3 days.

3. I may or may not be on low molecular weight heparin injections following surgery.

4. I will be non-weight bearing for 4 to 6 weeks.

5. I'll be in a cast for 6 to 8 weeks.

My surgeon has prescribed a knee scooter for me for after surgery. Initially I'll use a regular walker - but get a gander at the knee scooter - it's kinda trippy:

I think it'll work out well - and will definitely make the whole non-weight bearing thing more livable.

So - here in the last few minutes before midnight I'm getting caught up on my to-do list, sipping lots of iced green tea, and trying to remember if there's anything else I ought to pack in my bag for the hospital.

I gotta be honest - getting my head around this surgery has been pretty wierd. Every other surgery I've ever had has always included, "And of course, we'll want you up and walking as soon as possible." Not with this one. It's gonna be wierd.

I'm determined to be a good patient, though - and will try really hard to follow the rules. My surgeon says if I'm good, then he might let me drive after 2 weeks. I'm gonna be good!

So... time for me to get some sleep! I've got a busy day ahead of me tomorrow!

The 10 Most Common Mistakes Weight Loss Surgery Patients Make

2009-02-28T00:09:00.000-08:00

From http://www.nawls.com

While weight loss surgery (WLS) is considered the most successful treatment for morbid obesity, it is just the first step toward a fresh start. Weight regain is a common phenomenon, as is illness when weight loss surgery patients do not follow recommended guidelines.

Breaking old patterns, establishing an effective post-WLS lifestyle, and addressing the emotional issues that often complicate obesity takes more than commitment; it takes support, information, and resources.

The National Association for Weight Loss Surgery (NAWLS) helps WLS patients shape new lives. We teach people what they need to know and help them makes the changes they need to make to achieve long-term WLS success -- physically, mentally, and spiritually.

In a November 2005 poll conducted by NAWLS, the following were identified as the top 10 mistakes WLS patients make:

1st Mistake: Not Taking Vitamins, Supplements, or Minerals

Every WLS patient has specific nutritional needs depending on the type of surgery you have had. Not only is it a good idea to ask your surgeon for guidelines, but also consult with an experienced WLS nutritionist. Understand there is not a standard practice that all surgeons and nutritionists follow in guiding WLS patients. So, it is important to do your own research, get your lab tests done regularly, and learn how to read the results.

Some conditions and symptoms that can occur when you are deficient in vitamins, supplements, or minerals include:

Osteoporosis; pernicious anemia; muscle spasms; high blood pressure; burning tongue; fatigue; loss of appetite; weakness; constipation and diarrhea; numbness and tingling in the hands and feet; being tired, lethargic, or dizzy; forgetfulness, and lowered immune functioning.

Keep in mind, too, that some conditions caused by not taking your vitamins, supplements, or minerals are irreversible. For example, a vitamin B-1 deficiency can result in permanent neurological deficits, including the loss of the ability to walk.

2nd Mistake: Assuming You Have Been Cured of Your Obesity

A "pink cloud" or honeymoon experience is common following WLS. When you are feeling better than you have in years, and the weight is coming off easily, it's hard to imagine you will ever struggle again. But unfortunately, it is very common for WLS patients to not lose to their goal weight or to regain some of their weight back.

A small weight regain may be normal, but huge gains usually can be avoided with support, education, effort, and careful attention to living a healthy WLS lifestyle. For most WLSers, if you don't change what you've always done, you're going to keep getting what you've always gotten -- even after weight loss surgery.

3rd Mistake: Drinking with Meals

Yes, it's hard for some people to avoid drinking with meals, but the tool of not drinking with meals is a critical key to long-term success. If you drink while you eat, your food washes out of your stomach much more quickly, you can eat more, you get hungry sooner, and you are at more risk for snacking. Being too hungry is much more likely to lead to poor food choices and/or overeating.

4th Mistake: Not Eating Right

Of course everyone should eat right, but in this society eating right is a challenge. You have to make it as easy on yourself as possible. Eat all your meals--don't skip. Don't keep unhealthy food in sight where it will call to you all the time. Try to feed yourself at regular intervals so that you aren't as tempted to make a poor choice.

And consider having a couple of absolutes: for example, avoid fried foods completely, avoid sugary foods, always use low-fat options, or only eat in a restaurant once a week. Choose your "absolutes" based on your trigger foods and your self knowledge about what foods and/or situations are problematic for you.

5th Mistake: Not Drinking Enough Water

Most WLS patients are at risk for dehydration. Drinking a minimum of 64 oz. of water per day will help you avoid this risk. Adequate water intake will also help you flush out your system as you lose weight and avoid kidney stones. Drinking enough water helps with your weight loss, too.

6th Mistake: Grazing

Many people who have had WLS regret that they ever started grazing, which is nibbling small amounts here and there over the course of the day. It's one thing to eat the three to five small meals you and your doctor agree you need. It's something else altogether when you start to graze, eating any number of unplanned snacks. Grazing can easily make your weight creep up. Eating enough at meal time, and eating planned snacks when necessary, will help you resist grazing.

Make a plan for what you will do when you crave food, but are not truly hungry. For example, take up a hobby to keep your hands busy or call on someone in your support group for encouragement.

7th Mistake: Not Exercising Regularly

Exercise is one of the best weapons a WLS patient has to fight weight regain. Not only does exercise boost your spirits, it is a great way to keep your metabolism running strong. When you exercise, you build muscle. The more muscle you have, the more calories your body will burn, even at rest!

8th Mistake: Eating the Wrong Carbs (or Eating Too Much)

Let's face it, refined carbohydrates are addictive. If you eat refined carbohydrates they will make you crave more refined carbohydrates. There are plenty of complex carbohydrates to choose from, which have beneficial vitamins. For example, if you can handle pastas, try whole grain Kamut pasta--in moderation, of course. (Kamut pasta doesn't have the flavor some people find unpleasant in the whole wheat pastas.) Try using your complex carbohydrates as "condiments," rather than as the center point of your meal. Try sprinkling a tablespoon of brown rice on your stir-fried meat and veggies.

9th Mistake: Going Back to Drinking Soda

Drinking soda is controversial in WLS circles. Some people claim soda stretches your stomach or pouch. What we know it does is keep you from getting the hydration your body requires after WLS--because when you're drinking soda, you're not drinking water! In addition, diet soda has been connected to weight gain in the general population. The best thing you can do is find other, healthier drinks to fall in love with. They are out there.

10th Mistake: Drinking Alcohol

If you drank alcohol before surgery, you are likely to want to resume drinking alcohol following surgery. Most surgeons recommend waiting one year after surgery. And it is in your best interest to understand the consequences of drinking alcohol before you do it.

Alcohol is connected with weight regain, because alcohol has 7 calories per gram, while protein and vegetables have 4 calories per gram. Also, some people develop an addiction to alcohol after WLS, so be very cautious. Depending on your type of WLS, you may get drunker, quicker after surgery, which can cause health problems and put you in dangerous situations.

If you think you have a drinking problem, get help right away. Putting off stopping drinking doesn't make it any easier, and could make you a lot sicker.

Are you taking your Super B Complex?

2009-02-25T06:36:00.000-08:00

Cause if you're not, here's another GREAT reason to do so!

Can B Vitamins Lower Risk of Blindness?
Taking a Combination of Vitamins B6, B12, and Folic Acid May Lower Risk of Age-Related Macular Degeneration

By Jennifer WarnerWebMD Health News

Reviewed by Louise Chang, MD

Feb. 23, 2009 -- Taking a combination of B vitamins may offer a rare and inexpensive opportunity to help prevent the most common cause of blindness in older Americans, age-related macular degeneration (AMD).

A new study shows that women who took vitamins B6 and B12 along with folic acid had a 34% lower risk of any AMD and a 41% lower risk of AMD with significant vision loss.

Researchers say treatments for AMD are limited to people in the later stages of the disease.
“For the large population with early or no AMD, there is no method of disease prevention other than avoidance of cigarette smoking,” write researcher William Christen, ScD of Harvard Medical School and colleagues in the Archives of Internal Medicine. “From a public health perspective, this is particularly important because persons with early AMD are at increased risk of developing advanced AMD, the leading cause of severe, irreversible vision loss in older Americans.”

Vitamin Combo Curbs Macular Degeneration

In the study, researchers randomly assigned more than 5,000 women over 40 without signs of age-related macular degeneration to take a combination of 2.5 milligrams of folic acid, 50 milligrams of vitamin B6, and one milligram of vitamin B12 or a placebo every day. The women were part of a trial looking at the use of these vitamins and cardiovascular disease. The women had heart disease or at least three risk factors for heart disease at the start of the study.

During about seven years of follow-up, 137 new cases of age-related macular degeneration were diagnosed, including 70 that resulted in significant vision loss.

The results showed that women taking the B vitamin supplements had a 34% lower risk of any AMD and a 41% lower risk of AMD with vision loss than the placebo group.

Researchers say the benefits of the vitamin combination in preventing AMD appeared to emerge about two years after treatment began.

"The trial findings ... are the strongest evidence to date in support of a possible beneficial effect of folic acid and B vitamin supplements in AMD prevention,” the researchers write. They note that further research is necessary in other groups of people to confirm their findings.

View Article Sources

==============================
There are SO MANY reasons to stay on top of your B Vitamins - but if this one isn't way up there, I don't know what is!

Interesting! Very, very interesting!

2009-02-24T22:31:00.001-08:00

For years now I've heard DS'ers remark to me: "It's so strange - I just haven't gotten sick since my DS! For like years now! I can't figure out why!"

Maybe we know why now:

Low Vitamin D Levels Linked to Colds
Study Shows Vitamin D May Have a Role to Play in Preventing Colds and Flu

Also in my inbox today, from the Vitamin D Council:

The Vitamin D Newsletter
February 24, 2009

As readers from 3 years ago remember, this newsletter first published
evidence vitamin D would prevent influenza and many varieties of the
common cold in 2005:

http://www.vitamindcouncil.org/newsletter/2005-nov.shtml

I then published the theory in:

Cannell JJ, et al. Epidemic influenza and vitamin D. Epidemiology and Infection. 2006 Dec;134(6):1129-40.

As Science News reported, I realized this after observing an influenza epidemic at Atascadero State Hospital.

The antibiotic vitamin: deficiency in vitamin D may predispose people to infection. Science News, November 11, 2006

Last year, we used vitamin D to explain virtually all of the many unsolved mysteries of influenza.

Cannell JJ, et al. On the epidemiology of influenza. Virology Journal. 2008 Feb 25;5:29.

Our second influenza paper is by far the most accessed paper in the journal this year.

Top 20 most accessed articles for last year in Virology Journal

Today, researchers from Harvard and the University of Colorado, writing in the Archives of Internal Medicine, published convincing evidence my observations at Atascadero State Hospital were correct.

Vitamin D deficiency linked to more colds and flu. Scientific American, Feb 23, 2009

Adit A, et al. Association Between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009;169(4):384-390.

Influenza kill around 35,000 Americans every year and similar viruses cause additional mortality and untold morbidity. As I have said, It appears Linus Pauling was right about everything he said about vitamin C, but he was off by one letter. The Vitamin D Council, the nearly broke non-profit educational organization, now believes most influenza deaths and many other respiratory infections, like the common cold, could be prevented if Americans, and their doctors, understood some simple facts:

Vitamin D is not a vitamin, but a steroid hormone precursor, which has profound effects on innate immunity.
The amount of vitamin D in most food and nearly all multivitamins is literally inconsequential.
The correct daily dose of vitamin D for adults is approximately 5,000 IU/day, not the 200-600 IU recommended by the Institute of Medicine, the National Institutes of Medicine and the FDA.
The only blood test to determine vitamin D adequacy is a 25-hydroxy-vitamin D, not the 1,25-di-hydroxy-vitamin D test many physicians now order.
Healthy vitamin D blood levels are between 50-80 ng/ml, levels obtained by fewer than 5% of Americans.
Medicare’s new proposed rule change, which forbids Medicare carriers for paying for virtually all vitamin D blood tests (Draft LCD for Vitamin D Assay Testing (DL29510), will kill tens of thousands of Americans yearly.
The mechanism of action of vitamin D in infection, dramatically increasing the body’s production of broad-spectrum natural antibiotics (anti-microbial peptides or AMP) suggests pharmaceutical doses of vitamin D (1,000 IU per pound of body weight per day for several days) will effectively treat not only influenza and the common cold, but help treat a host of other seasonal infections, including meningitis, septicemia, and pneumonia, in both children and adults.
In 1997, when the Food and Nutrition Board (FNB) set the current guidelines for vitamin D intake, they forgot to correct for the widespread sun avoidance that began in the late 1980’s when the AMA’s Council of Scientific Affairs warned against sun-exposure, and recommended that all Americans should make every effort to never let a photon of sunlight strike their skin. The failure of the 1997 FNB to compensate for sun-avoidance, has led to millions of deaths around the world.
Physicians who ignore vitamin D deficiency will eventually suffer medical-legal consequences.
While many think the influenza virus causes influenza, Cannell notes it was George Bernard Shaw who first understood: “The characteristic microbe of a disease might be a symptom instead of a cause.” George Bernard Shaw, (Preface on Doctors, The Doctor’s Dilemma, 1911).

If you want professional newsletter services, you will need to help find a foundation that will fund us.

John Cannell, MD
http://www.vitamindcouncil.org/
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422

================================

It's so interesting.... my statement made at the beginning of this blog entry - I've made it myself. In fact, my kids have mentioned many times since my DS - "You never get sick. We get everything - but you never get a thing!" It's been true... until this winter, shortly after my revision. At which time I went off of my Vitamin D supplements for a time while I was healing up after surgery. Then it took me a while to ease into my full vitamin regime. During that time I got sick THREE times - one stomach flu, and two killer colds. I've only been sick ONCE before this since July 2, 2002.

Interesting, huh?

PLEASE READ THIS!

2009-02-23T10:44:00.001-08:00

If you are a WLS post-op - particularly a DS post-op - read this:

The Heart Scan Blog: Vitamin D for the pharmaceutically challenged

So - if you're a post-op, you're getting this, right?

If not - please comment and we'll continue the discussion, okay?

Confessions...

2009-02-21T21:23:00.000-08:00

I'm almost 15 weeks post-op.

During the course of my life as Patient Support Coordinator to Baltasar patients I can count on some things that happen like clockwork. Notably:

1. The panic expressed by early post-ops (usually at about the 1 month post-op mark) when they say things like, "He made my stomach too small!" "I'll never be able to eat enough!" "I'm going to die of malnutrition!" I know these statements will come, as surely as I know the sun will rise. I always tell patients - "You're not alone. Everyone feels this way."

*I* felt this way. Not my first surgery - but definitely with my revision. I knew I would. But I wasn't prepared for what a whiney butt I would be!

AND

2. The panic expressed by just about every post-op (at about 3 months post-op) when they say things like, "He made my stomach too large!" "I can eat too much!" "I'll never lose all of my weight!"

Yes, these are the same folks that made the previous statements.

I've always jokingly said I'd love to have just one buck for every time I heard these statements - 'cause they we could certainly be debt free and maybe even buy a house some day! LOL!

And just this week - I found myself thinking: "OH MY WORD! I can eat too much!"

ME!

*I* said that!

I know better!

I've longed for the day when I would eventually be able to eat a little more - cause, well, I like eating easily.

Lord! I'm such a wuss.

So there's my first confession.

Next: I'm addicted to orange juice.

I love orange juice.

A lot.

Too much.

Not just any orange juice - but the GOOD (aka expensive) orange juice.

I've consumed far too much of it in the past weeks. But, I reasoned, I had to get my fluids in... and orange juice was HELPING...

It didn't help that I couldn't bring myself to drink iced tea. I still think it's absolutely BIZARRE that straight green tea still makes me want to hurl. Which has meant that getting my fluids in daily has been a HUGE challenge.

BUT I'm happy to report - I've finally found a beverage I actually like, is non-sweetened, and makes it a breeze to get my fluids in! Woo Hoo! It is:

Half-green, half-black, iced tea.

Here's how I order it at Starbucks: Venti Iced Tea - half green, half black, no classic, with extra ice please!

How's that for a frou-frou drink?!

But you know what? I'm just so stinking relieved that I've finally found something to drink that I actually enjoy (almost as much as I enjoy orange juice!), I'm willing to live with it! I make it at home with the Stash Fusion Breakfast Green & Black Tea - it's every bit as good (and quite a bit cheaper than) the Starbucks version.

I will also confess that I invested some time this week trying on clothing. You'll note that I didn't say that I invested some time this week buying clothing. I just couldn't do it. I tried on bras... I'm just going to have to go and get a professional fitting. What a pain. But I just couldn't find a bra that was the right size in the cup - and still worked with all of the excess skin that cascades everywhere else! UGH!

And I tried several pairs of jeans on... All size 12. A couple were - well, a little roomy. Wierd. But I couldn't bring myself to buy any of them, either. Why? I don't know, exactly... part of me wished heartily that Jessica (my daughter) had accompanied me and was there to give me her honest opinion. Well, then there was also the fact that I've been in a cast on my left leg since June - and the legs of two of the pairs that I tried on wouldn't fit over the cast.

I finally decided that it was smartest to NOT buy jeans yet because I'm having surgery on my left ankle on the 4th of March - and will be non-weight-bearing for a month after that. And after that - will I only want to wear shorts or capris? If so - why buy jeans? I might not be in a size that I buy NOW for long, you know?

How's that for justification? :)

So, life as an almost 15 week post-op has been good. Eating is easier. Getting hydrated is WAY easier. Getting my vitamins in daily is going WAY better. And life is good.

Very, very interesting!

2009-02-10T12:26:00.000-08:00

New Study of Splenda Reveals Shocking Information About Potential Harmful Effects

James Turner, the chairman of the national consumer education group Citizens for Health, has expressed shock and outrage after reading a new report from scientists outlining the dangers of the artificial sweetener Splenda (sucralose).
In animals examined for the study, Splenda reduced the amount of good bacteria in the intestines by 50 percent, increased the pH level in the intestines, contributed to increases in body weight and affected P-glycoprotein (P-gp) levels in such a way that crucial health-related drugs could be rejected.
The P-gp effect could result in medications used in chemotherapy, AIDS treatment and treatments for heart conditions being shunted back into the intestines, rather than being absorbed by the body.
According to Turner, "The report makes it clear that the artificial sweetener Splenda and its key component sucralose pose a threat to the people who consume the product. Hundreds of consumers have complained to us about side effects from using Splenda and this study ... confirms that the chemicals in the little yellow package should carry a big red warning label."

Sources:
Globe Newswire September 28, 2008
Journal of Toxicology and Environmental Health Part A 2008;71(21):1415-29

Dr. Baltasar is going to be in the States in March!

2009-02-10T10:18:00.000-08:00

Dr. B will be in Miami for the 2nd Annual International Consensus Summit for Sleeve Gastrectomy March 19 – 21, 2009.

If you’re in the area – email him and let him know if you want to connect! a.baltasar@aecirujanos.es

Blessings,

dina

New pictures - finally!

2009-02-04T21:08:00.000-08:00

Yeah - I know - my jeans are too big. I need to break down and buy new ones.

But you get the picture!

12 Weeks Post-Op

2009-02-04T07:26:00.000-08:00

It's funny - when you're a brand new baby post-op - 12 weeks sounds ETERNAL. Here I sit - 12 weeks and 2 days post-op and it seems like a little blip on the radar! How'd the time fly by so quickly?

So... looking back, what do I think about having had this revision?

1. It was a good thing. I would do it again in a heartbeat.

2. It's amazing how quickly as a post-op we go back to pre-op behaviors - even when we think we haven't! :)

3. Having ghrelin curtailed is a very, very, very good thing.

4. Eating is still a chore - but a heck of a lot easier than it was, oh say 8 weeks ago!

5. I think my taste buds have gone on vacation! Stuff that I normally LOVE just doesn't do it for me any more. Most importantly - stuff I like to drink - and it's making getting and staying hydrated difficult... very difficult.

6. I like being 30 pounds lighter.

7. Getting all of those vitamins in is HARD with a teensy tiny tummy!

I think the thing that has been the biggest struggle in the recent few weeks has been the taste bud thing. I've been a green tea girl - for YEARS - like a LOT of years. I can't stand the stuff now. It's so bizarre. Know what I want? I mean REALLY want? A Coke. An iced cold, almost hurts it's so cold, Coke. Coke has not passed these lips in almost 2 years. WHAT THE HECK IS WRONG WITH ME?! It's so wierd. I'm dealing with it, though. Hot tea (English Breakfast is really floating my boat right now) is the way to go for now. I did go through a little fruit juice thing for a while - owie! Hurt my poor bottom! Not pretty! Not going there again!

Food gets better bit by bit. There's not really anything that I would truly classify as "loving" food wise. There are things that are more preferable than others (like, caesar salad versus steak - before, it would have been both; now - it's the salad!). I still unilaterally hate pretty much all fast food - which means that I've got to be prepared when I head out places. Not only do I hate the food, but bringing something along to drink is very important, too - cause no more just whipping through Starbucks to get my iced green tea to tide me for a while. Sad.

By and large, food is tolerated. I guess that's why I weigh 30 pounds less, huh?

I broke down and did measurements this morning, too - here you go:

My Body Measurements

Date Neck Bicep Forearm Bust Waist Hips Thigh Calf
2/4/2009 12.75 13.5 9.5 40 35 40 22.5 15
1/5/2009 12.75 14 10 40.5 37 40 24 16
12/8/2008 13.25 15 10.5 41.5 40 43 24 16

I sure wish I'd measured before surgery, dang it!

So - that's the scoop. I'm gonna try and get some pictures taken tonight and I'll post 'em, okay? And I'm going to try and do better about updating more frequently, too. Really!

I lost count!

2009-01-23T10:01:00.000-08:00

I seriously just cannot, for the life of me, remember how many weeks post-revision I am now! How wierd is that? At first, you're thinking.... this early post-op stuff is ETERNAL!!! Oh, for 1 more week to pass and stuff to be easier! Then the week passes, then two, and before you know it - and then you find yourself at week TEN!

Wow! Time flies! Okay - I can admit it - it hasn't all been fun. I've hated admitting the fact that I'd turned into a mindless scarfer again! As a DS post-op no less! How and when did that happen?! I can't believe how easily it was to revert to my pre-DS eating ways - and I didn't even know I had! Really!

I can also admit that it still kinda hacks me off when the food police points those things out!

I mean, HELLO, I know! I know, I know, I know! I'm supposed to know! I teach this stuff! I know it forwards, backwards, sideways, and upside down!

Yet, I still do the stuff I'm not supposed to. Like scarf. Like take huge bites. Like forget to eat. Like forget to drink. You know - all of the stuff I lecture on day in and day out!

Lord - I'm so bad!

BUT... I will say, it's going better. While I'm still not exactly thrilled at the prospect of eating - I mean, there's no warm fuzzy involved there, so there's no real pressing desire to do it - I am doing a better job of getting more protein in, and getting more veggies in - and hallelujah! - even salad! (I'm sorry - I really do love it! Especially caesar salad - which we had last night with tilapia - yummy!)

This morning - soon, actually - I have an appointment with my PCP. I was trying to remember when the last time I saw her was... um, it's been YEARS. Well, I run into her in the grocery store now and then, and I saw her when she was helping care for my Mom when she was declining. But for me? For an actual appointment? Um, yeah, years. Bad me. I usually just call up her MA (who is an AMAZING woman) and say, "Hey, Danielle, I need labs! Can you put in the order?" And sure enough, she has it taken care of in no time at all. Well, this time I have to actually go in - you see I have to have another surgery - this time on my left ankle - and I need an annual (you know - female type stuff) exam, and so I'm going.

This is a new place to be in. Seven years ago - before my DS, I saw this woman, my PCP, nearly weekly - sometimes more often - because of the myriad health problems I had. That and managing the 23 prescription meds I was on back then took a concerted effort, as well. She was a vital part of my day to day life.

I still think the world of her. How could I not? Here she is, this teensy, weensy, petite, about 5 foot, 95 pound (with five extra post-partum pounds) - and she GOT IT that I needed WLS, that I needed DS - specifically - and has been nothing less than a champion for me.

You know - I oughtta high tail it out of here and swing by and pick up flowers for her. Just to remind her that I haven't forgotten. And to say thanks again. Cause, dang, I'm so thankful.

Bad Eating Habits Can Alter DNA

2009-01-20T09:16:00.000-08:00

Bad Eating Habits Can Alter DNA

Monday, January 19, 2009 9:13 AM

Human genes remember a sugar hit for two weeks, with prolonged poor eating habits capable of permanently altering DNA, Australian research has found.

A team studying the impact of diet on human heart tissue and mice found that cells showed the effects of a one-off sugar hit for a fortnight, by switching off genetic controls designed to protect the body against diabetes and heart disease.

"We now know that chocolate bar you had this morning can have very acute effects, and those effects can continue for up to two weeks," said lead researcher Sam El-Osta, from the Baker IDI Heart and Diabetes Institute.

"These changes continue beyond the meal itself and have the ability to alter natural metabolic responses to diet," he told Australian Associated Press Friday.

Regular poor eating would amplify the effect, said El-Osta, with genetic damage lasting months or years, and potentially passing through bloodlines.

The study's findings were reported in the Journal of Experimental Medicine.

Copyright AFP

Vitamin D Deficiency in Infants and Nursing Mothers Carries Long-Term Disease Risks

2009-01-09T11:22:00.000-08:00

Vitamin D Deficiency In Infants And Nursing Mothers Carries Long-term Disease Risks
ScienceDaily (2008-12-29) -- Once believed to be important only for bone health, vitamin D is now seen as having a critical function in maintaining the immune system throughout life. The newly recognized disease risks associated with vitamin D deficiency are clearly documented in a report in Breastfeeding Medicine. ...

read full article
http://www.sciencedaily.com/releases/2008/12/081216161058.htm

It's a little bit scary...

2009-01-08T17:35:00.000-08:00

I admit it - it's something that apparently everyone should be comfortable with - but I'm not! I'm not good at it. Well - I am for other people - just not so much for myself.

I think - to be perfectly honest - the root of that discomfort has to do with the fact that I don't really - when it comes right down to it - know how to dress myself.

Yes, I'm talking about shopping.

I should interject here that I am the offspring of an accomplished shopper. If it were possible for a person to have a degree in shopping - my mother would have had a PhD in it and her practicum would have been breath-taking. I know I was a bit of a disappointment to her - being that I grew up HATING shopping. I must have more of my Dad in me than she bargained on... cause he hated shopping, too.

I had to go today. There was a memorial service tonight, and my baggy jeans just don't cut it in the dressed appropriately for the memorial service genre.

Why did I only allow myself 35 minutes to shop?

But, for 35 minutes, I didn't do so bad.

First - can I just say that it doesn't fill me with confidence when I walk into the Rack and look around and realize everyone BUT ME looks exactly like they know what they're doing and are completely comfortable with it?!

I admit it - I stood there for a good minute trying to decide which area I'm supposed to shop in. The jeans I had on at that moment were a size 16 - so that'd put me in the plus size section. But they were baggy... so maybe the regular section. But I'm short (really short) - so does that mean I go to the petite section? I was standing there looking from one section to the next when my eye alighted on a black t-shirt that I thought was cute... I bet someone with a PhD in marketing knew that would happen!

Of course - then the big dilemma - which size?!

I circled the rounder looking at various sizes before it hit me (not the rounder - an idea!) - I could try stuff on! So I picked up one or two of the shirt I liked in different sizes and moved on.

I waffled between slacks and skirt for some time before I decided to take some of each to the fitting room.

And I eventually grabbed a couple of sweaters to try on, as well.

So off to the fitting room I went.

Guess what!

I tried on size 12 jeans.

THEY FIT. Like - easily. Like - maybe they're a little bit roomy. BUT - they're also a foot too long for me, so I put them aside. (Plus, they were totally not on the appropriate for a memorial service to do list!)

Before it was all said and done I made my Mamma proud!

Remember the cute black t-shirt? I chose a size Large - I don't know, I'm a little too busty for a Medium and the XL was woefully too large. Here's the tag for it:

Yep - it used to be $28, then got marked down to $15.90, and I paid $9.97 for it. Not bad, huh?!

I ended up buying two skirts - cause I couldn't find a shirt - maybe blouse is what it's really called that would be appropriate for skirt - but thought I might have something at home that would work. The first one is a plain, black, just-below-the-knee length very attractive skirt. It started out at $78.00, got marked down to $19.97 and then had the 60% off the lowest price sticker, meaning that I paid $7.99 for this lovely little skirt! It was a size 14, by the way - I don't know - I think I was afraid to buy a 12, and I know it's a little big, but well, it's what I bought. This, by the way, was the skirt I ended up wearing this evening - and it worked out beautifully.

And the third item - the second skirt, which was a cream, gray, and black patterned skirt of about the same styling as the other - and really is quite pretty. I thought I had a blouse that went with it - but I was wrong. Dang it! BUT - this one had my Mom smiling down from heaven giving me my shopping gold star for the day:

Yes, this skirt started out at $348.00, got marked down eventually to $89.97, and has the wonderous 75% off last marked price sticker on it! I paid $22.49 for it. WOW!

So - it was with quite a bit more confidence that I left the Nordstrom Rack than I entered it!

Next assignment: jeans that fit!

Eight Weeks Post-Op

2009-01-05T17:19:00.000-08:00

So I broke down and did my measurements today.

Here's the results - changes since December 8, 2008 to today:

Neck: - 0.5"
Bicep: - 1"
Forearm: - 0.5"
Chest: - 1"
Waist: - 3"
Hips: - 3"
Thigh: no change
Calf: no change

WOW! I'm so surprised!

I did weigh myself the other day, too. (I'm just getting over the stomach flu, so I kinda forgot about weighing today.) I now weigh 167 pounds, meaning I've lost 23 pounds since surgery.

And this is how much extra room there is in my jeans... yeah, that's why they can go on and off without unbuttoning and unzipping them, and why I gotta yank them up so many times a day.

I guess this means I've got to face facts and find something a little more appropriate in size!

How DO you know?

2008-12-30T21:47:00.000-08:00

If your britches are too big, that is...

What's the criteria that moves you past the point of repeatedly hitching your britches up for the fifty-thousandeth time of the day and actually considering finding a size smaller?

John (my beloved husband) says its when you can take your jeans on and off - without unfastening them at all - easily.

When I had my original DS I had this pair of black pants. They were that stretchy jersey type material - with drawstring waistband - and they were size 6x. The only pair of pants that I owned that I could actually fit on my body. I wore them through the loss of the first 125 pounds. That that point in time I simply couldn't since the waist up any further and they simply wouldn't stay on my body. (And my husband was threatening to burn them - he was so sick of seeing them! They did not fit so well, I am willing to admit!)

So this time around - here I am seven weeks since my revision - and I've lost a mere 21 pounds (which I'm as thrilled as can be about, I should add) - but my britches keep falling off.

Do I tough it out?

I don't want to actually break down and BUY something - you know? How long will I be in the next size down, for heaven's sake?

It is getting to the point where I'm very seriously contemplating a trip to Goodwill or the Rack... Now the next question...

What size to try on next?

New Accurate In-Home Vitamin D 25 Testing!

2008-12-28T21:29:00.000-08:00

For all of you who are post-ops without or with inadequate health care coverage when it comes to labs - here's excellent news!

The Vitamin D Newsletter
December 28, 2008

The Vitamin D Council is happy to announce that we havepartnered with ZRT Laboratory to provide an inexpensive, $65.00, in-home, accurate, vitamin D [25(OH)D] test. The usual cost for this test is between $100.00 and $200.00.

If you read this newsletter, you know about our interest in accurate vitamin D testing. In the next few weeks, you may read about the Vitamin D Council's quest for accurate vitamin D blood tests in the national media. Before we partnered with ZRT, we verified, repeatedly, that ZRT provides accurate and reliable vitamin D tests and that their method corresponds very well to the gold standard of vitamin D blood tests, the DiaSorin RIA.

Our ZRT serviceis not just inexpensive, it means no more worrying about your doctor ordering the right test or interpreting it correctly. You buy the test kit on the internet or by phone, a few days later the kit comes in the mail, you or a nurse friend do a finger stick, collect a few drops of blood, and send the blotter paper back to ZRT in the postage paid envelope provided with the kit. A week later you get results back in the mail and know accurate 25-hydroxy-vitamin D levels of you and your family.

For every test you order,ZRT will donate $10.00 to the Vitamin D Council. Please read the new page hyperlinked below on our website as it both explains the procedure and how to order the test.

http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml

Executive summary: keep your family's 25-hydroxy-vitamin D blood test above 50 ng/ml, year around. Most adults need at least 5,000 IU per day, especially this time of year. Most children need at least 1,000 IU per day per every 25 pounds of body weight. Bio Tech Pharmacal provides high quality and inexpensive vitamin D. Currently Bio Tech Pharmacal is providing vitamin D for numerous scientific studies. To see their prices and for ordering, click the hyperlink below.

http://www.bio-tech-pharm.com/catalog.aspx?cat_id=2

As a gift to our readers for the New Year, Thorne publications have provided a free download to a basic paper aboutvitamin D. I wrote it earlier this year for educated lay people as well as health care practitioners. Please read this paper carefully, your family's well-being, even lives, may depend on you understanding it.

http://www.thorne.com/altmedrev/.fulltext/13/1/6.pdf

Seasons Greetings
John Cannell, MD
vitamindcouncil.org

Thank you for subscribing to the Vitamin D Newsletter from the Vitamin D Council. The Vitamin D Council is a non-profit trying to end the epidemic of vitamin D deficiency. Please reproduce this newsletter and post it on Internet sites. Remember, we are a non-profit and rely on donations to publish our newsletter and maintain our website. Send your tax-deductible contributions to:

The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422

Six Weeks Post-Op

2008-12-23T20:50:00.000-08:00

It's amazing how quickly six weeks can go by. Of course, I live a fairly busy life - so I guess it shouldn't be such a surprise that I was surprised that it was six weeks already!

I forgot to weigh again - but late last week the scale read 170 lbs - meaning I've lost 20 pounds since surgery. I did do measurements shortly after getting home - but I haven't had time to do them again - I think I'll wait until I'm two months post-op.

In terms of energy - totally back up to speed. I'm going full speed ahead - doing laundry, errands, taking kids to various appointments, cooking meals, washing dishes, taking care of dog, cats, chickens - to name a few!

Eating continues to get better with the passage of time. I'm finding that I'm craving stuff that I just don't do, though! I gave up Coke May 29, 2007 - I cannot believe how badly I want soda - any soda. But I don't do HFCS or carbonation at all any more. I seriously haven't given a rip about it in ages - but I want it now! I won't give in to the want - but dang, I can't believe how strong the craving is!

(Oh for the daywhen I can get my arms done!)

I am doing better with fluids, too. For a while I simply could not bring myself to do the iced green tea that I've lived on for YEARS now. Then, one day - out of the blue - it was the only thing I could fathom tolerating again. Wierd.

I am having quite the issue with jeans that are just too big. I'd just put these jeans on - straight out of the dryer when they're at their tightest - and they're a couple of inches too big. The biggest problem is the way that jeans are cut nowadays - you know, lower in the back - well, I'm having to hike my jeans up every few steps! It's such a pain in the butt! (Thankfully, not literally!) I can't bring myself to buy new jeans quite yet, though - I've got several very nice pairs of them that I will try to hold out with for a while yet.

So that's pretty much it for six weeks post-op reporting. It's been a good six weeks. I'm still blown away at how much easier it is on the body to have a lap surgery - dang! SO much easier!

It's so easy...

2008-12-20T22:52:00.000-08:00

...to do really stupid stuff.

You know, stuff like:

...kinda forget to eat - until 2pm
...focus on getting hydrated - to the exclusion to actual calories
...fail to remember that protein is super important - and just kinda forget to eat any
...listen to the emotional thing inside you that says you NEED to eat that last bite, even if you really already know that THERE'S NO STINKING ROOM!

It's amazing how distracting real life is. It blows me away how easy it is to simply forget about doing the stuff I NEED to do to be healthy.

Know what my very favorite food is right now? Bread with butter! Lots of butter. It goes down so well - and settles so nicely! I don't eat a lot of it - but if I'm feeling particularly urpy, it sure does the trick.

My favorite meal since getting home from surgery thus far? Home made pizzas. I actually just eat the toppings. Second favorite - ham and swiss with mayo and dijon on a toasted croissant. That's yummy!

I'm going through a really wierd transition with fluids, too. I've been an iced green tea girl for YEARS - I mean big time years. I've never been iced green tea'd out - never. But I am now. After single-handedly keeping Starbuck's in business with my Venti Iced Green Tea, no classic, with extra ice order - no more. Know what I want now? Plain old lipton iced tea. Wierd. AND, after years of being a mug of Constant Comment hot tea every morning - no more! Now it has to be English Breakfast Tea. It's so wierd these taste buds!

I will confess that I'm really struggling with breakfast right now. I'm completely egged out. Just can't go there - my egg allergy is really rearing it's ugly head. For the most part I just plain old don't want much of anything at breakfast time. This is the juncture when my "You need to eat even when you don't feel like it" lecture comes into play! I don't know why it's so hard to decide to eat non-breakfast food for breakfast - but it actually catches me by surprise nearly every morning when I find myself choosing a non-breakfast food for breakfast! Fave right now? Left over amazing Enchiladas that my wonderous husband made. They're the best!

So... here it is 5 weeks 5 days since my revision. Long story short - I'm still figuring stuff out. (Yes, I am supposed to know.) My scale says I'm down 20 pounds thus far, and my jeans would seem to agree - they're decidedly on the baggy side! All in all - I'm still glad I did it, and I'd do the revision all over again!

A Huge Revelation

2008-12-17T23:25:00.000-08:00

Something that I've been able to do since my original DS (July 2, 2002) is drink with my meals. I'd have a few nibbles of food, then a few sips of something to drink, then go on my merry way.

I must confess - food has not been that easy this time out.

About a week ago I had a nagging thought in the back of my brain. It would reoccur about the time I was suffering that horrible "one bite too many" sensation that we DS'ers sometimes experience... Only I was CERTAIN I'd not had one bite too many... I know my new tummy is tiny - I have more restriction now than I EVER had.

Then it hit me - kinda like a ton of bricks... (well, mostly because my husband has been whispering this in my ear over and over again and I just blatantly refused to believe it could be true!).

I can't drink with meals any more.

WAAAAAAAAAA

I like drinking with my meals. It's not like I want a gin on the rocks or anything! I want iced tea, for heaven's sake!

But there just ain't enough room at a meal for both food and drink. I gotta choose. That's a hard choice.

Consequently.... I'm facing a bit of a learning curve here - and it's hard. I admit it. All of you wonderful people I've lashed with a wet noodle for not doing a better job with hydration may now mock me - I give you permission. I concede - it's hard! It's really hard!

I'm trying really hard not to sound like a total whiner - but I am, huh?!

Okay - so just so we all know and are on the same page - I did WAY better today than I did yesterday. I did an easy 70 oz today. And I'm gonna work hard to keep up the hard work.

Now all I gotta do is remember to eat!

I forgot this might happen!

2008-12-08T21:42:00.001-08:00

It's kind of a "duh" but today, as I was walking around I had to do a very annoying thing - a LOT of times...

pull up my britches

'cause they're getting too big.

That's a little wild.

I mean, I did have surgery with the hopes of losing some weight, right? I thought some - but honestly, not a ton - about the fact that I wanted the scale to go down. But I think I forgot to think about the fact that my jeans would eventually get a little too roomy.

Go figure.

So - today I'm 4 weeks post-op. On Wednesday I'll be 1 month post-op. (How DOES that work, anyway?!) The scale still says 175 lbs - that's 15 pounds lost since surgery. Not bad.

Here are today's pictures:

I'm still feeling whiney about food. I'll get over it, though. It's still more probable than not that I'm constipated - I hate that. And today I realized something really - well, pretty amazing: I'm not sore - at all - from surgery any more. None. Wow - that was fast!

Today I was out climbing in and around the chicken coop, filling the feeder, chasing chickens and it occurred to me - I don't hurt at all. This after a day that included about five loads of laundry, three loads of dishes, grocery shopping, and taking a sick kid to the doctor.

I'm back up to speed - for the most part.

I will admit to being good and tired at bedtime each night - but not way more than normal.

Wild.

Oh - I went back to http://www.fitday.com/ today. It's been ages since I've used it - bad me! I was just wondering how my intake versus activity level balanced out... This is what I came up with:

The 503 is number of calories consumed today. The 2,837 is the number of calories I expended today. That - my friends is why my britches are too big!

So - that's my 4 week report!

Food is...

2008-12-05T15:47:00.000-08:00

When you're a new post-op there are a lot of emotions about food. First - when you're a pre-op there's a momentary panic because you know you're gonna have to fast at some point in time before surgery. (With Dr. Baltasar, that's pretty much just the actual day of surgery.) Then, of course, your mind goes forward to the fact that you're gonna have to have a period of time after surgery when you're only on liquids. (With Dr. B, that's two weeks of fluids - they're graduated, and honestly, a breeze.) Then, there's usually a graduation to soft foods - and people get a little excited (usually about half way through the first week of liquids!) about the possibilities. (With Dr. B, soft foods is defined as anything you can cut easily with a plastic fork - lots of options!) THEN, you think, anything I want! Glory be! Hooray! etc...

Yeah.

Well, here's my little montage to food and how I feel about it at the moment - at 25 days post-op.

Food is...

a necessary evil

boring

frustrating

kind of disgusting, if you really think about it much

a pain in the butt

time consuming

troublesome

did I say boring yet?

difficult

uninteresting

and just generally all around annoying.

Why, pray tell? Oh, let me tell you why.

(I should probably interject here that all of the patients I've coached through this stage of post-op life in the past six years are falling off of their office chairs laughing!)

First - while I can pretty much have anything that I want to eat... there's just really nothing that I want to eat.

Then, I have to factor in my own food allergies - there are myriad... Stuff like:

Shellfish
Egg Whites
Chicken
Soy
Milk (and I'm lactose intolerant on top of it)
Strawberries
Bananas
Tomatoes and citrus - if they're not completely vine ripened

Oh - and I hate peanut butter. And a bunch of other stuff. Okay - yeah, I admit it - I'm picky!

Some of my allergies are hit or miss. Like eggs... I can usually scramble an egg and eat it okay. If I haven't had too much egg in my world in the preceeding days, that is. I can be mid-meal and have eaten two or three bites of a scrambled egg just fine and then as soon as the next bite literally touches my lips they'll start to tingle and I'll know - "Well, that's the end of eggs for a while!"

And shrimp... I love shrimp - especially grilled shrimp with yummy spices on them. I can usually get away with eating - oh, on a good day (before this surgery, of course!) maybe five or six of them with no ugly raise of the ugly allergy head. But give me crab - or pretty much any other shellfish - and the room starts to spin, my airway begins to close, and I think, "Do I have an Epi-Pen with me or not?"

Strawberries are a definite anaphylactic response. Milk, and chicken, and bananas just make me throw-up - for hours on end. Makes me not want to include them in my world, you know?

Aside from the allergies, there are intolerances, of course. And then the stuff that I choose to not put in my body... stuff like HFCS, chemicals of all sorts, artificial sweeteners, etc.

I normally feel very good about all of this - I've learned to live my life in a very happy way with food by making wise choices about what works for me and what doesn't.

So, back to why food is such a pain in the butt...

Little bites are hard to remember to do. My son - who will be 2 years post-LSG (lap sleeve gastrectomy) in March keeps giving me the eye. You know, the one with the raised eyebrow and the accompanying, "That bite is too big, Mom!" There's nothing worse than getting nagged by your own kid - who also happens to be a patient that you actually coached through early post-op life.

Going slow is hard to do, too. Remembering to wait 2 to 3 - and sometimes even FIVE minutes between bites is really hard to do! And to be brutally honest - with my new stomach configuration, the 5 minute wait is really what I need to be doing.

Patients have been telling me this forever - and I know! I know it's true. I knew it was true when I had my original DS. So this shouldn't be a shock or surprise to anyone who is a DS or SG post-op... I just don't FEEL hungry. I *know* it has nothing to do with how I FEEL. (Can I just have 5 cents for every time I've said that to a post-op, please?!) It has everything to do with the fact that.... (let's say it all together)

food is FUEL

Yes, I know. I know! I teach this stuff!

But I don't really care!

(Aren't I a whiner?!)

Okay - and so, my next whiney complaint? There's a whole heck of a lot of stuff that isn't settling well. Like making me wish I could have someone reach a hand out there and take it out and throw it away! With my first surgery I only ever threw up once in the early post-op period (and only one other time in 6 plus years - when I had an incomplete bowel obstruction). I hate throwing up. But to be brutally honest - there have been many occasions in the past 25 days that I've longed for the ability to barf!

Aren't I pathetic?

So - yeah - it hasn't all been a joy ride. But... I will admit - every day is getting better. I'm actually learning from my stupid mistakes - for the most part, anyway. And trying to keep focused on the positive instead of the negative is really, really important for me. The thing that makes it doable for me is remembering to read my Bible, pray, and worship. I do a lot of driving in my cute little car - and I love that I can turn up the music really loud and sing at the top of my lungs - and no one else has to hear that I'm not quite on key - and know that God hears my heart first and foremost.

So I'm gonna make it.

Portland Baltasar Support Group Meeting - December 13, 2008 at 10:30 a.m.

2008-12-02T21:39:00.001-08:00

Hey guys! Just wanted to give you a heads’ up on our upcoming Portland Baltasar Support Group Meeting.

We’re going to have our regular support group meeting at Cedar Mill Bible Church (12208 NW Cornell Road, Portland, OR 97229; room P201 – it’s upstairs – look for the elevator and we’re just around the corner across from the restrooms and water fountain.

Since it’s December this next meeting we’re going to have a white elephant gift exchange at lunch. We’re gonna go to Happy Panda Chinese Restaurant (http://www.happypanda.com/) at 1:00 pm. Their address is:

1415 NW 185th Ave (corner of Walker Rd)
Aloha, OREGON
Ph: (503) 690-2753

I need to know if you’re planning on joining us for lunch – they have a separate room they can reserve for us if we have enough people. Last time we met there there were about 45 of us and it was a great space. RSVP to me here or via email (dinacmcb@comcast.net). It would be most helpful if you can let me know by December 6th if you can join us and how many are attending with you.

The rules on the white elephant gift exchange follow:

RULES FOR WHITE ELEPHANT EXCHANGE

1. It is more fun if the value is less than $20. Some people will ignore this and spend a lot more money hoping to impress everyone with their gift. It won't work. Gather these gifts together in a big pile.

2. Count how many people are in your exchange and write numbers from one to your total on slips of paper. Toss them in sack and shake them up to randomize them. Have all the players draw numbers and then form a circle around the packages in numerical order.

3. In order, each person should walk forward and choose a gift which they then open and show to the whole group.

4. When all gifts are open, the exchange begins. In numerical order, each person will get to exchange their gift for any other gift. They do not have to exchange if they like what they have. If they do choose to exchange, this allows the person they just exchanged with to switch with someone else. This series of exchanges goes on for 30 seconds. Whatever people are holding at the end of the 30 seconds is the gift they have going into the next turn.

5. Hiding your gift or in any way stopping someone from taking it is cheating and everyone who does it is a dirty rotten cheater who should be banned from the game next year.

6. After the highest number goes, whatever gift everyone has is the gift they get in the exchange. This usually result in one happy person and lots of disgruntled people. The perfect way to celebrate Christmas!

I’m not so sure I like the way explain the process – number 4 seems kinda iffy – we usually open them one at a time and then exchange as we go along. Suffice it to say we may change our minds between now and the actual exchange!

Should be fun!

Hugs,

dina

3 weeks post-op

2008-12-01T21:31:00.001-08:00

This was taken when I was 4 days post-op (July 6, 2002) on the balcony of my room at the Clinica (the nickname for Sanatorio san Jorge).

This was the Friday before my revision - on the same balcony that I had my picture taken on in 2002.

This is my stomach before my revision...

This is my stomach after my revision:

And here I am today - 21 days since my revision.

(I've got to work on my posture!)

So here are some of my thoughts about being three weeks revision post-op...

Getting hydrated and staying that way is a LOT of work. Hydrated meaning, of course, a bare minimum of 64 ounces of non-sweetened (artificially or otherwise) daily. For me, that means iced green tea (I love the Tazo Zen from Starbuck's) with a couple of mugs of some sort of tea each day as well.
Food is a pain in the butt. Working on getting calories in regularly is hard work. And stuff that sounded good 5 minutes ago may not sound so good now - after I spent 5 minutes preparing it! That's frustrating!
I'm still a little bit sore. I don't know why that surprises me so - but it does. It's one spot specifically - the one that bothered me before, when we were still in Spain and then magically went away. Well it's back - sort of. I *know* it's the trocar site where they made the biggest cut through my mesh. I know it'll just take a while for it to heal up and stop hurting. Doesn't mean, though, that I'm patient!
I'm not ready for jeans yet. I tried last Friday. Should have waited. It's not that I don't fit - but something about wearing them gives an aggravating counter pressure to my owie spot - and well, ow!
Even though I've been soundly in menopause for five years - I'm still spotting on occasion (have been since surgery). I guess it just goes to prove that there's still plenty of hormone stored in those cells!
All of my scabs on my tummy have finally fallen off - it happened on Sunday. Seemed like they'd never go!

Oh - and I've lost 15 pounds since my surgery. That means I weigh 79.54 kg and my BMI is now 29.9.

Thanksgiving as a baby post-op...

2008-11-27T19:18:00.000-08:00

We went to my uncle's home for Thanksgiving dinner this afternoon. I knew going into it that I'd only be able to take nibbles. That didn't bother me. What I wasn't prepared for was the fact that I'd end up throwing together a little vinaigrette for the salad. In normal me fashion, I'd throw some stuff in, take a little taste on cucumber, and then adjust. What I failed to factor in is that only 2 small slices of cucumber would fill me up ALL the way.

Bummer.

I did finally end up getting some bites of mashed potato and gravy and some stuffing (all chock full of celery and onions - yummy!), and a couple of little nibbles of the turkey dark meat. It was good. But it was, well, a little sad.

Know what I wanted the very most?

A big old plate of salad! Salad so isn't happening right now!

I will say that I did start the day out right. We picked up a quiche at Marie Callendar's yesterday, so I cut off a small slice of that, warmed it up and nibbled on it throughout the morning. That was good, and nice and high protein.

So here it is early evening.... later that I've been able to stay up thus far! Woo Hoo! And you know what I want now? A left-over turkey sandwich. Guess I gotta face facts that we have no turkey and that sandwich is completely out of the question for me right this moment....

So - what was the overriding theme for the day?

Was it the fact that I didn't get to eat everything that I wanted? Nope.

We actually went around the room as we paused for prayer this afternoon's dinner and all said what we were thankful for... overriding theme for the day - our profound thankfulness for our family - the ones we were fortunate enough to spend the day with.

And I'm thankful for a great surgery, a good outcome thus far, and the blessing of being able to even pursue this surgery. I am richly blessed, indeed.

Pictures!

2008-11-26T19:02:00.000-08:00

This is our last morning in Altea. To the left is Denise from Canada, who had surgery on the day I was discharged from the hospital. She's obviously doing fabulously!This is me 7 days post-op and on our balcony of our room in Altea.
Here are John and I on the evening of the 17th in Madrid - at the Flamenco show that we took in that evening. That was such a fun night!

This is the morning of the 21st - the morning after we arrived home. I asked John to take pictures of me for the blog... he did and then he said, "But you should take the sweater off - it camoflages too much." To which I said, "DUH! Why do you think I wear one?! Well, except for the fact that I'm always cold!"

BTW, I'd lost 10 pounds at this point in time. Below are the pictures without the :ahem: camoflage!

I'll take more pictures on Monday since that will be three weeks from surgery.

13 Days Post-Op - again!

2008-11-23T06:55:00.000-08:00

It's kinda funny... I know all of the stuff there is to know about being an early post-op. For heavens' sake I lived it July 2002 with my original DS. It really is still fairly fresh in my mind. Then, add on top of that the fact that I've been granted the extreme privilege of getting to walk along side lots of post-ops as they've gone through the same early post-op stuff and allowed me to coach them along... My husband and son included!

I know it.

I understand it.

I totally get it - why stuff happens and when.

What's kind of comical is the fact that when you throw in that free radical estrogen is at play as fat cells are being depleted of their stores - is the emotional factor that almost negates all of the stuff I'm supposed to know!

Case in point...

I always tell patients, "Never buy a lifetime supply of ANYTHING as an early post-op. You'll love it this morning, but you may well hate it by early evening."

I know that in my head, but when I taste something that may as well have been served by angelic beings on gilded platters (otherwise known as simple fruit juice - this was about a week ago) I'm positive that I will NEVER tire of it.

WRONG.

I'm totally sick of fruit juice now. Couldn't pay me enough to choke any more down. Now it's iced green tea or nothing. Well, except for maybe hot tea of various kinds. Hallelujah for tea!

This morning John and I made a huge batch of cream of potato soup with some finely chopped ground beef in it to add a boost of protein. OH MY WORD! It's amazing. I love it! I'm so glad I made a huge pot of it. (Forgetting that I have a very tiny tummy, of course! LOL!) I'll want to consume only this for the rest of my life. I said to John, "This is easily the best soup I've ever made." He looked at me, then responded, "That's your surgery talking." Yeah, he knows. :)

So how's it going at 13 days post-op the second round? (The first round being July 2002.) Good. I had kinda a barfy day yesterday. I don't know if it was exhaustion, dehydration, or what, but I felt all day long like I was about ready to hurl. Didn't actually barf at all, but kinda wished I could. I sipped my fluids all day long - most of them super iced, because night before last all of a sudden super iced was THE best thing on the planet. Along early evening came last night and I switched to hot stuff - and voila! The baryness went away. Go figure.

The jet lag is still doing it's crazy stuff. I fell asleep probably by about 8pm last night. That's actually pretty good for this stage of the game - but then I was up wide awake and raring to go at 3am this morning. That really is a pretty good night's sleep for me, so no wonder. But it would be good to get that normalized a little more - and soon. Life picks up at high speed, well, actually starting today.

I did have the requisite totally wiped out body clock completely confused, don't know what time of day or night, totally exhausted jet laggy kind of day yesterday. MJ, Ann, and I all felt encouraged that we were expericiencing it simultaneously! It's always good to have surgery pals!

Well, I've got pictures to post - but I'm too tired to mess with them right now. We've got church this morning, so I'll get a little cat nap and then get ready for my day - I may even break down and wear make-up!

Pictures later - I promise!

Jet lag lives...

2008-11-22T02:42:00.000-08:00

Here it is - early morning hours of the 22nd of November. Why am I up? Can you say:

JET LAG!!!!

Yeah, I can! LOL!

We left Madrid early morning on the 20th (Johns & my 15th wedding anniversary, coincidentally) Madrid time - and got home about 11:30 pm same day.

I love Spain. It's an amazing experience. I love going to Alcoy. I love going back to the Sanatorio San Jorge (the small private hospital that Dr. Baltasar operates on his private practice patients in). I love that first time to see Dr. B again - a big hug, a kiss on the cheek, an affectionate reunion. It's always like going home again. I actually always feel a big relief when I get there.

I loved the time we spent on the Mediterranean - Altea was gorgeous! The weather was 70's and sunny, the hotel was a resort - and gorgeous, you couldn't ask for nicer.

Madrid was fabulous. What's not to love about Old Madrid? Or the amazing flamenco show we took in? Or the Prado? Or the Royal Palace? Or Gran Via? The shopping is amazing!

But I love home. I adore my kids. I love my dog and cats and chickens. I really love my own fabulous bed!

If you've been reading my blog at all - you know we had a great time!

Oh yeah - that's right - I also had surgery somewhere in there! LOL!

My revision was on the 10th at 3pm. Surgery went well. We knew going into it that my stomach had dilated considerably since my original DS in July 2002. (And I started with a small stomach! About the 2.5 to 3 oz range. That was tiny for my generation of DS!) They found that the part of my stomach that had stretched out on the top part had adhered (gotta love those adhesions - not!) to my liver and spleen. So they carefully took it down as small as they could, and then made the bottom part very narrow. So I've still got a bit of a larger than normal top part of my stomach, but it's way smaller than it was going into this. They weren't able to reach my common channel at all. I had hoped for a re-measure - it was 65 cm at the time of my original DS - I was hoping to learn if it had lengthened at all, as they have been known to do if you do much reading over the years on outcomes and resurgeries. But I told Dr. B going into surgery if it meant unnecessary time on the table - I was totally with him on his commitment for surgery to be short and not super stressful on the patient - and to call it a day. My adhesions were so severe that it was completely impossible. I guess that shouldn't be surprising after all of the abdominal surgeries that I've had - all of them open - which means WAY higher chance for the fibrous difficult to release adhesions and much more difficult surgery. (Dang - what I'd give to have been able to have a Lap DS to start with!)

But you know what? I'm totally okay with it.

My restriction is SO MUCH more obvious now. I love that!

I weighed when I got up Friday morning and I've lost 10 pounds. Not bad!

Do I have a goal weight? Nope. My goal is to lose weight to prolong my mobility. If I listened to the orthopedic surgeons - who I think are totally unrealistic - they'd want me at about 110 to 120 pounds. Yeah, NOT. I just can't fathom that I would be - or look - healthy at that weight. So - I'll do my best to focus on the basics:

Get my protein in.

Get my fluids in.

Take my vitamins.

Move.

I want to be healthy. That's what this is all about. Well, that, and the fact that I'm not willing to give up my mobility without a fight.

Thanks for all of the thoughts and prayers, pals!

*smootch*

dina

I love home

2008-11-21T11:13:00.000-08:00

Ann was saying yesterday when we were in the Atlanta airport - after an already long day of travel: "No one ever talks about how sucky the trip home is!"

So I will. It' sucks. It's long. It's not really painful. But it's - well, long. Really long.

I got up at 5:30 a.m. in Madrid yesterday. That's a 9 hour time change from here in Oregon. We left for the Madrid airport at 7:30 a.m. from downtown Old Madrid. Got checked in with Delta. Got through security. Got a little breakfast. Shopped in Duty Free for about 15 minutes. Then we got on our plane at 10:10 a.m. It departed about 11:00 am. We arrived in Atlanta at about 2pm Eastern Standard Time - that's a 6 hour time change from Madrid - so, that would have been about 8pm. We had to board our plane from Atlanta to Portland at 6:30 pm - so that gave us enough time to try and find some food, go potty, walk some, and sip lots of Starbucks Iced Green Tea (with extra ice!).

Here's the thing about traveling as - for me, anyway - an 11 day post-op, is the fact that when you have weight loss surgery you burn lots of fat. And estrogen, my friends, is stored in fat cells. So, you've got all of this free radical estrogen at play - and the eternal day of travel about mid-way through the experience becomes the eternal day from hell!

Some of us get weepy. (I was - I missed my kids - BAD! And I was on the way home for heaven's sake!) Some of us get cranky. (I had my moments.) Some of us get depressed. Some of us get goofy. Some of us get mad. We are amazing individual beautiful creatures, aren't we? My goodness, God is an amazing Creator!

What makes it even more frustrating is the fact that it's hard to get calories in when you're a baby post-op and traveling. So you gotta go prepared. I took baby bells (they're great little semi-soft cheeses wrapped in wax - they travel well). I took some very tender tea cookies - they're bland and they go down well with hot tea, which is easy to get on a plane. I took cup a soups - again, hot water a breeze to get on the plane.

When we were in Atlanta we went to Chili's restaurant hoping to find a post-op friendly meal. Didn't happen. We tried to find soup. Um, not so much happening, either - much of anywhere. I did find a soup at one of the deli's - it was truly awful. Things got prettier when I got my Venti Iced Green Tea, no classic, with extra ice at Starbucks. I started sipping, and then I realized, my fluid intake had been dismal thus far for the day. Duh! I was seriously dehydrated. Then I got to thinking better - and a little more creatively.

I am still on fuller liquids, but that's nearly impossible when you're traveling, so you gotta maybe bump it up to soft foods until you get home. We found a great little restaurant in the food court called Paschal's - it's apparently a well known restaurant in Atlanta - and bless their hearts for having a place in the airport! I settled on some chopped steak with lots of gravy and green beans. I nearly wept with joy over the green beans - they were so good! The chopped steak, in tiny bites and chewed carefully with lots of gravy was perfect. As soon as I got some protein in me things got amazingly better!

The last leg home is always the longest, for some strange reason. We had a delay out of Atlanta by about an hour, so that put us into Portland later than expected. But you know what? I didn't care by then - I was just glad to be home!

It's a long trip. Is it worth it? You have moments in the midst of it when you wonder why the heck you chose to go halfway around the world for surgery - then you remember Dr. Baltasar... Yeah, no brainer - totally worth it!

We're in Madrid!

2008-11-17T16:04:00.000-08:00

Okay - so I should probably preface this by saying that while I *love* my life in the burbs on our wonderful 1/2 acre with our kids and chickens and cats and dog... I love Madrid.

It's beautiful...

It's historic...

It's exciting...

It's pretty much the heartbeat of Spain.

I usually spend just a few days in Madrid on the way out of Spain - but it's possible to do quite a bit in even just a couple of days.

One of the things that I recommend whole-heartedly is taking in a Flamenco show. If you're gonna do it, then choose the best - Corral de la Moreria. Most hotel concierge services (aka front desk clerk) can call and get you a reservation. Shows are at 9:30 pm and midnight. I've been to both - both are fabulous.

So fabulous, in fact, I just gotta share:

Obviously, we went last night - just a few hours after having arrived in Madrid. This is just a snippet - but you cannot sit through a flamenco show and not be moved.

Sigh.

It was amazing. I will also interject here that we three post-op girls managed to find stuff to nibble on - while the guys ate like kings. It was all I could do to keep from hitting John over the head and stealing his leg of lamb! LOL!

Today we're going to take the Madrid Vision tour bus today with a plan to take in the Prado - the world's largest art museum. That should be awesome.

More to report later!

Showers are good!

2008-11-16T14:49:00.000-08:00

Every post-op should have their first post-op shower in a shower like this:

Sigh... this could be habit forming!

We had a great day today. We found Denise and her sister Darcy at breakfast this morning. Denise had her sleeve surgery with Dr. Baltasar on Wednesday. They've actually been here a the hotel since Friday but we hadn't been able to find them yet. Amazingly enough, they are just a couple of rooms down from us!

After breakfast John and I, RJ and MJ, and Ann drove to Benidorm (6 km down the road) to the open air market. We had a fun time watching people. I wish I could access Ann's pictures - she got a shot of a lady trying on a bra over her clothes at one of the booths - it was a riot!

After the open air market we went to lunch at Tony Roma's in Benidorm. The girls enjoyed soup and the guys ribs - while the girls tried really hard not to drool visably at their yummy food. After lunch we walked the block to the beach.

This is a pretty classic snapshot of Ann, MJ, and I - laughing. We've done a LOT of laughing this trip. A LOT. LOL!

I am having one little wierd thing going on. I've got one spot on my abdomen that *really* hurts. Kinda feels like someone has punched me in a quarter sized spot repeatedly. It's definitely external - Dr. Baltasar and I talked some time ago about potential side effects or complications that could come about because of my mesh with a lap surgery. One of them is that some gas can get trapped in the mesh. I'm wondering if that's what's happened. I just emailed Dr. B and will likely hear from him in the morning about his thoughts on this. In the meantime, I'm trying to take it easy - and no laugh so much.

The sunset tonight was stunning - just had to share:

We're heading to Madrid on the noon train tomorrow. I'm not sure how we'll handle the change in weather - leaving the 70's for the 50's. Tough, huh? I guess we'll just have to buck up!

Thanks for all of the good thoughts, precious prayers, and emails of support!

5 Days Post-Op - Again!

2008-11-15T04:18:00.000-08:00

When you're 5 days post-op when you're a "virgin" DS every day is amazing - a little scary, maybe - but new and exciting. I've got to admit, it's a little more old hat this time out for me. Maybe that's because I've gone through this with so many patients now... nineteen that I've actually been a support person for. I think that's everyone... Then the others that were in Alcoy while we were there that we all adopted into our group... Then the others that I've had the privilege of talking with - whether in person or via phone, or email, or text, etc. as they've gone through the process.

So yeah, I had to stop just a moment ago and try and figure out how many days post-op I am! Surgery was Monday, today is Saturday - that's five days. Wow - they've kind of flown. And I feel really good. In fact....

I FEEL GREAT!

I will admit to the fact that Dr. B decided to pull my drains this morning since I was in Alcoy briefly *might* play into that a bit! :) LOL!

(This is in Altea - ancient olive trees in front of one of the churches in town.)

Yesterday we just kind of hung out around the hotel and some in town. Very similar to the day prior. (Below is a view of John on the Promenade in Altea on Thursday.)

Friday mid-day we had a conversation with Theresa, the wife of the general manager of the hotel here. MJ mentioned she wished we could cook some soup for we post-ops and Theresa promised to ask her husband if the chef couldn't prepare something specifically for us! As it turne out, MJ wrote down one of her recipies (she's a fabulous cook), it was given to the cook, and we were informed to report to the Miramar Restaurant at 9pm that evening to taste test! Cool!

Here's the Mediterranean at sunset.

Ann had not been feeling so hot since late afternoon, so went to rest after our outing Friday mid-day. We checked her vitals, etc. and everything was as it should be. However, her general sense of unwell continued and grew. We went to dinner - had the MOST AMAZING soup ever - and were having a fine time, when Ann suddenly felt very ill. I quickly phoned Dr. Baltasar and at his direction we quickly gathered a few things and John and I took Ann back to the hospital in Alcoy.

Long story short, her blood pressure is improving dramatically - and her body simply doesn't know how to handle that after many years of severe elevated blood pressure. Her medication was adjusted, and after a series of diagnostics she was deemed fine and dandy.

As you can see, she looks fabulous by this morning! This is she and Reuben, one of the nurses at the hospital.

We're back in Altea now, enjoying the much warmer and sunnier weather here. We're planning on heading out to lunch shortly (starts around 2pm). Tonight we will go to old Altea to visit art shops, do some general shopping, and enjoy a lovely dinner out.

Oh, interestingly enough, most post-ops don't start vitamins until thy are a month post-op. Dr. B and I have discussed it and we've decided that I will restart my vitamins now. I'm starting with calcium (I'm using UpCal-D travel packets) and Vitamins A, D, E, K, and magnesium. So far, it's going well.

Pictures from our balcony...

2008-11-13T04:18:00.001-08:00

We're in Altea

2008-11-12T23:26:00.000-08:00

My surgery went well. But as Dr. Baltasar explained to John, it was "very laborious" for the surgeons. Because off my three prior abdominal surgeries (not to mention the sheet of titanium mesh across my abdomen from my 5 years prior hernia repair) my gut was one big mass of adhesions. Yet another reason to push for a LapDS if you're someone trying to make the decision between lap or open surgery. It took them about an hour and a half to get through enough adhesions to reach the stomach. They took off quite a bit of the fullness on the lower part of the stomach, and took some off of the top part as well. The clock on surgery time was getting long enough and the adhesions so severe that it was decided to not mess with the common channel - it wasn't even possible to measure the length. I tolerated surgery well, however coming out of anesthesia was another story. I've earned the disinction of having one of the worst re-entries on record. The anesthesiologist finally administered a dose of calcium, of all things, and everything went to rights. Interestngly enough, my calcium levels were fine going into surgery, but not as fine as my body needed, apparently. While I was in the hospital on an IV they continued to administer additional calcium every 4 hours.

The first night was long, of course - they always are. My biggest complaints being my ankle was unsupported by the cast and so it was cranky. After that a bit of remaining lap gas in the shoulders. That first night I was able to get up, walk to the toilet, go potty, change to sitting in a chair - which was more comfortable than the bed, and make general advancements.

Tuesday was the standard course for recovery... Learning to ambulate independently. Having the blue dye leak test (blech). Working on spirometry to strengthen lung function. Doing lots of rinse and spit. Then "big" leak test and subsequent removal of NG tube (hooray)! Starting liquids. Walking more and more.

By Wednesday morning I felt pretty sure I'd be ready to leave the hospital by the afternoon. When Dr. Baltasar came by for his morning rounds we discussed the possibility and he said if I was ready by the time he came for mid-day rounds then we'd see. So I got showered and dressed. John got us packed up. We conferenced with Ann, MJ and RJ (her husband), and decided that if I was sprung that we would, indeed proceed on to Altea where we had reservations.

So I got released. We got the cars loaded (like how liberally I use the term "we" - yeah, I watched) and got in and headed for Altea. It's about a 50 minute drive. We're staying at a lovely place called Melia Villa Gadea - I stayed here in May with some other patients. It's the kind of place where they go out of their way to serve - they're so kind and gracious. It seemed like the right place to stay for this trip.

So here it is Thursday morning. I'm doing very well. I'm sipping my water, fruit juice, consomme, and blue dye (every morning until I am drin free), and working on my spirometer. The weather here is GORGEOUS. I'll have to take some pictures and upload them. The Mediterranean is showing off today, that's for sure!

Off we go to breakfast!

Surgery Day

2008-11-10T00:16:00.000-08:00

(That's me typing this post!)

So I've decided to go forward with surgery today (Monday). It's Monday morning, November 10th, 2008 at 9:16 am Spain time. My surgery is scheduled at 3:00 pm today - the first surgery of the day. I've just enjoyed my breakfast of tea and a nice glass of agua fria (cold water) and that's it for a while. Nothing by mouth now until tomorrow, when it will be blue dye test (blech), then tomorrow night (probably) big leak test (aka upper GI), and then if everything is PERFECTO! I will be allowed to start sipping water.

I have peace. I really waffled before making the decision. It would be so easy to just do nothing. The ankle would continue to deteriorate and then my mobility would go, yes. But it would be the path of least resistance. I've never been one much for that, I guess. I don't want to just lay down and not fight.

Okay - so if this seems a little disjointed as to what exactly I'm having surgery for, let me recap a bit.

I had my original DS July 2, 2002 at 3:00 pm with Dr. Baltasar in Alcoy, Spain. I weighed 365 pounds and had a BMI was 64 - although Dr. B insists it was 66. I don't know - it was up there, and I was dying. Going forward with DS was a no-brainer. It was that or die. I was dying, there was no question in my mind or in the minds of my medical team. It wasn't hard to decide to go forward.

So what is a reasonable goal weight for a woman who starts the DS post-op life with a BMI in the 64 to 66 range. There's a mathematical formula that has been worked on recently (Dr. Baltasar and some colleagues are working on a paper regarding this) that a mathematician has labored over in trying to extrapolate what a REASONABLE goal weight would be for any given patient. It's beginning BMI times .33 plus 14. That means that my goal BMI should be somewhere in the 35 range. A normal BMI is 18.5 to 24.9. Most of us who are bariatric post-ops are told to shoot for a BMI of 25. But is that reasonable? Especially if you start out as a super, super morbidly obese individual?

So I'm 5'2" tall. I weigh (well I did Friday night) 86 kilograms (that's 189.2 pounds). That means my BMI is about 34. Totally in the range of success if you use that extrapolation.

So why would I pursue a revision to my standing DS?

Because my orthopedic issues are winning. Specifically, the thing that is the driving force right now is the fact that my total right hip replacement last year left me with a right leg that's 5 mm's longer than my left, totally changing the alignment and gait, and accelerating the level of degeneration in my left ankle. I have Grade 4 degeneration throughout the ankle/foot. I would be a candidate for an ankle replacement IF I weighed at the low end of normal BMI for me.

Do I want an ankle replacement? Not sure yet - but after having seen SEVEN orthopedic surgeons thus far, the unified theme that all of them have stressed is the fact that I need to lose weight - a lot of weight - and not exercise. Yeah, right. You ever try doing that? Not very realistic is it?

So why do it? As I stated previously, I'm not willing to give up without a fight. They say I will lose my mobility in the coming few years if I do nothing. Even if I did go forward with an ankle replacement, there's no guarantee it would be a success. The statistics curently are that the ideal candidate (someone in the lower end of the BMI range being a key ingredient) has a slightly less than 50% chance of having a successful outcome. Not great odds. However, if I've learned anything thus far, it's that getting any excess weight off will afford less continued damage on my poor joints - and that can only help.

Of course, having a revision to my DS offers no guarantees and in fact carries a fairly significant amount of risk. Every surgery does. It's only after much prayer, contemplation, study, and several sets of diagnostics that we've arrived at the decision that it's a reasonable course of action.

The plan for my surgery today is to make my sleeve more narrow - down to the 50 cc size. My common channel will be re-measured and if it's found that it has lengthened over time, then it will be shortened. I don't have a problem with that at all - I really believe my level of malabsorption has lessened over time. And that will be that.

Things potentially complicating this surgery? The fact that I have a full sheet of mesh across my abdomen from my hernia repair 5 plus years ago - and this will be a laparoscopic procedure. Dr. Baltasar and team have done this previously with success - but it won't be as easy as if it weren't there, of course. And the potential for adhesions is very real. First - will I have any? Or will there be lots? Or somewhere in between? The nature of the adhesion is really the big wild card here. If they are there and are soft and easily cut away - no problem. However, if they are there and hard and fibrotic then it may well not be possible to proceed.

Of course, Dr. Baltasar's driving force is never to do harm. I go into this with complete peace that I'm exactly where I am supposed to be, doing what I ought to do.

So, we'll spend the rest of the morning packing up our room here at the Hotel AC, checking out, and then heading over to the Clinica. I've already been over for labs this morning. Then at noon surgery prep will begin.

I'm hoping Ann will feel up to getting dressed and heading out for a walk up to the Mercadona (grocery store) to check out some of the soup options for after she leaves the Clinica. MJ could have been discharged yesterday, but chose to stay one additional night. Her husband arrived here late Saturday evening and it's been wonderful having him here. He will likely move her to the AC this afternoon. Honestly, Ann is doing so well, I wouldn't be surprised if she's discharged today as well. We'll see.

So it'll be a pretty quiet day. I'll get settled at the Clinica, maybe do a little work, then spend some time reading my Bible and praying. Seems like the perfect way to head into surgery to me.

Time to go.

We're in Alcoy!

2008-11-09T10:41:00.000-08:00

It was - as usual - a LONG trip! Funny how routine it's become - of course, this is my 12th trip to Alcoy, so I guess it should!

We met Ann on Wednesday evening - she drove from out of state to join us for travel. We had to be at the airport at 4:00 am. Our a little *ahem* over-eager airport transport dude showed up about 30 minutes earlier than scheduled so there was some mad scrambling to get out the door. MJ met us at the airport to join us for travel.

Honestly - everything went exceedingly smoothly. Flights arrived on time, taxi cabs were appropriated with ease, transfer to the Charmatin Train station went flawlessly. Quick plug for buying Renfe tickets from Paul the wonder travel agent BEFORE heading to Spain!. It goes so smoothly just walking into the train station and finding a seat and watching for your train's gate to be announced. No lines to wait in for purchasing tickets - and with that, no wondering if they've sold out due to some holiday the rest of us were unaware of!

As we were waiting for the train I got a call from Dr. Baltasar on my cell phone wanting to know if MJ would like to move her surgery up to - THAT DAY! After a moment's contemplation she decided that yes, she would. (She'd originally been scheduled for Saturday.) So the plan was made for John and MJ to get off of the train at Villena and be met by one of Dr. B's taxi driver friends where they would be whisked off to the Sanatorio. Ann and I would then proceed on to Alicante where we'd pick up our rental car.

The plan went completely smoothly. By the time Ann and I made it to Alcoy MJ was indeed in surgery. We stayed at the Clinica until Dr. B came out of surgery to report on MJ - he said, "PERFECT surgery! Excellent!"

After doing rounds checking on other patients, Dr. B came back and talked with John and I about surgical options for me. He and I have been going through a flurry of emails over the past few weeks over what to do - if anything. John and I came to Spain fully prepared to not know for sure what the plan would be until we got here.

"I will walk by faith, even when I cannot see... Because this broken road prepares your will for me... I'm broken, yet I still see your face... You've been so faithful for all of these years... Your grace covers all I do." Words from the song "Walk by Faith" by Jeremy Camp. Just came on as I was typing. Funny how timely God is, huh?

Anyway - couldn't ignore that! :)

So - Dr. B felt that doing a quick Upper GI was the best course of action - so off we went to do just that. It's amazing how quickly things can happen with private health care in Spain. The doctor says - "hey, let's do an Upper GI" and down you go and do just that. No red tape, no weeks of waiting for scheduled appointments or results. We had results in about 15 minutes and had a little conference about the finding.

Bottom line: my stomach has "dilated" (that's the official term) considerably since the time of my original DS. Back then - 6 years 4 months ago - stomachs were not made as small as they are nowadays if you're a Baltasar patient. At the time of my surgery my sleeve (that's the shortcut term for sleeve gastrectomy - a procedure that removes the excess portion of the stomach, leaving a tube shaped remaining stomach) was probably at the 2 to 3 oz capacity. Today patients are given a 50 cc capacity sleeve (that's 1.69 oz to you and me!) The thing is, the excess material (along the greater curvature) that is removed is very stretchy stuff. So the more narrow the sleeve, the less stretch later on.

So, after seeing the films, Dr. B asked if we couldn't have Ann have surgery on Saturday (the next morning, that was my original day) so that he could have time to confer with his surgical team and look at my films, etc. I said sure thing, no problem. John and I wanted time to talk through the options as well.

With Ann at dinner the night before her surgery.

So the next morning Ann and I got to the Clinica about an hour before her surgery so she could go through surgical prep. I got to check in on MJ - who was doing FABULOUSLY! Seriously, Dr B keeps saying, "Perfect!" and she is! Once Ann was safely off to surgery I returned to the hotel and met John for lovely breakfast at the Hotel AC's breakfast buffet. We talked through a lot of stuff - to do surgery or not, if yes, then what the pros and cons of the different surgical options were. We left there without saying for sure one way or the other what the decision would be. John - as always - offering his incredibly caring support!

At the conclusion of Ann's surgery Dr. Baltasar came to report. Everything went beautifully. Excellent surgery, excellent outcomes anticipated. Then we sat and talked about what my plan would be. During the course of the morning - well, the the many weeks previous to this point in time - I'd been praying, asking God for His wisdom on this, whether I should go forward or not, asking that He'd give me clear direction. And at that moment, I knew great peace with what my decision would be.

What's ideal?

2008-10-18T18:55:00.000-07:00

At some point in time during your WLS journey you have to decide on what your goal is... What, pray tell, would your ideal weight be?

For some it's a number on the scale.

For others it's a milestone.

For others it's a size on a piece of clothing.

For others it's being able to do or NOT do something.

A lot of us have lists of 100 things. They are lists of things that you want or hope to do during the course of your weight loss and eventual completion of your weight loss. You know, things like:

1. Cross my legs.
2. Fly on a plane without a seatbelt extender.
3. Buy clothes in a regular size department.
4. Close my Lane Bryant charge card account.
5. Ride a horse.
6. Blend into the crowd...

I wish I'd kept the many I've read in the past seven or eight years. They're amazing! I wish I'd made one!

Goals are amazing. They're incredible motivators. They're a really healthy way of saying, "Hey! Look! I've accomplished something!" They keep you mindful of where you started and where you hope to go.

They make you feel amazing when you accomplish them.

And they can make you feel like crud if you don't.

So - how do you decide what ideal is? How do you know what your goal should be?

There's the whole BMI thing - a normal BMI falls somewhere between 18.5 to 24.9. When you start as someone with a BMI of 64 that seems laughable. Strangely appealing and mythical and alluring - but laughable when compared to - well, me!

Wanna figure out what percentage of your excess weight you've lost? Here's the formula:

Starting weight (SW) minus Goal Weight (GW) equals Excess Weight (EW)

Starting weight (SW) minus Current weight (CW) equals Weight Lost (WL)

Weight Lost (WL) divided by Excess weight (EW) multplied by 100 equal percentage of excess weight (PEW) lost

Example:

Jane’s SW: 330
Jane’s GW: 180
Jane’s CW: 215

SW - GW= EW330-180= 150 lbs. excess weight

SW - CW= WL330-215= 115 lbs. weight lost

WL / EW*100= PEW115/150*100= 76.67% excess weight lost

Statistically Jane is a raging WLS success. They (the ubiquitous they) say anyone who loses 50% of their excess weight and keeps it off is statistical success.

But how does Jane feel about where she's landed at the 5 year post-op mark? Is she happy to weigh 180 pounds? Does she FEEL like a success? Is she happy where she lands? Does she stare wistfully at clothes that are 2 or 3 or 4 sizes smaller than her own?

Or does she count her blessings?

Does she decide to look at it differently - remembering to look back to where she started and say with resolution, "I'm so much better off than I was! My weight starts with a ONE, for heaven's sake!"

The new way of qualifying your success or failure as a WLS post-op is the excess of BMI lost equation. It goes like this:

Percent BMI Loss = [(Operative BMI – Follow-up BMI) / Operative BMI] x 100.

Percent Excess BMI Loss (% EBMIL)

Since the NIH/NIDDK defined excess weight as starting at a BMI > 25, BMI units >25 have been defined as % EBMIL = 100 – [(Follow-up BMI – 25/ Beginning BMI – 25) x 100]

For example, if an individual has an initial BMI of 45, then the 20 BMI units above the upper limit of the normal of 25 BMI units represents a %EBMIL of 100; a loss of 10 BMI units (to a BMI of 35) would be a %EBMIL of 50. It is possible that %EBMIL may become the standard to present weight loss data in clinical studies of the overweight and obese.

Complex, isn't it?

It's one thing to look at it clinically, but it's completely different when you factor in emotions, isn't it?

I know this girl...

2008-10-01T22:52:00.000-07:00

I've known her for a long time. Gosh, maybe 15 or more years. Maybe longer? I can't remember if I knew her before I got married... maybe? Yeah - well, it's been a while.

We'll call her Carrie.

This girl (who, of course, is a grown up woman) is truly beautiful. Strikingly so. She's also one of the most intelligent people I've met. She is gifted - works with kids in a way that few are capable of. (I'm certainly not!) She is kind, thoughtful, and sweet.

We've never been buddy buddy or anything. But we've known each other socially - from afar a bit - and had any number of very pleasant interchanges. To be honest, I'd love to know her better - but as lame as it sounds - life is busy.

Years ago - before my DS, I was the larger of the two of us. Yes, Carrie is morbidly obese. Years ago she (like me years prior to my DS) was a very healthy heavy person - no or few co-morbidities showing up. Word was out in the circles in which we travel in pretty quick order that I would be having bariatric surgery, and that I'd be going to Spain, and it really was life and death - that if I didn't get the weight off and the co-morbidities under control - my life was forfeit.

Carrie assured me in passing one day that she'd be praying for me. I believe she meant it sincerely - she's that kind of person. A woman of faith. A woman of integrity. I have the utmost respect for her. And I went into surgery completely believing she would - indeed - be praying for me. A gift that I personally count priceless.

Fast farward a few years... I still ran into Carrie on occasion around our area - she lives close by. Saw her at the grocery store now and then. Saw her at common interest social events. I had lost my weight... she was gaining. My heart hurt for her.

The past few years I've seen very little of Carrie. The one function that we both attended for years - she far more faithfully than I - she'd stopped attending quite so faithfully. Why? For one, her health. But primarily - I can feel the very footsteps that she must feel - her mobilty. Any of us who have been super super morbidly obese know how simply standing makes your back feel like it will snap in two if you have to stand a second too long. Or how difficult it is to walk under the weight of HUNDREDS of extra pounds. Or how embarrassing it is to eye a chair and wonder if it will support the bulk of your body - or horrors - not.

Here's the thing. I'm dying to talk to her. To tell her that there's hope.

I should back up here a bit. She's not stupid by any means possible! She's incredibly intelligent. Maybe even brilliant. The word genius seems completely at ease in her company.

I assume she knows about weight loss surgery in general. (Of course, other people assumed the same about me - only I didn't!) I hope she knows that there are many types of WLS available. I desperately wish she would ask me about my experience. I long for her to know healing.

If I had the money - I would put it in an envelope and enclose a little card, along with airfare to Spain - and give her the gift that someone gave me those six plus years ago. My heart cries out to God each time this beautiful, kind, sweet, intelligent, wonderful, amazing woman comes to mind - "Please God," I plead, "Please! Please make a way for Carrie! If you will use me to help somehow - will you make it clear? Will you bless her, please? Will you bring healing for her, soon, please Lord?!"

I am near tears right now as I write. My heart is breaking for Carrie. You see, I remember well the pain... the fear... the humiliation... the worry... the certainty that my life was in jeopardy...

Please God... please.

Bone Health post-op...

2008-09-22T06:56:00.001-07:00

Amy was kind enough to send along an abstract of a report of a clinical trial on Vitamin D injection treatment. It's worth a read!

http://www.mja.com.au/public/issues/183_01_040705/dia10054_fm.pdf

It's actually a study that a post-op I know was in - you'll note it took place in Australia. So much for the theorum that it's only those of us who live in the northern areas of the world who suffer from Vitamin D deficiencies, etc.!

So - folks are known to say - just take Vitamin D. Well - we are! Did you know it comes in various forms? The most commonly known form being the lovely little gel caps that doctors are famous for prescribing - they are 50,000 IU's of D2 in those little caps. And, if you weren't aware - gel caps without exception - are packed in oil. Unfortunately, for those of us who have intestinal malabsorption - we may as well just skip the swallowing the pill part and flush it down the toilet! We malabsorb oil! That means it is not absorbed in our GI tract - it literally just goes through us.

A lot of us are taking the Bio-Tech Dry D3-50 - it's a dry form of Vitamin D3.

There's a petition going on in the WLS post-op world... it can be found here:

http://www.petitiononline.com/vitaminD/petition.html

Sadly, only 73 folks have signed. Yet I know literally THOUSANDS of post-ops (of various surgeries) who are struggling with keeping their Vitamin D levels in the correct ranges for those of us who live with intestinal malabsorption daily.

So what's the big deal? Why not just pursue the injections?

Some in the WLS world cite "potential for complications" as the reasoning behind not making them available here in the United States. Well - do some homework - read up. Can you find citations for complications because of injection series? I'm looking - if you find them, will you let me know? Cause I'm honestly trying to figure out if it's a good option or not.

I'm about to head to Spain in November. I plan on investing some time and effort into trying to locate injectable Vitamin D. I'll report back on what I find.

Orthopedic Nightmare

2008-08-28T09:59:00.000-07:00

I've had degenerative joint disease for ages - my Dad had it, another of my siblings has it. My maternal grandmother had osteoporosis, my Mom had osteopenia. I was diagnosed with osteoporosis before my DS, as well. (Thankfully, with good supplementation, losing the weight, and weight-bearing activity/exercise I've improved to osteopenia!)

At 365 pounds I was wheelchair-bound - for a couple of years. My pain level had been at a constant 7 or 8 on the fabulous 1 to 10 scale. Had two knee (one on each knee) surgeries the year prior to my WLS. Was told that the level of degeneration on the knees is at about 3.5 to 4. My patella looks something like shag carpet. Definitely bone on bone on both knees. Not pretty. Had my DS - lost 210 pounds, my wheelchair, and the high pain level - was living life at more of a 2 to 3, than the previous 7 to 8. Funny how invincible we feel when we lose the weight, huh?

So the orthopedic issues never went away (duh!) - they, of course, improved without the extra couple of hundred pounds around. I got active - really active! Yeah, probably overdid a bit now and then - kinda trying to make up for lost time, you know?

I'd been told before my DS that I'd need both knees replaced. About 5 years ago they told me to hold out as long as possible - but to think around 10 to 15 years out. I'd been focusing on the knees, the back, the ankles - but kinda forgot about the fact that my hip pain could seriously sideline me as well.

I was shocked and surprised a little over a year ago when I went in for a check-up for what I assumed was a torn or sprained something in my hip to find that my hip needed to be replaced - like a while ago. I was 43 at the time. Me? Hip replacement? Saw an excellent surgeon, got a 2nd opinion - it was unanimous - the hip must be replaced! So, August 23, 2007 I had total right hip replacement.

Can I just say here and now that I have a WORLD of respect for old people who have hip replacement done? OH MY WORD! Wow! What a surgery! BUT - I can say with absolute assurance that when I woke up after surgery I knew immediately that my pain was better - how wild is that? I was amazed, as well, at the little 86 year old lady who would lap me as we were walking our laps in the hall! LOL!

What I didn't know then was that when they replace your hip, they do their best to make your legs the same length. My new hip makes my right leg 5 mm longer than my left leg. Not much, you'd think, right? Well, it can be a big deal. Long story short (believe me, it's REALLY long!) that leg length discrepancy has changed the trajectory on my left ankle - and the degeneration there has accelerated at mind-blowing speed. In short - I'm losing my mobility again.

I've been referred to NINE (yes, that's 9) different specialists. It's both encouraging and dismaying to hear the surgeon who is thought of as a regional leader in his field say, "You need someone with more skill than I have." when you go in for a consult. They're talking ankle replacement now. I laughed when the idea was first raised - I thought they were joking, right?! Ankle replacement? Do they really do that? Well, yeah, actually, they do. Who would have thunk?

So - last specialist (who treats the professional athletes in the region for foot/ankle problems) said - wait 5 years if at all possible. The only way he'd say go for it for surgery (aka replacement) right now is if I lose my mobility completely before then. Problem is - there's less than a 50% chance of success - it's a new specialty. There need to be lots of advancements in the field. With my other orthopedic issues - I'd likely not be in the success group.

So - I find myself contemplating some big stuff. It's daunting. Since I'm a DS post-op with pylorus still intact - no NSAID prohibition. But I'm allergic to the world - so finding pain control that doesn't leave me in anaphylaxis or a zombie is difficult. When I'm in Europe I pick up the 600 mg Ibuprofen tablets - if I pop 2 or 3 of those at a time, then the pain can be at least headed off a bit.

I find myself thinking thoughts about how stupid I've been in the past 6 years - pushing the limits on what I could/should do given my orthopedic issues. It wasn't so much that I was ignorant - as just downright stupid. Funny how we chalk everything up to the weight - and then when the weight is gone - hmmm. got some things to reconsider, huh?

So - I alter my thinking a bit. I strategize a lot more. I consider my options. I know that in the coming years the ankle will go, the knees will go, and because I was young when I had my hip replaced, that will need replaced again in maybe another 20 years. I know with assurance that I'd rather NOT lose the mobility! I have three teenagers - Lord! - I NEED my mobility! I'm with the rest of you who have voiced similar thoughts, though- why not do something NOW - rather than wait until we're older to address some of these issues? I understand if it's a new field or medical advances are right around the corner - but stink - keep us moving! That will keep us healthier!

Vitamins

2008-06-24T17:48:00.000-07:00

At the risk of repeating myself..

If you go to the doctor and you have hypertension, he evaluates your case, he looks at your history of your blood pressure, and then he decides (based on a number of factors - drug reps not to be excluded!) which form of medication to prescribe to you. You typically stay on it for two to four weeks, record your B/P at home and then when you return, show what your levels have been. The doctor will then evaluate how the medication is - or isn't - working, and may keep you on the same dose, may cut your dose in potency, may increase it, or may try another drug altogether. It's a trial and error kinda thing.

POST-OP VITAMINS ARE MUCH THE SAME!

[Frankly, there a lot of normies running around with some majorly screwed up vitamin levels, too, only they don't pay attention to it until it becomes life altering.]

Who your surgeon is (because each surgeon has his/her own personal set of surgical protocols and philosophy of surgery), what your particular surgical specs are, your health history, your level of compliance with taking your vitamins, any other RX's you might be on, as well as the trends of your post-op labs from your pre-ops to NOW all come into play.

This is why I believe WHOLEHEARTEDLY that every post-op ought to:

Have a spreadsheet of their labs - from pre-op forevermore. If you don't have a template, there are some in the files, or you can borrow mine -it's at: http://www.bodybybaltasar.com/html/labs.html
Have the list of their vitamins/supplements written out somewhere -including manufacturer name, strength, dosage, and any notes as to when/wherefores pertaining to tweaking of supplements - and on hand -always.
DEMAND (if necessary) a hard copy on ALL labs drawn - no matter what. My doctor's MA knows that it doesn't matter if it's a post-op related lab, I want a hard copy of it - so she takes a photo copy of whatever comes in and I get it as soon as possible. I've learned more stuff from some of those "auxiliary" lab runs that had nothing to do with my DS, but helped me to have a better understanding of what's going on with my body. It's *my* responsibility to know what's going on with my body - I am, after all, the one who has to live in it!
Have a copy of their op report from their DS (and nowadays more and more surgeons are providing a video of your surgery as well - important stuff to have on hand) and know their surgical specs.

Sorry - a little warning here - a rant is about to ensue: people, we go into DS knowing we're asking for intestinal malabsorption. The DS isAMAZING - phenomenal, wild, wonderful, and honestly one of the best gifts I've ever been given. However, it's a very powerful surgery - and if you don't take it seriously, there is potential that you can give yourself a slow fairly tortuous death. And it's not just us - we have a whole heck of a lot more in common with some of your RNY peers than a lot of us are willing to accept - at least on the malabsorption front. WLS is a big deal.

Duh - so is morbid obesity - and for those of us who were at super, supermorbid obesity and on death's door, we were willing to accept the big deal!

Getting the DS and chalking "but I feel fine" up as sufficient for how you're doing as a post-op and an excuse for not being vigilant about supplementing, labs, and knowing what's going on with your own is willful NEGLIGENCE.

Okay - sorry - I couldn't hold that in.

So yes, there are some fairly universal truths for malabsorbers. We need more B-12 than the average bear, our low lipid numbers are not a bad thing, we do need to supplement B's no matter what the community (and some of our surgeons) were saying five, six, seven years ago. Some folks need more of one thing than another. That's why it's so important to take ownership for your labs and being consistent with having them done and yes, even knowing what your numbers are.

Okay - I'll shut up now.

Post-op Activity Levels

2008-06-19T15:54:00.000-07:00

I think it's really important to clarify a bit on what the expectations are about post-op activity levels.

I had my own DS coming up on 6 years ago in Spain with Dr. Baltasar. I was one sick girl - my doctors had told me I'd live no more than 6 months without drastic intervention. Hence, the DS!

I was wheelchair-bound, and had been for a couple of years. I could stand for maybe 30 seconds. My BMIwas 64. Dr. Baltasar said to me, "the goal is to walk one step further each time you walk." I was up walking to the toilet within 4 hours of surgery.

Within 24 hours of surgery I'd walked from my bed to the doorway of the room and then one step further to just out in the hallway. That was a banner day! I had (and still have) big time orthopedic issues. I have degenerative joint disease. I've got bilateral grade 4 degeneration of my knees and need both knees replaced. Last August I had my right hip replaced- I'm 44 years old. Right now I'm in a cast because they're trying to immobilize my ankle long enough to decide if I'm a good candidate for ankle replacement. You get the idea - a mess!

By the time I was 1 week post-op from my DS I was able to walk 1/8th of a mile. May not sound like much to anyone - but to me it was a MIRACLE! I walked that far standing behind and holding onto my wheelchair. By the time I'd flown home to Oregon and was alittle more than 2 weeks post-op I was able to walk nearly a mile - I had to have my wheelchair with me for the trip back from wherever it was that I'd walked to, but hey - amazing!

By the time I was 3 weeks post-op I'd given up my wheelchair and was using 2 canes. By the time I was five weeks post-op I was down to 1 cane.

By the time I was six weeks post-op I was using no canes and was finally brave enough to get rid of the wheelchair.

For me, it was baby steps.

I guess one thing that I should clarify is that within just days some of my constant high-level chronic pain had begun to subside some. I know for certain that the constant swelling I experiencedwith both knees had decreased dramatically by the time I was a week post-op.

Part of the reason I was able to stand longer and walk further was that my pain was so much improved. The other reason was that I went into it determined to NOT sit on my fanny and feel sorry for myself. I also have a history of having had blood clots (five different instances since my teens)- I knew for sure I didn't want to have a DVT or PE or any other kind of complication, and everything I knew from my work (I worked in health care)and research told me I needed to be disciplined about moving. So I did.

I've now gone back to Spain ten times as a support person to lots of other patients. There are some basic things that we have to have an understandingon before I'll ever agree to be someone's support person:

You have to do what I tell you.
You have to do what I tell you even if you think I'm obnoxious and a pain in the butt.

And the things I tell them:

Never stop doing pedal exercises. (Seehttp://www.bodybybaltasar.com/html/travel.html - click on the In-Flight Exercises link.) From the moment you board the plane you keep doing the exercises - even when you're waking up after surgery - keep doing theexercises. Whenever you're sitting anywhere - keep doing the exercises.

Sitting up is way more comfortable than lying down.

If you're having discomfort - try moving before asking for pain medication.

Get up and walk at least one step further each time - once an hour during waking hours.

No bending at the waist to pick up stuff from the floor, or to tie shoes, orthe like.

No lifting anything heavier than 10 pounds the 1st week post-op.

Once they're cleared to drink - take a sip (teaspoon sized) every five minutes during waking hours.

Once released from the hospital - continue the walk once an hour during waking hours thing.

After released from the hospital - one two hour nap a day, or two one-hour naps a day. The rest of the time stay out of the bed, get off of the couch, etc.

Use pain medication as needed - but stay alert, remember the more you move,the less you'll hurt.

Make sure to adhere strictly to the post-op diet (we do 2 weeks of liquids after surgery with Dr. Baltasar).

Be certain to get calories in at least every 2 hours - that's probably too long those first few weeks.

It's basic stuff, but it really and truly does help and make a big difference.

That all being said, I'll add that I carry a pedometer in my pocket everyday - whether I'm at home or abroad. My goal is always to try and get in 10,000 steps a day (which can be a challenge now that I'm in a cast!). When I'm in Spain I make note of how much a patient walks each day. On average, most patients are able to walk a mile by the third or fourth day post-op. It's not about doing it quickly or all in one stint.

We often go down tothe Mediterranean (Benidorm, Alicante, Altea, Calpe, the general area of the Costa Blanca - which, incidentally is endorsed by the World Health Organization as one of the best places to recover from an illness or surgery!) and stay in one of the little towns along the Coast. Virtually all of the little towns have beautiful beaches and lovely tiled promenades running along the beaches - with benches every so often. I always encourage patients to walk as long as they feel they can do so comfortably, then find a bench, plant yourself, watch the ocean, watch the people (always fascinating!), close your eyes and soak up some of the lovely sun. Then, after a brief rest, get up and walk a little further - until you need to rest again. It's truly not about walking miles - or even setting any particular distance record - it's about the motivation behind it. Do I want to have a blood clot? Do I want post-op pneumonia? Do I want to be on meds for pain for a long time - or free of them sooner? Do I want to heal faster? Do I want to be able to step back into my life sooner?

Every patient's condition - is of course - individual and unique to them, even though we all share some common things that we've suffered from or gone through. I've been to Spain three times with a patient who was wheelchair-bound - but every single one of them has been willing to get up and at least try to walk a few steps if it was at all physically possible.

This most recent trip to Spain (mid-May 2008) I had a patient who had been pretty significantly immobile due to a number of health issues. This same patient is the one who walked 2.5 miles the third day post-op. I, frankly, was blown away at the level of dedication and honest assessment that was made by that patient to stop and self-assess (at my urging) periodically and say,"Am I in pain? Experiencing growing discomfort? Short of breath?" This patient continued the rest of the trip in this same mindset - the day we walked the most we covered 3.5 miles. We flew home on the 13th day post-op. During the last three days alone we saw the Prado, The Royal Palace, took a tour of Historic Madrid, took in a midnight Flamenco show, among other things!

I truly believe that a patient's frame of mind and willingness to be disciplined those first two weeks post-op have a HUGE impact on how the rest of recovery will go.

One Year Ago Today...

2008-05-29T15:36:00.000-07:00

It’s amazing how time flies!

A year ago today I made a life-altering decision. Well, I had made the decision prior to May 29, 2007 – but this date a year ago was THE day that I took the big plunge.

I decided to eliminate high fructose corn syrup (HFCS) from my diet.

Might not seem like such a monumental decision – except that I have always readily admitted to the fact that I’ve been a lifelong Coke (as in the soft drink!) addict. Seriously – Coke is the great Southern cure for colic – and I must have been a colicky baby, cause that’s when I started getting Coke – in a baby bottle.

One friend quipped to me at one juncture in my adult life that she wouldn’t be at all surprised to find that if I went to have labs drawn they’d get Coke – not blood!

And yeah, you guessed it – high up there on the list of ingredients on the label of Coke is HFCS.

Stink.

So, why all of the fuss about HFCS? There are lots of reasons why – it actually may be harder to prove a case FOR consuming it! However, in my own personal case, here are my motivators:

Before my DS I was diagnosed with osteoporosis.
Since my DS I’ve improved to have my diagnosis changed to osteopenia. (Yay!)
I take a boatload of calcium, Vitamin D, and magnesium to keep things going in the right direction.
HFCS *and* carbonation are both known to block calcium absorption.

Double stink.

Last August 23rd, at the ripe old age of 43, I had to have my right hip replaced. Years of having an extra couple of hundred pounds on my frame, my family’s health history (my Dad had degenerative joint disease – so do I; my Mom had osteopenia; my Grandmother had osteoporosis), the fact that I was in a wheelchair for a couple of years, the fact that I didn’t consume many dairy products growing up since I’m lactose intolerant and allergic to some other components of diary products, and that I didn’t ever supplement calcium until AFTER my DS - *ALL* big factors that led me to make the decision.

All it really took was some serious reading – a willingness to get a little technical and wade through some fairly boring papers on the subject for the horror of it all to hit home and decide that I had to decide which was more important: my addiction to Coke, or my skeleton?

Yep – the skeleton won out!

So, on May 29, 2007 – without any fanfare at all, other than a quick notation on my calendar – I had my last Coke.

Simultaneously, I decided to aggressively avoid HFCS in any/all forms, as well as carbonation. I figured, heck, if I’m gonna take it seriously, I may as well do it well.

I have some lifelong friends who are still in shock that I made it past the first week. Well, I was, too, for a while. You know, after the initial breaking the first so iced cold it actually hurt going down Coke of the morning (my mouth is watering at the memory of it – even still!) habit, it was easier than I thought it would be. I went through a brief panic around the first of the year when I mentioned that I was celebrating 6 months of being Coke-free to my daughter – who laughingly asked, “So you gonna have a celebratory Coke?!” She was joking – I was seriously trying to decide if I was gonna or not! But after some wise counsel and lots of consideration, I decided to make a goal of being able to say, “I’ve gone a whole year without Coke!” as my New Years’ Resolution.

I gotta be honest. Two days ago when I was on the flight from Madrid to Atlanta on the trip home from Spain every time that beverage cart stopped in close proximity and started pouring drinks – it seemed that every one of the folks seated nearby was asking for an iced cold Coke! Aaagggghhhh! It still smells good! The memory of the taste of it can make my mouth water! Yes, I still want one! But I’ve decided – tentatively at least – that I’m better off without it.

So I mark a milestone today. There were days when it seemed impossible. Today, it just makes me smile that I could do it.

Bathroom Issues

2008-03-18T15:27:00.000-07:00

Bathroom Issues

I know there are several out there who have talked about how they feel as if bathroom issues are ruling their lives, so I figured it was time to start talking in earnest about what can be done for this. But before we go there, I think I need to back up to the beginning just a bit.

There is great urban legend out there that says that DS = butt glued to the toilet. I’m sorry, but that just really isn’t so. And if it is, then something is NOT right. So if that’sbeen your understanding and you’ve decided that you’ve just got to live with it, can I just encourage you to take a minute and do some careful examination of some basic choices in your life to see if we can’t find a better quality of life for you? Okay? Seriously – it’s not supposed to be like this, and if it is – I kid you not, there is something wrong going on.

First of all – let’s define diarrhea. I know, seems obvious – but until I worked for GI doctors, I really had no idea what the definition of it was. So here we go!

Diarrhea is watery – there is no form. There is no waiting if you have the urge. It is no respecter of time or place. It is in control.

Here are some excellent references that everyone should read:

http://en.wikipedia.org/wiki/Diarrhea

http://www.mayoclinic.com/health/diarrhea/DS00292

http://www.nlm.nih.gov/medlineplus/ency/article/003126.htm

http://www.medicinenet.com/diarrhea/article.htm

http://www.medicinenet.com/script/main/art.asp?articlekey=14 220

http://www.webmd.com/digestive-disorders/digestive-diseases- diarrhea

Next, if you are a newbie – i.e., less than three months post-op, and feel like every BM is essentially pudding consistency and wonder if that’s diarrhea, then the answer to your question is this: NO. Those are pudding poops, and that’s normal early out. In fact, that may be normal for more than early out. I’m six years post-op and I still have some pudding poops. (Hooray – that means the surgery is still doing it’s thing!)

There are things that can cause diarrhea – for anyone! And there are things that can definitely tip a DS’er in that direction. The problem with all of this – you have to factor in the basic detail that every person has a unique physiology. So for one person – lactose may be the big enemy. For someone else – it may be simple sugars. Both instances may be true for a normie, but for some DS’ers it’s even more true.

When I talk to a DS’er who has having bathroom issues that involve more than a few trips to the toilet for a BM daily, I immediately want to know - are you doing the basics? They are:

Minimum of 64 oz of non-sweetened (artificially or otherwise) fluids daily, with the goal of doubling that consistently
90 to 120 grams of protein daily
30 to 35 grams of dietary fiber daily
Sufficient fat intake – and good for you fats are important!
Taking all of my vitamins daily (See http://www.bodybybaltasar.com/DS_vitamins.pdf if you’re not sure about vitamins.)
Getting my labs done consistently

If you’re doing the basics, then it’s time to start looking at whether or not you need to tweak some stuff.

First and foremost, it’s really important to understand that chronic dehydration can and will feed chronic diarrhea. The problem being that there is some urban understanding that you should just throw any fluids at dehydration and everyone will live happily ever after.
Unfortunately, not so. Some people find that sugar (whether it’s high fructose corn syrup – which is in a LOT of drinks, or other forms of regular sugar) can actually cause the problem to be worse – or at least enable it to continue on. There are also folks who find that artificial sweeteners actually cause problems for them. The only way you’ll know one way or the other for either regular sugars or artificial sweeteners is to do some little cause and effect trials.

Next, you gotta be realistic about the fact that human beings are not designed to consume massive amounts of sugar. I know – everyone wants tons of license with no repercussion – but sorry, that’s not real life. If you are consuming LOTS of sugars I have two thoughts:
one, are you getting enough protein in? cause if you’re not, your body may be asking you for a quick fix to it’s basic need for a good consistent intake of protein; and second, are you dehydrated? Cause if you are, you may be answering your body’s basic thirst with a quick pop of something in the mouth that gives you a brief warm fuzzy in exchange forwhat it really needs – to be hydrated.

Basic fact: Sugar feeds the BAD bacteria in the gut. It not only CAN, but in most folks WILL cause a serious imbalance that CAN and WILL cause looser stools.

That’s why so many folks find that probiotics are SO helpful. They restore the balance of good and bad bacteria in the gut. Not making a change in your sugar intake, however, will not help you – probiotics can only do so much. You’ve got to accept the fact that shooting yourself in the foot will not make you a better marathon runner.

Next, dietary fiber is your friend! If you are not getting in enough dietary fiber, you will have bathroom issues. Not just because the dietary fiber increases the bulk, but because dietary fiber is rich in vitamins that you need to have healthy flora and fauna in your gut!

Please – EVERY single post-op should read http://www.slrhc.org/healthinfo/dietaryfiber/ - and pay serious attention to the fact that you gotta get good for you food in your body. It takes work. It takes forethought. It takes – yes, that horrible word we all hate: discipline. If you don’t know what dietary fiber is, then look at the content chart on that site. Another excellent resrouce: http://www.nal.usda.gov/fnic/foodcomp/Data/SR20/nutrlist/sr2 0w291.pdf

The cool thing about dietary fiber is that quite a bit of it packs serious protein punch. A 1/4th cup serving of lentils has a ton of dietary fiber and is very protein rich as well!

Now, lest you think, “my bathroom issue is constipation, so I don’t need dietary fiber,” let me just make a point of saying: wrong! If you’re constipated, you DO need more dietary fiber, and more fluids, and probably more fats. But that’s for later.

Next, do you know that some DS surgeons “require” their post-ops to avoid dairy for the first 18 months post-op? Wanna know why? Cause a significant number of post-ops (but no, not everyone) develop lactose intolerance as early post-ops. If you’re not sure what lactose intolerance is, or what it would feel like if you had it, try reading these:

http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintoler ance/

http://www.gastro.org/wmspage.cfm?parm1=854

http://www.mayoclinic.com/health/lactose-intolerance/DS00530

http://www.nlm.nih.gov/medlineplus/lactoseintolerance.html

Know what? If you were lactose intolerant BEFORE your DS, you’ll probably be lactose intolerant AFTER your DS. (Although some people report improved tolerance as further out post-ops.) Also, some people who do have issues with lactose intolerance as early postops sometimes find that it lessens as time goes on. It’s not a given, but it’s also not unheard of.

Something to keep in mind: lactose is sometimes places that you wouldn’t think of right off of the top of your head. You gotta pay attention to the details! You gotta read food labels – it’s just basic common sense! This from the NIH web site:

What is hidden lactose?

Although milk and foods made from milk are the only natural sources of lactose, it is often added to prepared foods. People with very low tolerance for lactose should know about the many food products that may contain even small amounts of lactose, such as

bread and other baked goods
processed breakfast cereals
instant potatoes, soups, and breakfast drinks
margarine
lunch meats (other than kosher)
salad dressings
candies and other snacks
mixes for pancakes, biscuits, and cookiespowdered meal-replacement supplements

Some products labeled non-dairy, such as powdered coffee creamer and whipped toppings, may actually include ingredients that are derived from milk and therefore contain lactose.
Learn to read food labels with care, looking not only for milk and lactose, but also for words such as whey, curds, milk by-products, dry milk solids, and non-fat dry milk powder.
If any of these words are listed on a label, the product contains lactose.

Lactose is also used in more than 20 percent of prescription drugs and about 6 percent of over-the-counter medicines. Many types of birth control pills contain lactose, as do some tablets for stomach acid and gas. However, these products typically affect only people with severe lactose intolerance.

SOOOO…. If you are using protein products (powders, shakes, bars, etc.) keep that in mind! Also, people are often terrified that being lactose intolerant means they will never be able to again consume cheese. Remember – there are alternatives available! Some people do GREAT with goat’s milk or sheep’s milk cheeses where they are irritated by cow’s milk cheese. (Also, don't forget, the harder the cheese, the less likely you are to have an issue with lactose intolerance with it.) Just remember to do any “trials” with some basic controls in place – i.e., don’t consume something that may or may not be an irritant for you around the time you are doing a test to see if goat’s milk cheese is a good alternative for you!

Next, some people are just super sensitive to fats. And it’s an easy thing to want to make a sweeping generatlization and say “all fats are bad” or “all one type of fat or the other” is bad. The fact of the matter is we each have unique physiology and some people tolerate fats poorly all the way around. If that’s the case, respond accordingly – use fats sparingly. Do, of course, give it a good go of trying some alternatives to the fats you use in your day to day life. I.e., if you’ve always used margarine, then try butter. If butter isn’t working out for you, try olive oil. So on, and so forth.

Next, supplements. This is basic stuff, but sometimes we forget it. Calcium citrate – not in company of magnesium – is something akin to quick dry cement in the bowels. So – again – a basic: every post-op needs 2000 mg of calcium citrate daily – AT LEAST. (Of course, labs are the determiner of how much!) Calcium citrate typically comes in a formulation that includes a 2:1 ratio calcium to magnesium, and hopefully has some D3 thrown in there as well. All good and wonderful – unless you are sensitive to magnesium. Some folks are. If that’s the case, you need to try a trial and error between magnesium citrate and magnesium oxide. Magnesium citrate is actually used to specifically move the bowels (more than move – actually clean out!) – ever been given a bowel prep? That’s what it is! You can/will have some benefit from the citrate – particularly if you are one of us who lean more toward the side of constipation as a post-op – but that’s not the topic at hand. (Interestingly enough - magnesium citrate helps support nerve and muscle function. It is also involved in carbohydrate and mineral metabolism and assists in calcium and potassium uptake.)

If you find that the brand of calcium is bugging your gut – and there are different variations on that theme – sometimes it’s stomach ache (Citracal is notorious for this!), sometimes it causes gas/bloating/distension (again, Citracal is not unusual to see with these types of complaints) – THEN IT’S TIME TO TRY ANOTHER BRAND! There are LOTS of them out there. BUT – PLEASE – be certain you are choosing Calcium Citrate. It’s the best choice for DS’ers. Honestly. Totally serious.

The product that more people say has made their lives vastly improved with regard to lessened BM frequency is UpCal-D. It’s a powder, it has 500 mg of calcium citrate in one serving (which is awesome!), and it has D3 in it. I like it because it’s so easy to take. I get the little packets of it, open one up – dump it in on my tongue, let it dissolve a bit, and then chase it with a sip of tea or something. It tastes a little bit like pixie stix dust. You can find it at Vitalady or Amazon.com – compare prices – bargain shop. This stuff is worth it’s weight in gold. Thankfully, it’s nowhere near that expensive! (I think we pay $12 for about 120 packets.)

You may need more than 2000 mg of calcium citrate a day to firm things up in the bathroom department. That’s okay. The key is to baby step to the correct amount for you.

Next, accountability sucks – but we all know it’s good for us. That’s why I love
www.fitday.com or www.sparkpeople.com – they are a great place to get a reality check. Do some basic recording of what goes into your mouth – and then also pay attention to what’s going on in the bathroom department. It’s hard to know if the stuff that’s going into your mouth is causing a problem if you don’t know what’s going into your mouth. I know, I know – it smacks of weight watchers – but if it’s going to improve your quality of life significantly, is it worth working past the flashbacks of WW?! LOL! (The answer to that is supposed to be yes, by the way!) Pay attention to the details. If you’re finding that having a Wendy’s frosty is giving you killer gas, distension, bloating, and then a little later on explosive diarrhea – well, folks, there’s proof in the pudding there. (Sorry, I couldn’t help it!)

Next, it’s entirely possible you’ve got a bug going on in your gut that needs medical attention. Get tested for c. diff, h. pylori, and bacterial overgrowth. These are treatable. Why suffer if there’s something that can help – even though it may take a little bit of dedication and work to get there?

Finally, if you’ve tried all of these things and you’re still experiencing frequent BM’s, your labs are showing you to be in malnutrition (and there’s a profound difference between managed malabsorption and malnutrition, folks!), then it’s time to talk seriously with your surgeon and your PCP about whether or not you are in need of a revision. Lest you be panicking right now – it’s not the norm – not everyone goes through this – it’s the exception. It totally and completely as profoundly as possible SUCKS big time that *anyone* has to go through it. BUT, the great news is that those who do find that a surgical response is the best option for them find that it DOES, in fact, make a huge difference and brings hugely improved health and quality of life.☺

All of that being said, we have to be honest with ourselves, as well. I’ve lost count of the patients I’ve talked with who have been suffering horrible bathroom issues, have identified the cause (not at all out of the ordinary for it to be won ton indulgence in sugars – remembering that sugars come in lots of different forms!) and then look me in the eye and say, “I’m not willing to give up the sugar.” To that I have to say, “That’s completely your choice. I can’t make that choice for you.” But if you do make that choice – own up to it. Please.

I guess I need to add one more little snippet here before I close. Everyone always assumes that what it's like the first month, three months, six months, year - even two years - is what it's like forever more. That's sort like saying as a human - my whole life will be just like it was my first two years of life - babyhood and toddlerhood. Yeah, not so much. Things even out with time. Lots of growing up happens over the course of those first few years as a post-op. Figuring out that there are good and bad decisions dietarily AS HUMAN BEINGS - not just DS post-ops - is one of the lessons that happens during that frame of time - hopefully.

Okay – so that’s my book length post for the day! LOL!

Author: Dina McBride

Low Fat? Low Carb? Not me!

2008-02-13T15:39:00.000-08:00

I don't do any low fat or low carb. I do avoid artificial sweeteners like crazy. In fact, I try to avoid chemicals in general. I'm kinda a granola girl! LOL! I embrace a whole foods lifestyle and avoid stuff like: Soy, high fructose corn syrup, MSG and the like. (Yes, I do have a subscription to Organic Gardening and read every issue from cover to cover! LOL!)

Whenever possible I use natural forms of fats. I have a degree as a professional baker and I LOVE to bake, but I love to cook more. (I was definitely in the wrong arm of the culinary school!)

I don't count carbs. I don't do any low fat - most low fat items are filled with additional sugars to make them taste more appealing. Plus - I'm a DS post-op! Hello! I have a ton of intestinal malabsorption going on! That being said, I'm also a staunch proponent of a healthy, balanced diet. I don't believe in eliminating any whole food groups from my diet. (Well, I do have a boatload of food allergies, and I of course eliminate those items, but well - only makes sense, huh?!)

I'm 5 years 7 months post-op and have managed to lose a couple of hundred pounds. There are definitely some things I would have done differently as an early post-op. They include:

Giving up soda for good before my surgery. I had only consumed regular sodas for gosh - years - because artificial sweeteners were giving me nightmarish migraines. Not so much for the sugar, though, but due to the fact that carbonation and high fructose corn syrup inhibit calcium absorption. Why go there? Why take boatloads of calcium and then shoot yourself down with a swig of soda to wash them down? (Yes, I am an addict. I can admit it. I am addicted to Coke. BUT, I haven't had ANY soda sinceMay 29, 2007. Not bad if I do say so myself!)
I would have incorporated even just mild toning exercises on a daily or every other day basis. I'm 44 and had my right hip replaced in August 2007. (I have had big time orthopedic issues for years prior to my DS, and spent acouple of years before my DS in a wheelchair.) The thing I'm finding now is that even though I'm exponentially more active and healthy now - some basic baseline strengthening would have served me well during my recovery from hip replacement. Just because I'm WAY thinner, doesn't mean I'm way more toned!
I would have been much more conscientious of the fact that there is a season as an early post-op life when your body is just gonna jettison pounds like crazy and I think I would like to have (in retrospect) taken more advantage of that. I'm pleased as punch with my weight loss and the fact that maintaining that loss is pretty stinking easy, but it just seems like when I was a baby post-op I didn't know so much about this sort ofthing, and maybe it would have been wiser to have been mindful of it. (Maybe the info was out there and I didn't want to know? Maybe I wasn't told? Don't know.)

I will say that I *do* use resources like http://www.fitday.com/ and http://www.sparkpeople.com/ to do checks on what type of quality food I'm getting in and to make sure I'm getting in sufficient protein, fiber, fat,and fluids. It's easy to get lazy and not do the basics when you're so busy living life. So I try to be mindful and choose wisely. [I should probably also interject here that my surgeon believes in a pretty aggressive DS - for which I will be eternally grateful! I started out with a small (incomparison to my peers, but not against current standards!) gastric sleeve, 185 cm alimentary limb, and 65 cm common channel. So I have significant malabsorption. If I did not, I certainly would be more mindful about certain dietary components.]

If you haven't yet, take a few minutes to read Dr. Hess' patient brochure on food and eating. It's a keeper! Here's the link: http://www.duodenalswitch.com/surgeons/hess_brochure/hess_brochure.html

And that's my take in a nutshell.

Iron

2008-02-02T12:52:00.000-08:00

I was horribly anemic before my DS. I know my numbers were always marginally low due to extremely heavy menstrual bleeding for – well – decades! But they went way south when William was born via emergency c-section – his head was so stuck in my pelvis they had a hard time getting the kid out, and I lost 9 units of blood in the process. For over 5 years before my DS I was *always* battling anemia. Tried all sorts of iron supplements, but my doctors didn’t feel like anything horrible was happening because of my anemia. So I accepted it for what my normal would be.

Had my DS. Started taking different iron, and lo and behold – my iron numbers finally came up in the normal ranges – and stayed that way for over 5 years!

The past year or so my H & H were kinda wacky, so when I went in for my hip replacement in August my surgeon felt strongly that I needed a 10-day course of Procrit injections to get me ready for my surgery. He went majorly to bat with my insurance company – finally talking them into covering the injections. (Which is good, because even with great insurance coverage, our co-pay was still over $500!) So – had the injections.

The day of my hip replacement surgery I remember waking up in recovery and seeing a bag of blood hung and being given to me. I asked the nurse about it and she told me that they’d harvested my own blood and were giving it back to me. (I’d been told beforehand that hip replacement is a very bloody surgery.)

So, I go on with recovery – nicely, I might add. Did notice some kind of different things going on over the past few months – some insomnia, some itchy skin, some little owies that took AGES to heal, and then this big need to consume sour stuff (was keeping Smartees in business!). Went in for my labs at the end of December and the next business day I got a call and letter – both – from my PCP notifying me that my ferritin level was 10! Good grief! It had been fine in August!
So, it was determined that I needed to see a hematologist and pursue iron infusions. Saw the hematologist on Monday of this week. His opinion was that the Procrit injections, combined with the hip replacement is what finally did my ferritin levels in. They scheduled me for an iron infusion – had it on Thursday, actually.

Had iron dextrose given – which can sometimes cause an allergic response, and being that I’m the queen of the allergic response, they proceeded cautiously. I was given 50 mg of Benadryl via IV and then given a test dose of the iron. No reaction – woo hoo! So, I got cozy in my comfy recliner, and slept through the 4 hour infusion!

I'm pretty amazed at the changes that I've noticed since the infusion:

I've slept through the night both nights - I've not slept through the night in over a year - before the hip replacement it was from hip pain, since then, from anemia!

I haven't had a single sour candy - don't want them, don't care about them. Amazing!

I'm not as cold. It was taking four quilts and a heating pad on my side of the bed with me wearing flannel PJ's and 45 minutes to get me warm enough to fall asleep. I love that I'm warmer!

I feel more satisfied with what I've eaten... I don't know if that's the right way to say it - but it seems that I'm not as hungry or something.

Just a few things. So far - only positives from the experience. I'm so thankful for a proactive PCP, a really educated hematologist, and the wonderful care I received during my infusion!

Is changing one's food mindset before surgery a critical step?

2008-01-25T18:10:00.000-08:00

You know – that’s a pretty difficult question to answer! We are all so individual and go into surgery with different things going on. Some of us have a physiology that has been resistant to weight loss our whole lives –no matter what method was employed. Others have been successful at losing hundreds of pounds – just not keeping them off. Others have gone into the surgical experience with different issues that may have spurred behavioral outcomes that have been harmful.

When it comes right down to it, though, the bottom line is this:

Food = fuel

I don’t know why it took me so long after my surgery to figure that one out, but honestly, it just is. I can choose to put really cheap fuel into my body and maybe get a quick burst of energy from it and not such great outcomes later on down the line. OR, I can choose to put really GREAT fuel into my body – have excellent sustained energy from it, and excellent outcomes later on down the line.

I’ll admit it – I’m a bit of a granola girl. We have ½ an acre and a huge garden and we organically grow as much as we can, I preserve and can pretty much whatever I can find in my own garden, at local farm outlets, etc., and cook from scratch – we’ve got way too many food allergies in our household to do otherwise.

This isn’t new! It was stuff I would have done as a pre-op had my health allowed it. I’ve got a culinary degree – I love food! I’m a certifiable foodie! (I live in the beautiful Pacific Northwest – it’s hard not to be here!) I’m not a food saint. But, I do basic stuff to take care of me first and foremost:

Get in 90 to 120 grams of protein daily (from food – I’m allergic to pretty much all protein products)
Get in a bare minimum of 64 oz of non-sweetened (artificially or otherwise) fluids daily, with an eye toward actually getting in twice that - gotta love iced green tea!
Get in 30 to 35 grams of dietary fiber daily
I need at least 50% of my calories coming from fat – or my hair/skin/nails are just too dry.
Take all of my supplements.
Try to move a little more today than I did yesterday. (I’ve got some orthopedic issues that make this a challenge sometimes.)

I don’t diet. I do go through periods of time where I have to do some self-evaluation and determine if I’m meeting my own goals. (Part of the reason why I love www.fitday.com and www.sparkpeople.com – they are great resources!)

I don’t count carbs – I just make sure I get in all of my dietary fiber.

I don’t count calories – but I make sure that I’m thoughtfulabout the choices I make. I want to be healthy and strong! I’ve got three very active kids – a 10 and 14 year old boys, and a 15 year old girl – andI’m the chick they spend the most of their time with – so I want to not only be alert – but not a boring Mom, either! And, I’ve got the coolest husband in the history of the world – so I want to be at my best for the time we have to share together, as well.

There’s lots of motivation to make the most of my DS. I guess the one thing that I should say though – is that before my DS it was harder to make healthier choices. After my DS I CRAVE the healthy stuff. It’s like my body knows what a wonderful gift it is! Before DS a cheeseburger would make me happy. Today, yeah, well, I could choke one down, but it doesn’t thrill me at all – I’d MUCH rather have a grilled halibut filet in some yummy sauce. It’s a weird, thing. But something I won’t take for granted – I consider it a gift.

We aren't supposed to use pain killers anymore, right?

2007-11-06T18:22:00.000-08:00

I chose the DS over an alternative form of WLS due to the fact that I had an ongoing need for pain control.

I have degenerative joint disease - it's pronounced throughout my spine and was in my right hip pretty badly - but of course, that was before my right hip replacement 10 weeks ago! (Now I have a pretty new titanium and steel hip!) I also have bilateral grade four degeneration of the knees - i.e., bone on bone with every step and the patella is pretty much trashed on both. And there is osteoarthritis in several other areas of my body. I'm pretty sure a good part of it is hereditary - my Dad was much in the same boat. One of my brothers also has similar orthopedic issues. My son also has an orthopedic disease.

I always have a stash of various RX pain relievers - my docs make sure I never have to go without. I use a wide variety of pain relievers and muscle relaxants. I am, however, allergic to a boatload of meds. Honestly - Ihave a full typed page of them. In fact, just yesterday I had an allergic response to a new med and spent the better part of my day in the ER. Whatfun. Anyway, of those available to me - my *favorite* pain reliever - firstline anyway, is the Ibuprofen. I pick up when I'm in Spain. They come in 400mg and 600 mg tablets. When the pain is significant - I pop 3 of the 600 mg tablets. I love it because it helps the pain - quickly - and has no mind-numbing or coordination affecting side effects. I should also point out that I am not taking this dosage several times daily - if things are that bad, then I do resort to the mind-numbing variety. My goal, however,is not to have to get there.

I have also suffered from migraines since I was maybe 8 or 10 years of age.Went through the whole gamut of RX's for that. Nothing worked that well, to be honest. Then my doctor asked me to give up all artificial sweeteners -and guess what! 90% of the migraines went away! Woo Hoo! Now, if I get a migraine I take 2 Advil Migraine and honestly, they work 500 times better than any RX migraine med I ever got in the past.

So. I guess what I'd like to say is this: there are a lot of docs who equate *any* WLS with RNY. There is clear cut and valid concern over taking NSAID's, etc. if you are a RNY. Don't go hog wild, of course. But use caution. Be mindful of details. Pay attention to - i.e., listen to - your body. Make decisions based on study and evaluation of the facts. Understand your surgery and be ready to explain and illustrate it to your doc in order to advocate for your needs. I carry a picture of the DS on my cell phone so I can pull it out and show it to a doc if I need to. (Just did that yesterday in the ER.)

2 1/2 Weeks Later...

2007-07-11T12:50:00.000-07:00

Okay - not since the last post, but since I had my right hip replacement. I am AMAZED at my recovery thus far. I can't believe that it's only been that long!

I went for my *almost* two week post-op appointment last Wednesday, the surgeon took one look at me and said, "You look more like a 4 week post-op, not an almost two week post-op! Amazing!" and then he immediately upgraded me to a cane from my walker. Cool!

So - interestingly enough, while I was still in the hospital, one of the pharmacists at the hospital came to talk vitamins with me (ha!) and try to understand all that I take and why... We got into a talk about how smoothly my surgery and recovery had gone thus far. He said the first thing, of course, was having a fabulous surgeon, and the other he felt was diet. He asked if I'd had any diet changes of late. I said no, not much - well, except I'd given up High Fructose Corn Syrup May 29th and that I hadn't had any sodas since then. HIs eyebrows raised and he said, "Interesting! I was just reading about how folks who abstained from carbonated beverages healed up faster! I wonder if you'll be my first in real life confirmation of the theorum?!" VERY interesting, huh?!

So - I'm walker free. Have the cutest cane - it's white with little blue flowers all over it. (The little old ladies at the memory care facility where my Mom lives want it!) Not only am I getting proficient with the cane, but I can actually walk a little bit without it. AMAZING! I'm still getting used to the fact that my right leg is now 5 mm longer than the left - a little wild how that feels. But, it seems to all be easing into place, and I'm feeling more and more "normal." Hooray!

Interestingly enough, since my hip replacement surgery, I've actually lost some weight. I've lost about 10 pounds. I'm not eating less. I'm not eating much differently from what I would normally eat. BUT - walking does take a lot more work... Who knows. But it's kinda fun!

I'M REAL!

2007-07-02T12:46:00.000-07:00

I will praise your mighty deeds, O Sovereign LORD. I will tell everyone that you alone are just. Psalm 71:16 NLT

I had always felt - as a pre-op - that when I hit the 5 years post-op mark that I'd be "real" - or at least a little bit "grown-up" as a post-op. But honestly, if you think about it, I'm only a kindergartener! LOL!

So today, July 2, 2007, I am 5 years post-op. I can't believe it. On one hand it feels like it was just the other day. On the other - it seems like aeons ago.

Of course, I was just as sick as they came back then. I'm still amazed that Dr. Baltasar would take a risk on me. What an honor to have him as my surgeon - and now five years later - a dear, treasured friend.

I remember saying about a year or so after surgery that I'd never be able to forget how badly I hurt, how difficult it was to live, how hard it was to get through even the simplest tasks - living my life as a super, super morbidly obese woman with a BMI of 64, and pretty much every co-morbidity in the book.

Here I am five years later, and I can say that it - the remembering how hard it was, how bad it hurt, how difficult it was to live - all of it - remembering it - is a little hard. I can see someone who is struggling to make it under the weight of morbid obesity and my heart just literally aches for them. But do I remember the acute pain? Do I remember clearly what it was like?

To be honest, I think it's fading. I think the crisis of the day to day living is becoming a more faint memory. And in a way, that sort of makes me sad. Not that I would want to go back there and relive it. But it makes me want to be careful to NEVER take this amazing gift I've been given for granted.

And that's what I firmly believe my DS is to this day. It's a gift. I feel honored and privileged to have been given this amazing opportunity to be given my life back. I am still in awe over the generosity of that amazing (still anonymous) faithful follower of God who went to my bank that morning of April 22, 2002 and deposited $15,000 into my surgery account so that I could have a chance. I'm still moved to tears that God would value me so - even though in my head I know He holds me precious in His sight.

I still wonder - Why me, Lord? Why did you choose to bless me so incredibly? How can I ever say thank you enough? How can I ever give back enough to begin to show my gratitude for you faithfulness and amazing mercy and grace - for me, someone who totally just doesn't deserve it?

But God...

My favorite phrase. Just when it all should have been over, it wasn't, simply because God chose to step in and willed a miracle to happen. I guess I could ponder it forever, and I likely will, but I've learned some over the past five years just when I feel overwhelmed by it all, to stop, to be still and know that HE is God, and to simply thank and praise Him.

So five years later. Had the bounce. Bounced back to the place I stayed FOREVER before I hit my all time low. I'm not so stressed about the number on the scale, as I am about the excess skin that I would SO happily say goodbye to! But in the scope of the real world, it's not that important. There are far more important things that need to be dealt with in the world.

I still have an incredible quality of life - the likes of which I had no HOPE or ability to fathom I could ever have as a post-op.

My labs are pretty darn good.

My marriage is the most amazing and precious thing ever.

My children are a blessing to my heart.

And God continues to bless me - even in the midst of personal storms and heartaches. My Mom is dying. There are other difficulties in my extended family that I can't go into at the moment. When hard times hit I am amazed anew at the fact that God brought healing to my life when he did - and that I'm able to do so many things I couldn't have ever dreamed of doing now five years ago.

I'm still just awed over the fact that just a little over five years ago I'd never even dreamed of going to Spain - once - and here I am five years later, having made the trip nine times! LOL! Who would have thunk I'd be a world traveler some day? Or that I'd have the incredible privilege to be able to accompany thirteen other patients to Spain as their support person for their surgery? Or that I'd get to scrub in and observe - pretty up close and personal - four DS surgeries (one open, three lap).

Wow. I'm so thankful. I'm so awed. And I'm so humbled that God would bless me so.

Here's to the next five years!

23 Days Later...

2007-06-22T12:43:00.000-07:00

I cannot believe I've made it 23 whole days without any HFCS *or* Coke!

AMAZING!

So - it's blowing my mind how infrequently I have ANY inclination to grab and down a Coke. Today was probably the first time I felt like I had to fight an actual urge to drink one. My cousin and her children were over for lunch - her daughter decided to have a Coke as her beverage. She popped the can and poured it over ice, and I seriously nearly grabbed the thing! From a 7 year old!

What's kinda wild is that we bought some Coke before Memorial Day weekend when it was on sale. It's all pretty much still there. Good thing we're having a few BBQ's here at the house this summer - we'll have to pawn them off on other folks! LOL! Actually - I guess no one ought to be drinking them. Scary stuff that HFCS.

Several people have asked for more info as to the WHY I'd do such a thing as give up HFCS, so here are a few:
http://www.ajcn.org/cgi/content/full/79/4/537
http://www.washingtonpost.com/ac2/wp-dyn/A8003-2003Mar10
http://www.westonaprice.org/modernfood/highfructose.html
http://www.westonaprice.org/motherlinda/cornsyrup.html

Well, there's a little to get you started. I'll bring out some more later.

The whys...

2007-06-14T12:36:00.000-07:00

So what got me to this place of going past my laughing dismissal of my pathetic addiction to Coke, to a deeper level of contemplation as to what was really going on with me – and what I needed to do – in good conscience – in response?

The scale.

I “came up” (to borrow a great Southern term) in the group of post-ops who lived in the shadow of some of the early “greats” of the DS online world. They told us to eat anything and everything – and lots of it. That there would be complete liberty and license from the day of our surgery forward – with the acknowledged adjustment period of the first months post-op. We were told nothing could do us harm (i.e., cause us to not lose weight, loose slower, or make us gain weight) – and dang, that was a message we wanted to hear!

I’m the rebellious type – so I wasn’t willing to take that as gospel, and started doing some digging on my own. Long before my DS I was leaning more toward optimism on the liberty front than not. People that I was meeting (online and IRL), studies of anatomy and the resulting DS alteration, clinical data, etc., seemed to support a huge level of liberty with the DS – nothing like what was seen with other forms of WLS. Cause for rejoicing! However, guarded rejoicing – I did a lot more digging (and honestly, have never stopped researching – this is the surgery that I’ve chosen to live with for the remainder of my life, after all) and realized that yes, there would be great liberty (better than ANY diet I’d ever taken part in!), but also great responsibility. Responsibility to eat a balanced diet, responsibility to stay hydrated, responsibility to supplement appropriately.

I had my DS. I weighed 365 lbs on the day of my surgery, with a BMI of 64. By the time I was flying home from 2 weeks later I’d already lost more than 20 pounds. By 1 month out I was down 34 lbs. Down 65 lbs the 2nd month, 80 lbs the 3rd month, 105 lbs by the 6th month, and 175 lbs by 1 year post-op. For the longest time – honestly, the better part of a year, I stayed at 183 lbs – right at the 182 pound lost stage. I was thrilled. No, I was beyond thrilled – I was ecstatic.

I had made wise choices with my diet in those first 18 months post-op – hadn’t been an actual food saint of course – but I’d worked hard at getting the right kinds of nutrients in my newly altered body, and worked hard at supplementing, and worked hard at continuing to try and understand my surgery. The one thing I could never give up, though – try as I might – was Coke. I’ll confess – I was only 1 week post-op and still in when I had my first sips of Coke as a post-op. Tiny sips, yes, but sips nonetheless. (Dr. B would so kick my butt!)

Some magic point in time right about the time John had his DS with Dr. B (2 years to the day after my DS) and we were in my body went through another shift. By the time we got home from I realized my pants were a little too big, and my body was changing again. By this point in time I rarely weighed any more – it was just really inconvenient to find the scale! (We lived in a multi-generation home with every square inch appropriated!) But a couple of mornings after getting back from Spain I found the scale, hopped on, and stared at the number for the longest time. It read 155. I seriously stood there and just stared at it for the longest time. I stepped off, stepped back on again, and thought – “What does that say?” I actually had to have John come over and see it and tell me that the number I was seeing was real. It was. That put me at 210 pounds lost since my surgery.

I didn’t ever start out with a number I thought I ought to end up at with my weight loss after my DS. Honestly, I thought anything under 200 would be phenomenal. Not only that, I hoped and prayed I’d get to the place where I could just simply order clothing from a regular clothing catalog. Or walk into a department store and buy clothes in the “regular” section. Those were things that couldn’t happen for me at just barely trying to still fit into my 5X sized clothing.

Dr. B told me that normal BMI for my height would put me at about 135 lbs. I laughed out loud – me! At 135?! LOL! I think the last time I weighed 135 was when I was in the 3rd or 4th grade! He pretty emphatically told me that was just what a normal BMI was, that it didn’t have to be the big gauge by which to measure my success. He went on to assure me that my body would likely stop right where it ought to.

When I hit 155 lbs I honestly felt like I was a little too thin. I had virtually no boobs left. My butt was so bony it hurt to sit. My hip bones were downright dangerous – if I bumped into the corner of a counter – it felt like my hip bones had been seriously jarred. And I wasn’t just cold – I was frozen all of the time. I think that was about the point in time I quit weighing. Life aside from my DS was beyond hectic – it was downright out of control. I felt healthy, my labs were good, I was active, involved in life, and getting on the scale seemed pointless.

So life went forward. Every now and then I’d end up at the doctor’s office for a yearly exam, or an appointment with my endocrinologist – be required to get on the scale, and I’d passively take note of the number but it seemed to have nothing to do with my day to day reality. I realized at about the time I was a little over 3.5 years post-op that my weight at the endo’s office that time was something like 172. Yeah, a little up from my low – but I expected a bounce – and I actually felt healthier, more rounded at that weight. Didn’t stress me out at all. In fact, I felt my clothing felt like it fit more appropriately – I liked that I had at least a *little bit* of boobs back, and my butt didn’t seem quite so bony.

Needless to say – my life has been full of major stressors – won’t go into them, but major nonetheless. I’ll admit it – when life is at it’s busiest, I often opt out of taking care of me and take care of others. Not completely out of the question for me to grab a Coke for breakfast, thinking I’ll grab something to eat later – but it never happens. In terms of orthopedics, my issues have been exacerbated over the past year, as well. Not only that, but I’ve got a new hernia along the top line of my abdominal mesh. Exercise routines have been started – but not followed through with consistently. Every single day I think, “It would be so nice to go take a nice walk.” But it never happens. I hate that.

At some point in time this winter – probably after we moved my Mom into the assisted living place and I had some semblance of a life returning – I realized, “I’ve gained some weight!” I didn’t break down and really weigh at that point, either – I just kind of mentally made note of it – and was a little perturbed about it. More time passed, and it must have been about January before I actually got on the scale and looked at the number staring me back in the face. 195. I don’t like 195. It’s a BAD number.

So I started doing some self-reflection. I had to confront the fact that taking care of others had almost completely edged out taking care of me. Granted, there wasn't much of a choice involved - but somewhere along the line balance went completely out the window. I started realizing that while I started out each day with every intention of doing the right post-op things (sufficient non-sweetened fluids, enough protein, enough fiber, enough exercise) I was only very rarely getting them done.I knew something had to change.

So, I decided some time in January that I'd give up Coke. Noble of me, I knew it was bad for me on so many fronts - blocks calcium absorption, is nutritionally worthless with simply NO redeeming qualities whatsoever, and horrible for my teeth. I started with great intentions... it just didn't happen, though.

It wasn't until later on - after having talked to my orthopedic surgeon and endocrinologist that I learned that HFCS and carbonation BOTH block calcium absorption. So here I was on one hand working like crazy to get enough calcium in to make improvements in my bone density - and on the other kicking myself in the butt!

Stupid! Stupid! Stupid!

So I did some research, lots and lots of reading, and I came to a conclusion.

The HFCS had to go.

Day 15...

2007-06-13T12:33:00.000-07:00

Today is the start of the 15th day without HFCS (high fructose corn syrup) - which means, of course - my 15th day without Coke.

I honestly didn't think I could go this long without it. It hasn't been as hard as I thought it was going to be. Maybe because it's not just the Coke I'm getting rid of - but the HFCS. It seemed when I eliminated the whole category it made the Coke thing just a little bit of the bigger picture. Wild!

How do I feel?

Good! I'm amazed that I'm not having to haul out some sort of Amazon-woman iron will to avoid Coke. At restaurants or - well - anywhere, it seems easy to NOT have it. The longer I go, the easier it gets.

I guess I should have known that. But in the past when I've tried to just give up Coke this has NOT been my experience - it's been a battle of gargantuan proportions.

Ramifications?I lost 4 pounds right off the bat. Been staying there. Still at that range where I stayed forever before I had that dip to the low-low.

I'm NOT avoiding sugar. I'm not embracing it, either, though. If I want a cookie - then I bake it instead of buy it, because the bought stuff 99% of the time has HFCS in it. If I want a dessert, I get it - but just make sure there's no HFCS in it.

Funny thing is - I want far fewer sweets now.

Maybe that's because I'm not grabbing a Coke as a "meal replacement" now and am actually eating more real food! Go figure! (Duh - I can be so stupid sometimes!)

So... Will I stick with it?Yeah - I definitely will. I decided at the beginning of this whole thing that I wasn't outlawing Coke - which I've had a life-long love affair with - but HFCS, BUT, that if I felt I simply HAD to have a Coke, then I'd have ONE, not one right after another. But you know what? I don't even want the one. I'm blown away.

So far, so good.

HUGE decision...

2007-06-09T12:31:00.000-07:00

I’ve made – what may well be - one of the biggest decisions of my adult life.

To say that this is going to affect my life is myriad ways is likely an understatement of gross and gargantuan proportions – hence, the reason it’s taken me so long to get to the place where I can actually say the words…

I’ve decided to eliminate high fructose corn syrup from my life.

Phew.

I said it.

That was hard.

Harder still, was doing the research and realizing what I’ve been putting my body through for all of these decades.

As anyone who knows me even passingly knows – I am completely addicted to Coke. I’ve always blamed my Mother and Grandmother – they gave it to me in a baby bottle when I was an infant – it *is* the great Southern cure for colic, and yes, I was a colicky baby. I’ve loved it since – for more than forty years.

I did go through the late 80’s decision to kick the regular Coke to the curb and wholeheartedly embraced Diet Coke. Stuck with it – in a big way – until the year after my son was born. By that time I was having migraines so frequently and with the kind of intensity that I can’t even begin to explain and my PCP came across a study that she asked me to read and then urged me to eliminate artificial sweeteners from my diet to see if my migraines – that thus far had not responded well to RX’s and other modifications – would be lessened. Suffice it to say, getting rid of the artificial sweeteners brought about an amazing healing to my system. Yes, I still occasionally get a migraine – maybe one every three to six months – but never to the extent or degree of intensity that I would have before.

So – when I gave up Diet Coke, I – of course – switched back to “the real thing” – regular Coke.
I hang my head in deep and utter shame when I confess to you that at the worst of it – in the height of the Diet Coke days – I would easily consume six to ten cans of Diet Coke a day. More often than not, it was to the exclusion of food. It was my drug of choice.

Now – 10 years later, firmly entrenched back into my regular Coke habit – and nearly 5 years since my DS - I’ve had to do some deep soul searching and admit to myself that yes – I do have a chemical dependency! At first I pointed the blame solely at Coke. But I stumbled across an article about six weeks ago that made me start thinking through the whole thing. My problem isn’t just Coke. It’s HFCS – acronym for High Fructose Corn Syrup. If I’m honest with myself – I am addicted to it, and it is my drug of choice, and I’m truly sick of it.

William Update...

2007-04-06T14:31:00.000-07:00

It's Good Friday - of Semana Senta - Spanish for Holy Week - and it's a big deal here. There will be a bull fight here in Benidorm, there will be parades galore, and there will be a LOT of partying. We were so surprised last Sunday that given all of the excitement about Palm Sunday, that people didn't seem to know about the Biblical tie in. It should be an interesting balance of the week - today and Sunday are national holidays. If we were in a smaller, less tourism-driven town, it might be virtually impossible to get meals, find an open grocery store, etc. As it is, it may still be a bit of a challenge!

William has done phenomenonly well. I got the green light from Dr. Baltasar Thursday afternoon to go ahead and pull William's surgical drain - output had reduced significally, and quality was excellent. (Dr. B trained me to do this a long time ago - so it's pretty routine for me.) William seemed pretty hesitant to believe my qualifications - but eventually decided my services in this instance would suffice. He was so worried it would hurt - then, like everyone else at the end said, "That's it? I was worried about THAT?" He's relieved to have the tape off of his port sites and drain gone!

Dr. B had an orthopedic specialist take a look at William and his x-rays. The report came back. The normal measurement for the knee angle is in the single digits - 19% is WAY bad and horrible (top of the measurement scale). William's right knee is 27% and left knee is 39%. Each step of the way there is reassurance that we have done the right thing. We have already noticed a marked decrease in his orthopedic pain. We find this amazing phenomenon to be true of the DS post-ops (the surgery John and I have - William's surgery is in essence one component of ours) - we weren't sure if it would hold true for him. We are so pleased that thus far it is!

Today is William's first post-op day without a nap AND getting in all of his required fluids (64 oz - all post-ops struggle getting this much fluid in early post-op). He's kept up like a real trooper. We have hopes he will sleep through the entire night. All in all - not a bad 1st week post-op at all!

We've tried hard not to focus on the number on the scale with William - we've tried to keep the focus on being proactive and conscientious about healing, giving oneself the tool needed to facilitate healing, and that the future will be bright for him. Yesterday he mentioned that he's noticed that he looks different. This morning when we were at the farmacia William weighed himself. If the farmacia scale is to be believed - then he's lost 11.61 lbs in the past week. He laughingly remarked that he's doing better than the poor people in the commercials! (For diet pills, etc.)

We are really looking forward to home. Spain has been beautiful, but we miss home. Please keep us in your prayers - particularly as we drive to Madrid on Monday.

Blessed Easter, dear ones!

He is risen!

Much love,

dina

To the beach!

2007-04-03T14:36:00.000-07:00

William's recovery has been textbook - or better. He went through the very normal phase of relearning body mechanics (and with IV pole in tow!) - learning to go slowly and carefully. The hardest part was the pretty typical 10-year-old kid aversion to needles.

Surgery was Friday afternoon. By 24-hours out he was walking the hall proficiently, using his breathing incentive device, and going back over the Q&A we've been doing for weeks. (i.e., What comes next? How long will I have pain? Is salmon a soft food? How long will I be jet lagged?)

Early Sunday morning it was pretty clear that William's IV had given up the ghost. Dr. Baltasar gave the order to remove the IV. There was rejoicing in the ranks! We got him a shower and he realized he was feeling pretty good. Early evening he went down to radiology for the 'big' leak test. There are a series of tests designed to ensure that suture lines are intact. There are two that are actually done during surgery - before everything is final - with two mediums (water and methidine blue). Then the morning after surgery there is another blue dye test - the first substance taken by mouth. The surgical drain is then watched to see if any blue shows up there. The big lesk test is with having consumed gastrografin, and then a series of x-rays are taken. To be honest - it tastes WICKEDLY awful. *shudder* - gives me the willies just thinking of it. We warned him, prepped him, gave every tip known to man to make it easier. I was completely blown away at how well he did. And my shoulders really relaxed when the radiologist exclaimed, "Perfecto!" (They are so kind to allow me to sit in the control booth.)

Once we had the big leak test behind us and it was confirmed to be a-okay, the order was given to go ahead and start fluids. Sips are teaspoon sized and must be spaced at least 3 minutes apart. He is allowed water, herbal teas, fruit juice, yogurt drink, consomme, and popsicles. He must stay on the liquid diet for 2 weeks. After that, there will be a week of soft foods - defined as anything you can cut easily with a plastic fork. Following that - anything.

From Sunday evening to Monday morning there was easily an overall improvement in coloring, disposition, and marked reduction in operative pain. Monday morning Dr.Baltasar commended William for his exemplary behavior, excellent compliance, and courage - and then discharged him. We got packed up and only moved as far as the AC Hotel in Alcoy. We stayed Monday night there, and then this morning headed out for Benidorm - where we have a reservation for the coming week.

Our apartment suite is right on the beach and we have a lovely view of the beautiful Mediterannean from our balcony.

Our first item of order these coming days will be to get out and walk as much as possible, and continue to help train William regarding his new dietary needs.

Well we're bushed, but oh so incredibly thankful to God for his watch-care over us.

More uodates later!

Blessings,

dina

B Vitamins

2006-03-15T15:40:00.000-08:00

B-Vitamins

This is kind of my pet peeve right now. I'm 3 years 8 months post-op and the assumption across the board(s) (bit of a play on words there) is that you're a DS'er - you NEVER have to worry about your B levels. WRONG-O! Yes, we do have intrinsic factor working in our favor. (RNY'ers don't.) HOWEVER, we have tremendously smaller stomachs AND malabsorption working in our new GI tracts - so (I should have figured this out WAY long time ago) we DO need to be concerned about your B Vitamin levels.

Most DS docs DO NOT require post-ops to test full B-spectrum vitamins in post-op labs. However, more and more of us who are further out post-op started having low B Vitamin problems. Here's the thing - the new thinking is that *anyone* with a malabsorptive surgery (whether WLS or a gastric cancer type reconstruction) needs to pay serious attention to their B Vitamin levels. For instance - the range (from the lab I use - every lab's ranges are unique, but within a somewhat reasonable range) for normal B-12 is 211 to 911. The newer research is starting to show that those of us with malabsorptive procedures (remember, we aren't normies - the range for the lab is for normies - with completely intact, non-adjusted GI systems) is rock bottom is 1400, distal RNY post-ops should be more around a minimum of 2000.

Why didn't I pay attention to the fact that my number was tanking before my very eyes on my lab tracking form until I was over 3 years post-op? Because public opinion (DS post-op community) was that "We're DS post-ops, we don't have to worry about B Vitamin deficiencies, neener, neener, neener!" Total bunk.

My endochronologist and I have been doing some serious digging into this subject, and when I go back next month for my next check-up, he's hinting that a series of B-12 shots is in my future (my number is in the low 200s - totally sucky). Even though I take four times the recommended dosage of Super B Complex - but the fact of the matter is this: 3 years of malabsorption without supplementation to counter it has done it's damage. Here's the thing, though - people think, B Vitamins - no big deal. But it CAN be a HUGE deal. Do some reading (there are some excellent published articles on this very topic! Some incredible web sites out there devoted to further education and advocacy for folks who suffer from problems related to B Vitamin deficiencies) - it will floor you how serious these deficiencies can become! B-12 levels play into anemia issues, B1 levels get severely low enough - you can suffer paralysis! B2 gets low - you'll start noticing that spices are spicier and the corners of your mouth might crack and bleed. B Vitamins are important. It's part of the crux of being part of a sub-population where education is garnered because of the things we experience as post-ops (regardless of which type of surgery you have) - we're kinda like guinea pigs!

By the way, my surgeon gave me a great list of labs to have run, too. BUT - make sure it's sufficient. My endochronologist and I, along with my PCP, and in cooperation with my surgeon - have been refining my lab list - the "basic" list that most surgeons give their post-ops is NOT as thorough or sufficient as it should be.

And... about your PCP acting kind of stupid about the DS - honey, that's just the way of it. My PCP is the most amazing, sweetheart, proactive, advocate in every sense of the word. When I was researching WLS she was 1000% behind me and researching with me along the way. Even though she's a grand 95 pounds dripping wet - she was as convinced that WLS was the ONLY answer for me as I was. However, she does not live my surgery - I do - so it is MY responsibility to remain informed, continue my research, and stay proactive about the stuff that needs done to make sure that I continue to be as healthy as can be.

So - sorry I'm so long winded. Bottom line is this: you DO need to supplement B Vitamins. You don't necessarily need B-12 injections (unless, you, as a unique individual started out deficient in that area to start with - some folks do!), unless of course your B Vites tank on your labs at some future point in time. I highly recommend you take two super B complex (I use NatureMade - I can get them at Costco easily and inexpensively) daily. Don't take them in close conjunction with your iron. And of course - my theme song once again: DRINK LOTS OF WATER!

3.5 Years Post-Op

2006-01-18T12:28:00.000-08:00

Wednesday, January 18, 2006: I remember being a pre-op - oh, proably about five years ago, and reading all of the profiles on ObesityHelp and thinking, "Gosh, to be a post-op! I can't imagine being a whole year post-op! What would it be like to be two years post-op? Or three?" So here I find myself at 3.5 years post-op. Kinda an old lady in some circles! LOL! :)

So what do I think now that I've lived with this surgery (BPD/DS) for 3.5 years now? I think I love it. I think I'm happier each day that God made a way for me to be able to have surgery. I think, "How could I have possibly been so fortunate?"

I have so much to be thankful for! In some ways, I'm even more thankful for my husband's switch - what a huge relief to see the many co-morbidities that he struggled with GONE! The excess weight GONE! So much stress a thing of the past for him! What a gift from God!

There are changes happening in our world. We're getting ready to move. I'm looking for a job. We're moving one portion of the extended family to a new location - almost simultaneous to our own move. And you know what? Yeah, it's kind of a pain because it's so physically demanding (all of it!) but there's no dread (like there used to be)!

I remember thinking as a pre-op how thankful I was for the job that I had at that time (working from home) because I knew that if I lost that job that no one in their right mind would have hired me. Yeah, I could do the job - but I was a 365 pound woman with a boatload of co-morbidities, in a wheelchair, constantly in and out of the doctor's office, struggling to just survive! Today, when I go into an interview, I know they are judging me on a completely different level - they don't even know that 210 pounds ago I was wondering if I'd be alive another year!

Wow - it's been an incredible journey thus far. I continue to be just amazed at the great things God has done for me!

Blood/Plasma Donation

2006-01-13T00:26:00.000-08:00

This from Dr. Baltasar this morning:

On the blood donation issue and reasons for not giving blood:

DS patients need Iron forever! Iron is used to build up red blood cells. Many patients (mostly females) get anaemia.
DS patients should not give any plasma. Plasma is mostly made out pf proteins. DS patients may have trouble in getting enough absorption of their own proteins. The situation for a DS post-op is PCM (Protein Caloric Malnutrition)
NO PATIENT WITH DS SHOUD BE ALLOW TO GIVE ANY DONATED BLOOD

So… that’s the scoop! It really does make sense, and the folks that I know who have given blood (as post-ops across the board – not just Baltasar post-ops) have had big issues trying to recover from doing so. It not only wipes them out physically for a couple of weeks, it also wacks their labs out.

Hope that helps explain some.

Blessings,

dina

2005-07-05T12:23:00.000-07:00

Tuesday, July 5th, 2005: Can it really be true that a whole year has passed since I last updated here? How did the year go so quickly? Does time speed up somehow? Wow!

So... Amazing - three years now since my DS with Dr. Baltasar. I have maintained my 210 lb weight loss. My life has seemingly gotten busier - okay - well, honestly, it has. LOL! So many more things get packed into my day because they can be. I don't have to worry about diabetes or any of the other many co-morbidities I once juggled, or scheduling taking the many prescriptions I was on previously, or dealing with a wheelchair, or making it to frequent doctor's appointments, or struggling to simply breathe and move. I walk effortlessly, I am healthy, I volunteer in my son's classroom at school, I volunteer at church, I live my life to the full, I love my life.

I've even - gasp! - taken up exercising in the past month or so. Funny how beneficial it's proven to be to my back pain issues! (While I've lost the many co-morbidities, I still have degenerative joint disease in my back, and bilateral grade 4 degeneration of my knees.) My husband, children, and my Mom and I all go to the high school track and walk each evening after dinner - a mile or two - and enjoy talking to one another while we walk. I'm amazed at how much it has helped my back pain.

As far as supplements go - I'm actually getting better about taking all of them every day. Amazing how consistency helps with that! My labs are good - going for my 3 year lab draw day after tomorrow, but I am encouraged with the fact that everything has been trending in the right direction the last couple of rounds of labs.

Food continues to be great fun! I'm not ashamed to say I love it! I love to cook. I love to experiment. I even love to eat. I know - shhhh! - those of us who are or have been MO are not supposed to admit that, but sorry, it's true - so I must. My real guidelines are these:

1. Avoid artificial sweeteners like the plague.
2. Avoid anything low fat or low carb.
3. Avoid chemicals and dyes.
4. Avoid processed foods.
5. Use fresh, whole foods.
6. Eat small meals throughout the day, with a focus on protein, fiber, and adequate fat.
7. Pay attention - and don't overeat! - it hurts!

I love the farmer's market, and New Season's Market (gotta love their meat department!), and I love growing lots of my own veggies. We've taken up going out to the local u-pick farms and picking fresh fruits and veggies and canning our own, even. It's been great fun!

I love it that my children are learning that food isn't the enemy. I love that they are being given the opportunity to learn to love stuff that's good for them, and to learn that moderation is an okay thing.

The overeating thing was a recent realization that I was consistently trying to eat too much when sitting down to the table. I don't know when it started, but it finally dawned on me a couple of months ago that I felt so much better if I didn't push it so much with food. It's a strange thing giving up that one last bite - it's a little bit of an emotional tug of war that goes on. BUT - I just feel so much better when I don't overfill my poor little tummy! It is so worth it to slow down again, to take my time eating, and to pay attention to the fact that I'm getting full, and that I don't have to clean my plate, and that I can be emotionally satisifed with a smaller portion consumed - in fact, more than satisfied! I haven't changed WHAT I eat at all, just HOW MUCH of what I eat at a sitting. Little things that have helped me to keep perspective have been things like cutting sandwiches and burgers in half, ordering smaller sized items as opposed to larger - and being okay with not being able to finish something off!, and paying less attention to the speed that other people at the table are consuming their food - it's not a race! It's okay if I'm slow! It's okay if I can't eat as much as they can! I CAN - and DO - enjoy every bite. I don't have to deny myself anything, so there's no sorrow or deprivation involved. Funny how the brain can subtly lull you into not paying attention to the details!

It's been a GREAT year watching my husband shrink, I've got to say. He had his DS with Dr. Baltasar 2 years to the day and time after I had mine. He's lost 93 pounds, diabetes, hypertension, high cholesterol, high triglycerides, etc., etc. He's gone from 3X and 4X sized clothing to XL. He's shaved his bushy beard and got a very cute goatee now - looks awesome on him! He wears a smile a lot more nowadays, too... It was amazing what a huge and dramatic change there was as soon as the diabetes was gone - his stress level seemingly just vanished. I was blown away at how much that affected him that way!

Being a DS couple has been fun date-wise, too. We get to go to restaurants that are maybe a little more expensive, and enjoy funner food - splitting a meal between us is more than enough. We've enjoyed several weekends away - where we can walk, and see the sights, etc... Of course, those are not the only benefits! :) LOL!

So - here I am, 3 years later. Would I do it again? In a heartbeat! Am I still thrilled with Dr. Baltasar as my surgeon? More thrilled than I could have dreamed possible - he continues to be a wonderful friend, and caring participant in my life. Anything I would change? Can't think of a single thing - except maybe have done it sooner.

So that's my recap in a nut shell. I'll try and do better with more frequent updates this year. If you want to chat, let me know - I'd love to email! And if you want to see our web site, check out www.bodybybaltasar.com

Blessings,

dina

2 Year Reflections

2004-07-20T12:15:00.000-07:00

Tuesday, July 20, 2004: Where did the last 2 years go? And actually a little more than 2 years now - my anniversary was July 2nd. I find it nearly completely impossible to believe that 2 years have passed since I had my surgery.

Two years ago I weighed 365 lbs at 5 foot 3 inches tall, with a BMI of 64. I was in a wheelchair. I had out of control diabetes, stroke level hypertension, severe obstructive sleep apnea, horrible GERD, stress incontinence, and was experiencing thse horrible chest pains and shooting pains to the arm. I remember my PCP sitting me down and saying, "Don't die on me yet - you're so close to hope!" She gave me a little tutorial on how to recognize a heart attack and seek emergency help. She was very concerned I wouldn't live until surgery.

A lot of people talk about their road to WLS - all of the pre-op tests, the support group meetings, and the like. For me it was an entirely different kind of journey. I was a self-pay patient. Starting out I didn't have dime one to go toward my surgical costs. At first I looked into surgeons based on the bargain shopping method. How dumb is that? It was my LIFE that was hanging in the balance. My medical team all insisted I needed to be under anesthesia for less than 2 hours - my orthopedic surgeon wouldn't even do my two knee surgeries in the months preceding my DS with general anesthesia - it was pretty trippy being alert during those two surgeries! So I started searching for a surgeon who was not only good - but who was great. Over and over again I ran into post-ops of a surgeon who by all accounts was kind, compassionate, caring, and committed to the morbidly obese getting more than a chance at hope. So, I contacted Dr. Baltasar - by email - and was floored when I had a response from him in less than 24 hours. Wow! And an actual email from the surgeon - how trippy was that? (I work in health care, not something I see in my day-to-day life!) He was kind, courteous, and happy to answer my long list of questions. He told me he believed I needed surgery soon. I couldn't agree more, but we had no money. So, we prayed.

On April 22, 2002 someone anonymously donated $15,000 into my surgery account at my bank. Still don't know who it was, I'm pretty sure it was someone from church. But wow - what an amazing selfless gift. So, I got a date, and got stuff in order. I was going to for surgery.

So when you talk about WLS journey - I had not only a figurative one, I also had a literal journey. A journey - as a super super morbidly obese wheelchair-bound woman from Portland, Oregon to Alcoy,Spain. No, fitting into economy seats in a crowded airplane wasn't easy. No, getting around cobbled streets in Madrid wasn't a joy ride. BUT - it was a part of the journey I wouldn't trade for anything. Oh - the memories I have of my first trip to Spain!

I remember checking into the Clinica. I remember meeting Dr. Baltasar for the first time face to face and realizing that for the first time in my life I was meeting a doctor who was thin - but GOT IT about what it was like to be SSMO, and living the pain, and agony that I lived with each day - and that he just plain old cared about me. It was something like meeting an old family friend - someone whom you deeply respect and care very much about how they think of you. I saw in his eyes an immediate acceptance of me, and a comprehension of the pain I was living in. What an amazing thing! And I remember the sweet nurses! The day of my surgery they lined up and kissed me on the cheek and wished me well, and two even serenaded me. I remember sitting on the balcony in the warm Spanish sunshine. I remember the beautiful hillside that I could see in the distance from my Clinica room. I remember climbing up onto the surgical table in the OR and having Dr. Baltasar there, and that he stroked my forehead and sang me a Spanish lullaby, prayed for me, and promised to take care of me just as if I were one of his daughters.

I think one of the things that amazed me the most was the fact that compared to my c-section 5 years earlier, my open BPD/DS was a total walk in the park. I only needed one shot of morphine after surgery - and that was it for pain meds. I was on pain medication for 8 weeks after my c-section. After surgery, on days 2, 3, and 4 my blood sugars spiked up into the 600s and 700s and I was on insulin for the first time in my life. I was amazed that I could actually walk the halls a bit - even though before surgery I could only stand for about 30 seconds at a time. I was discharged from the Clinica on day 6 - I could have left on day 5, but my husband came down with a bad virus on day 4, and Dr. B wouldn't release me until John was well.

We spent the week after leaving the Clinica in a lovely little town on the Costa Blanca called Villajoyosa. The houses that face the ocean are painted different brilliant jewel tone colors so that the fishermen know how to find home again from the sea. It was beautiful, restful, a perfect place to recooperate. One week out from surgery I walked 1/8th of a mile from our apartment down to the boardwalk along the beach. I hadn't walked that long in years. The next night I did it again - my motivation (besides just the fact that I COULD) was that I could get some of that wonderful Spanish ice cream at the little heladeria on the corner - deeply appreciated on those 90 plus degree days! Every night I walked down to the boardwalk. It was amazing.

I thought - maybe - if I lost my weight, within a year I might be able to lose the wheelchair. You should have seen the happy dance I was doing at 6 weeks post-op when I sent that thing back to the medical supply company. Just a couple of weeks later I gave up my cane.

I remember the absolute amazement and wonder that I felt at every doctor's appoitment - seeing the number on the scale a smaller number than the visit before.

Two years ago I had no way of knowing that two years from that day I'd be back in Spain - on my fourth trip to Spain, actually - sitting in my husband's hospital room - waiting for him to walk to surgery. He had his DS two years EXACTLY (same date, same time) from the time I had mine.

Two years ago I had no way of knowing that my life would have been completely renewed. I hoped for an end to diabetes. I had no way of comprehending that it would be gone by the time I left the clinica. I hoped for an end to hypertension - today, it's a thing of the past. I longed for a life not filled with chronic pain - today I am surprised when I experience pain after a day of long, intense labor.

A couple of weeks ago, when I was in Spain with my husband for his surgery I walked about 8 miles. There's a joke those of us who have been to Spain for surgery laugh about - ask a Spainard if a destination is within walking distance, and pretty much they will always say, "Oh yes, it's within walking distance." I can walk and keep up with the Spainards! I would never have believed that.

Two years ago I had no way of comprehending what it would be like to weigh 210 pounds less than I weighed then. I had no way to fathom the challenges associated with being a "normal" sized person after being heavy my whole life. Like - the absolute wonder I still feel when I hold up my size 12 shorts that are too baggy for me and wondering, "How do I fit my butt in those?!" How can I possibly wear clothing THAT small? Or, feelings of wonder that still pass through my mind when I pass through a space that would previously have been impossible for my 365 pound body to fit through. And the slight holding of breath that I still go through when I sit in a booth at a restaurant, momentarily wondering, "Will I fit?" and then remembering, "Oh yes, not only do I fit, but I can sit here with lots of extra room."

My life is so rich. I am so blessed. I'm floored by God's goodness and generosity to me. I'm so thankful that my husband is now post-op DS, too - and that his health is steadily improving! The gift of this surgery keeps me with a constant, breathless anticipation of the next wonderful surprise around the corner. What an amazing thing that these two years have gone by in just the blink of an eye!

Weighty discoveries about fat show how obesity kills

2004-05-11T20:21:00.000-07:00

May 11, 2004
- By DANIEL Q. HANEY

Research into the biology of fat is turning up some surprising new insights about how obesity kills. The weight of the evidence: It's the toxic mischief of the flesh itself.

Experts have realized for decades that large people die young, and the explanation long seemed obvious. Carrying around all those extra pounds must put a deadly strain on the heart and other organs.

Obvious but wrong, it turns out. While the physical burden contributes to arthritis and sleep apnea, among other things, it is a minor hazard compared to the complex and insidious damage wrought by the oily, yellowish globs of fat that cover human bodies like never before.

A series of recent discoveries suggests that all fat-storage cells churn out a stew of hormones and other chemical messengers that fine-tune the body's energy balance. But when spewed in vast amounts by cells swollen to capacity with fat, they assault many organs in ways that are bad for health.

The exact details are still being worked out, but scientists say there is no doubt this flux of biological crosstalk hastens death from heart disease, strokes, diabetes and cancer, diseases that are especially common among the obese.

"When we look at fat tissue now, we see it's not just a passive depot of fat," says Dr. Rudolph Leibel of Columbia University. "It's an active manufacturer of signals to other parts of the body."
The first real inkling that fat is more than just inert blubber was the discovery 10 years ago of the substance leptin. Scientists were amazed to find that this static-looking flesh helps maintain itself by producing a chemical that regulates appetite.

Roughly 25 different signaling compounds - with names like resistin and adiponectin - are now known to be made by fat cells, Leibel estimates, and many more undoubtedly will be found.

"There is an explosion of information about just what it is and what it does," Dr. Allen Spiegel, director of the National Institute of Diabetes and Digestive and Kidney Diseases, says of fat. "It is a tremendously dynamic organ."

Fat tissue is now recognized to be the body's biggest endocrine organ, and its sheer volume is impressive even in normal-size people.

A trim woman is typically 30 percent fat, a man 15 percent. That is enough fuel to keep someone alive without eating for three months.

The fat cell's main job is to store our excess calories as fat. When people grow obese, their fat cells swell with fat and can plump up to three times normal size. As very overweight people get fatter still, they may also layer on many more fat cells.

The problem is the volume of chemicals these oversize cells churn out, says Dr. George Bray of Louisiana State University.

"The big cell secretes more of everything that it secreted when it was small. When you get more of these things, they are not good for you."

Many scientists are trying to learn exactly what these excess secretions do that is so harmful. The answers will help explain - and perhaps offer solutions to - the real tragedy of the obesity epidemic, its disastrous effect on health.

Obesity is a huge and growing killer, in the United States just slightly behind smoking. Moderately obese people live two to five years less than normal-size folks. For the severely obese, the reduction in life span may be five to 10 years.

By far the biggest single threat of obesity is heart disease. Someone with a body mass index over 30 has triple the usual risk. Scientists can visualize many ways that fat cells' chemical flood contributes to heart attacks, heart failure and cardiac arrest.

For instance, it has long been known that weight increases blood pressure. Once doctors thought this was a matter of physics, the force needed to push blood through the many more yards of blood vessels that nourish the extra flesh.

But now it is clear that fat can trigger high blood pressure by making blood vessels narrow in several chemical ways.

For instance, it produces a substance called angiotensinogen that is a powerful constrictor. At the same time, it stimulates the sympathetic nerves to squeeze the circulatory system. And that may just be the beginning.

"It's a very complicated system, and the more we learn about it, the more complicated it becomes," says Dr. Xavier Pi-Sunyer, head of obesity research at St. Luke's Roosevelt Hospital Center in New York City.

One of the clearest hazards of overfilled fat cells is their influence on the body's production and use of insulin, the hormone that instructs the muscle to burn energy and the fat cells to store it.
Oversize fat cells blunt the insulin message, in part by leaking fat into the bloodstream. So the liver must compensate by making more insulin and other proteins.

Scientists now understand that increasing insulin levels - part of a condition called insulin resistance - are particularly harmful. They can directly damage the walls of arteries and lead to clogging.

That leaking fat may also infiltrate the heart muscle, contributing to congestive heart failure. Misplaced deposits of fat can also ruin the liver and have become the second-leading reason for liver transplants after hepatitis B.

Fat cells churn out a variety of proteins that cause inflammation, too. These may be especially destructive to the gunky buildups in the arteries, causing them to burst and triggering heart attacks and strokes.

These inflammatory proteins and other fat-driven chemicals, such as growth hormones, may also contribute to one of the less appreciated consequences of obesity - cancer.

"There is now conclusive evidence that obesity causes some cancers and strong evidence that it contributes to a wide variety of others," says Dr. Michael Thun, epidemiology chief at the American Cancer Society.

The cancer society estimates that staying trim could eliminate 90,000 U.S. cancer deaths a year. Among the varieties most clearly linked to weight are cancer of the breast, uterus, colon, kidney, esophagus, pancreas and gallbladder.

The best evidence of how obesity causes malignancy is in breast cancer in older women. When the ovaries shut down after menopause, fat tissue becomes the primary producer of estrogen, which in turn can fuel the growth of breast tumors.

The heavier women are when diagnosed with breast cancer, the more likely they are to die from the disease, says Dr. Michelle Holmes of Boston's Brigham and Women's Hospital. "Presumably it's because their cancers are dependent on estrogen, and heavier women have more estrogen."

Still, big ticket killers like heart disease and cancer only start the long list of obesity's health ills. Among other things, obese people are more prone to depression, gallstones, even dying when in car accidents.

Says Dr. Michael Jensen of the Mayo Clinic, "There are so many ways that obesity can kill you."

(Copyright 2004 by The Associated Press. All Rights Reserved.)

20 Months Post-Op

2004-03-05T12:14:00.000-08:00

Friday, March 5, 2004: Somewhere over the last two weeks I magically, all of a sudden happened into a zone that I wasn't sure I thought possible for me. I lost 15 more pounds, meaning - I've now officially lost 200 pounds since the day of my surgery. It's rather surreal. It's quite fun. It's really very mind blowing. I have a BMI of lower than 30 - I started at a BMI of 64. Wow.

I gotta tell you - I love my DS. Never in my wildest dreams did I have any sort of an inkling that post-op life could be this fun, liberating, and downright livable. The quality of life that I enjoy now I never dreamed of enjoying prior to surgery. What a gift!

16 Months Post-Op

2003-11-15T12:10:00.000-08:00

Saturday, November 15, 2003: Today we went shopping… Had to get my kids a few things, so we went to the outlets. Went into the Gap outlet with my kids. Found few things, and as I was getting stuff together to head toward the dressing room with my son, I spotted a pretty cute skirt that I could really use! (I don’t really have any of my own “church” type clothes – I’ve been borrowing my Mom’s stuff – all of which is VERY long – like to my ankle length – and well, kinda frumpy.) So, I saw this cute wool blend slightly longer than knee length skirt, and thought – I should try it on. It’s a size 14, and it’s on sale for $12. So I grabbed it, and went off to the dressing room.

Got William through his try on stuff, and when he was done, I tried the skirt on. It’s a wrap around skirt – really pretty cute! But, it seemed a little large in the waist, but I figured I’d wear it with a sweater, and it would cover it up. I have such a hard time knowing if something fits APPROPRIATELY, you know? And John was holding the fort away from the dressing rooms, so I just decided I’d get it, and that would be that.

Well, we were out getting ready to head for the checkout line, and I spotted some more of the cute skirt – in some different colors, and I said – “Gee, I wonder if I should get another one, in another color.” John encouraged me to, so I went over, but all I could find was a size 12 in the right color. I looked at John and said, “Well, the 14 was a little roomy. Maybe I should try it on.” He agreed. We glanced over at the dressing room line – 14 miles long – and I said, “Maybe I should try it on here!”

So – there in the middle of the Gap outlet, over my pants and shirt, I tried on the size 12 skirt.

IT FIT.

I own a size 12 skirt now. ME. I’m not entirely sure that’s allowed. I think I was in the 4th grade the last time I wore a size 12. I’m sure there must be some mistake. How could I possibly wear a size 12?

Sorry – I’m still a little dumbfounded. Wow.

Off to stare at my size 12 skirt again…

Portland Area Baltasar Support Group Meeting

2003-10-18T00:03:00.000-07:00

Saturday, October 18, 2003: It’s finally going to happen! There will now be a regular Baltasar post-op meeting for the Portland, OR area! It will take place the 2nd Saturday of each month at 10:30 a.m. at Cedar Mill Bible Church in Portland . All for anyone who is interested in the option of going to Dr. B for their surgery, those who are pre-op, those who are post-op, and of course, their support people.

Location:

Cedar Mill Bible Church
12208 NW Cornell Road
Portland, OR 97229

www.cmbc.org

Meeting on the 2nd floor – there is an elevator – in room P201. There will be signs pointing the way.It’s best to park in the rear of the building – there is close by handicap parking for those who need it.If you have any questions, let me know! Feel free to email me! dinacmcb@comcast.net

The BBB is Live!

2003-07-24T00:02:00.000-07:00

July 24, 2003: Well, we've finally done it. We've (several post-ops) gotten together the beginnings of a web page for people interested in going to Spain to have surgery with Dr. Baltasar. It's still in the works - but if you want to peek, you can find it at www.bodybybaltasar.com - I hope it is helpful to people!I'll update more later.

Please feel free to email if you have questions! dinacmcb@comcast.net

1 Year Post-Op

2003-07-03T23:57:00.000-07:00

July 2, 2003 - 1 Year post-op Photos

July 10, 2003: Wow - I'm a year post-op now - a year and 8 days, actually. Time has flown like crazy! Below is the update I sent out to friends on July 2nd:

One year ago today, I was 38 years old – with very little hope of seeing much, if any, of 39. If you’ve known me any length of time at all, you’re probably tired of hearing it – I’m sorry – but I’ve got to say it again. It still blows me away. It still amazes me. It still brings tears to my eyes when I think about the amazing things that have happened in the last year of my life.

One year ago today I was more than ill – I was dying. I weighed 365 lbs at 5 foot 3.75 inches tall – with a BMI of 64. The co-morbidities that I struggled with daily: out of control diabetes, stroke level hypertension, incredibly debilitating sleep apnea, daily acid reflux, I was in a wheelchair, I was in horrible pain around the clock.

Today…Today is a great day. In fact, it’s an awesome day. Not just because it’s my 1 year anniversary. But just because life is so good.

Today I’m 39 years old. I’m going to be 40 this year – I look forward to it – and I have every hope of not only seeing it – but also enjoying it and each year that follows!

Today I weigh 188 lbs at 5 foot 3.75 inches tall – with a BMI of 33.3I don’t have diabetes, or sleep apnea, or acid reflux any more. No more wheelchair or chronic pain. Yes, a little teensy bit of hypertension – which is very well managed with 1 med daily.A year ago for breakfast I had the famed Spanish toast with butter and a glass of that lovely fresh squeezed orange juice.

Today for breakfast I had a turkey sandwich and a Twix bar – to be honest, the Twix bar was the funner part of the meal.A year ago I didn’t quite understand or believe that the DS – or anything – could work for me. I didn’t believe that I was not having my last meal of my favorite foods – most of which were absolute taboo.

Today the best way I can say it is like this: food is fun! I just love it! It’s the first time in my life that I’ve felt this incredible freedom to just enjoy eating.

A year ago I would never have believed that I’d weigh 177 lbs less than I did at that moment.

A year ago I would never have believed that I’d be able to run up and down a flight of stairs – like 50 times a day!

A year ago I would never have believed that I’d be able to out walk my kids.

A year ago I would never have believed that I’d sleep every night – all night long – totally uninterrupted.

A year ago I would never have believed that I’d be planning a weeklong camping trip at the beach…

What’s my life like today compared to a year ago?

Rich…
Blessed…
Fun…

I often wonder – “Why have You counted me worthy to be so blessed, God? I’ve done nothing to deserve it!” (Much like the Grace He’s fully and freely given!) Yet, He still continues to bless.

I’ve got the world’s coolest husband – he’s my best friend, the first person I think of to share a laugh with, an incredible lover, and the kindred of my soul.

I’ve got two pretty cool kids, too. They’re fun, intelligent, a total riot to watch in action and be with. No options for a boring life with them around!

And God has freely given me forgiveness, blessed me abundantly with grace, mercy, and richer than anything else – His closeness.

How could I not stop and write a long sappy post about my 1-year anniversary with all of that to be thankful for?

11 Months Post-Op

2003-06-03T23:53:00.000-07:00

Tuesday, June 3rd, 2003: Two weeks ago today I was just heading into surgery - for my hernia repair/abdominoplasty. It was kind of trippy when I was getting admitted. The nurse who admitted me saw my discharge report from that Dr. Baltasar gives all of his post-ops - and it includes a picture of you either the day of or just after surgery. Mine is 4 days post-op.

She looked at it and said, "Who is this woman?"

I said, "It's me!"

She looked at it, she looked at me and said, "No. Really - who is that woman?"

It took a while to convince her. She was totally blown away that that could be me - just 10.5 months earlier.

My surgery went well. It lasted 2 hours 41 minutes. They did the ventral hernia repair, put in mesh side to side and top to bottom, and the abdominoplasty - cutting off 8 lbs of flab and skin. I was in the hospital until Friday the 23rd. I was able to walk a mile by the next day, Saturday. The most uncomfortable part were the JP drains that got pulled the following Wednesday, along with about half of the 80 staples. Yesterday the balance of the staples came out.

It's amazing how light I feel! I am really bad at posting pictures, but I'm happy to post the link to my photo page - feel free to go over there and take a gander - www.bodybybaltasar.com - go to the Photos page, and look for my name.

10 Months Post-Op

2003-05-02T23:52:00.000-07:00

Friday, May 2, 2003: 10 months ago today I had my BPD/DS.

Today I weigh 153 pounds less than I did that day.

Today I am so healthy - it blows my mind.

Today I can go out and walk a mile or two, if the fancy strikes.

Today I can enjoying eating whatever sounds good to me - and not worry about how it affects my body.

My weight is coming off. I don't have to worry about regaining it. In fact, I only have 82 more pounds to lose to be at goal. How amazing! I know I'll make it there, without a doubt!

Next hurdle: hernia repair/abdominoplasty scheduled for May 20th. Now that will be a trip! Still trying to figure out just exactly what "flat tummy" means.

8.5 Months Post-Op

2003-03-21T23:45:00.000-08:00

Well, it's been a while since I recorded my progress, and I thought I should update my status.

Today is Friday, March 21st, 2003. I am 8.5 months post-op. I've lost 135 lbs. My starting BMI was 64, today it's 40.7 - that's totally amazing to me!

I am in the process of arranging for a hernia repair (from my emergency c-section 6 years ago) and abdominoplasty. I still have another 100 lbs to lose, so I had no idea that it might be happening this soon. A little scared - but also thankful for the insurance coverage! God has this amazing way of working this out. Lots to be thankful for!

I need to take photos - I've been really bad about that! So, I promise that when I get some done next, I'll head right over here to post them, okay?If you have questions - please feel free to email me! dinacmcb@comcast.com

Meeting Susan

2003-03-05T11:04:00.000-08:00

It was in January when I first met and started talking to Susan. She was a pre-op - interested in knowing what it was like for me to have my surgery with Dr. Baltasar in Spain. Her story was interesting - she'd had a VBG (vertical banded gastroplasty) and Nissen fundoplication done years before - in Texas. She quipped that she'd lost some weight - stayed at her low weight for about 10 minutes, and then the weight came back. Needless to say - she was not pleased.

Over the course of some weeks I learned that she was an amazing woman - she was active in the foster care system, and had several special-needs children. She was determined to have a conversion from her failed VBG to BPD/DS and wanted a surgeon with a proven track record.

After some conversations I laughingly joked, "Have Passport - will travel!" to her because she was trying to figure out how to work out the whole trip to Spain thing, wanted a support person to go with her, but her husband had to stay home with their children - who truly had to have a parent on point at all times. Not much time passed - like minutes - before I had a private email from her asking if she could telephone me. I said sure and gave her my phone number.

Our conversation was to the point, she said she thought I might be an answer to her prayers, and asked if I'd ever consider going back to Spain as a support person for someone else. She told me to think about it, pray about it, talk to my husband about it, and let her know. Soon. Cause she had to make her plans.

As it turned out - John and I agreed that it would be an okay thing for me to go back, I was able to arrange the absence with my work, and we figured out the logistics with the kids. About three weeks prior to our scheduled departure date, I told Susan, "Yes, I'll come to Spain with you as your support person."

She traveled from Texas - a day ahead of me as it turned out because my schedule required a little bit later departure - and the plan was for us to meet in Alcoy - the day of her surgery - right before she would head into the OR. Ah... the best laid plans...

If you've ever flown as a morbidly obese person - you know it's no joy ride. First - getting on and off the plane is not easy - we just don't fit down the aisles. Of course, we don't really fit in the seats, either - but there are ways to make it, well, I suppose you could call it bearable. Miserable is the word that pops to mind first when I think of the flights that I made as a super, super, super morbidly obese woman. You know what? Being in a wheelchair did make it a little bit easier - at least then you can pre-board and not have to try and make it down a packed plane to your seat, then then have to maybe have at least one someone get out of the way so you can get to your own seat. It's humiliating.

Then there's the whole seatbelt thing... They just don't fit. It would be nice if they did - but they don't. So you have to either try and hide the fact that the seat belt doesn't fit you (not a good plan) or ask the flight attendant for an extender. There are different types of flight attendant personalities, of course. I love the ones who have a sweet, gracious, merciful spirit - you know, the ones who very discreetly find you an extender and then unobtrusively hand it over at the appropriate juncture. Then there are the kind who yell from their section to the attendant in the other section, "Hey - do you have a seat belt extender up there? This lady needs one!" then when said extender shows up, loudly proclaims, "Oh - okay - here's your seat belt extender." Almost like they're going to great pains to share your humiliation with the ENTIRE plane load of people just to make sure you're not all alone - or something. Right.

Then comes beverage service, snacks, and meals... You may as well lump them all together because they're all one big humiliating, frustrating, difficult experience. Particularly if you're traveling alone and there's a stranger in the seat next to you. Because - if you've ever been there you know this - the tray table simply does not fit if you are morbidly obese. It can't go down all the way - so there's no place to put your drink, or your little baggie of pretzels, or your meal - it's simply not worth the effort to take the table down, because you know it won't fit. The law of physics simply dictate that. Again - flight attendant personality does come into play a bit here - there are those who discreetly work something out to work for you - like maybe moving the stranger in the seat sitting next to you to a different location. (Which, honestly - face it - most people are willing to move. It's not easy sitting next to someone who is a BMI of 64!) Or, there's the flight attendant who acts like they've never had a morbidly obese individual on the plane ever in their 24 years of career as a flight attendant and heavens! what are they going to do to handle this conundrum! Yeah - you get the picture.

And of course, the ever present humiliation that at some point in time the reality of things is that you may eventually need to pee - or heaven forbid - poop during the course of your flight. Just getting out of your seat is a major thing - usually involving at least one seat mate having to clear the way for you. The obvious distress of having to move down an aisle that was not designed to accommodate a person of your size, and then the desperate hope that you'll actually (a) fit through the folding door to the toilet and (b) be able to reach to wipe your bottom once actually in the latrine.

So in case you missed it - to sum up - flying as a morbidly obese person SUCKS.

There were some emotions of not knowing what to expect when I flew from Portland to Newark that day in February - on my way to meet Susan in Alcoy. Would I need a seat belt extender still? I was 125 pounds lighter than my first trip to Spain - but I was by no stretch of the imagination thin. Just thinner. Would the tray table fit? What would it be like to board with everyone else? Would I fit down a crowded aisle?

Ever have one of those moments in life when you wish someone had a video camera on you (without you really being cognizant of it at that moment, of course) as you do something? Well, this was one of those moments! I don't think I'll ever forget those inagural moments...

Walking down a crowded airplane aisle - and fitting...

Sitting in my economy class seat - fitting comfortably - and then buckling my seat belt - sans extender! - and - gasp! - tightening it!

Looking around furitively and putting the tray table down - and nearly choking up with emotion because it fit - ALL THE WAY - with room to spare... and then putting it up, and then putting it down.... over and over again.

Realizing that getting up to walk to the toilet was no big deal, not was fitting through the door, not taking care of any other kind of business related to toileting.

And sitting back and realizing that I could relax and just smiling - cause I was flying, and I actually was enjoying it.

As it turned out there had been a record snowfall recently in Newark, and after a number of delays getting out of Newark headed for Madrid, we finally made it off of the ground. The delays were substantial enough, however, that I missed my connecting flight in Madrid for Alicante - darn it! I was able to find an English-speaker to help me arrange the new flight and call Pepe (the taxi driver who was scheduled to meet my plane in Alicante), and determine which gate I was to report to for my new connecting flight.

I've got to admit... For a girl who had been wheelchair bound and 365 pounds not that long ago - traveling internationally - by myself - was pretty heady stuff! Being mobile on my own two feet, at 125 pounds less of me than there'd been on my previous trip was not a bad thing at all! And, I'll admit - I'd worried a bit - being that I didn't speak Spanish - that I'd get myself into a situation that I couldn't get myself out of, but that was not the case at all.

So I'm sitting at my gate in the Madrid airport, waiting... I keep an eye on the clock and think, "Hm... you'd think people would start showing up to board this flight to Alicante, I mean, it's supposed to leave in 30 minutes!" But I was the only one there. Of course, there were announcements being made overhead all of the time - in Spanish - but I had no clue as to what they were saying! Five more minutes went by and I decided I'd better find someone who could help me figure out if I was at the right gate, afterall.

Of course - there had been a gate change - to a gate literally at the other end of the terminal. It was already boarding, and I would need to RUN the whole way to make the plane.

So I did.

Okay - so that might not mean anything to anyone else. But HELLO - *I* ran the entire length of the terminal to catch a plane! ME! The girl who had spent a couple of years in a wheelchair! Wow!

So - made the plane - they actually held it for me. Don't you love that feeling when you're the last person on the plane and they're boarding through the front door and you get on and every eye on the plane turns and stares you down when you get on?! LOL! Yeah, not.

Pepe had been kind enough to find Manolo to meet me at the airport - my bag had actually made the first flight - so we rounded that up, headed for the car and raced for Alcoy - where Susan should be heading into surgery in moments.

I should interject here that when I did my research into what to pack for this trip I'd done a bit of digging to ascertain what the weather would be like. I'd just lost a lot of weight - and while that's wonderful, it can mean that your clothing resources can be - shall we say limited? Everything that I could find indicated that the weather was going to be mild - it was, afterall, the time of year when the almond trees would be in bloom, the Valencias would be harvested, and flowers should be abundant. I packed accordingly. And I chose an outfit that included some mule-type slide on sandals for the trip. Comfy, practical, goes with lots of stuff.

Did I mention up there about meeting Manolo in Alicante that there was snow on the ground? By the time we got to Alcoy it became quite clear that this was NOT going to be mild weather!

(See the snow in them thar hills?)

When I arrived at the Clinica (that's what we call it - the real name is Sanatorio San Jorge - it's a small private hospital) I was quickly greeted by Dr. Baltasar - who had a warm hug and welcome for me. He said,

"There's been a change of plans. We had the opportunity to move Susan's surgery up a bit. She actually went into surgery at noon today. Her surgery went well - excellently, in fact. She's out of recovery, back in her room resting. Audrey, Perry, and Sarah are keeping an eye on her until you got here."

Wow!

So the first time I met Susan, she was pretty out of it. But the first thing she asked me was, "Was he able to do a true DS? The whole thing?" You'd have to know Susan to know how hilarious that is. And I was able to respond, "Yes, and your surgery went beautifully." To which she said, "I'm so glad you're here... I think I'm going to sleep now." And she did.

The First Six Months

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August 5, 2002 - A little more than a month post-op and down 34 pounds. Holding my little cousin.

Labor Day, 2002 - Two months post-op - down 65 pounds. John and I toured model homes this day - and I went up several flights of stairs! AMAZING!

September 14, 2002 - about 2 1/2 months post-op. Officially done with the wheelchair for good! Woo Hoo!

Here's what the scar from my open surgrey looked like at 2.5 months post-op.

October 13, 2002 - 3 months post-op and down 80 pounds. I cooked, cleaned, arranged, transported people, things, and multi-tasked galore. Yes, I hurt like crazy at the end of it all, but HEY - I did it! WOW!

At my Grandma's surprise 90th Birthday party.

At Multnomah Falls - free of wheelchair and canes at 3 months post-op.

October 19, 2002 - Out to lunch with some post-op friends from the various WLS support groups in town.

November 15, 2002 - out to lunch with a bunch of WLS pals.

November 24, 2002 - This is at the very first Portland Area Baltasar Get Together! We had a great time gathering together at The Chart House in Portland. There were 24 of us - and we had a truly wonderful time.

December 4, 2002 - 6 months post-op and down 105 pounds.

December 20, 2002 - Sharing lunch with former work friends.

Pictures of My Trip to Spain

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This is the view out our hotel balcony in Old Madrid. It is the Best Western Hotel Carlos V - it was a very nice hotel - not exactly handicap accessible - but the staff went out of their way to try and assist in every way conceivable.

The day we arrived - June 28, 2002 - it was early afternoon by the time we got settled in our hotel. We got into our room and opened the balcony doors and the sweet strains of Handel's Water Music came floating in - a string quartet was on the street across the way from our room. It was beautiful.

This is a very commercial part of Madrid. LOTS of shoppers out. There's a huge department store here called El Corte Ingles - I think they carry just about a little bit of everything under the sun.

Speaking of sun - it's hot - like 100 degrees with humidity hot.

And... I kept wondering... have these people never seen a fat woman before? (Admittedly, there aren't that many heavy people on the streets.) Or have they never seen a woman in a wheelchair? (Again, not many in wheelchairs out, either.) Or maybe it's that they've never seen a fat woman in a wheelchair? Dunno. Definitely felt like people were not just staring - but were really unsure about how to handle seeing me. Wierd.

Oh - and if you could earn your salvation - my husband will have earned his - pushing this 365 pound woman in 100 degree heat up cobble stone, hilly streets in a foreign country and not uttering one word of regret or derision or anything to make me feel anything but cherished and loved. My oh my - what a blessed woman I am!

Dr. Baltasar was kind enough to arrange for a private taxi to meet us at our hotel in Madrid on Sunday to drive us to Alcoy.

When we arrived in Alcoy - which is about a 5 hour drive from Madrid - we went straight to the hospital.

Here's the front door of Sanatorio San Jorge - we call it the Clinica. It's really a small private hospital. Health care in Spain is socialized, so people who prefer to self-pay for their health care utilize small private hospitals like this one.

I thought the stairways - with all of the beautiful wood work and marble - were lovely.

Here's the view from the balcony of my hospital room.

John took me out for a walk the day of my surgery. We went down to this bridge - which apparently is sort of famous! It is pretty.

After I was discharged from the hospital John and I went to Villajoyosa where we had rented an apartment through Spanish Holiday Rentals. Here's a little plaque along the promenade that explains the ancient history of the town.

This is the street that our rental was on - see the chair on the sidewalk on the right? That's adjacent to our door.
There I am hanging out in the little plaza across the way from our apartment. (See, the place with the tourquoise door with the chair near it? That's our apartment.)

This is the view looking up from where I was sitting in the plaza. The town is terraced up the hill. We would hear people in the evenings as they gathered on their patios and shared a meal or simply talked and laughed together.

See the sign on the wall below? It says, in essence, that this wall is ancient (like goes back to Roman era!) and if you take stones from the area you could/would be prosecuted to the full extent of the law. Wild, huh?

At the end of our street you can turn right or left. To the right you go one block to the waterfront. If you turn to the left, you'd go around this castle (yes, it's a real castle) and go up the hill toward the mercado (market) - which John had to do daily (in the heat!) to bring back each day's groceries.

Here's the beach at Villajoyosa.

I didn't actually get to go out onto the beach - wheelchair and sand don't mix well. But it was lovely what I did get to see of it.

So - that was our trip to Spain!

July 2002

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July 2, 2002 I had my BPD/DS in Alcoy, Spain. Dr. Aniceto Baltasar is my surgeon. My surgery was open, included the DS, appendix and gallbladder removal, as well as liver biopsy - all in 80 minutes. 3 hours after surgery I was up walking to the potty. It was an incredibly positive experience, and I'm so thankful to God for providing a way for me to have surgery!

Here I am at 4 days post-op, on the balcony of my room at the Sanatorio San Jorge in Alcoy, Spain.

This was actually at two days post-op. I really wanted Dr. Baltasar to keep my stitches in a LONG time cause I was afraid! My c-section incision dehissed at six days post-op, so I thought keeping those stitches in as long as possible was the best option! (I'm so opinionated!) As it turned out, Dr. B removed the stitches on the third day post-op rather than the 2nd, as is his normal practice - just to humor me, and everything was hunkey dorey!