Gwen's WLS Journey

Random Thoughts

2011-11-24T02:00:00.000-08:00

Yes, I've been away. Between work and my toddler, I don't get much blogging done! (Or really any computing.)

I have had some posts percolating for some time, but at this time they seem to be just little thought bubbles, so that's all I've got.

-I secretly want to be a mommy blogger. I follow a ton of crafty-mommy blogs, and I don't know how they do it (or if they even do it, or if they are faking!) but I am amazed. Maybe they really have secret helpers or elves that do the magic behind the blogging curtain. I'd love to spend my days hanging out with my girl and making fun stuff. And decorating my house, and doing all this crazy DIY stuff. But, yeah. I'm doing pretty well just to read their blogs from time to time.

-I read an article recently on CNN that was titled something like "Horrible guests, vegetarians, and other Thanksgiving nightmares". I think the title wasn't quite that nasty, but that was the idea I took away from it. I'm an omnivore nowadays, but I spent over 20 Thanksgivings as a vegetarian. Why is a vegetarian at Thanksgiving dinner such a nightmare? For every snooty, finicky, self-righteous vegetarian, there are at least 20 who want nothing more than to enjoy your company and a nice meal, and who will do anything to avoid you stressing out over feeding them. It's not that big a deal, really. Thanksgiving dinner to me has always been more about the sides than the bird anyway.

-The difference, for me, between now and when I was losing weight is not what I'm eating or even my level of restriction, it's running. I was running at least 10 miles a week when I was losing weight. Now, well, running has been sporadic at best. It's very hard to find time to run on top of everything else. I've experimented with getting up earlier on days I work (like 4:45) to get in a run, and that has worked best, but this week it wasn't really possible between working and staying up late cooking for Thanksgiving. Next week, though, I hope to get back at it. At least I'm not gaining. I am hoping to lose 5 lbs by the end of the year. Not gaining would be a minor victory.

That is all for now. Happy Thanksgiving y'all.

Frustration

2011-10-15T08:41:00.001-07:00

Well, I'm super frustrated with weight loss. I have been gaining and losing the same 5 lbs for months now. In fact, I've been at this weight for nearly a year and it's making me crazy. I've tracked my calories, and I'm paying attention to urges for mindless eating. I'm NOT getting regular exercise, because I still haven't figured out how to fit it into my schedule, but I am working on it (looking at biking to work, and I'll be going to shorter shifts soon so I'll have a bit more time on work days). But I think exercise is a fairly small part of the problem. My stress is probably a big part of it.

One of the big stressors is the house hunt. In June, we signed a 1-year renewal on our lease of the house we are in. In August, our landlord announced he was selling the house. A few weeks later, we got the foreclosure notice from his bank's attorney. Needless to say, this threw us into a tailspin. We had wanted to buy a house, but were planning on a year from now. We just spent all of our money on treatment, and we have huge amounts of debt. But, when we looked at the situation, we realized that going to another rental is likely to end up the same way, since so many houses for rent right now (especially the nicer ones) are first homes of people who bought something else and couldn't sell their first place, and many of these end up in foreclosure.

There actually turns out to be a lot of upside to our situation. We consulted a couple attorneys (our landlord is an attorney, so we wanted to be sure of our position) and found that current federal law protects us because of the foreclosure. In fact, in many ways we seem to have more rights than the owners. Once foreclosure proceedings began, our lease became protected even if the house is sold or auctioned. Also, we were able to use our deposit--all of it--towards rent, because in either a sale or auction there is nothing compelling the original owner to return our deposit for any reason. Many people have told us we can "squat" here, not paying rent at all now, but that isn't true unless we don't care if we are evicted. And we do care, because we are using this time to look for and purchase a home, and we want to have this place to live in until we close on a house.

So, it's good--we are buying a house!--and we will end up paying less for the mortgage than we do in rent, but it's quite stressful nonetheless. We might buy the house we are in, since we love the location so much, but that is not a certainty by any means.

We are accustomed to having a lot of stress in our lives, and we are trying to learn how to cultivate serenity instead of chaos. I am hopeful that this process has a side effect of helping me to change whatever behavior is keeping me from losing this weight.

A couple weeks ago, our Lucy turned 1--I can't believe it. We had her first birthday party, and it was much bigger than we had intended, and it was exhausting for all of us, but fun. It was a pretty traditional party--kids, presents, cake, chaos--but we decorated with Indian elephants, to celebrate her heritage. She had fun, although she was frequently overwhelmed by everything happening around her. We dressed her in the cutest baby sari that I found online. Super adorable. When I get the pics off the camera, I'll post some.

Summer Pics

2011-08-26T22:01:00.000-07:00

Two-Legged Life Again

2011-08-26T21:48:00.000-07:00

I am out of my boot, my xrays show good healing bone, and the sprain is mostly healed. My ankle still gets a bit sore, but I went back to work this week and it went fine. It's kind of good, actually, after almost 8 weeks at home, to be back at work, although I've enjoyed the summer spent with Lucy and the past few weeks with hubby as well. I was afraid of losing my skills at work, so it's good to get back to it.

Being laid up for a couple months, or at least having less than usual activity, isn't great for weight loss. But I think I am getting to understand my emotional triggers for eating a lot better now. There is a lot of talk in the WLS community about "emotional eating" and that basically seems to refer to eating for any reason other than actual physical hunger. This, I have found, is a vast generalization, to the point of becoming meaningless. Emotional eating? Most eating is associated with emotions. The advice given is that one should start therapy and get a handle on their "emotional eating" before going through with WLS.

This is well-intended advice, but again, I think it is a bit meaningless. What I am learning about myself is that I have a lot of underlying anxiety. My daily life, in fact, is filled with a lot more anxiety than I have ever been conscious of before. I don't notice my anxiety because, A, I am so used to it and have lived with it for so very long, and B, I self-medicate before I notice that I was anxious. Frequently the self-medication is food, but not always. I also read, shop, or sew or do other crafts. None of those things is bad in itself, but they do help me continue to ignore the anxiety that led me to those activities in the first place.

I'm hoping that as I start to notice myself suddenly get "hungry" (which is actually "appetite", an emotional trigger, rather than "hunger" which is physical, and comes on gradually) and realize that it is often because I am experiencing some anxiety over something, that this triggered eating will diminish. My weight loss has halted again, and I suppose I should also determine if I need another fill. I don't think I really do, I think that I do more eating when I'm not hungry than I realize. So, I am more focused right now on improving this area of life.

I'm pretty frustrated by this weight loss thing, to be honest. I am still 20 pounds above pre-pregnancy weight. I would like to have another baby, and I don't have much time to do it, but I can't fathom getting pregnant at this weight for a starting point. It's depressing. Getting back to the gym should help a little, though. And we are doing pretty well about following the goals I listed in my last post--preparing meals at home, eating at the table, eating lots of fruits and veggies. Lucy is doing much better with her solids and pretty much eats what we do.

I'm not saying much about hubby's progress because it's not my place to do so here, except to comment that he is doing much, much better and we are feeling much more hopeful for our future. I'm very happy to have him home and on a better path.

"Normal" Eating?

2011-07-18T19:23:00.001-07:00

I was raised by an anorexic/bulimic. This isn't a secret, and if my mother read this, she would agree. Her mother was also an anorexic, and felt she was overweight at 90 lbs. My mother knew the ins and outs of her eating disorders before I was even born. It was so not a secret, in fact, that she explicitly inducted me into the club as a pre-teen (or as they are called now, "tween"). She taught me, in clear language, that "this is what women do": diet to be thin, purge if necessary. I don't think this would have come to me naturally without coaching; I was and am much more prone to simple overeating. But this was my instruction, and I followed instruction until I realized that it was making me sick and miserable. This was around age 16.

Now I am raising my own daughter. She is only 9 months old, but I realize that she is already learning how to eat from me. She has been slow to take to solids, and it became clear early on that she was mostly interested in things she could hold herself, and things that her dad and I were eating. No baby food or purees for her. She wants real stuff. She often isn't interested in food at all, anything I offer her, so we skip a lot of "meals" since she is getting her nutrition from formula still. At least once a day I put her in her high chair and eat a meal with her, but it's rarely 3 times a day.

This isn't just her, though. I don't really eat "meals" when left to my own devices. Since I was banded, it seems like so much trouble to go through to prepare a meal for just myself when I'm only going to eat a cup or so of food. It's a lot easier to pick something out of the fridge that will keep me satisfied for the next several hours. And lately, those choices have not been particularly band-wise.

I realize this isn't normal. And while in a lot of ways it makes sense for me, my daughter is not banded. If she is lucky, and has good, healthy instruction in childhood, she will never need to consider something like that. But how do I teach her normal attitudes about food? How can I teach her how to choose a normal, healthy meal when I don't really know what that is myself?

My mother cooked meals for us, don't get me wrong. There were plenty of nights we ate out, or ate TV dinners, but usually she cooked dinner, we almost always had a packed lunch, and sometimes on weekends she would make breakfast. She is a good cook. And I give her a lot of credit for feeding us healthy foods and not letting us become picky eaters. We always had a good variety of foods, and when I ate with friends, I was always the least picky eater of the bunch.

I don't know why I have this aversion to preparing meals on a regular basis. I do, but I don't understand it. But I'd like to overcome it and teach Lucy healthy attitudes about eating. I think it is probably "normal" to have parents who cook or prepare most of your meals, to usually eat at least one meal together, and to eat sitting down, slowly. Not scarfing down something over the sink (I do that regrettably often). It's "normal" (I think) to learn when you are full and not be forced or cajoled into eating more than that amount. It's "normal" to mostly eat freshly prepared food (that is, not packaged/store bought/restaurant food) and to have sweets only "occasionally" rather than with every meal or every snack. Am I right? Am I missing anything here?

I don't eat normally. My husband doesn't either; we both are in the habit of grabbing something when we are hungry. He is better about it being something healthy than I am. He is more of a cook than I am, especially an everyday cook. But maybe I could make some sort of list of eating goals, and work toward them slowly, with a goal of modeling more "normal" eating than I had modeled for me? (Because, despite all those home-cooked healthy meals, the majority of the eating that took place in our house was anything but normal.)

Goals:

1. Cook dinner at home most nights.

2. Eat a variety of vegetables and proteins

3. Have fruit instead of sweets

4. Prepare healthy breakfasts at home (this I'm reasonably good at, especially hot cereals)

5. Eat slowly, at the table

Those seem like pretty normal goals. Any other bandster parents have comments to add? I have an opportunity to break or diminish the cycle, as my daughter is still a baby. I don't want to screw it up.

A Sedentary Life

2011-07-06T14:56:00.000-07:00

Lucy and her nanny are off to the zoo today. Summer arrived in Portland a couple of days ago (in time for the 4th--a rarity in the Pacific NW) and I have mostly stayed inside, not only because of my gimpy leg, but I also got the yucky cold going around. I woke up last night around 3am unable to stop coughing, and had to find some cough suppressant to get through the rest of the night. Today my head hurts every time I cough.

Lucy has a bit of a stuffy nose, but so far that seems to be it.

Things are going okay. I am waiting to hear the outcome of my short term disability claim. I don't think it will be denied, but I haven't really checked to see if I really have an 8 day waiting period (instead of longer). I guess I have too many other things going on.

I haven't been weighing myself in the past week. I'm afraid what a week of inactivity will reveal on the scale. It can't be good.

Hubby is doing pretty well. He will probably come home around the 23rd of July, after 45 days of treatment. He sounds really good on the phone.

I guess I'm off to read, knit, or sleep.

Today's Gift

2011-06-29T16:28:00.000-07:00

I get the "Today's Gift" daily meditation emails from Hazelden. I usually ignore them, honestly--most of them are too churchy for me. But sometimes one is really helpful, like this one, which seemed quite timely in light of both physical and emotional injuries that are in need of healing.

Stopping, calming, and resting are preconditions for healing. When animals in the forest are wounded they find a place to lie down and rest completely for many days . . . They just rest and get the healing they need.
--Thich Nhat Hanh

We hurt. We suffer. We wrong our loved ones and they do wrong by us. Reaching desperately for an answer will not help us. Pretending we're not hurt doesn't help either. When we are wounded, the wound needs rest in order to heal. So it is with our souls. If we poke at our hurt, pick at the sore, rub it in the dirt of others' opinions, we do not allow it time to heal.

If you've been hurt, accept that. Feel the hurt. Be aware of it. Let it heal. Maybe it would be better if you didn't talk to that person for a while. Maybe you need to let go of the relationship. Maybe you just need some quiet time. Whatever the answer is, find a safe place and allow yourself to heal.

If you're feeling pain, be aware of it. Feel the pain, and then quit picking at the wound. Lie low. Quit fighting. Relax. Give your wounds time and enough rest to heal.

No, Seriously...

2011-06-28T14:13:00.000-07:00

We have been on our own for about 2 1/2 weeks now. Hubby is doing well in treatment. I talk to him daily, and he seems to be really getting into the program and practicing lots of new healthy behaviors. He sounds very healthy and honest.

On Sunday, I was getting ready to take Lucy for a walk outside. It was a gorgeous day, maybe 80 degrees, no clouds. I got her ready upstairs, put on shoes that I thought would both be comfortable to walk in and go well with my cute skirt. I then proceeded to slip on the second step and fall down the next 5.

Lucy was scared, and cried for a minute, but she was fine. I was initially writhing in pain and nauseated. At first I thought, "For sure, I've broken my ankle." Then I reconsidered: often, people think their ankle is broken and it's just a bad sprain. After about 10 more minutes though, I knew whichever it was, I had to go the ER.

Luckily I had my phone with me. I got ahold of a friend to take me to the ER, and my neighbor to watch Lucy while we were there. They got me through very quickly (I went to my own hospital) and in fact, I did have 2 fractures on my fibula (the thinner bone of the lower leg). The good news is that it does not need surgery. The bad news: 6 weeks of no weight-bearing.

If you are wondering how I am going to take care of Lucy with one leg, you're on the right track. Also, our house is 3 stories. There's no bathroom upstairs, or I could live up there. And if you're wondering if I can work, no, I can't. I should qualify for short-term disability with this. I can't drive either.

Hubby was sort of distraught at first when I told him, and wanted to come home, but knew after we talked for a bit that the best thing was for him to continue the work he is doing. I don't know why I'm not more stressed than I am about this turn of events, but I guess I've just sort of surrendered to it all. My nanny is still coming during the daytime to help with Lucy, and I'm lining up friends to come in the evenings and on the weekends to help with Lucy. I'm getting around okay between the crutches and the walker. I just can't carry Lucy anywhere. Lucy doesn't really understand why Mommy can't pick her up or play with her as much, but she is settling down a bit. Poor girl.

I guess the good news is that now I'm not working for a while...while I do really need the money, I'll make most of my salary on disability, and am forced to slow down and take care of myself more. People are bringing food...it's good to have friends and family who care.

A Different Path

2011-06-11T09:20:00.001-07:00

I am now, temporarily, a single mom.

My husband had a serious relapse after a long series of small relapses. I won't go into the details, but there was plenty of heartache to go around. Finally, he agreed to inpatient treatment, and the recommended program is in a southwestern state. He left on Thursday morning, and will be gone for a minimum of 30 days, and likely 60-90 days in total.

Because of our history, I entered into parenthood with the knowledge that I might be a single parent eventually, but I don't want to be. And if this treatment program goes well and my hubby truly achieves meaningful recovery, then this will be a temporary bump in the road. But in the meanwhile, I'm piecing together a life for Lucy and myself on our own. I have twice as much childcare to pay for, and no personal time at all. Lucy is disrupted--sleeping poorly, wants to be held all the time. She's not really fussy, but normally she can entertain herself for a decent period of time.

I really should find a counselor for myself, and an Al-Anon meeting. But that requires more childcare, which isn't really in the budget. I don't have a large support network in Portland, because I have been focused first on my pregnancy and then with parenting since I moved back here. Also, things have been falling apart for several months, and I've isolated myself. So now I am working on cultivating some support. So far, I've had some luck, thankfully.

Did I mention that the program is very expensive? And we just lost a large chunk of our income by sending hubby to treatment? Thankfully our insurance pays for part of it, but the remaining portion is still staggering. I make a good income, but I don't know if it is enough--I've already had to borrow money to get this started.

I haven't really had much time to think about all that has transpired yet, but I know that is coming soon.

Hey, at least I've lost a little weight! But I'm finding that I have a bit of reflux when I am really stressed. I don't usually have it, and no food ever gets stuck or comes back up, I still never barf. I don't think the band needs to be loosened.

This program is really our only option, though. Addiction is deadly, and I know he will die early without real, meaningful treatment and recovery. I do love him dearly. And I do believe that addicted people are sick, not bad. But that doesn't keep me from hating the behavior, or being angry and hurt, and resentful for being left holding the bag here at home. I guess you could say I'm struggling.

That's my stuff today.

Finally

2011-05-26T14:39:00.000-07:00

The scale is finally moving. After about 10 or so days at the exact same weight, it went down 2 pounds. It stayed there for about 4 days, then it went down another pound today. Whew!

For the first time since I was banded, I started having heartburn last week. It wasn't when I ate, it was always when I went to bed, which was usually about 3 hours after I eat. And even weirder, when I am home with Lucy, I lay down to nap with her pretty often, and would never get heartburn then. But finally I realized it was probably just my period causing it. It never happened before, but the last few nights I haven't had it. I did reduce my bread and rice intake, which I probably needed to do anyway. So I guess it turned out to be a good thing, since it helped me change my behavior, which is what the band is all about, isn't it?

I had a comment recently about the blog and about getting the VSG instead of the band. I think that's great. I've often thought that if I needed to have a revision done for some reason, I would have a sleeve instead. Finding the sweet spot with the band can be a pain. Every surgery has its pluses and minuses, but the VSG sounds like a pretty good surgery, and I know of a lot of former bandsters who had to revise and went to that. No matter how one feels about the band, I would definitely recommend something like a sleeve to anyone who is going to be living a significant distance from a follow-up care surgeon. Sometimes you need to be seen right away for a too-tight band, and if you have to fly somewhere it is a real problem.

I'll post some recent Lucy pics when I have another minute--right now, she beckons, adieu!

the longest journey

2011-05-16T20:35:00.001-07:00

I haven't had much time for blogging, although I have thought about topics often. I find that when I am home I am too busy to even open my laptop, and I can't blog at work. So I am going to try on my phone, even though the phone app doesn't allow me to format.

Lucy is sleeping on me right now. Poor girl has her first cold, and she can't breathe lying down. She made it almost 8 months before getting sick, which I think is pretty good. We all had the crud this weekend, just in time for a planned visit with my father. None of us were up for much entertaining, but we made it ok.

My weight isn't getting higher or lower. It has been exactly the same, to the tenth of a pound, for about 9 consecutive days. Frustrating. I had a fill on Thursday but it was tiny. I return in 3 weeks. I can still eat way too much.

I have been to my new gym, and dropped Lucy off with the childcare they offer. They fell in love with Lucy and begged me to bring her back. Pretty cute. I will try to go again tomorrow. After not running during my pregnancy, I am back to square one with fitness. But for now I am just trying to reestablish the habit first.

So far to go to reach my goals! But I am hopeful that I will get there.

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Caution: Extreme Cuteness Ahead

2011-05-01T09:11:00.000-07:00

Back to working the band

2011-05-01T08:51:00.001-07:00

I have been wanting to blog for quite a while now, and have had many bloggy thoughts to follow up on. Now, I have a spare minute to do it, with baby and daddy asleep, and...my mind is a blank.

It's been hard to find some time to blog lately. Lucy is 7 months old now, and I want to spend all my time with her when I'm not at work. Consequently, I'm never on my computer at home anymore. I can do some limited web-surfing at work (check the news, Slate, etc) but I can't really blog or Facebook, so I'm just not on there much anymore.

I say "limited" because anything that requires real concentration (like blogging) isn't the best thing to do while taking care of a patient, and I couldn't do that. There are definitely moments in a case when the patient is stable, the surgeons are doing something tedious (I work in a teaching hospital, so routine cases usually take a bit longer since there is teaching going on) and I can check out msnbc. But if I become engrossed in writing something...that's not good, so I just don't do that.

Anyway...

I had my upper GI and fill on the 14th. It was good to get back to my original surgeon's office, and to have my insurance pay for this stuff! The upper GI was fine, Dr P said it looked like she had just put the band in yesterday (although it was one of her former partners, actually). She gave me a small fill, which I have noticed a difference from, but I still have a ways to go. I'm working on being mindful about eating, and making better choices, and I think it's helping--I'm bouncing around the same couple pounds, but I'm not gaining. And I switched gyms. Yes, I left my beloved march wellness, probably for good because their one location is really inconvenient now, and they don't offer childcare, so I only ended up being able to go about once a month. We have a 24 Hour Fitness less than half a mile from our house, an easy walk, so I moved over there. I added my husband too, and our dues together are only $10 a month more than I was paying for my own membership at march. And they have childcare. So, win.

Being a new parent, I find myself thinking a lot about how we are going to influence our daughter's attitudes about eating and body image. One thing I think about is that my husband and I have sort of evolved into an ad-hoc dinner style; we rarely plan and execute a sit-down dinner at home for ourselves. We often just grab a snack in the evening instead of making a meal for us both. The nights I work, I will come home sometime between 7 and 8:30 (unless I'm working late, then it's between 10-midnight). Hard to plan, and once I get home I have to put Lucy to sleep because she refuses to sleep if I'm not home (or she wakes up once I get home--don't know how she does it). But I would like Lucy to have a family that eats dinner together. So we'll have to work on this, and figure out what works for our family.

Lucy is growing like crazy. She got her first 2 teeth about 3 weeks ago, and is about to have her upper 2 come through as well. She sits up on her own and crawls on her belly (hasn't figured out how to get that belly off the floor yet). She laughs a lot, often at totally unpredictable things. She loves going on the baby swings at the parks. She usually doesn't like us to feed her solids with a spoon, but she'll eat anything if she can do it herself. She babbles all the time, and says "mama"--it used to be only when she was upset, but now she just says it randomly sometimes. She has the cutest little voice. She is getting so big so fast, it makes us sad sometimes that her tiny baby days are gone so quickly. But we have a blast with her.

A Letter

2011-03-27T21:49:00.001-07:00

Dear Left Breast,

I know it is kind of odd to be writing to you. I mean, I don't think you've ever gotten any mail before. But I feel like I owe you a lot these days, and I want to thank you.

Almost 10 years ago, you were huge. I had surgery to reduce you and Right both, which was successful, and which I was quite happy with. That surgery helped me to exercise more and relieved my back and neck pain. You were just too big.

When I had that surgery, though, I didn't realize that one day I really would have the chance to have a baby, and that it would become very, very important to me to breastfeed that baby. I don't regret the surgery, but I had a lot of concerns that I wouldn't be able to provide my daughter with breast milk.

That came true with Right, which has so much scar tissue now inside that my baby could not latch at all, and I can barely express any milk from that side. But you, Left, have been a trooper. Together with some pharmaceutical help, we have provided Lucy with about half of the milk she has drunk in the past 6 months. We grew her strong and tall, with a nice big brain, and have made her very healthy. In fact, so far (knock on wood) she has not been sick once, and she was just a few months old through the winter cold and flu season. Without breast milk, I don't know if her immune system would have been so strong.

Tomorrow Lucy will be 6 months old, and I have weaned off the domperidone. I'm still producing milk, so I am going to keep pumping a few times a day for a little longer--maybe just a day or two--just to see what happens. I am wrapping up this part of my life, and I don't know if I will have another chance to provide a baby with milk. It's hard to say goodbye. But you've given me one of my first important lessons in parenting: that often, things don't go the way you want them to go, and although they might be very important to me, I have to find a way to make peace with it.

Now you are a little droopier than Right, and more painful most of the time. But you've accomplished something remarkable. Thank you for letting me provide something so important for my baby.

Slowly but Surely

2011-03-20T22:44:00.001-07:00

I'm tapering my domperidone dose down, and trying to wrap my head around stopping pumping. I have mixed feelings about it, as I think I've shared here before.

The good things are: I've lost 4 pounds, and I have a lot less hunger and cravings for sugary foods since I started tapering. I'm on about half the dose I have been taking at this point. Today I made a Costco run, and was shocked that I didn't even have any desire to get anything in the bakery section (a killer for me, usually) or any sugary goodies. It made the trip much quicker than usual!

The bad, or confusing, things are: I have a hard time letting go of this phase of our lives. Even though pumping doesn't have as many positives connected to it as nursing does, it does feel kind of like weaning from nursing. If Lucy was nursing, instead of just taking expressed milk from a bottle, I would still be doing it and not even considering stopping, even if I gained another 40 pounds over the next 6 months. (Okay, maybe not that much.) But pumping, and only pumping, with a nearly-6-month-old, is tough. Still, I love that I can give her my own milk. It's not saving me any money, between pumping supplies and medication, but it's so good for her, and she enjoys it more than formula, and it's something that only I can make just for her. I will miss that. But this weekend I have another painful blister that bleeds and makes me question pumping at all right now. So I feel it's time to start letting go of pumping, yet I have a hard time with it.

I do want my body back. I do want to fit into clothes and to be able to run again. And I'm mostly sure I want to have another baby, one more, and cannot stand the idea of getting pregnant at an even higher weight and gaining even more weight. I have to give myself these pep talks and remind myself why I am doing this.

Fill and upper GI on April 14!

Coming down to it

2011-03-04T13:59:00.001-08:00

This week, I was mistaken for pregnant twice.

This is unacceptable to me. I almost shut down Project Milk right then. I discussed how unhappy my weight and the pumping are making me with hubby. I actually resolved to quit, despite how important it is to both of us that Lucy have 6 months of breastmilk. Then I went to bed.

The next day, I just worried about that day. I am going one day at a time.

I do feel ambivalent about giving up pumping. I do think it is important, and I am proud that I have been able to provided much of her milk despite my physical challenges. At the same time, I have been making every personal decision about my body with my child in mind for 15 months now, and I am ready to have my body be mine again. And I am ready to see my coworkers during breaks instead of spending them huddled in a shower stall every day.

So it starts now. I bought a lovely BOB stroller this week and started the Couch to 5k plan this week. I am slowly tapering the domperidone over the next 3 weeks, but not reducing my pumping frequency yet. And I am watching what I eat. I still won't have my fill until April, but I expect to have made a little bit of progress by then.

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The Date is Set!

2011-02-27T09:06:00.001-08:00

April 14 is when I return to my original band surgeon (now that I am back in Portland) and get an upper GI and a fill. About 6 weeks from now, which is actually perfect. By then, Lucy will be 6 months old and I will stop taking domperidone (and probably stop lactating after that), and I'll be ready to start losing weight without fear of damaging my milk supply. In the meanwhile, I am looking for an inexpensive jogging stroller (on Craigslist mostly) to give me more options for working out. I think I might also arrange for our nanny to come once a week so I can go to the gym.

Meanwhile, I'm trying to compile a list of easy-to-prepare, healthy dinners to make quickly and a list of ingredients to keep on hand. Most of the cooking here is done by my husband; sometimes I enjoy cooking, but I don't like the day-to-day meal preparation, and I've never been good at planning ahead for meals, although I know I could save a lot of money if I did.

So, anyone have any favorite go-to recipes for dinner that are healthy and band-friendly (weight loss friendly)? I'd love to hear them!

I'm relieved to start this process. As much as I enjoyed (most of) my pregnancy, and this time of providing nourishment for my daughter, I am ready to fit into my clothes again. I'm also ready to get back into shape.

And there's more. I've been following up on this benign lump in my breast for some time. I've seen a bunch of doctors, and it's not anything dangerous, but they do think I should have it removed. It's large enough that removing it means I need a repeat breast reduction (which I needed anyway) to make things even. But...we still might have another baby, and it would have to be relatively soon if we do (like the next couple years), and I want to try breastfeeding again. Also, I want my tummy tuck at the same time (!). So, I have a referral to a plastic surgeon, but I would need to lose weight first at a minimum. What would make the most sense is waiting for all of that until I've either decided against a second baby or after that baby is born (and weaned). So, that's on the horizon, but I don't think it will be for a few years. Meanwhile, losing weight is definitely part of the plan.

So, one more month of pumping for Lucy. Pumping is so much work. I know I've complained about it before. I don't think if I had a second child that I could do this exclusive-pumping thing again, not with a baby and a toddler running around. It just takes too much time and ties you down too much. 6 months is my max for Lucy because she is already getting too restless to tolerate my pumping schedule. Many pumping sessions get started and abruptly interrupted because she needs or wants my time (and you can't blame a 5 month old for that). I can't see her tolerating it very well beyond 6 months. And it really sucks being tied to that thing every 3-4 hours for at least 30 minutes. I'm going to miss being able to provide milk for Lucy, but not the pumping.

Start where you are!

2011-01-31T18:09:00.000-08:00

Looking over at my "About This Blog" blurb to the right, I see that my 4 year bandiversary is coming up on March 13. 4 years sounds like a long time to me. A lot has transpired since my surgery day...I've started and completed graduate school, moved to Spokane and back to Portland, become a CRNA and started a new job, and of course, given birth to the beautiful joy of my life, Lucy. And now, I am getting itchy to get my body back.

I've kept most of the particulars off this blog, like my exact weights, but that feels cumbersome right now, so I'd rather just put it all out there, as I get into a mindset to lose weight and regain my body again after pregnancy and lactation.

A band recap:
Starting weight: 234 in March 2007
Lowest weight: 165 in February 2009
Prepregnancy starting weight: 180 in December 2009
Highest pregnant weight: 209 in September 2010
Current: 196

I actually initally lost all but 5 pounds of my pregnancy weight in the first two weeks post delivery, but when I started domperidone to increase my milk supply, the weight came back on and has stabilized. I've been this weight for at least the last month, with very little variation.

I have very mixed feelings about where I am. On the one hand, I realize that my body is still doing a lot of work in nourishing my child, and it's not the time (yet) to seriously try to lose weight. And I'm happy that I can provide at least some (about half) of my child's nutrition. It's all coming from just one poor post-op breast, so I'm happy I can do this much, and although I still find exclusive pumping hard, I am going to try to make it at least to 6 months. But on the other hand, I really am ready to get my body back, and hopefully get back to my goal weight before (possibly, probably) trying for one more pregnancy.

My goal will be 165. By BMI standards, that seems high, but when I was that weight, I was a size 6 and quite thin. I don't need to be any smaller than that. Maintaining 170 wasn't too tough, but 165 took a little work. We'll see what I am able to do.

Some people get into weight loss mode very quickly and jump right in. I've always found it works best for me to take my time to ramp up to the right mindset. I'm in that process now. I'm just working on paying attention to what I'm eating, not necessarily editing it but making some effort to make good choices. I'm trying to work out still, but am finding it very hard to get out with the baby. Part of it is that I just don't want to spend my time off away from her, so I don't go. I do want to get a jogging stroller now that she is old enough to be in one (around 4 months their necks are strong enough for the jostling) to help me get out more. (That might take some convincing for my husband, since we already have 2 strollers. But I really do think it will help me get more exercise.)

And as for the band? I probably need a fill. I had 1 cc removed at the start of the pregnancy, and haven't had any fill since then. But I definitely need to see how I do with good eating choices first, to determine if I really need one. Because I've never gotten really strong "restriction" signs, and have never felt overfilled, it's always been hard for me to determine if a fill is needed. I suspect I'll find that I want one, but not while I am still pumping, and I doubt they would do it even if I wanted it now. So we'll table that thought for the time being.

Meanwhile, the Lucy Report: She is awesome! She just turned 4 months old, is smiling and sometimes laughing, and can roll over from tummy to back. She's getting very strong and might be sitting on her own in the next few weeks. She can sit in her Bumbo quite nicely. She went through some sleep regression over the last month but has done better the last 3 nights, basically sleeping through the night in her crib like a big girl! We are having so much fun with our sweet girl. She has our hearts for sure!

Pumping Sucks

2010-12-16T12:38:00.000-08:00

So, I started back at work last week. It's been a bit stressful--I worked 2 months in my new job/new profession, as a new grad, then took 3 months of maternity leave. Coming back has been, professionally, difficult and rusty, and personally, very emotional and draining. My skills are slowly coming back to me, but I definitely have a lot of moments when I feel less than confident. And leaving Lucy with a nanny has been difficult, although I think we are all adjusting relatively well. I think it's hardest for hubby--he never left his sons with anyone except his ex-wife, and he is actually working from home a couple days a week, so he hears how Lucy does with the nanny (she cries more than with us) and it's stressful.

The worst part might be the pumping. I don't mind pumping at home, really. It takes some time and I'd rather just nurse Lucy than pump and feed, but she doesn't want to nurse. I've given up trying, it's too hard on both of us. So I am pumping several times a day, which is okay at home, but very hard at work. At my hospital, the birth center is very active in making sure women everywhere can breastfeed, and they try to extend this to their employees, but my particular job makes this very difficult. Basically, every break I get, I pump while I eat. Unfortunately, most of the convenient pumping locations are in shower stalls, in the locker rooms, which are uncomfortably close to the toilets. Yuck. There is something about eating your lunch hunched over a breast pump in a shower stall, by yourself, that makes you feel a little less valued as an employee. The logistics are very difficult (packing food that I don't have to heat, getting an extension cord, finding a location to pump in that isn't already in use, etc) and it all takes a lot more time than I would normally be allotted (15 minute break? Hah!). Luckily the staff are pretty accomodating for the most part. But I have, at best, 4 breaks in a 13 hour shift, and if I get to pump for all of them, it's good (except that I spend every break eating in a shower stall).

It's funny, though. We aren't allowed to wear polar fleece in patient care areas because of infection control, but it's no problem to let employees produce their offsprings' food in a bathroom. I find a bit of dissonance in that. And I'm torn between understanding how difficult it is to accomodate nursing moms in this kind of job, and feeling that they could do a lot better. There are some designated pumping areas that are not toilets (this is, of course, a legal requirement), but they are only convenient to me when I work in angio, which isn't very often, and they are frequently already in use. So I leave for a 15 minute break and spend the first 10 minutes going from one location to the next, trying to find a place that is unoccupied. Then once I finally find one, I have to wash up, set up, pump and eat, wash everything, put it all away, and get back to my location. I always tell my relief person that I will take longer because I have to pump. But it's all just difficult, and I totally get why women give up when they go to work.

I'm not really wanting to complain about my employer about this--I am a little bit, but mostly just complaining that in general, this is difficult to do, and I don't know how much longer I will do it. I want to continue for at least this first year, but may not be able to. If Lucy was actually nursing, it would be a little easier because at least I wouldn't be pumping all the time, although it still wouldn't alleviate the work-pumping issue--at least I would have an even better reason to keep doing it. We'll see how this goes.

Born to Run? Running after Birth...

2010-12-04T22:12:00.000-08:00

I am starting to wonder how you get any real exercise with a baby. I know, shocking, right? I can walk all over the place with the baby. But I want to start running again. This isn't working out very well so far.

I was able to get to the gym twice and get on the treadmill. I think I posted about that earlier. I realized that I needed to get a new sports bra to accomodate the milk jugs. So I did that a few weeks ago. After getting a few good supportive sports bras from Title 9 (love them), I have been unable to get out to run since. I started to go the day after getting the bras (it's been 2 weeks now) but my husband needed to do some work and so I had to watch the baby. Since then I haven't had any time to do it. Either no one else is available to watch the baby, or I have a zillion other things that have to be done. (I haven't been able to go to the pharmacy to pick up a prescription in the last week, either.) It's frustrating, because I really do want to get out there and get moving again. It's just not happening. Anyone out there have any great ideas? She's still too little for a jogging stroller--she has to be 4 months old, or is it older?, to have the neck strength necessary.

I did return to work this week. It was so hard! We are lucky to be able to have a nanny come to our house, so we don't have to wake her up early and get her ready and take her somewhere. But it was still very, very hard. I get up at 5, pump, get ready for work, and leave by 6. Baby is still asleep, and usually so is my hubby. I don't get off work until 8pm, and get home between 8:15 and 8:30. By then it's time for her to be going to bed (and that's now, in a couple months her bedtime will have moved up even earlier...she'll either be in bed when I get home or she'll be way overtired and needing to be there). Again, I'm not exactly reinventing any mommy problems here. But it's tough.

Not only was leaving Lucy all day hard, but getting back into the job was also very tough. I'm in a new career. I was in my new job for two months, then was off for 3 months. I wasn't really feeling proficient by the time I left, and coming back felt very rough. The second day was better than the first. My job isn't really normal--you don't want your anesthetist to be preoccupied with her newborn baby, or to be feeling like she's off her game for any reason. And then there was the pumping. The closest location I can pump in is the shower stall in the locker room. I get two 15 minute breaks and two meal breaks in my 13 hour work day. During those breaks I have to pump and eat, and getting there and back takes almost 15 minutes in itself. Then there's setting up, pumping (which requires relaxing, ha!), washing everything up, and getting back. Plus the joy of eating in a shower stall on a little stool. This country is so messed up when it comes to supporting working parents. And this is at a big hospital, one that is supposed to be supportive of lactating moms. Needless to say, on that first day, I was only able to pump a little over half what I usually do. Very frustrating.

I think next week will be better, though. I'm orienting to the areas I couldn't work in when I was pregnant next week. The nanny has the lay of the land, more or less. I hear this gets better, and everyone says that eventually I'll be glad to get to work and get away from the demands of parenting for a little while. I'm sure that's true, but for now it's definitely hard!

Breastfeeding and Losing Weight---or Not

2010-11-21T10:48:00.000-08:00

Well, I haven't posted much here because I've been trying to keep this a little more WLS-appropriate, and I don't have much WLS stuff to post right now. Losing weight isn't really my plan at the moment. But that's not to say I wouldn't like to, it just doesn't seem to be happening, and I'd rather make sure I can produce milk.

I did learn, rather interestingly, that breastfeeding does NOT actually help most people lose weight, as is popularly said. I'll try to find the particular study, but I recently read that on average, women who are nursing actually gain a few pounds versus those who formula feed their babies. This is presumed to be because elevated levels of prolactin, the hormone that causes lactation, also increases appetite--presumably because lactation requires more calories.

This is significant to me because I am taking domperidone to increase my prolactin levels and thus increase my milk supply. My weight has levelled off, but I gained back some weight after getting very close to pre-pregnancy weight. I knew that this could happen, but it does bug me a tiny bit.

As I have discussed elsewhere on this blog, I had breast reduction surgery in 2001 (long before my lap band). I was told at the time that I wouldn't be able to breastfeed, and I was okay with that at the time. I was recently divorced, and although I wanted children, it didn't seem like it would happen anytime soon, if ever. But when I got pregnant I started researching, and discovered that a lot of women who have had the same surgery have been able to breastfeed at least somewhat. I read everything I could about the subject and was very hopeful that it could work for me. The fact that it had been 9 years since that surgery was a plus in my favor. But there is no way to know until you try.

Just like giving birth, nothing with breastfeeding has happened exactly the way I envisioned it. My daughter did nurse very soon after birth, and was placed on my skin immediately after birth, and stayed there for the first 2 hours. She nursed exclusively until the day after we got her home, when she started seeming a lot more lethargic and jaundiced. We brought her to her pediatrician that day, and she had lost quite a bit of weight from her birth weight--almost a pound. Sometimes a large weight loss can be attributed to the fact that birth weight is falsely elevated by IV fluids given to mom during labor--but in our case, I arrived at the hospital and Lucy was born 15 minutes later. There was no time for an IV, so this obviously couldn't have been the case. And if she wasn't obviously symptomatic, we might have been able to let her nurse a little more without intervention, but she was too sleepy to nurse, and looked obviously dehydrated, so right there in the ped's office we gave her her first bottle of formula, which she gulped right down. (And I cried my eyes out, seeing how hungry she was. It was hard to feel that I couldn't provide what my baby needed.) It turned out that my surgery left only the inner most milk ducts intact, and that plus a large nipple meant that she was just not big or strong enough to compress enough to get much colostrom out.

I continued to try to nurse her as we gave her bottles, but over time she became less interested in the breast. We tried the non-bottle methods of supplementation, but we couldn't get any of them to work well for us. I started taking domperidone when she was about 4 days old, but it still took close to 2 weeks for my milk to come in. I've been pumping constantly since then, and now am making about 60-70% of the milk she takes in each day. Considering the surgery I had, and the fact that only the left breast produces enough to pump or nurse from, I feel pretty good about that, but I am still trying to get her to nurse more so I can pump less. I've been working with some great lactation consultants on this, and have a lot of support and information about it. I won't be able to really lose weight until I stop taking this medication, but as long as it doesn't increase anymore I think I'm probably okay with this.

This whole nursing/lactation deal has been very emotionally intense. I was much more invested in things going the way I envisioned than I realized, even though I knew intellectually that the chances were that it wouldn't go perfectly. I'm happy we are doing as well as we are, but it has been hard to let go of the high hopes I had of feeding her exclusively from my breast. Despite all of this, I'm not sorry I had the surgery. It gave me a much better quality of life, and enabled me to exercise so I could lose weight and keep it off. Whenever I decide I am done having children and lactating, I will probably need to have another reduction or lift, which I do want to do, but it is worth it. (I was a 38H preop, down to 38C post op. I ended up a 34D after losing weight, then was a 36DD during pregnancy, and now am a 34F. There will be a lot of sag when I am done nursing, and I will be pretty lopsided.) If I have another baby later, it should be easier to nurse, because breast tissue continues to develop as the first baby nurses, so the second usually has an easier time.

I don't know if this stayed more on-topic, but oh well. :) Lucy is doing great...getting big and sassy, and cuter by the day. We are having a great time together! Being a mommy is pretty fun so far.

Getting Back On Track

2010-11-03T10:07:00.000-07:00

Someone asked in the comments how pregnancy with the band was different. I don't know, since I wasn't pregnant without a lap band. But for the most part, it wasn't much of an issue for me. I did have some, but not all, fill removed; I went from about 3.5cc (in 4cc band) to 2.5 at about 10 weeks. I considered trying to remove more at the end of my pregnancy but decided not to; I couldn't eat much at the end (and felt very full anyway) but it wasn't a "restriction" issue, my stomach was just too compressed by the baby, and I don't think the band was making much of a difference there. I do think the band helped keep my weight gain within the recommended range--since I started out overweight, the recommended weight gain for pregnancy was 15-25 lbs. (My total ended up being 29 lbs, but I gained the last 7 pounds in the last 2 weeks, all in fluid.) I did have a lot of heartburn throughout the pregnancy, but I don't think that would have changed at all with less fill in the band, either.

My final verdict: band helped keep my weight in check, and really no negative effects noted.

Yesterday, I went back to the gym for the first time since about a week before Lucy's birth. (6 weeks total). I was swimming there pretty regularly through the last trimester, but not doing anything else. Now, I want to start running again. I spent 30 minutes on the treadmill, mostly at a brisk walk, but I did run a few minutes. This was the first time in almost a year! I stopped running just a few weeks into my pregnancy because I couldn't keep my heart rate within the recommended range, so I just walked. It felt good to run again. Maybe I'll go outside to run today--it's a beautiful, sunny Portland day, unseasonably warm for November.

The next step is improving my eating, and determining if I need to bump up my fill again. I graze a lot. And lately, I've grazed a lot of sugary goods, so I need to work on that. I didn't really pay too much attention to what I was eating at the end of my pregnancy--I wasn't worried about weight gain, I wasn't able to eat very much at a time anyway, and I was getting good nutrition. But now, I have a goal weight that I would like to see again within the next year.

I probably won't return for a fill before going back to work, and when I do, I know they will want me to have an upper GI, since they recommended that when I switched to the local band doc in Spokane (who declined to do the upper GI, deeming it unnecessary.) I don't mind doing it, but I'm not sure insurance will cover it, so I definitely need to be working again.

Baby's fussing--got to go.

Lucy Pics--10-15-2010

2010-11-01T18:57:00.000-07:00

A New Life

2010-11-01T18:41:00.001-07:00

It has already been a month since Lucy was born. It seems hard to believe. In fact, tomorrow is 5 weeks. The time has certainly flown quickly. I can't believe I have to go back to work in just 4 weeks. I don't mind working, but leaving Lucy will be hard, even if only for 3 days a week.

So far, I have to say that I enjoy every bit of being a mother. I didn't necessarily expect this. I have been childless for a long time--37 years, in fact. While I have always known that I wanted children, when it came to be time, I didn't know if I would miss my old life, the convenience of not having to worry about all the things that go along with having children. So far, this hasn't happened once. It's just such a different life, but I haven't found anything about it I don't love yet.

I'm also enjoying the SAHM thing for this brief time. I'm sure lots of moms think the same thing when they are on maternity leave, and find that months or years of it is a very different proposition. But right now, it's something that I didn't think I would enjoy so much. Of course, I have a pretty low maintenance little baby, and only one of them. She can't really get into anything or talk back to me, or make much of a mess. She sleeps a lot. So other than sleeplessness, this is probably about the easiest it gets as a SAHM. Still, I am enjoying it, and appreciating the fact that it is such a short time. It's definitely work, and a different kind of work, trying to keep up with housekeeping, baby laundry, and taking care of baby and myself, plus trying to support my hubby, who is working hard. I could stay home rather than go back to work, but having just finished school and started my new career, and with all the student loans I have, it just doesn't make a lot of sense to me not to go back to work. And I do enjoy what I do, and want to get my practice really going, and become a better anesthetist. As I have noted before, I work 3 days a week, so while they are long ones, it's a pretty good schedule for a parent. I'll see how I feel after a few months of it.

My weight is another matter. I'm not checking it now. It went back up about 5 pounds after my lowest weight. I believe this is because I am taking domperidone to increase my milk supply. (This is because of my breast reduction surgery which I had in 2001, which impacted my ability to produce milk.) I have read about this before, and most women say that the weight comes off once the drug is discontinued. But, I don't like my weight going back up, and I was really looking forward to working towards my goal weight again. I am stuck in my sort of "in between" clothes. All in all, it's not a huge deal to me at this point, but this being a WLS blog, it is worth mentioning. In six months, if I am still dealing with this, it WILL be a big deal. But hopefully we won't have to worry about that!

Adjusting

2010-10-13T22:42:00.000-07:00

I am blogging my mommy-posts over on my daughter's very own blog. If you are interested, it is called Dear Lucy. It can be found at lucy-evelyn.blogspot.com. If not, I'll try to resume my more WLS-type posting here. I have been posting over there fairly frequently. As you can probably imagine (especially if you've been through this before), this is what is really my whole life right now, so I have a lot of thoughts to share with Lucy, and the world.

Meanwhile, my weight got down to about 2 pounds above pre-pregnancy weight, and I think it's stopped there for now. That's a 27 lb weight loss in 2 weeks, so I really can't complain. I think it has stopped there because I started taking a medication to increase my milk production, and it tends to cause a lot of women to retain weight (not necessarily gain) despite the increased calories required for nursing. We'll see if that changes soon, but I'm not too worried about it. Today I fit into pre-pregnancy jeans--two sizes above my "skinny" jeans, but still, not maternity clothes. I felt that was an NSV! And I'm able to wear heels for the first time since my first trimester (I got way too unstable after that for heels!).

I've been sorting my clothes, actually, packing away the maternity clothes and finding my fall and winter clothes, figuring out what fits now and what will fit later. I didn't expect it to be so bittersweet. I am still not totally mentally adjusted to no longer being pregnant. And I don't know if I ever will be pregnant again--I don't know if we want to have another child (I know my husband does, but I hadn't planned on a second) and I don't know if it will be harder in a few years or not. I don't know if I even need to keep the maternity clothes, or if I should pass them on again (I received most of them from my SIL's friend, and the rest were "fat" clothes I saved along the way).

I still feel a little weird going out into the "world"--in the first couple days, I felt like an alien disguised as a human. To other people I looked like a normal, somewhat overweight woman, but they didn't know I had just had a baby a few days before. I was emotional and exhausted and out in the world only for as long as I had to be. Now I feel more adjusted and normal, but still trying to get used to being a different person yet again--not a pregnant woman, but a mother of a very young infant. It's a big mental adjustment.

We'll try to return to our previously scheduled content soon, with occasional Lucy updates...

Birth Story

2010-10-07T04:09:00.001-07:00

I did write out Lucy's birth story. I started a new blog for her, called "Dear Lucy...Letters to my Daughter" I posted her birth story there; check it out!

One more thing...

2010-10-07T00:17:00.000-07:00

...since this started out as a lap band blog, I should note that I have lost 24 lbs since Lucy's birth. I gained 29 (7 in the last week) so I'm 5 lbs over prepregnancy weight. Another good thing about nursing a baby... :)

More Lucy pics

2010-10-07T00:14:00.000-07:00

Babymoon

2010-10-06T23:52:00.000-07:00

The first 8 days have been wonderful, exhausting, and filled with emotion. I have definitely had stress (parents stayed with us for 6 days! until I asked them to leave a day early...) but we have been blessed with a peaceful and mellow (so far) child, and I am trying to soak in every moment of having a newborn. She loves to snuggle, and we love to snuggle her. Tonight I'm trying to get her used to sleeping somewhere other than one of her parents' arms, but it's hard because I want to hold her all the time.

One of the biggest joys and challenges for me so far has been nursing. My lap band surgery definitely impacted the pregnancy, but my breast reduction has a greater impact now on my life than the lap band. I had breast reduction surgery in 2001. At the time, I was 28, divorced for less than 2 years, and had no prospect or intention of ever remarrying. I knew I wanted to have children, and also knew that if I did have a child I would like to be able to breastfeed, but I felt that it was a distant possibility, while my back pain and difficulty with exercising were a present reality. My surgeon told me that breastfeeding was unlikely given all the manipulation of the duct tissue. And I had a lot of tissue removed, so when it came time to actually plan a pregnancy, I didn't know what to expect. I did a lot of reading on the subject, discovered that there are lots of women with my history who successfully breastfeed their babies, and that it was definitely possible. (For more information, visit bfar.org.)

I'm still glad I had the surgery, because for the past 9 years it has greatly improved my quality of life. Luckily, I have been able to nurse and pump milk for my daughter, although I have had to supplement with formula because I don't quite make enough to keep up with her. What I didn't realize was just how invested I would be in being able to nurse my child. She lost too much weight in the first couple days, and when I brought her back to the pediatrician and saw how much weight she had lost, I burst into tears. I cried again the first two times my husband gave her a bottle of formula, heartbroken that she was hungry after I had fed her, and devastated that I had to give her formula. I knew in my head that this was a possibility, but for my heart it was another matter.

Now I am discovering how closely stress is related to the ability to lactate and nurse effectively. Lucy can tell when I am tense and she won't latch then. When I am relaxed, she does great. What I am able to pump is also affected by how stressed I am. This is why I asked my parents to leave early--I just wasn't able to relax enough to get our nursing relationship the way I wanted it. My parents weren't helping out, they were expecting to be treated more like guests on vacation, and they were stressing my husband and me out. I love them, but it was too much with a new baby. So now we have our privacy to bond with Lucy, and I am working on keeping things as mellow and calm as possible with the nursing. As much as I am able to do, I will be grateful to have.

Time to feed and cuddle Lucy. :)

Lucy: 9-28-2010

2010-10-06T23:49:00.000-07:00

She's Here!

2010-10-02T17:00:00.000-07:00

Finally! Lucille (Lucy) Evelyn arrived at 12:05am on Tuesday morning, September 28. It was a fast labor, especially for a first time mom, and she is beautiful and amazing. Everything was worth it, even the waiting. :)

I hope to get around to posting her birth story sometime soon. It will be long, as it was an exciting one, but also a perfectly healthy and normal one. She was very nearly born in the car on the way to the hospital! Right now I am enjoying the first quiet in the house since we got home Weds night; everyone is asleep, and I got up from a nap an hour ago.

I tried posting pictures, but it's not working right now, so I will try again the next chance I get.

The waiting is the hardest part

2010-09-26T16:28:00.000-07:00

Today is not a good day. I woke up with every part of me hurting. I'm very irritated.

I am avoiding the phone, and staying off Facebook. I just can't take anyone else asking me where the baby is. Know where she is? In my pelvis, hurting me. I know people care, and just want to know. I know I'm overly sensitive because every moment of every day, I know exactly where she is and that she isn't where I want her to be, which is out of my body. And I'm hormonal, and maybe a little unreasonable.

I started this whole adventure out wanting to avoid any artificial induction--the thought being, labor induction leads to all the other interventions that I want to avoid. And I still think that's a good plan. But like Chris Rock says in his famous comedy bit-- I UNDERSTAND. I totally get being ready to just deliver and be done with this part, and move on with life. My OB is really great, and very supportive of my desires to avoid unnecessary interventions, and she even suggested I try some acupuncture (which I did, twice, and which doesn't seem to have helped), and I've tried every other at-home technique except castor oil (no thank you).

And of course, every day I spend on FMLA pregnant is one less day I get to spend with my baby. Either way, I go back to work Dec 1. This country's family leave policies SUCK. I was actually lucky to even get FMLA--I wouldn't have qualified, since I just started this job a couple months ago, except someone advised me to ask if my previous employment at the same hospital made me eligible, and it did. I don't have any more paid leave than before, but at least I don't have to pay COBRA for insurance, and my job is protected (not that they would let me go after spending so much money training me).

The whole idea of a "due date" is a huge mind f*ck. Half of all babies arrive after their due date. But we get this "date" in our heads--you really can't help it, the whole pregnancy focuses on this due date. And when the date comes and goes, you have to readjust, even though part of you knew this would probably happen. It is hard to really be prepared for the extra waiting, even if in the grand scheme it is a relatively short period of time. When you are so uncomfortable, and your brain can only fixate on this one thing, it seems impossible to wait another moment.

So, appointment tomorrow, and we'll see where we go from here. Sorry about the complaining. It's about all I feel like I can do right now. I do hope to have something better to report soon.

Stir Crazy

2010-09-19T13:25:00.001-07:00

39 weeks and 5 days. But who's counting?

I'm becoming more stir crazy, cranky, and lonely by the day. And bored. Yet, my mind isn't really able to focus on much other than baby, or getting baby out of me. It seems like a waste not to be working, except that I don't have much focus, and don't think I can tolerate either the 13 hour days or the pushing and walking involved. I have a stack of books and a couple knitting projects, and of course my baby shower thank you cards that still haven't gotten done. But these things aren't helping much.

I learned early on in the pregnancy that this can be a very lonely time for us women. Even though many, many women do experience pregnancy and birth at some point in their lives, when you are actually experiencing it, it is still an isolating time. I find my brain wanting to isolate and focus in, and I'm experiencing things that I feel dumb complaining about or talking about. Yeah, everybody knows that being late term means not sleeping, having lots of back pain, heartburn, etc. But it sucks! And I do feel somewhat trapped in my body. It's been long enough now that the mystery and fun and beauty of pregnancy has worn off, and I'm ready for the next stage. And hearing people warn me about the sleeplessness and endlessness of the next stage doesn't make waiting right now any easier or better.

I sit at home each day, and my husband mostly works from home. I think he's sick of me being around, most of the time. I don't have many friends in Portland now--being gone for 3 years will do that, and a lot of people did move away in the meanwhile. I only worked at my new job for 2 months, so I didn't establish close friendships there. So I hardly see anyone at all. I try to stay active--walking, going to the gym to swim, sitting on my yoga ball instead of on the couch, doing squats. Sometimes I worry that this loneliness and lack of interaction is going to really blossom when I am home with a newborn, but what do I do about that now?

I'm just ready to move on.

Due...almost

2010-09-10T16:45:00.000-07:00

I was planning on working until my due date, which is in 10 days. But this past weekend things seemed to be moving undeniably toward labor (yes, on Labor Day weekend), and when I went back to work on Tuesday, I was miserable enough that I threw in the towel. My supervisor was extremely understanding and supportive, and I went on leave at 38 weeks exactly.

At first I felt terribly guilty about this. I've found that many women who worked during their pregnancies have told me similar things about it: you don't want to be waiting around at home, you don't want to spend any of your maternity leave pre-baby. There is a sort of pride about it, working until you deliver. But after a day of feeling like a weenie for dropping out of the race, I'm over it. My job involves 13 hour days, a lot of which are pushing stretchers with patients on them down long halls to and from operating rooms, bending over to do things on the OR floor like empty urine bags and pick up all the stuff I drop, and sitting in (or avoiding sitting in) incredibly uncomfortable chairs while monitoring my patients under anesthesia. There isn't much space up at the head of the bed for walking around and relieving back labor. Plus, having a patient on my last day who was "ruling out" for VRE (a particularly nasty multidrug resistant organism) reminded me that every patient in the hospital has the potential to pass along a bug I might not want my newborn daughter to get when I deliver her.

Plus, I don't mind having the time to get my head in a new space, and being able to do as much or as little activity as I see fit to do right now. Yesterday, I was walking around a lot and being more active, but today I just haven't been able to do much at all. I have great plans to do all this cooking for after the birth, go grocery shopping, write my shower thank-you cards...but I haven't been motivated today. This blog post is the most ambitous thing I've been able to do yet.

My profession has made me a little more educated about pregnancy and delivery than I used to be, and perhaps more so than the average person, but one thing I didn't really get before is how ambiguous labor signs can really be. Not just the fact that contractions can start and stop multiple times, but that you can be unsure if they are actually contractions. Or if what you are experiencing is 'progressing' or not. Or if your water has broken or not. If it's your first time, not only can you be unsure yourself, but there are a hundred other women to tell you their hundred different experiences, which doesn't add clarity. I want something more definitive, but I haven't gotten it. And being stuck in a moment in time, unable to see if an hour or three from now things will be more obvious (as I know they eventually become...usually), is terribly disorienting. I find myself losing perspective. For every woman who tells me knowingly, "Oh, you'll know," there is another whose experience was not knowing she was in labor for hours, or days.

Anyway, I'm ready to be done. I realize it may still be a few weeks, or it may be any day.

Getting There

2010-08-27T10:50:00.000-07:00

I am 36 weeks and 3 days along...only about 3 1/2 weeks to go, if you don't count the rumor that most pregnancies, on the average, ACTUALLY go 41 weeks before delivery. I choose to ignore that rumor.

I have had an uneventful pregnancy. I had morning sickness in the first trimester, reflux in the second which has extended up until now (and isn't going away yet), back pain now. Bladder troubles, which while totally normal, are SUPER annoying and embarrassing. (DON'T tell me to do more Kegals! They are NO MATCH for a hugely pregnant uterus, grr.) But nothing on that list has been unusual. Baby Lucy is totally healthy by all appearances, and kicks the living snot out of me constantly. (Rarely does this bother me.) Honestly, I can't complain about this pregnancy at all.

But, I'm officially ready for it to be over. As much as I wanted to get back to work...and I did, and I do enjoy my job...this week my back pain is just telling me that this is all foolish, what the hell am I doing still working?

I am entering the "one-day-at-a-time" phase. I can make it one. more. day.

Before, my thinking was that pregnancy discomfort would be the same whether I was at work or at home. But now, I just want to lie down and rest my back. Now, walking and pushing stretchers for 13 hours is too much.

I definitely need the salary, which ends once I go on leave, and I need the health benefits, which also end until I return from leave, so I at LEAST need to get into September. And I want as much of my maternity leave to be spent with the baby as possible. So I still go to work, at least next week. We'll see about the week after that...

But, now for the complaint-free part. The baby's room is finally done, and we are happy with it. The room has white siding on one wall and is painted taupe for the other walls...we are renting, and I hate to paint, so I just decided to leave it the way it was. Our crib, changing table, glider and armoire are all set up and filled with baby things. I made linens and curtains out of cute Amy Butler fabrics in pinks and oranges. And I'm having a small shower next weekend. I've ordered the car seat (baby can't come for a week, until we get it...). The bassinette is in our bedroom. The "stuff" part of being ready is pretty much completed. Of course, that's the LEAST of "being ready."

And since this is ostensibly a band blog, I can report that I have gained about 22 pounds for the whole pregnancy. I measure exactly on target for size. I'm sure I'll gain a little more, but I have room to do so, if I can eat enough. The truth is that my stomach doesn't hold much now, and that's true for most pregnant women at this point. As long as baby still looks healthy, my OB has no concerns. I am pretty sure that I would have gained much more without the band. Hopefully, between the band and nursing, it won't take too long to lose the baby weight after Lucy is here. I've stayed healthy otherwise too--BP is normal, no GD, nothing but the usual pregnancy complaints.

I hope to post some baby bump pics, and some pics of the nursery, but it's taken me this long to even blog, so I am not making any promises.

Alien

2010-07-25T18:20:00.001-07:00

First things first...does anyone know how to stop the Chinese spam from invading my comments? I moderate them, but it is getting really annoying.

Next up, I have started my new job, and even received my first paycheck (which was WAY smaller than I expected, btw, but still nice to get). Things are going well...I am off orientation tomorrow (gulp!) and swimming on my own. I am still not sure how 13 hour shifts will go for me as my pregnancy gets closer to completion. As it is, I use the restroom every hour, which has been feasible while I have been orienting (and thus had another provider to cover for me when I left for the restroom) but when I am on my own I will be at the mercy of someone else being available to watch my patient while I go. It's all part of the deal, of course, and will only last for another 8 weeks or so...

I do like the job a lot, and everyone I have worked with. People seem to enjoy working for the group, and enjoy each other. The OR atmosphere is much more respectful of everyone in it than where I trained. No one is allowed to have tantrums and unprofessional outbursts, which was more common than it should have been in Spokane. It makes things more collegial, more respectful, and frankly, safer. It will take a long time for me to meet everyone and for everyone to get to trust me. A really long time, since I will barely have established who I am when I go on leave. But that is also expected.

I can't really complain about the pregnancy. Everything I am experiencing is normal, the usual back pain and heartburn, the usual feeling huge and unwieldy, but it is a healthy, normal pregnancy, thank goodness. I have only gained 20 pounds to date, which is probably just fine but surprises me nonetheless. I'm sure I'd be looking at a lot more weight gain without the band!

One thing that has surprised me is how little I can eat now. I get hungry very quickly, but I get full way faster than I ever did prepregnancy, no matter how tight the band has ever been. I'll ask my OB at my next appointment if I ought to have more of an unfill, but I don't think what I am experiencing is unusual for any pregnant woman, band or not. I don't think an unfill would necessarily change it, but I'll ask. Nothing ever gets stuck or anything, I have nothing distinctly "band related" to point at. I just get full very quickly. I don't necessarily STAY full, but again I think that's pretty normal.

The baby moves all the time! I think it's funny that they advise women to do "kick counts" a couple times a day to make sure there isn't a decline in fetal movement. Lucy moves all the time. No need to count, and I can't keep track. I hear a lot of women talk about how their baby's head is here, or feet over there, or the baby is hiccuping, or doing different things. How do they know? I don't have a clue what's going on in there. I just know it feels like an alien moving around all the time. It's strange and interesting, but I can't tell what part is what or exactly what she's doing in there.

And finally, here's one thing that losing 70 pounds before getting pregnant did for me: I have been able to grow into my belly (my extra belly flab, that is) without any stretch marks. I know I can get them, because I got all kinds of stretch marks when I gained weight. But nothing new on my belly, and I still have a little skin left to go before it gets tight. Sweet! I may get out of this without any new stretch marks, which would be really cool.

If anyone is still reading out there, thanks...I know the updates have been infrequent, and perhaps not that interesting. But this is just how it is right now. There is a lot going on, and I don't have that much energy. I guess that probably won't get any better up until and after I deliver, so I'll just do my best to post something interesting when I can.

New adventures in the Rose City

2010-06-18T14:59:00.000-07:00

We are moved, but not really settled. We've been here about 3 weeks now. I'm about 85% unpacked. That last 15% is the really annoying part...stuff you haven't really found a place for, things put in their general area but not organized. It probably won't all be done before I go back to work in a couple weeks.

I've found with this move that my tolerance for the stress is lower, and my energy is a lot lower. I can only work for a couple hours before having to rest. My belly gets tight and sore, and I get very tired. I guess it goes with the territory, but as many times as I've moved before without these issues, it is a little frustrating. The move itself was the most stressful one I've ever done. Issues with movers, lots of stuff to move 400 miles, having to pay more money than we actually had, etc. At the end of 28 months of grad school, we are broke as a joke. It will nice to start getting a paycheck again.

Baby seems to be doing well...kicking a lot. I worried for so many weeks that I wasn't feeling movement when I thought I should be. Yes, I know it's my first baby, and I started out a little bit heavy, and like most women at this stage of pregnancy I have an anterior placenta still, so all of these things add up to not feeling much movement for a while. But she's moving and shaking now. It's startling to see my whole belly just move on its own every now and then. Fun, and yet alien in a way.

The day we moved to Portland, everyone in town informed us that it had been raining for about 2 months straight. People here have been going crazy with the lack of sunshine. We continued to have about 2 more weeks of straight rain, and we've only had a couple sunny days in between. I've lived in this before, and I will take it over having to shovel snow in the winter. But the sun is out today, which is lovely.

I went for a walk today (or should I say a waddle), to get outside and relieve some of the restlessness and boredom. I probably walked a couple miles, although I can't tell because my pedometer website is down. I'm showing enough now that people smile at me when they see me. People love to see pregnant women. I don't think most of them (perhaps even the ones who have been pregnant themselves) realize that the pregnant lady is often feeling rather bewildered by the whole state of things. At least, based on my own experience and my interactions with other expecting moms. It often feels like I've been abducted by aliens and returned, but just not quite the same as before. I feel looser and clumsier and slower, and of course bigger.

And it's amazing how 3 months can seem so far away, and yet so frighteningly near. It's not fear of childbirth, or having a newborn. It's feeling unprepared, in about every way possible. We aren't even close to ready to bring a baby home...no furniture, almost no stuff. No money. And that's just the material aspect of it. And I'm not startled by the idea of having a baby, but when I see a 5th grader, or a teenager, I realize I will have one of those, too...and that is very startling. Even thinking about potty training a toddler seems impossibly distant, or just impossible.

Most of all, I guess I'm lonely. My husband is mostly working from home, and working ridiculously long hours. I think I see less of him than if he worked full time for a company. I'm not working yet, so I don't see many people. I've reconnected with a few friends in the area, but not many. My supportive community I built up in Spokane is now far away. And pregnancy can be a lonely time, I am finding. While lots of other people have experienced it, it can still be an isolating experience, and very individual. I'm lucky that I've been healthy throughout it all, and my baby shows no signs of problems. But I'd like to see some people now!

Moving again

2010-05-27T16:35:00.001-07:00

So, I'm taking a breather from packing the house to blog about packing the house. I feel like I am becoming something of a pro at moving. I'm not thrilled about that, but it's true. And I've kind of got a system by now.

I didn't move at all as a kid. My parents decided they wanted us to stay in the same school district when we were growing up, so we were lucky that we didn't move when I was young. My parents moved into the house I grew up in a few months before I was born, when my dad was still in the Army, but he retired from active duty when I was about 3, and we stayed until my parents divorced about 16 years later. By then, I had started making up for lost time myself, as a young adult.

I moved a couple times before going to college, and 4 times while I was an undergrad. Nothing extraordinary for a young person starting out...we start out renting cheapo little apartments, our needs change, we want to live somewhere else or we get restless, or we have bad roommates. Whatever, you live and learn.

Once I got married and then later divorced, I decided I wanted to stay somewhere for a while, and I bought a condo. I lived there, in my condo in Seattle, for about 3 years before I decided I wanted to become a travel nurse. I packed most of my belongings in my best friend's garage, and started taking contracts around the country. I lived in about 6 different places, moving about every 6 months, and enjoyed it. Then I ended up in Portland, and met my future husband there.

I'm not sure why, but we've been moving ever since. Most of it was within Portland, a couple of the homes we had were actually second homes, times that he was working in a different city from where we lived, so we were actually renting two places. But by the time we had been together 1 year we had lived in 3 different places already (4 if you count the second place we got in Seattle when he worked up there). Now we are preparing to move to home #9 for us, in just 6 years together.

I think I might be a little crazy this way, but all this moving has made me a box hoarder. I never throw out my moving boxes until they are no longer usable. I stash them everywhere (this time we have had a great basement where I could flatten them all and put them under the basement stairs, but we had to be pretty creative at our last place). I write on the tape that I close the box with, so I can rip it off and re-label it the next time. If the box is actually written on itself (I always use a black Sharpie) then I just reuse it for the same thing next time.

Every time I have to move again, I see these little idiosyncracies that I've developed over the years of moving, and it makes me wonder if other people are this way. I know we aren't the only ones who move so often. It hasn't really been for any particular reason, and we aren't in the military (obviously), but just one thing or another. I sometimes wonder if we will ever just buy a home and settle down, but I don't know. Even when you buy a home, you rarely end up just staying in it forever. I mean, how do you know it's your last move? You don't.

So, I'm doing it again. It's tiring, but in some ways I like the organizing that packing and unpacking forces you to do. We've reduced our things about as much as we can at this point. Usually I use several weeks for packing, from the non-essentials to the last-minute things, but this time I had to force myself to keep studying, and trust that we could get it done in a week when I was done. It is the kind of lifestyle that my grandparents' generation couldn't really imagine, but it seems pretty common these days. Home is where you make it, I guess.

Milestones

2010-05-27T16:16:00.000-07:00

I graduated, yay! And then, I took my National Certifying Examination (boards) yesterday, and passed! Yay! So now I have completed all the requirements for licensure as a certified registered nurse anesthetist, and just have to wait for the state of Oregon to grant my license. And wait for credentialling at my hospital, which will hopefully happen in time for me to start work by July 5.

So, that's great. I had been studying for boards since January, but once I graduated on the 7th, all I had to do was study. I'm not the best at concentrating on dull material for hours on end, especially at the end of this long marathon of a program, and especially while pregnant, with that hormone-induced fog pregnancy can cause. I love anesthesia, but studying in that format was hard, and two and a half weeks of it nearly drove me mad. In addition, finding a good study spot was hard. I liked to study at the library, but I couldn't get comfortable there. I could only last a couple hours before my back or my butt started complaining too much and I would have to leave. So then I studied at home for the last week or so, which was much more comfortable, but our city has been tearing up the street we live on (a relatively busy one) for a month or so, and the noise right outside the window was at times unbelievable. I used earplugs, barricaded myself in the back of the house, but it still made it tough. I'm so glad that is over, and I don't have to do it again!

Now, my job for the next week is packing the house. More on that later. We move on June 3 to Portland.

Meanwhile, the baby is doing fine. At 23 weeks, I am finally feeling what I recognize to be kicking, which is kind of fun. I've chosen a bunch of beautiful Amy Butler fabrics to make a crib set out of, all in pinks and oranges, and am looking forward to unpacking the house, getting some baby furniture, and sewing that all up. We had another ultrasound this week because our little girl wouldn't move enough to see the cord insertion and all of her spine last time, so we got to peek at her again, and she seems to be doing great.

My only major complaint in the last few weeks has been the heartburn. It just gets worse as time goes on...I really don't think doing anything more with the band would help, as I can already eat quite a bit and I don't think there is any over-restriction issue by any means. It seems pretty clear that as the baby takes up more room, the heartburn gets worse. It doesn't matter what I put in my stomach. So I was on Pepcid for a while, then Prilosec...then both...all while taking lots of tums every day. Finally I called my OB and he put me on Protonix, which has helped a lot more, but doesn't last all day, so in the evenings it's still tums or an occasional Pepcid. Ugh. It's really a bummer.

But all in all, I would have to agree with everyone who says the 2nd trimester is a good time in pregnancy. Packing the house makes me more tired this time than when we did it 6 months ago, but that might have as much to do with everything that has already happened this month (graduating, studying and taking boards) as it does with being pregnant. I'll be in the 3rd by the time I start work, and I hope I am able to work until the end, but I can see how it could get hard.

Whew...

2010-05-04T15:45:00.000-07:00

I finished my coursework last week, and am graduating this Friday. Wow! There is so much to do, and so little time, it seems. I am trying to study as much as I can. My family will be coming in on Thursday for the Friday graduation banquet, which is also my hubby's birthday.

Then after that, a couple more weeks of studying, and hopefully I can schedule my board exam for right before Memorial Day, so I'll have about a week to pack up and move on June 1. We are moving back to Portland. I received 3 job offers, and accepted a position at my former hospital, which I am very excited about. It sounds like it is going to be a great opportunity in a great department. We just got back yesterday from Portland, after spending the weekend looking at houses and apartments. We chose a lovely place in Northeast Portland.

And! We just got back from our anatomy ultrasound. Baby looks healthy, although she wouldn't move enough to get a good look at the cord. Yes, it's a girl! My hubby couldn't believe it...his family rarely produces girls, he has two sons now, and he kept asking if the tech was sure it was a girl. But the images were pretty clear. I had a pretty strong feeling we were having a girl, but didn't want to be set on that, so it's nice to have the pictures and be able to pick a name and not think of the baby as "it" anymore.

So, things are moving along quite quickly...we are busy, but happy and feeling fortunate. I'm healthy, and so far the weight gain seems on track. I'm definitely feeling anxious about it, mainly about losing it afterward, but trying not to worry too much. The good thing is that I still have restriction even though I had fill removed around 10 weeks (or whenever that was). So I have no reason to think the band won't work for me after delivery. I'll just have to get used to eating the old way again...I've been satisfying my cravings through this pregnancy, although trying not to go overboard. I'm not in an "eating for two" mentality (I'm obviously getting enough calories for baby) but when I want something, I go ahead and have it. :)

I do feel lucky that I was banded before getting pregnant, because I think I would be eating way more without it. I've gained about 12 pounds at this point; who knows how much without the band?? With all the risks associated with excessive weight gain during pregnancy, especially for those of us on the "fluffy" side pre-pregnancy, I'm glad I have some help in keeping it in check.

So, I don't know how much blogging is going to happen in the next few months, but I will try to keep some updates coming as time goes along. And some pictures, at some point...

14 weeks

2010-03-24T12:55:00.001-07:00

Hmm, yeah....

I just haven't felt like there was much to post. Still pregnant. 14 weeks and 1 day, all testing fine so far, all systems go. I don't think I have another US until May, so it will be a while until I find out if we are having a boy or girl, unless I see my OB at work again and convince him to do a freebie US. :)

(I did see him last night when I worked 3-11. He was hanging out in L&D, waiting for a patient to get her epidural from a colleague of mine so that he could check her and see if he could deliver her baby. We chatted and watched the UNC-UAB game.)

I can report that my slight unfill to 2.5 cc was totally the right thing. I still have restriction, amazingly, and yet am more comfortable. According to my home scale, I've gained 6 pounds in the pregnancy, which I think is not bad. I do still have fairly regular heartburn, but I don't think that has anything to do with my band and don't think it would help even if it was totally unfilled. It's just pregnancy heartburn, it's mild and occasional, and it is what it is. 80% of pregnant women have heartburn. Mine happens sometimes after I eat. Tums helps.

In the meanwhile, I am still jobless and graduating in 44 days. My hospital doesn't know if they can offer me a job yet. I have one interview done elsewhere (Seattle) and don't know yet if they will tender me an offer. I have 2 more interviews in 2 weeks (Portland). I hope to know something soon, like, am I moving?? Can I work?? But, meanwhile I am just going to work and being patient.

Second trimester is much nicer than first, like everyone says. All my symptoms are better, I'm really not nauseated anymore, and I have more energy. I still get tired easily, and sometimes still take naps, but it's not nearly as bad as that first trimester fatigue. Ugh. I can even start studying again, which is nice.

So thanks everyone, for reading. I want to send a special shout-out to my blogger friend in Texas with her broken leg with her baby plans on hold--I feel good things are in store for you, I thank you for your support, and things will get better soon! And I hope this is the year. :)

Update

2010-03-01T18:30:00.000-08:00

Well, life has taken off, and I haven't blogged...I expect it will probably be like this for a while. Things are crazy busy now with school ending in just over 2 months (?!) and trying to find a job SOMEWHERE and having a baby...

I was finding myself eating a lot to quell the morning sickness, and then getting overfull and uncomfortable. Not barfing or PBing at all, but very uncomfortable. Then I was also having pretty frequent reflux, so I went back to the band doc for an unfill. I wasn't sure if they would insist on a complete unfill or if I could get away with just a partial.

As it turns out, the PA I saw actually didn't have any experience with pregnant bandsters. (Say what?) Being in the fairly secluded and specialized world of bariatric surgery, he didn't really have experience with pregnant women at all, and didn't understand why I would tend to have more reflux in only my first trimester. (Answer: increased hormones like relaxin start early in pregnancy, causing the lower esophageal sphincter to loosen and reflux as a result.) He didn't really see why I needed an unfill at all, and questioned whether I could keep my eating under control with no fill in my band. I answered: no! I can't! I'd prefer a small unfill please, just 1cc?

So I went from 3.5cc to 2.5cc. It has helped a great deal. I can eat, but I still have reasonably good satiety. The reflux is almost gone now, just the occasional Tums. And I have the morning sickness under better control (thank you B6, Unisom and Phenergan) so I don't have to keep eating all the time to keep that under control. I've gained about 6 pounds, more than I'd like at this point but still not terrible.

The pregnancy seems fine. I'm having a screening ultrasound in a couple weeks, and I'm going for all the testing, due to my "advanced maternal age". I want to be prepared for anything. There is a history of birth defects in a family member, so I want to know ahead of time if I should be prepared for something.

Someone asked in the comments if I have to tell potential employers that I am pregnant. That is a dicey question, and there's no easy answer to it. I am going to tell anyone that I interview with, at or before the interview. I think it's only fair, since I am looking at taking leave about 3 months after starting work, if all goes well. If they don't hire me because of it (which is technically illegal) then it's probably not a place I'd want to work anyway. I want them to know that I wish to start work as soon as possible, and I don't want any later problems of trying to figure out how to tell them.

Finding work with a pregnancy hanging over it all isn't easy and is a bit more stressful. But there is no perfect time to have a baby, and I'm just glad this is all going okay so far. Fingers are still crossed, though.

Thank you!

2010-02-05T19:03:00.000-08:00

Thank you so much for your outpouring of encouragement! It means so much, coming from my bloggy friends.

Here's my status: I am nauseated, exhausted, spacey, bloated, gassy, and have sore boobs. In other words, pregnant. Not barfing, at least. No heartburn. I'm keeping my fill for the time being. But I know it won't be forever. And I feel like I'm already gaining weight without control anyway. I've put on 5 pounds and am not "showing" except that between bloating and plain-old weight gain, I look more pregnant than I am. I had an early ultrasound last week that showed things are on track, and they moved my due date up to September 22. My first official appointment is in 2 weeks.

All this stuff with my body is screwing with my head. It's weird to try to be accepting of the changes happening, when I am so anxious that I'll never lose the weight again--even though I know that's probably not true. And there is so much going on right now, and trying to find a job while pregnant is a challenge, since I have to tell people that I'll be going on leave just a few months after I start.

But at the same time, it is exciting. And I know that anything can happen at this point, but so far things are looking good. With all the uncertainty and anxiety, it is still exciting to finally be expecting a child.

I'm considering whether I should have a separate pregnancy blog. I'd like to blog this stuff, but I can't imagine who would want to read another pregnancy-only blog, so maybe I'll just keep it here and keep it relevent to my experience as a banded preggo.

Thank you again, you guys are terrific. :)

Shifting Focus...

2010-01-25T09:48:00.001-08:00

Dear Blog,
I'm not avoiding you. I've just had a change of focus, and wasn't sure whether, or when, or how to address it on the blog. I'm not trying to lose weight right now. I'm pregnant.

I have been struggling with the "who to tell, when to tell" thing ever since I found out just over a week ago. On the one hand, with my first pregnancy at an "advanced maternal age", I am, naturally, at a somewhat increased risk for miscarriage. I don't want to have to tell dozens of people if that happens.

On the other hand, I had to tell the people I work with early, because I can't do certain kinds of cases anymore. (Very early pregnancy is an especially critical time for exposure to radiation and nitrous oxide.) And I have told my family, and a few close friends. But the blog? The blog, and my blog friends, are kind of different. Here I can talk about what I have been obsessing over ever since I found out. And if I am unfortunate and do lose this pregnancy, I can say it once and everyone here will know. Plus, someone might wonder why I'm not still trying to lose 15 pounds.

So, yes, I am excited and so is hubby. There is so much going on, trying to study for boards, finish school, and not barf in the middle of it all. I am hoping against hope that my nausea (which really just started a couple days ago) doesn't turn into vomiting, because I don't want to have to have the fill removed from my band. I know a lot of people do automatically. But because I have never had barfing or heartburn before, and because I can get plenty of calories the way I am (OBVIOUSLY, more than I need if not pregnant), I don't see why I can't let the band keep my weight gain to a reasonable amount. I am starting overweight, so if I can keep my weight gain to about 20-25 pounds I'd be happy. I doubt I can do that with an unfilled band, though. But if I have any barfing or reflux, I will have the band unfilled. And my OB may insist, when I see him in March, that I have it unfilled before the end of the first tri anyway, while they still can. We'll see.

In the midst of the exhaustion, the soreness, and the nausea, I am sharing my "secret" with the internet. I am so scatterbrained right now, I'm really having a hard time focusing on school at all. If all goes well, I am due Sept 26.

Article: If Obesity is unhealthy, then why are the cures for it just as bad? (Double X Blog)

2010-01-11T12:00:00.001-08:00

A lot of this is stuff we already know, but I'm glad someone in the media is questioning the safety and sanity of shows like The Biggest loser.
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(Original article: Double X)

One of the major arguments of the growing fat acceptance movement is that fear-mongering about "health" functions more as a tool to bash fat people than as a genuine expression of desire for a healthier populace. You couldn't ask for a better argument for that point of view than this article in the New York Times about the dangers posed to contestants on the reality show The Biggest Loser, though the very name of the show has always suggested to me that it's more about mocking fat people than promoting healthy lifestyles. Contestants from the show are claiming that the rapid-fire weight loss encouraged on the program led them to dehydrate themselves, some to the point where they were urinating blood. These concerns are coming after a recent episode had contestants rushed to the hospital for heat stroke.

But as the article points out, even contestants that didn't try to cheat the system by dropping water weight were still putting their bodies in grave danger by losing so much weight so quickly. You're not really supposed to aim to drop more than two pounds a week on a responsible weight loss program, because doing more than that can cause heart problems and electrolyte imbalances that could cause a heart attack. Yet The Biggest Loser is far from the only cultural product that promotes the idea that rapidly turning fat people into thin people is a legitimate strategy for "health." That message blares at us from a variety of tabloid coves, weight-loss advertisements, TV shows, and puff pieces fawning over fat celebrities that dropped half their body weight in a short amount of time due to gastric bypass surgery. Why is it not enough for fat people to lose weight? Why does it have to be so much so quickly?

Part of it is a numbers game. Look at the numbers given in this Times article: Contestants lost 118 pounds, 112 pounds, 122 pounds. At the recommended weight-loss rates, that means most of them would have taken more than a year to accomplish their goals. But searching around the Internet, it seems that the show tapes for only 10 to 12 weeks. Committing yourself to a year or many years of weight loss can seem like an overwhelming goal, especially since the emphasis in the world of weight loss is self-deprivation and pain, as if you're punishing yourself for getting fat. But most people would like to believe they could give a couple months over to the misery of dieting and exercise, as long as they see a light at the end of the tunnel.

The emphasis on rapid weight loss goes a long way to explaining why diets don't work. The demands of dieting are unsustainable, and people who diet spend all their time thinking about how they're going to reward themselves with all the forbidden foods when they finally cross the line. It goes straight back up to an American inability to conceive of moderation. Extreme dieting rests next to virginity pledges or teetotalism, or from the left, Buy Nothing Day or throwing out your television set. When looking for alternatives to excess, we latch onto abstinence. But abstinence pledges defeat us, and we don't just fall off the wagon, but fling ourselves off it. Indulgence/punishment rituals satisfy our need for drama, but they don't do much for our health or well-being.

Amanda Marcotte recently moved from her home state of Texas to Brooklyn, NY. She blogs at pandagon.net and rhrealitycheck.org.

Edited: Food Addiction (full text)

2010-01-11T10:08:00.000-08:00

I added the full text of Sparkly Jules' superb post on food addiction to my blog post below. Sometimes it's easier not to click on links in blog posts, I get that. But I really wanted to share her awesome post here. Check out her blog too, it's great. :)

More Thoughts on Food, Company, and Impermanence

2010-01-11T09:24:00.000-08:00

This morning I'm re-reading the post about Ebert's food memories, and wondering what it is I think is so familiar about his thoughts. He writes about missing the socialization of eating more than the actual food experience. I think that is a common experience for WLS'ers. I had read a little bit about other newly post-ops who felt awkward going out to eat with other people, especially people they didn't want to disclose their WLS to, but I didn't realize what an issue it might be until I had surgery myself.

I wrote about restaurant dining in this blog when I was just a few weeks post-op. At the time that I had surgery (nearly 3 years ago, for those who are keeping track) my hubby and I were frequent restaurant diners. We had many favorites around Portland: Nicholas', a Lebonese restaurant; Hubers, the oldest restaurant in Portland, where we loved the mussels (cheap and delish); and of course our very favorite, Saburo's, which serves "Godzilla" sushi in a very casual, almost cafeteria setting, doesn't take reservations, and where the patrons start lining up 45 minutes before it opens, every day of the week. Then there was breakfast, my favorite meal. We loved the J&M Cafe, Zell's, Sanborn's, the Cup & Saucer, and Lorne & Dottie's (before they stopped weekend service). We love breakfast so much that we had a brunch wedding reception. Our friends fawned over the bacon, and insisted that if I ever wanted to start eating meat again, this was the time, and this was the bacon.

But after surgery, I had to follow the post-op diet, which involved liquids for 2 weeks, then pureed soft foods for another 2 weeks. It took a while to get used to it, what was allowed, and by the time I'd been post-op for a month, I would get hungry fairly quickly after a meal of pureed tuna or pureed broccoli. I felt the need to be near home, to deal with the rapid onset of hunger. I got full quickly, but then got hungry quickly too. My body had been living on 1000 calories or less per day for a month by then, and it was certainly a shock physiologically.

I felt somewhat exiled from society because of this, because my meals became solitary, artificial things. There weren't really communal meal times, because the meals were small and frequent. I had to stay close to home. And what I was now eating was very different from what I had been eating for years. Meanwhile, my hubby had lost his dining-out partner. He loved going to all those great places too. He asked me several times if I wanted to go to this or that place for dinner, even when I was still on liquids. At the time I was astonished by the insensitivity of this. But in time, I realized that he probably hadn't anticipated having to make this kind of sacrifice himself just because I decided to have WLS. And I didn't seem so different, once I had mostly healed from surgery.

Once I was eating a regular Lap-band diet, I still had a hard time with dining out for quite a while. I felt guilty eating restaurant food, where I often had a hard time finding something that conformed well enough to my new diet. I never had to deal with the worst thing that many bandsters dread more than any other aspect of public dining, which is the consequences of eating one bite too many or too big or too solid. I never had a slime, PB, or barfing episode, in public or in private. But this is one of the biggest fears for many people who have had this surgery, to have this happen in public, especially when dining with people who don't know about your surgery.

The loss of socialization is a rather unexpected loss. When you want to catch up with a friend you haven't seen in a long time, what do you do? Usually set up a lunch or dinner date. There are expectations when dining out with others. All parties present eat, for one thing, and they drink something. We often count on one another to validate our menu choices, too: if your friend orders fried chicken, and you order bean soup, there is a loss of balance, and at minimum the friend will question your choice. "Is that enough food? Are you okay? Gee, I'm really pigging out, huh?" I can't imagine how that must be complicated for Ebert, who not only can't even eat the bean soup, but can't speak either. There is a great unspoken loss at that table, which I'm sure he feels at least as greatly as those he "dines" with.

The parallels between the WLS experience and Ebert's experience end somewhere around this point. Over time, I was able to start dining out again comfortably, and now no one eating with me would ever realize that I had WLS. (Exhibit A: 18-pound regain.) I can talk and socialize over a meal with ease. My loss was temporary, and for that I am grateful. Realizing this makes me sad for those like Ebert who have to adjust permanently, and yet filled with more wonder and appreciation that he has as much insight and grace as he does about the new circumstances of his life. Buddhists call this "impermanence", and as humans, we tend to resist this idea. Nothing in life is permanent, and you never know what might be lost from one moment to the next. Far from being something sad, this idea helps us to celebrate what we have right now, and frees us to enjoy our life more.

In light of this idea, my coffee doesn't taste better, but the fact that I can sit here in my kitchen, write this blog and enjoy my coffee is something to appreciate. And while I am continually disappointed in myself that I have regained weight, there is a lot to be grateful for: that it has only been 18 pounds, despite everything that has happened in my life in the last year; that WLS was available to me, and I chose it when I did, and did lose 70 pounds; that I am still healthy, and still have the ability to choose healthier ways to live; that I am alive, and aware of the choices I can make for myself.

By Request: Nil By Mouth by Roger Ebert

2010-01-10T18:20:00.000-08:00

My hubby suggested that I post this blog entry by Roger Ebert. As you may or may not know, he has struggled with cancer, and its after-effects, for many years. He had thyroid cancer, which was successfully treated, and then salivary cancer, which I believe was also sucessfully treated. However, the effects of the radiation treatment weakened the tissues of his head and neck, and he has struggled with numerous health problems as a result, and now is unable to talk or eat. This post is a beautiful ode to comfort foods, and the comfort of food. He also explains how it is that he can still have the enjoyment of his memories of food, although unable to eat.

I've always felt a kind of six-degrees-of-separation closeness to Ebert, because I grew up with my mother telling me about going to the same high school as him (Urbana HS, in Urbana, Illinois). He ran track and was the editor of the school paper. I remember his pictures in her yearbooks, looking exactly like Ebert (same glasses even) except skinny. It's hard not to like him anyway; unlike so many critics (movie or otherwise), he always has approached his work not as a writer or some kind of cinema purist, but as a fan of movies. He just loves movies, and he writes beautifully about the things we love about movies. I've always appreciated that about him, and felt that it made him unique among his peers.

It's clear Ebert won't be around forever, or even all that much longer in all likelihood. But he writes prolifically in the Sun-Times blog, and at rogerebert (dot) com.

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Nil by Mouth (Roger Ebert)

I mentioned that I can no longer eat or drink. A reader wrote: "That sounds so sad. Do you miss it?" Not so much really. Not anymore. Understand that I was never told that after surgery I might lose the ability to eat, drink and speak. Eating and drinking were not mentioned, and it was said that after surgery I might actually be able to go back to work on television.

Success in such surgery is not unheard of. It didn't happen that way. The second surgery was also intended to restore my speaking ability. It seemed to hold together for awhile, but then, in surgeon-speak, also "fell apart."

A third surgery was attempted, using a different approach. It seemed to work, and in a mirror I saw myself looking familiar again. But after a little more than a week, that surgery failed, too. Blood vessels intended to attach the transplanted tissue lost function, probably because they had been weakened by radiation. A fourth surgery has been proposed, but I flatly reject the idea. To paraphrase a line from "Adaptation's" orchid collector: "Done with surgery."
During that whole period I was Nil by Mouth. Nobody said as much in so many words, but it gradually became clear that it wouldn't ever be right again. There wasn't some soul-dropping moment for that realization. It just...developed. I never felt hungry, I never felt thirsty, I wasn't angry because the doctors had done their best. But I went through a period of obsession about food and drink. I came up with the crazy idea of getting some Coke through my g-tube. My doctors said, sure, a little, why not? For once the sugar and a little sodium wouldn't hurt. I even got some tea, and a little coffee, before deciding that caffeine addiction was something I didn't need.

I dreamed. I was reading Cormac McCarthy's Suttree, and there's a passage where the hero, lazing on his river boat on a hot summer day, pulls up a string from the water with a bottle of orange soda attached to it and drinks. I tasted that pop so clearly I can taste it today. Later he's served a beer in a frosted mug. I don't drink beer, but the frosted mug evoked for me a long-buried memory of my father and I driving in his old Plymouth to the A&W Root Beer stand (gravel driveways, carhop service, window trays) and his voice saying "...and a five-cent beer for the boy." The smoke from his Lucky Strike in the car. The heavy summer heat.
For nights I would wake up already focused on that small but heavy glass mug with the ice sliding from it, and the first sip of root beer. I took that sip over and over. The ice slid down across my fingers again and again. But never again.

One day in the hospital my brother-in-law Johnny Hammel and his wife Eunice came to visit. They are two of my favorite people. They're Jehovah's Witnesses, and know I'm not. I mention that because they interpreted my story in terms of their faith. I described my fantasies about root beer. I could smell it, taste it, feel it. I desired it. I said I'd remembered so clearly that day with my father for the first time in 60 years.

"You never thought about it before?" Johnny asked.

"Not once."

"Could be, when the Lord took away your drinking, he gave you back that memory."
Whether my higher power was the Lord or Cormac McCarthy, those were the words I needed to hear. And from that time I began to replace what I had lost with what I remembered. If I think I want an orange soda right now, it is after all only a desire. People have those all the time. For that matter, when I had the chance, when was the last time I held one of those tall Nehi glass bottles? I doubt I ever had one from a can.

I've found memories now come welling up almost alarmingly. It's all still in there, every bit. I saw "Leap Year," with its scenes in Dublin, and recognized the street where I stayed in the Shelbourne Hotel, even though the hotel wasn't shown. That started me on Trinity College nearby, where I remembered that McHugh and I saw the Book of Kells in its glass case. And then I remembered us walking out the back gate of Trinity and finding a pub where we were to join two of his brothers. And meeting Kitty Kelly sitting inside the pub, who became famous in our stories as the only whore in Dublin with her own coach.

"Are you two students?" McHugh's younger brother Eugene asked them innocently.

"I'm a working girl meself," the first said.

"Her name is Kitty Kelly," her friend volunteered. "I'm her coach."

I walked into that movie with the Book of Kells and Kitty Kelly's coach and Eugene McHugh far from my mind. The story itself had long since fallen from our repertoire. But it's all in there.
When it comes to food, I don't have a gourmet's memory. I remember the kinds of foods I was raised to love. Chaz and I stayed once at Les Pres d'Eugenie, the inn of the famous Michel Guerard in Eugénie-les-Bains. We had certainly the best meal I have ever been served. I remember that, the room, the people at the other tables and our view in the photo, but I can no longer remember what I ate. It isn't hard-wired into my memory.

Yet I could if I wanted to right now close my eyes and re-experience an entire meal at Steak 'n Shake, bite by bite in proper sequence, because I always ordered the same items and ate them according to the same ritual. It is there for me.

Another surprising area for sharp memory is the taste and texture of cheap candy. Not imported chocolates, but Red Hots, Good and Plenty, Milk Duds, Paydays, Chuckles. I dreamed I got a box of Chuckles with five licorice squares, and in my dream I exalted: "Finally!" With Necco wafers, there again, the licorice were the best. The peculiar off-purple wafers were space-wasters. As a general rule in candy, if anything is black, red or green, in that order, I like it.

This got carried so far one day I found myself googling White Hen-style candy with the mad idea of writing an entire blog entry on the subject. During visits to a Cracker Barrel I would buy paper bags filled with licorice, root beer, horehound and cinnamon drops. Searching for Black Jack gum, I found whole web sites devoted licorice in its many forms. I even discovered and downloaded a photo of a basket that seemed assembled from my memory, and it is below.

But the last thing I want to start here is a discussion of such age old-old practices of pouring Kool-Aid into a bottle of RC Cola to turn it into a weapon. Let me return to the original question: Isn't it sad to be unable eat or drink? Not as sad as you might imagine. I save an enormous amount of time. I have control of my weight. Everything agrees with me. And so on.

What I miss is the society. Lunch and dinner are the two occasions when we most easily meet with friends and family. They're the first way we experience places far from home. Where we sit to regard the passing parade. How we learn indirectly of other cultures. When we feel good together. Meals are when we get a lot of our talking done -- probably most of our recreational talking. That's what I miss. Because I can't speak that's's another turn of the blade. I can sit at a table and vicariously enjoy the conversation, which is why I enjoy pals like my friend McHugh so much, because he rarely notices if anyone else isn't speaking. But to attend a "business dinner" is a species of torture. I'm no good at business anyway, but at least if I'm being bad at it at Joe's Stone Crab there are consolations.

When we drive around town I never look at a trendy new restaurant and wish I could eat there. I peer into little storefront places, diners, ethnic places, and then I feel envy. After a movie we'll drive past a formica restaurant with only two tables occupied, and I'll wish I could be at one of them, having ordered something familiar and and reading a book. I never felt alone in a situation like that. I was a soloist.

When I moved north to Lincoln Park and the Dudak's's house, Glenna Syse, the Sun-Times drama critic, told me about Frances Deli on Clark Street. "They make you eat your vegetables," she told me. There were maybe a dozen tables inside, and you selected from the day's dishes like roast chicken, lamb stew, lake perch and, yes, the veggies, although one of them was rice pudding. You want roast chicken, here's your roast chicken. It was so simple it almost made you grin. You didn't even have to ask for the bed of dressing on which it slumbered.

Frances has moved into a bigger space across the street but nothing much else has changed. Nobody will look at you funny if you bring in the Sunday paper and spread it out. And breakfast? Talk about the breakfast. If a place doesn't advertise "Breakfast, Lunch and Dinner" and serve tuna melts, right away you figure they're covering up for something.

There's a place called the Old-Timer's Restaurant across the street from the Lake Street screening room in Chicago. I love that place. No fuss, no muss, friendly, the owner stands behind the cash register and chats with everybody going in and out. I've ordered breakfast at lunch time there. "You're still serving breakfast? I asked. "Hey, an egg's an egg."

I came across this sentence in its web review, and it perfectly describes the kind of place I like: "A Greek-style chow joint replete with '70s wood paneling, periwinkle padded booths, a chatty wait staff and the warble of regulars at the bar. Basically, if you've ever had it at any place that starts with Grandma's, Uncle's or any sort of Greek place name, you can find it here." Yes. If a restaurant doesn't serve tuna melts, right away you have to make allowances.

So that's what's sad about not eating. The loss of dining, not the loss of food. It may be personal, but for, unless I'm alone, it doesn't involve dinner if it doesn't involve talking. The food and drink I can do without easily. The jokes, gossip, laughs, arguments and shared memories I miss. Sentences beginning with the words, "Remember that time?" I ran in crowds where anyone was likely to break out in a poetry recitation at any time. Me too. But not me anymore. So yes, it's sad. Maybe that's why I enjoy this blog. You don't realize it, but we're at dinner right now.

Food Addiction

2010-01-10T18:01:00.000-08:00

How timely that as I've been thinking more and more about food addiction and its role in my life, I came across this great post by Sparkly Jules. She has a great way of getting across the pervasiveness of food addiction in one's thoughts...check it out.

I went for a run today, and again was shocked that my running felt so sluggish and slow. When I went to enter my 2.8 miles into my running log, I looked back on all the runs I have recorded. I always record my weight as well. It appears that I am the heaviest I have been since I started running almost 2 years ago. So, the sluggishness isn't all in my head.

Everything is just so. much. right now. I'm studying for boards, going to 12 step meetings, trying to figure out my marriage and maybe even improve it, going to therapy, finishing my thesis, and working full time. (Giving free anesthesia...not free for the patients, but I don't get paid.) I'm looking for a job now, one that WILL pay me, when I am done with this and have some credentials. It's been a long 2 years. I understand in my head that everything I have been attempting to do since I have been in school is a lot, and a weight gain is not a surprising affect of trying to do too much and living in too much stress. But knowing this in my head doesn't make the reality easier. I still feel tremendous pressure to lose the weight, and still do all the other things I have been doing all along.

And yet, before I can even become conscious of a surge in stress or unpleasant emotions, before I even notice the emotions, I am eating something that will give my brain a boost of endorphins and glucose, something carb-y, sugar-y, whatever. I've already eaten it before I notice what happened. This is an example of neuroplasticity; a response becomes automated in the brain, and the neural pathways that produce this response become larger and more reinforced. It is exactly what happens to addicts, when they find themselves drinking or using again despite their desire not to, and find themselves doing it before they are conscious of having done it.

The idea that we can overcome these kinds of impulses through sheer willpower seems laughable at times, and indeed research has shown that this is a large part of why diets don't work. Our brain chemistry is smarter than we are. Yet, in learning about addiction I also learn that while we are powerless over addiction (our own or another person's), we are not powerless over our behavior in response to that addiction.

So, I'm working it. I'd like to get my butt into some individual therapy to try to get a handle on the food issues. That's about 3 years too late, but it's not like I can't start now. But then again it feels like yet another thing to add to my already overflowing plate. It's a good idea, if I can make it happen.

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ETA: Here is the text of Jules' post, because sometimes it's just too much to click another link. I really love this post. Be sure to read more of Sparkly Jules' blog if you have time. It's varied and experiential, and well-written, and alternately funny and hopeful and poignant.

What is Food Addiction Like?

I will attempt (donuts) to try and explain what it feels like (waffles) to be a food addict (pancakes). I had a therapist once (danish) who said he'd had it explained to him by previous (cookie) patients that it was (donuts) in some ways sexual in nature. That first bite of (donuts) of food, whatever it might be, was very orgasmic. I told him (waffles) that I agreed; it was, in many ways, a very (pie) sexual experience, one that I felt throughout my (cake) body.

I am as addicted to food (donuts) in the same way that an alcoholic (banana bread) is addicted to alcohol, and a drug addict (ice cream) is addicted to a drug. I have a paternal aunt (pudding) who has been to drug rehab five times over the last (muffins) fifteen years, and she's still not (sourdough bread) sober. Her addiction has a much more unfortunate outcome--she is unable to maintain jobs, (pizelle), relationships, and any sort of stability (cheese won tons) in her life while she is using or drinking. In fact, I've cut off all contact with her until she quits.

As a food addict, the side effects are two-fold: 1. obvious obesity 2. (donuts) poor health, although obesity does not always equal poor health, over time, it will, in one way (chocolate) or the other.

As for exercise, I would love to exercise. I always (cookies) feel better after I do it (toast with jam). In 1979 I broke a vertebrate (pizza) in my back and it has never been the same. I was sixteen. It hurts in varying degrees (cheese) nearly every day. Since I have had the Swine Flu (ham), it's been even worse. I'm not sure what the correlation is there, but that's when the (pie) pain got worse.

I took myself over to the local indoor mall New Year's Eve. I needed some (cinnamon rolls) pantyhose, and there is a Lane Giant there (waffles). Guess what? They no longer carry pantyhose. Although I''m (croissants) glad to hear that because I've always hated pantyhose, I did want a pair for NYE (baguette). So I walked that mall, and my back hurt so badly, that about every 10 minutes I had to sit down to take the pressure off of it so I could keep going (caramel corn).

Add into the (tortillas) mix my bad left knee, which I fell on 12/30/04 and never really had it seriously looked at aside from an (Trader Joe's Gorgonzola Crackers) x-ray. It ain't right, tho, I kin tell ya that. Of course, I could never convince any of my (pie) doctors that it was an injury and not weight related. (Brie.)

I also have diabetic neuropathy in my feet. It was so bad in the fall of 2005, my first semester back in college, that by the time I had (cannoli) walked across campus and then several blocks to the car, I was crying, no, sobbing. Burning, stabbing, shooting pains. I take medication for it that keeps it to a dull (tiramisu) roar, now. That and keeping my BG level. (ha ha ha!)

So, just for a moment, (strawberry shortcake) imagine that you are me. You're carrying 150 extra pounds (a whole person!), you have a bad back that has been exacerbated in some way (donuts) recently, a bad knee and bad (donuts) feet. How motivated are you, really, to get up
off of your duff?

Remember the Schick Center for weight loss and alcoholism (cream puffs)? They used aversion therapy. My GF attended for weight loss. Every time you take a bite of (cupcake) something, they shock you. With booze, they made you drink and drink and drink until you vomited your brains out (donuts).

So when I think about exercising, I think about pain, because I know I'll have it and that's just getting out of (Danish) the chair. So I am averse to exercise due to the constant pain. And yes, it is a vicious (waffles) cycle. Many people who have WLS (weight loss surgery) do not start exercising (donuts) until they have lost a significant amount of (pie) simply due to pain.
I say this not as an excuse, but as an explanation. If I decide to exercise, I have to force myself to do it, even while doing it. I have to stop and (Linzer torte) rest a lot due to back or knee pain. Oh, and then there's the asthma. I need to be careful not to set that off, too.

So you see (pancakes), it just sucks to be me.

Seriously. I'm a food addict. The only person who gets hurt is me. That does not make it any easier, nor does acknowledging that I am a food (pie) addict. (Cinnabon) it's like trying to wean yourself off of crack or meth: it's nearly impossible. And then your body (Danish) works against you by changing up your metabolism (cookies) when you do "diet": 97% of all diets fail with dieters gaining back more weight than they lost. That is a scientific fact.
It's a terrible, horrible, sad place to be. I wouldn't choose this for anyone.
(Donuts).

Addictive personalities also don't change once they discard a harmful (pie) addictive behavior. I've known many recovering alcoholics or drug addicts who replace their substance of choice with coffee, cigarettes, candy or food, or all of the above (donuts). The addictive behavior just moves to a new place. I've seen post-WLS people suddenly become alcoholics, or compulsive shoppers or sex-addicts. It's a b*tch and a half, and I wouldn't wish it on anyone (donuts).
So I hope I've made myself clear (as Jell-O) with the insertions of food items, noticeably carbs. That's what my day is like. Food is constantly (peanut butter cookies) popping into my brain. A visual or auditory trigger can produce thoughts of food as can certain situations, and emotional (donuts) reactions, such as extreme stress or sadness (cake). It's like this for me, every d*mn day (chips).

I'm doing the best that I can here (bearclaw) with what I've got. I'm only human (napoleon).
And I have an ultra-sound scheduled for next Monday to see if there's an alien or something growing in my right side (potato salad).

Thanks for letting me share.

;-D

It's Mental

2009-12-30T11:54:00.000-08:00

This morning, I am:

knitting a blanket
sitting at my (old) new kitchen table
looking out at 1.5 inches of snowfall (the perfect amount)
drinking coffee
listening to an old This American Life podcast

This is what vacation looks like for me. It's not bad. It's a bit lonely--I don't see many people during my vacation, but I don't try very hard either. But it's restful, and I am doing some things that I won't be able to do much of for the next 6 months, once studying for boards begins in earnest. I've done a bit of reading, but not as much as I wanted--I ordered about 5 books in anticipation of all this vacation time, but didn't read very much of it.

The kitchen table I finally got yesterday off Craigslist. We have a breakfast nook in our new house, with windows on two sides and a built-in china cupboard. It's right in the entrance from our back door, which is our usual entrance to the house, so I wanted a table big enough to spread my anesthesia books out on to study, but not so big that it would block this entrance. My hubby was really against putting a table in this space, but I really wanted it. I just did. I wanted to be able to sit here with coffee and my books, I wanted to be able to make breakfast and not eat it in the dining room, I wanted to be able to sit and chat with hubby when he was cooking. So I finally found a table that met my requirements. It's not the greatest table but it's not the worst, the price was right and so was the size. And we're both happy with it. I'm really enjoying being able to sit in this spot with some natural light, drink my coffee and have my quiet morning.

We didn't have a white Christmas, which we usually seem to in this part of the state, but we got a little snow last night. Not enough to create any real problems, just enough to look nice. We are supposed to get more this week, but I don't think we are expecting huge amounts. I'm preferring this milder winter to the past two years of major dumpage. For the record, I really don't care for snow. I grew up in an area that rarely got snow, and when it did it was never more than 1". I don't like cold weather or snow. But now I live in Spokane, so snow it is. I'm dealing with it.

I've lost 3 pounds, yippee. Mainly I have been running every other day (even though I usually feel like I am dragging an ox behind me when I do), and not snacking. I am back to "only eat when you are hungry" aka the 3-year-old diet. I realized that I had gotten to the point that I was used to feeling full all the time. My restriction is fine, but I've always been able to eat even after I feel full (with no PB or barfing) and I'm sure this is stretching my stomach. I'm trying to reverse this trend now and actually use my band the way it's supposed to be used. The thing is, I've gained a net of about 5 pounds this year: I started the year at 177, lost to 165 (mainly through stress), then slowly gained to 183. That doesn't seem like too much in the grand scheme of things. But if things continue this way, I will regain back up to my previous weight--it will take time, probably years, but it will happen if I don't do something about my intake. The point of the band is to stop hunger so you can eat less, but I'm not hungry ever, and I'm still eating. That is madness.

So, I had cottage cheese for breakfast, and coffee. I'm not going to be draconian about this. I'm just planning to use the band. Eat a small meal when I am hungry, stop when I am full. Try to get my target amount of protein each day. If I'm not hungry but still feel like eating, I either chew gum or drink water. Pretty simple. Add in exercise, and hopefully get results. If I do this and feel like I'm getting hungry too soon, first I'll evaluate my meals to see if they are suitable to keep me satisfied, then if that doesn't work, go in for a fill.

This is all mental work. The band is a simple device, and it does one simple thing: it makes you feel satisfied after a small amount of food, and keeps you feeling that way for 3-4 hours. It doesn't have any effect on emotional triggers for eating, the desire to have one of those cookies sitting right in front of me, the choice of meal I make when eating out, how well I can resist my hubby offering me food when he is eating and I'm not hungry, my ability to get myself outside to run, or how I see myself in the mirror. All of those other things still matter, and they still have to be addressed. The longer this journey lasts, the harder this gets.

So, nearly 3 years out, there is less and less to write about this "journey." It's not as interesting as losing weight every week as in the first 18 months (your mileage may vary). But this is where that annoying phrase about WLS being only "a tool" comes into play. There are a lot of ways to fail at this, and just assuming that the band will do all the work seems to be the biggest factor in most of them.

Baby, It's Cold Outside

2009-12-12T14:57:00.000-08:00

I'm a rather solitary person by nature. I think it was why I was able to work night shift for 7 years. When I was single, it was easy to stay on my night schedule and do the solitary activities I love, like sewing, beadwork, reading, etc. When I met my husband I was still working nights and I worked them for 2 more years before making the switch back to days. It's much harder working nights when you live with a dayshift person.

All of this is to say that it is in my nature to spend time alone, although I love having a partner now and spending time together. When I get the opportunity to spend time alone, however, it is nice. As happens to most people who get married, that precious alone time becomes less and less frequent.

My husband's brother is in Portland this weekend from New York. I would have liked to see him, but I didn't have it in me to make the 700-plus mile round trip this weekend. It's been a long exhausting year, and so we aren't even planning to travel for Christmas this year, which is rare. I really needed a weekend to do nothing--no school or studying, no traveling long distances. So hubby is in Portland visiting his dear brother, and I am sure they are having a great time together. I would like to be there, but as it happens I have some alone time this weekend instead. It's been a very long time since I have had that.

I've done a lot today already: went to the sale at Joann's Fabric to get a new pair of sewing shears, got things to make a holiday wreath, and then made it and hung it, and now I've just gotten back from a run. This evening I plan on sewing and organizing the basement, and then maybe watching a movie and knitting. I'm not doing one bit of studying!

The running is going slow--I wasn't able to get out there during the week for various reasons. I'm still averaging less than 5 miles a week so far. But running in the cold is better than I anticipated, since I hate being cold. I found today that although my lungs want me to stop, I keep running longer because my legs start to get cold when I walk. Bonus!

I saw something really cool when I ran around the little park by our house. It has a pond, and people were ice skating there. I've never lived somewhere that you could actually ice skate on a pond! It looked like the cover of a Currier & Ives catalog. (Remember those?) Most of the people were preparing for an ice hockey game, but a few people were out there figure skating. It's not a very big pond, but the weather is perfect for it: it's been very cold, single digits at night with highs in the 20s during the day, and so it's been too cold to snow, and there isn't much on the ice to sweep away first. I'm not a cold-weather gal, but I loved seeing people out there skating on a pond. It made it feel very small-town, which happens a lot in Spokane actually.

I hope everyone's Christmas preparations are coming along well. Ours are pretty much done. Normally we go to my brother's house for the holidays, but his wife just gave birth to my first niece this week. As much as I would love to see them, and meet little Kiera, they are very busy with the new baby, and we are too tired to try braving the snowy mountain pass this year. So we are having some friends over for dinner and games and movies on Christmas evening. I'm really looking forward to it. We'll go see my family after the holidays when the mountain driving is a little less stressful.

Return to Form

2009-12-07T14:48:00.000-08:00

I took a running break. I intended it to be just a few weeks but it ended up being about 6 weeks. I needed the break mentally more than anything else. Like anything else, if you run for a couple years (21 months) without a significant break, you'll get bored and lazy. At least, I will.

The break did me some good, although I have gained about 5 pounds more. In that interim, we have moved, and had a lot of other stress as well. Thanksgiving came and went. Last week I knew it was time to get out there again: actually, I was so stressed out I didn't feel I had much choice but to go move my legs and exhaust my lungs and think about anything but my life for a while. Today's run was better than last week, and I almost didn't notice that it was 15 degrees outside. The sun was shining and it was lovely. My legs want to do a lot more than my lungs are capable of right now, but hopefully we'll be back in sync soon.

Since we've "fallen back" to standard time since then, it gets dark by 4:30 now, so I decided to invest in a good headlight, as one less reason not to run in the winter. Our neighborhood doesn't have many streetlights, and it's an old neighborhood with sidewalks interrupted by old tree roots. It's treacherous without light. The headlight was a resounding success on my first night-time run--I was amazed at how much I was able to see with just a $25 headlamp.

Now I have some serious weight loss to concern myself with--in late January I was at my lowest weight of 165, and today am back to 181, after staying right around 175 for most of this year. This is significantly higher than I want to be, but despite the holidays being upon us, I think I can tackle this at least somewhat. I'm hoping we don't get tons of snow this year, so I can either run outside or get to the gym without too much trouble.

It was good to take a break, but I'm glad to be back. Weight loss will be a bonus--I need the stress relief and the endorphins. And I intend to take Bloomsday again next spring! It's the weekend before I graduate, but hopefully I won't have so much on my plate that I can't do it.

A Deep Breath

2009-11-19T15:07:00.001-08:00

Sorry for the long time without posting...we are coming up for air now. It's been a crazy week.

We moved last weekend. After 2 weeks of packing, the move was pulled off in one long day with two hired movers. I had a little last-minute mild freak-out because we didn't get moved before the first snow, but the snow we got (the day before the move) was minimal and we didn't get the frozen slick roads on moving day that I feared.

Moving day was more stressful and longer than anticipated, but we got it all done in one day. Yes, some things were broken by one of the movers (an inexperienced, strong guy without much sense of where things he holds extend into space). But it went fairly well, all things considered. It surprised me how much stuff we had managed to pack into our little apartment; easily enough to fill this 1800 square foot house we have moved into.

But! We love the house, so so much. We are renting, because we aren't in a position to buy and because I don't know if we will be able to stay in Spokane when I graduate in less than 6 months. If I get a job here, we'll extend our lease, and we may even have the opportunity to buy this house down the road.

We moved on Saturday, and on Sunday my hubby cleaned the old apartment while I unpacked at the house. He enjoys cleaning and I enjoy packing and unpacking, so it was a pretty good trade-off. The apartment looked GREAT when he was done with it. We should get our deposit back (we might have some knocked off because that mover crashed into a corner and knocked off a big chunk of plaster with a box, but we told the landlords and they may not charge us). I do like the organizing part of moving, but there is definitely a reason that we had not planned on moving again until after I finished school. It's so hard to do homework and study when most of my home is still in boxes. My mind has a hard time focusing when I feel like so much is in disarray.

The other big excitement is that my hubby started a new job on Monday. Yes, we moved AND he started a new job all within 3 days. He's been looking for work for several months now, so this is pretty exciting. Unemployment is hard, especially with both of us unemployed. But I think the time was important for rest and recovery, so while I think he wishes he had found a job a long time ago, I am proud of all the hard work he has done in the interim. It's been stressful, but overall it's been a good thing.

I have no idea how my weight is doing; my scale is still in a box. I usually weigh myself every morning so it's weird to go several days without doing so. There's been no exercise either, since every spare moment has been spent either packing or unpacking. I hope to get back into a healthier routine once we are more settled.

I must say, it is so wonderful to be in our own place and out of our apartment building. The tension with the sociopathic neighbor was so thick, it made being there miserable. He enjoyed doing things like parking just so I couldn't get into my parking space, or playing loud music at 7:30am, stuff like that. I'm way too old to be dealing with crap like that anymore. We spent many months trying to diplomatically handle the situation, first ourselves (mainly hubby) and then through the landlord. Finally, when it was time to resign the lease, and the landlords were starting to look at the option of evicting the neighbor (they preferred to keep us over him), we realized that would be a very long process, and it was the perfect time for us to just get out, before it started to snow so much that no one could move for a few months. So that's what we did. It was a disappointing end to a good relationship with a great landlord, but definitely the right thing for us to do.

So, my mind is full of things related to nesting and unpacking, but I'm pleased to say we are here and we are happy. Happy Thanksgiving to everyone!

Good luck moving up, cause I'm moving out...

2009-11-04T10:46:00.000-08:00

It's been busy around here. My hubby and I live in an apartment that is the main floor of an old house. We've been having trouble with neighbors. Specifically, our upstairs neighbors have been acting unneighborly. We've been working with them and with our landlord for a few months now, but finally it became apparant that nothing was going to change. I can't study in our home because of the noise, and I am uncomfortable around the hostility and passive-aggressive behavior.

We were about to resign our lease (we've been here 2 years) when we realized that, hey, we can move.

I didn't want to move before I finished school, but suddenly it seemed the best solution. Our landlord toyed with the idea of evicting the upstairs neighbors so that we would stay, but eviction takes time. They wouldn't move voluntarily. And the winter is fast approaching; in about a month, it will probably be unsafe (or actually impossible) to move due to snow. We want to live somewhere where we don't share walls with neighbors anymore (maybe it's more me than hubby). So we decided to move into a house.

The decision came quickly, and the move as well: we are moving in about 12 days. It's not easy to get ready to move while in the thick of the semester, working and going to school. But it's the right thing to do. So it's been very busy here. But, the house we are moving to is just a few blocks away, and it's beautiful. Really, a steal for the amount of rent they are charging us. I can't wait to be out of here and into our new home. We have had great landlords here, and we're sad to be suddenly leaving, but it just doesn't make sense to deal with an untenable situation if we don't have to.

Between moving, working, wrapping up my research project, and studying, I haven't been running in a couple of weeks. And this week I've lost 2 pounds. Go figure. I'm thinking of going for a run today, but we'll see. I'm not stressing about it right now, which is nice, for once.

Guest Blogger: Hubby

2009-10-22T14:06:00.000-07:00

It was an unusually humid evening at Isla Mujeres, Mexico. Isla is a bean-shaped island just off the coast of the Yucatán peninsula, home of Cancun at its most north-eastern tip. My new bride and I were taking a walk, and she casually mentioned to me that she was seriously considering weight-loss surgery of one type or another. She was upset that she was obese, and felt that a surgical procedure could aid her toward the weight and health that she sought fit. I was taken aback.

My initial reaction was a form of confusion. Here was my new bride, my wife, a trained and intellectually-keen medical professional, who was going to “cop out” of hard work including exercise and a calorically-restricted menu? I married my wife knowing that she in fact was indeed overweight, and I never lost the sight of the fact that her weight was more of an issue for her than it was for me. I loved her more than anyone I had ever known, and it seemed odd to me that she was feeling as if I would not accept her given her weight.

That was my own issue, in fact. My wife had never gained a substantial amount of weight in our nascent relationship of a couple of years, and I knew that I was no muscular BMI-perfect “hottie” either. I honestly felt that through a joint regimen of active exercise and healthy diet, that we would both be able to achieve our individual weight loss goals. From my perspective, I knew that I would be able to gain or lose at least twenty pounds or more over a given calendar month, and so I assumed that Gwen would be able to do so also.

My wife later confided in me that in fact she had always battled weight gain in her lifetime, and in fact had even battled bulimia and forms of anorexia. Her mom had provided her morbid templates of unhealthy eating and living, and basically forced her to condition herself to purge her extra calories. Gwen had never been able to sustain a “reasonable” weight level, and her weight had fluctuated considerably since her junior high school days. A decade prior to our marriage, she had a substantial breast reduction, going from an obscene cup size down to a DD or D cup, reflecting about a 2/3 breast weight reduction. Weight and self-image had always been the bane of her existence, and even though she had found someone like myself who honestly loved her despite her obesity, it was still a salient and often daily concern of hers.

I honestly did not know what to think after our vacation. I only wanted the very best for my new wife, but I never really considered surgery for her as an option. Nevertheless, she looked into the surgical options, and came to a determination that a lap-band surgery would be her best choice. She discussed it with me, informing me of the pros and cons of the decision. To me it made sense, knowing that it was a fairly non-invasive approach, and the fact that it was reversible made me feel better. In the Spring of 2007, she underwent WLS surgery to have a lap-band in place. Over the next year, her weight loss was fairly dramatic, as is often the case with those who underwent said surgery. As of today, in late 2009, she has lost all of the predicted pounds she was supposed to have, which amounts to over sixty pounds. She is able to run several miles, and is in the best shape, weight, and health of her life. She is also still a knockout by any measure.

One of the considerations that I have dealt with in this journey is that I wanted to be sure that I did not look at her weight loss results as culminating in a “hot wife” or “thinner, sexier, mate”. However, I would be lying if I were. I was anxious to see what the net effect of the weight loss and healthier regimen would have on her overall physical appearance as well as inner demeanor. When I say “inner demeanor”, I meant her internal “thermostat” as to how she honestly perceives her weight, health, and overall appearance. To date, I know for a fact that she feels better about who she is and how she appears. I also know that my wife feels better about herself in general. A large part of this has to do with the fact that her WLS surgery is only the beginning. She needs to still take care of herself and monitor her nutrition and maintain her weight via exercise and proper association of folks that are similarly congruent in her path of wellness. At this juncture, it can honestly be said that my wife’s lap band is more of a secondary preventative measure, and her attitude toward proper nutrition and exercise, not to mention healthy habits in general, is her first level of defense against obesity and an overall unhealthful lifestyle.

Vanity is always a part of weight loss, whether we consciously acknowledge it or not. In my case, I honestly just wanted my wife to be able to attain a healthy weight and thus a healthy self-image concerning her body and appearance. However, I still have to smile when I think about how Gwen has transformed into a not just an even more gorgeous woman, but one that is dedicated toward a healthier lifestyle in general, regardless of her weight or appearance. This has rubbed off on me as well.

Approximately three months after the lap band surgery, we came across some of our wedding photos that we had hanging in our home on the wall. She remarked how “fat” she looked, with her flabby arms and chubby face. Looking at her at that moment when she said that, I suddenly realized that I could no longer reconcile who I saw when looking at my wife, and who I saw in the pictures of the bride during our wedding day. To be perfectly honest, I never really ever viewed her, in the wedding pictures especially, as “fat” or “obese”. But now, given my wife in front of me, they honestly looked like two very different persons. And yet, I knew that I absolutely loved my wife with all of my heart and intention before and after I married her, regardless of her appearance. The fact that she took her health and appearance so seriously after our marriage only extended the depths of my appreciation and love for her.

In short, weight loss surgery is not just a physical transformation, it is also a personal and inter-relationship transformation. Our western society tells us that we should look and act in a certain way, and when we don’t, an enormous amount of inadequacy and shortcomings tend to plague our personal judgment and self-perception. Many spouses of those who undergo WLS surgery of one type or another are usually eager to see the end result of the effort, which basically amounts to a physical change and appreciation thereof. In my experience, weight loss surgery is only the first step toward a true life transformation, and only seeing the physical results of this effort is seriously short-changing what the reality is. The reality is that it is a life transformation that has much to do with the inner person and their own impression of who they really are, and subsequently a physical transformation that becomes congruent with their inner self-image. I am often reminded of those who undergo sex-change (transgender) operations, and the fact that they must complete and pass a psychological process and examination prior to their physical surgery. In the realm of weight loss surgery, the emotional and psychological change prior and during and especially after the actual surgical procedure is every bit as important as the physical change.

My wife and I often look back at our wedding pictures, and it serves as an important benchmark as to how far she has come regarding her appearance. What is not so evident upon visual observation is how that woman in the wedding dress is in fact not just a thinner, slimmer, sexier, healthier woman…she is also a more integrated and balanced woman. Appearance is over-valued in our culture, but nonetheless it still stands a yardstick as far as how we subjectively determine who is “fat” and who is “not fat”. The fat bias is strong and prevalent, and much of it is unfortunately due to two factors: 1.) the general public’s ignorance as far as body types and healthy physiognomy, and 2.) the inability to perceive ethnic and genetic normalizations and tendencies toward one’s overall appearance and weight. My wife, Gwen, has always felt that she was a much thinner person trapped inside an obese body, and she has since rectified that. Fortunately, she has also come to terms with her overall baseline of health, weight, and appearance and thus can be properly attenuated toward such an ideal. Ironically, as her husband, I have much more work to fulfill toward both of those outcomes, and am thankful that my wife, heavy or not, obese or not, fat or not, chubby or not, has set a wonderfully balanced example for me.

I am so very proud of my wife, in her journey toward a healthier self-realization. It was not just a matter of WLS surgery, but also of hard work, character adjustment, and a fundamental appreciation for who she is as a human being apart from her weight or appearance. I love my wife, and even more so because of not just the work she was willing to do, but her pragmatic understanding that those who are in her life and perceive her as someone important in their lives must look past her physical presence and perceive her far more holistically. WLS surgery did not give her sudden physical acceptance. Her attitude adjustment and constant work in all aspects of her existence is what provides her that, and in turn helps her to know that her physicality and appearance is only a small subset of who she truly is.

(Gwen adds: This photo was taken when we returned from our honeymoon, at a friend's wedding. It was these photos, plus our wedding photos, that convinced me to proceed with WLS. I was appalled at how overweight I had become.)

This photo was taken April 2009 on Capitol Hill in Washington, D.C. Total weight loss 69 pounds.

Back again

2009-10-22T13:45:00.000-07:00

It has been some time since I was last able to blog. School is back in full swing, and the stress is somewhat different at this stage of the process, but very palpable. I hit a wall of sorts about 2 weeks ago, when I felt I just couldn't do this for one more moment. Of course, I have to...there are 6 months left before graduation. So, like high school seniors around March, we continue to go through the motions and do what we have to do.

Our days are now mostly clinicals, which I mostly enjoy. 4 days a week we are in the operating room for 8 to 10 hours. In our training, we also happen to generate a lot of billing for the anesthesiologists, but we are not paid because it is part of our training. (This could be an entire blog post itself, but this blog isn't about anesthesia politics, so I'll spare you all.) On Thursdays, we have classes and no clinicals. In our off hours, we study for our classes, start studying for boards next spring, prepare for the next day's cases, and work on our research projects, most of which are wrapping up this semester. Then we have our real lives on top of that. Most of my classmates are parents, all but one are married, and we have the same complicating factors in our lives as everyone else does. It will be nice when we are graduated, have taken boards, and can start earning money for our work again. Mostly due to my school loans, we will be around $100K in debt by the time I graduate.

On the weight front, I haven't made my follow up appointment with Dr P yet, partly because I haven't remembered to do it when they are open, partly because I don't have my November schedule yet, and partly because I want to have more success to show before that happens. It's been a good fill most days. Some days, I'm still super hungry. Other days, I'm not hungry at all. I have had two days of mild heartburn in the past 3 weeks, which is something I am monitoring. If it becomes any more of a problem, I'll have to see the doc about it. Right now I'm about 4 pounds down since my fill. Meh.

I'll be posting a guest blogger post from my husband in just a little bit. He generously offered to write a guest post on WLS from the spouse's perspective. I think when I was spending time on the lap band boards, I heard a bit about marriages ending in divorce after WLS, but not much on the experience of spouses. I hope you enjoy his post.

The Lessons of the Band: 3 1/2 years later

2009-10-09T12:56:00.000-07:00

The Click samples have gone out, and hopefully all the winners have received them by now. I was surprised by how hard it was to mail them. We used to have a post office outlet about 3 blocks from our house, but it has closed. We had to pick up a package at the postal hub last weekend, so we thought I could mail the packages from there...but no, the postal hub doesn't accept outgoing packages! WTH?? I finally found a post office that was open at reasonable hours, but it was surprisingly difficult in the age of Google. Anyway, I am glad that they have gone out, and hopefully others like the stuff as much as I do.

I am happy to report that my latest fill seems to be a good one, and seems to be staying put. If I follow my own rules and don't eat unless I am actually physically hungry, I can eat very reasonable portions (small end of normal) and stay satisfied for a long time. And I've lost about 4 pounds. But it still definitely requires me to be mindful of what and when I eat. I have impulses to eat for reasons other than hunger several times a day, and I have to consciously stop and determine if I am physically hungry and if there is something else that would satisfy me more, like doing something fun, talking to someone, or just getting out of the house. In other words, the band still isn't magic, even though I am at probably the best level of "restriction" I've had in 2 years.

I haven't had anything get stuck, or had any reflux, vomiting, or sliming. In other words, still none of the most common problems that people with the band complain of. I still haven't found a food that I physically can't eat because of the band. Some people like to use those things to help with their behavior modification. I can't really speak to that, because I've never experienced it. What I can speak to is my own experience, and that is that at the end of the day, most of this is the same mental work and energy that I experienced when trying to lose weight without the band. Only now I'm not physically hungry, which is exactly what the band is supposed to accomplish.

I knew in my brain that like a lot of other people, I ate for reasons other than hunger. But until my surgery, I didn't really get how significant that was, and you know what? I don't know that I ever would have, without surgery. I used to have a terrible hunger, and I was scared of feeling it. I was terrified that I would be suddenly hungry in a place where I couldn't eat, so I would eat "pre-emptively." Hunger truly was a significant factor in my difficulty losing weight and maintaining weight loss.

But it definitely wasn't all of the battle, or even close. I can see that now, as every evening I come home from a stressful day in the OR and start scavanging for something to eat. If I can get myself to stop and evaluate, usually I find that I'm not hungry, just looking for stress relief or comfort. Sometimes I am actually hungry, and in that case, I go ahead and eat something, but try to make it some sort of protein. If I don't stop and do a self-check first, I can often find myself in the midst of eating quite a bit of food (for a bandster) before I realize what I'm doing. And sometimes, not infrequently, I am conscious of the fact that I crave something specific--usually sweet--without being the least bit hungry. Sometimes I can talk myself out of it or distract myself. Other times, if I've tried for a long time but am still obsessed with it, I will just have it--a small portion--and be done with it. At least then it is a conscious decision, not soothing an impulse.

I hope to get to goal, but even if I get back to where I was at the beginning of the year (11 more pounds) and without the incredible stress that brought me to that point, I will be happy. It is certainly a lot easier to keep my eye on my goal when my hunger is tamped down with a good fill. And it's good to know that even after being "off the wagon" for several months, I can get back to a good fill level and lose again.

Inspiration: Featured Blogger

2009-10-09T10:29:00.001-07:00

About 7 years ago (really?!?! it doesn't seem so long ago...) I was living in southern New Mexico as a travelling RN, on a contract. I'd had an interest in beads and beadwork for many, many years, and had always wanted to learn how to make beads. I was doing new things (I had just moved from my home of over a decade, Seattle, to start travelling) and decided to look up a bead artist I had become interested in when I lived in Seattle, Kim Miles. She had moved from Seattle to Taos, New Mexico some years before, and according to her website, she taught beadmaking out of her home studio on a 1-on-1 basis. I emailed her, and before I knew it, I was at her home studio, learning the basic craft of beadmaking from one of the best. And I was lucky, too: not too long after that, she decided to devote herself entirely to her art, and stopped teaching, so I think I was probably one of her last students. Making beads was an art I loved developing (until I started anesthesia school and no longer had time, unfortunately), and it was made possible because of the skills, and more importantly the passion and art, instilled and inspired by Kim.

I've followed her from afar since then, and bought some of her amazing beads (through her online store). She had a blog about her life in Taos, which if you haven't ever been there, is one of the most beautiful places I've ever been to in America. Then, gradually, she and her lovely husband Rick decided that they didn't so much want to be tied to their house in Taos anymore. They started to get wanderlust, the kids were grown and out of the house, and the open road called to them. So this year, Kim and Rick bought a trailer, fixed it up into a little home-away-from-home, rented out their Taos home, and hit the road. She's even got a mini bead studio in the trailer, so she can work whenever or wherever inspiration hits. Their plan: to visit any place their heart drew them to, and find a spot to lay some roots down. Isn't that fabulous?

In a way I have done this, when I started travelling in 2002. But I was single, no kids, and it wasn't too hard to sell my condo, pack the cats into my Jetta, and follow the jobs. Travelling that way is certainly a life-changing experience. But I love the idea of doing it with your mate, after raising kids, having a few businesses, and doing a lot of the other stuff you had wanted to do with your life. Their pictures mostly show them having a grand old time with each other or with friends and family they visit along the way, but I'm sure there's a lot of hard work too, in negotiating how to travel for so long in such close quarters with your spouse. Most marriages might not be able to tolerate it. But then again, maybe more could than we think, if they learn to take themselves less seriously and have fun with it, like Kim and Rick seem to.

Their adventures are an inspiration to me, that you really can find a way to follow your dream, no matter how unconventional others may find it. They look like they are having the time of their lives. Check out Kim's blog if you are interested in their adventures: Taking The Long Way Home.

Strange week

2009-10-01T17:52:00.000-07:00

So, I intended to mail the Click packages last week. We even went to the post office on Saturday. Only, the post office we went to actually doesn't mail packages. You can only pick them up there. Who knew? The post office by my house closed last month, so now I don't know where to mail packages. I will send them out as soon as possible, I promise.

I was hoping to find another place to do it this week, but it's been a weird week. As long-time readers of this blog know, I am in graduate school for nurse anesthesia, and it is a small program, only 8 students admitted each year. One student in the class behind me (class of 2011) has several younger siblings, and her high school-age brother suffered a devastating head injury last weekend. He was a patient in our hospital until he was declared brain dead earlier this week, and became an organ donor. Such a small program is pretty close; we become a sort of school family to each other, and get to know each other's spouses, kids, etc. I don't know her family, and I didn't know her brother, but I know her, and it has been a sad and emotional week for everyone. It's hard to know what to do or say when something so devastating happens.

It's been tough to get back in the swing of the school year. I think my classmates are all feeling that the end is near for us. We graduate in 7 months. We have just 2 semesters left, including this one. It's tough to get up the enthusiasm and energy for one more big push towards the final goal. I come home from clinicals most days just totally exhausted. Eating has been a challenge; I do fine all day but in the evening all hell breaks loose. I have to force myself to exercise. Everything is just an effort. It has been a long haul, both school and weight loss, and it's harder to be enthusiastic at this point.

One bit of good news is that the fill is good. I definitely notice a difference in my satiety. Hopefully it will start to pay off soon at the scale.

Off to find a post office, perhaps things will get mailed tomorrow? Sparkly Jules, expect an email from me soon.

Contest update, and fill update

2009-09-25T09:25:00.001-07:00

Click contest:
I have heard from 2 of the contest winners. I am still waiting to hear from KernieC, and if SparklyJules wants to be a winner, I have stuff for you too. The other two should receive their Click stuff sometime next week.

My update:
I saw my surgeon yesterday, Dr P. I haven't seen him in over a year, since I've been seeing the PA. But the PA changed his office hours, so he's not there anymore on the only day of the week I can definitely make appointments, Thursdays. I saw Dr. P, and was shocked that he remembered me, that my band was done elsewhere, and that I was an anesthesia grad student. He still reminds me of the actor Philip C. Hoffman. We talked for a while about what's going on with my band, I updated him on the empty band-refill situation, and let him know that my weight has been stable for the most part since then. He asked if I wanted a fill, and I was honest about where I am. The fill level I have provides good restriction most of the time. It could possibly help me more if I had a little more fill, but I thought the majority of the problem was mental. This made him laugh; he said he's never heard a patient tell him that, usually it's him telling the patient. But it doesn't really help me not to look at my situation honestly. I've had 30-plus years to develop my eating habits and mental craziness around food. I know that I eat when I am no longer hungry, even now. That is by far the hardest thing to overcome.

But still, I have never been overfilled, have had extremely rare heartburn, no vomiting or "PB's", ever. We decided to go ahead with a small fill. He accessed the band, found I actually had 3.1 instead of 3.0 cc, and gave me another 0.5cc (which is actually a pretty big fill at this point) to a total of 3.6cc in a 4cc band. He told me to come back in a month to 6 weeks for follow-up.

This time, instead of following my old "liquids-only" instructions after a fill, I ate a small dinner. My husband made a curried mahi-mahi risotto and I had about 3/4 c. of that and was full. What are other surgeons saying about diet after fills these days? It seems like the old recommendation to have only liquids for 24 hours has gone away now, but I don't really know. Neither my surgeon nor the PA have ever given specific instructions for eating after a fill. In Portland, they started out saying liquids for 24 hours after a fill, then went to "take it easy", whatever that means. I'm wondering: is this no longer the general recommendation? Either way, it wasn't a problem. The fill seems pretty good. I just have to stop eating way earlier than I usually want to.

There's no getting around it. I like to eat. It's not easy to stop after a small amount when the food tastes good and I feel like eating it, even if I am "satisfied" or even "full." I used to be able to do it, when I was an early post-op and jazzed about the whole weight-loss thing (and still getting the positive reinforcement of constant weight loss). Now it's been close to 3 years, and that motivation has waned, and I don't see much weight loss anymore. I do hope to see some weight loss now, but it's going to be much more dependent on my mindset than on my restriction.

That's Why I Can't Eat Ice Cream....

2009-09-15T19:05:00.000-07:00

Whoa. What we always suspected...

Ice cream really can control your brain
Certain fat molecules suppress appetite-control signals, study finds
(source:Reuters, via MSNBC.com)

Before you flip open that tub of Ben and Jerry's, be aware that ice cream really can control your brain and say "eat me."

A U.S. study by UT Southwestern Medical Center at Dallas has found that fat from certain foods such ice cream and burgers heads to the brain.

Once there, the fat molecules trigger the brain to send messages to the body's cells, warning them to ignore the appetite-suppressing signals from leptin and insulin, hormones involved in weight regulation — for up to three days.

"Normally, our body is primed to say when we've had enough, but that doesn't always happen when we're eating something good," said researcher Deborah Clegg in a statement.

"What we've shown in this study is that someone's entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets "hit" with the fatty acids, and you become resistant to insulin and leptin.

"Since you're not being told by the brain to stop eating, you overeat."

The researchers also found that one particular type of fat — palmitic acid which is found in beef, butter, cheese and milk, is particularly effective at instigating this mechanism.

The study was performed on rats and mice but the scientists say their results, published in The Journal of Clinical Investigation, reinforced common dietary recommendations to limit saturated fat intake as "it causes you to eat more."

The study was conducted by exposing rats and mice to fat in different ways — by injecting various types of fat directly into the brain, infusing fat through the carotid artery or feeding the animals through a stomach tube three times a day.

The animals received the same amount of calories and fat and only the type of fat differed. The types included palmitic acid, monounsaturated fatty acid and unsaturated oleic acid which is found in olive and grapeseed oils.

"The action was very specific to palmitic acid, which is very high in foods that are rich in saturated-fat," said Clegg.

The Real Cause of Obesity (Newsweek)

2009-09-14T10:28:00.000-07:00

Newsweek is running a web-exclusive series called The Fat Wars: America's Weight Rage. There are lots of great articles in it. I thought this one was particularly relevent: The Real Cause of Obesity.

I'm so tired of the moralizing about obesity, the blaming, the shaming. We should take responsibility for the things that are within our control, and that means doing what we can to control our weight. But we should also acknowledge that there are things about our weight that are not so much in our control. There is a genetic predisposition to obesity in many people, and eating the modern American diet (in the modern American way: big portions, big calories) will unveil this tendency towards obesity in most of us. Also, when we lose weight (a lot of weight), our metabolisms adjust to help us hold onto whatever calories we ingest. Same goes for exercise: studies have repeatedly shown that our bodies respond to increased activity by increasing intake. Usually our exercise only burns a few hundred calories at a time, and it's very easy to ingest a few hundred more calories without noticing. This is why just exercise doesn't cause weight loss in most people.

The fat wars are becoming more public as talk of health care reform intensifies. The press and the public are identifying the biggest health care costs and arguing over how to address them in a system where potentially the taxpayers will be (overtly) bearing more of the direct costs, and obesity is one of those areas. There is a lot of finger-pointing going on. But WE know that obesity is not a moral failing. It isn't a sign of laziness or stupidity. The solution ISN'T "take the fork out of your mouth." Wouldn't it be great if, as a society, we could actually address the real causes and conditions of obesity as a society, in a holistic way, rather than pointing fingers and shaming? What if we could devote more research to things other than the magic weight-loss pill (that will make some company billions of dollars, even if it causes other health problems, a la Fen-Phen), and identify real ways to prevent and treat obesity long-term? What if we actually stopped publically supporting the corporations that profit from our food addictions and susceptibility to marketing and subtle ways of getting consumers to eat more high-calorie junk? What if we altered the way we work and live to make room for a healthier lifestyle as a society?

But no, instead we spend our energy complaining that the new surgeon general, Regina Benjamin, recipient of the MacArthur Genius award and champion of rural primary health care, is not qualified for the position because she is obese. Never mind that she is a real representation of the real problem that most Americans face: healthy lifestyle, extremely busy professional and personal life, trying to get a handle on weight. By all accounts she is active and healthy, but obese. Hey, that sounds familiar! Perhaps she could actually be an example for Americans? Is that possible?

Anyway, I found the article to be interesting and refreshing. Enjoy.

Contest Winners

2009-09-14T10:03:00.001-07:00

The contest ended on Saturday, but I was out of town, rafting the Tieton River with friends. It was lots of fun, and renewed my jones for getting outdoors more and doing more stuff--hiking, camping. I want to learn how to river kayak, and living in eastern Washington, there are lots of rivers around here great for rafting and kayaking. So...stuff to look forward to next summer.

There are 4 contest winners: KernieC, Jo, and HillHilly, plus Sparkly_Jules, who asked not to be entered in the contest but officially has another chance here. You don't have to have had WLS (or be in the process) to be in the contest, so if you want to try this stuff out, I'm happy to send it to wherever you are.

So, contest winners, send me either your email address OR your mailing address in a comment on this post. I will not publish the comment or your personal information (I moderate the comments here), just use it to send you your goodies.

Thanks for your entries. It was really fun to read your stories on here, and fun to check out the blogs that were linked to some of the profiles. (SparklyJules, it's been a long time since I read yours...love it!)

I know some others have sent me links to your blogs in the past...some I have checked out, some I forgot to check but wanted to. Anyone have a blog you want people to know about? I think it's time to update my blogroll, so if you want yours linked here, send me the url in a comment and I'll publish it (AND read it, promise) here.

Sharing The Love

2009-09-05T09:31:00.001-07:00

CLICK came through and sent me a box of goodies yesterday. Lots of goodies! So it's only right to share them with my readers. I got a bunch of single-serving packets that are easy to send to you guys. I've been thinking about how to do this, and here's how I think it will go: I will send 5 people 3 packets of Click. (I could send more people fewer, but I'm still a poor graduate student, and shipping isn't cheap.)

So, let's call it a contest. It's a simple one. I want to know a little bit about my readers. What led you to WLS? It doesn't matter if you have already had surgery, lap band or another surgery, or if you are just researching it. Just a little something about what brought you here. Leave me a comment with your story (not too long, I don't even know what the word limit is for comments on Blogger). I will choose 5 of them and post here on the blog who they are. The winners will need to comment back with your email address or mailing address--I moderate the comments here, so I promise not to publish your personal information on the blog, I will only use it to mail you your prize, and will then delete it. Promise!

I'll leave this contest open for one week. Deadline is September 12, 2009. Have fun with this! And thank you to CLICK for making this contest possible. I think you are gonna love this stuff. It's yummy and has protein and vitamins and gives you energy, what's not to love?

Beginners: Are there foods I can't have?

2009-09-02T10:17:00.001-07:00

@aminorharmony asked a few weeks back about foods you can't have after lap band surgery. She is having surgery soon (congrats!) and I was planning on addressing that a while back but didn't get around to it. So, here goes.

When I was pre-op, my doctor and nutritionist went over what foods I should eat, and what foods I shouldn't eat. There wasn't a "can't" in there. They told me that a lot of bandsters can't tolerate certain foods--breads are a common one, foods that are rubbery like eggs are a problem for some, foods that are fibrous like asparagus, celary, or pineapple are another. Basically they told me that it will be trial and error, and you'll know if it's something you shouldn't eat again. Bread is probably the most common problem food, and some people can eat one kind of bread product and not another, others can't have any bread-type food at all, not even tortillas or flatbread. Which is fine, because bread isn't the most nutritious thing you could be eating anyway. Grains are important, but you can get your whole grains in other ways and skip all the carbs in bread.

Personally, I have never found a food that my band wouldn't let me eat. I've never been super tightly filled, either--I think the most I have had is 3.5cc in my 4cc band, and I've never once had reflux or had any food come back up. The tighter the band is adjusted, the more problems you are likely to have with foods that form a gummy ball or aren't chewed well enough. Some people use this to their advantage. The band helps them modify their behavior by not letting them eat certain foods, like bread. But I would offer a caveat to this--the band will never prevent you from eating the real "junk" like ice cream, candy, or most other sweets. Unless you are overfilled, if you can get water down, you can get sweets down. This is one reason that people can be overfilled and still gain weight. They like having their band so tight that it prevents overeating, but they subconsciously alter their diet to include only "soft" foods that go down easily, and just trickle through the banded stomach. This is known as "eating around the band". So, if your band is so tight that you can't eat a good band meal--4-6 oz. solid protein, then a small amount of veggies--but you compensate by eating ice cream and processed junk foods all day, you can take in a lot of calories and get no nutrition. If the tight band causes you to vomit every time you try to eat solid food, or have a lot of acid reflux, you can risk a band slip, as well.

I hope that your nutritionist went over how you should be eating once you are banded, and I hope you've started eating that way before surgery so you know what to do, and can start changing your habits now. A good band meal consists of SOLID food. You should be eating about 1/2 to 1 cup total per meal, and it should consist of solid protein (chicken or meat, fish, etc.) followed by veggies, and if you aren't full/satisfied yet you can have a little starchy food like potatoes. You should not drink while eating, because this can wash food through the banded stomach and cause you to eat more. Your meal should keep you satisfied for 3-4 hours. All of this is once you are past the post-op diet and have had a few fills so that you are starting to experience what bandsters call "restriction".

Refill update

2009-09-02T09:39:00.001-07:00

Well, here it is, September already. I miss you, August. Please come back soon.

Yesterday I returned to my band people to check out the status of my refill 2 weeks ago. It seems that my (new) band surgeon has turned over all things band-related to his PA, Brian. Which is fine with me. Brian is the band guy at NW Surgical Bariatrics. That's cool. I get that surgeons like doing surgery, not long-term management afterward. I know, I know, but really. There's a reason that bariatric surgeons often recommend gastric bypass when the band would work just fine--they didn't go to med school and do a surgical residency and a bariatric surgery fellowship just to manage fills and help patients figure out that drinking a McDonald's milkshake every meal will not help their weight loss. Surgeons like doing surgery. So my surgeon turned over band management to the PA, which is not unusual and works out fine for everyone.

Anyway, there was good news when he accessed my port: all 2.5cc were still there. It felt like there was nothing there again, but it was there. He said this isn't uncommon, and I know many people have talked about their fills "settling in" after a day or so. He added 0.5cc to put me at 3cc total, and told me to come back to check on it again in 2 weeks.

We also talked about how losing this last bit of weight is going to be all in the details. In the beginning, you can go along doing the "right" things 80% of the time and lose weight. But he used a good analogy for the last few (several?) pounds of major weight loss. He said if you want to get an A in a class, you have to get about 95% right, and that's what I'll have to do now to get an A in my weight loss. Eat the right things 95%, exercise right 95%. That makes good sense to me. He also reiterated what I have said on this blog for a long time: I am more efficient at storing calories than many people are, or in other words, I have to eat fewer calories to lose weight than most people do. There are people who are even more efficient than I am, and they have to work even harder, but a few calories makes a big difference for me. The same is true for most people who have WLS. If simple dieting would have worked for us, we wouldn't have had surgery.

I'm happy not to have surgery looming on me now. I still wonder what happened to 2.5cc over the course of 15 months (since my previous fill). The saline fairies must have taken it. I guess I will just be more vigilent about keeping a good fill level and going back to the office if things don't seem right.

In the future, if I do find the band is leaking, I'll do what I have to do then. For now, I hope I can get back to a place where I am losing weight again and keeping it off. I do acknowledge that gaining only 15 pounds with an empty band for 6 months is itself something of an accomplishment. I don't want to think too much about that, though, because complacency will not get me to goal.

Think doctors know everything?

2009-08-25T18:37:00.001-07:00

I love watching my patients interact with various health care personnel. So many patients completely change their demeanor when any doctor walks into the room, whether it is THEIR doctor or not. Sometimes it is as if an angel had fallen from heaven. A lot of people think doctors know everything about everything.

Today I anesthetized two people who were being banded, and one who was having a gastric bypass. I was really glad my second band patient was already asleep when my anesthesiologist started talking about how ridiculous it is that we are doing these surgeries at all. (Good thing the surgeons weren't in the room; these surgeries are how they make their livings, and they happen to think they are doing a good thing.) Dr. R started talking about how there is a TV show that shows them how to do it--The Biggest Loser. (I'm not kidding.) Then he stated that those people probably keep their weight off (no, they don't) because they learned how to do it on the show (um, 6 hours of exercise a day, and a chef?) and their metabolisms go up when they lose weight. (I know.) Then he said something about how these surgery patients don't learn how to eat, they just get forced to stop eating because of their stomachs, and something about how lap bands are basically the same as the gastric bypass.

Yeah, I couldn't hold my tongue anymore.

Mind you, this Dr. R is about 6'5" and probably has a BMI of 19. He's like a stickman. I can tell you with every assurance that he has never struggled with obesity in his life.

I explained to him that I've had a band for 2 1/2 years, and I can eat whatever I want. Not everyone is like that, but it's always been that way for me. I explained that we have to learn how to eat, just like everyone else, and the surgery--whatever one it is--doesn't do all the work by a long shot. I didn't explain the differences between the band and bypass because I was busy, intubating the patient.

I think he was a little chagrined, and surprised. The last acceptable form of bias is against obese people, and it is terrible in the OR. I am so sick of hearing people bashing obese people and reciting every variation of the basic theme, "Why can't they just stop eating?" I doubt he would have spouted his ignorance if he knew I was banded. And this is an extremely competent and well-trained anesthesiologist, who knows a lot about clinical anesthesia and has a lot to teach us students. But they don't know everything about everything, even if they think they do.

And I didn't have near enough time to cite the research showing that patients who have recently undergone major weight loss experience a decline in metabolic rate of up to 50%, which is why it is so easy to regain weight after it is lost...

The upside was that I got to pick the surgeons' brains a little bit about my band leak. They seemed to think that replacing the port would probably solve the problem, because it was likely the tubing nearest the port that is leaking, and that gets replaced. The port is attached to about 6" of tubing that then attaches to the long piece that comes off the band itself. They thought it would have to be done in the OR under general anesthesia, though. I think I've spoken to bandsters who have had their ports replaced in the office--anyone out there verify this? I may have to price-shop if I have to self-pay for any of this work, so I may end up having one of them do it. (Although I think my surgeon would help me figure out how to afford it. He knows about my program, and he likes CRNAs, since the hospital he operates in only uses CRNAs.) These surgeons I was with today didn't know of many bands that developed a leak at 2 years post op. They also thought I should probably have some imaging done, i.e. a scope and/or fluoro to check everything out. More money...sigh. We'll see. I'm trying not to worry about any of that before I have to, but that isn't easy.

Click for you, too!

2009-08-24T17:44:00.000-07:00

So, I've never done a product review before on the blog. My hubby sent the nice people at CLICK the link to my review, and they are so nice. They are sending some individual serving packs as samples. So when I see how many come, I will figure out some sort of give-away and you all can try this stuff.

There is a special rate right now on amazon.com (here's the link via MeltingMama's amazon store so she gets some little kickback-love) but they sold out immediately, apparently. You can still order it and they'll ship it when it comes in again. The special rate is $20.88; I paid about $27 at SuperSupplements.

I think the restriction I enjoyed for about a day is sadly gone. It seems I'm back to where I was with an empty band: able to eat too much. I stay full 2-4 hours but it takes more to keep me from scavanging for food. I'm not too happy about that...appointment next week sometime.

So far....

2009-08-21T12:34:00.001-07:00

Breakfast 2+ hours ago: 1 c. of eggs scrambled with veggie sausage and onions. So far: not hungry. I assembled 2 pies just now and put them in the oven (one for my friend who watched my kitty while I was gone, one for friends we are visiting tonight) and had no urges to nibble the fruit or anything.

I'm hopeful that this will help.

Click: Love it!

2009-08-21T10:07:00.000-07:00

So far I have lost 6 pounds this week, as of this morning. After my fill yesterday, the PA didn't say anything about how I should eat the rest of the day--and I forgot to ask. So I went with what I was always told by my original band surgeon--liquids for the rest of the day, then start up slowly the next day. I think this might be a little bit outdated, I'm not sure, but it's definitely safe. I didn't get that hungry at all yesterday, so that's good.

After the fill I stopped at Super Supplements to pick up some protein for the rest of the day. I don't keep much on hand, because I've never been a big believer in protein shakes as a daily part of band life (I know many people are). But I thought I should try some new ones, so I had some recommendations from Melting Mama's blog, and went to see if I could find some of the stuff there.

I found Click--the espresso protein shake that MM raves about. I like her product reviews because she is super picky--so if she likes it, I'm pretty sure I will like it, I'm way less picky than her. Anyway, WOW. It is great. It mixes easily in a shaker, no icky protein-y taste or texture. Tastes really good. And 2 scoops in 12 oz. has a double shot of espresso, and 15 g protein, for just 120 calories. It tastes great mixed in just water--I added a tiny bit of half and half afterward, but it probably didn't need it. I've had it over ice this morning and yesterday; it's supposed to be very good heated, but they recommend heating it after you mix it (I think MM actually adds hot water to the powder though). This stuff could definitely replace my morning coffee and give me some extra protein for the day. And I feel a bit better about replacing my morning coffee with something better for me rather than replacing a solid meal with a protein shake--since solid meals are how the band actually works, I don't like the idea of drinking liquid calories. Maybe that doesn't make much sense, but anyway, love Click. Highly recommended.

More later on restriction, is it here or not?

Not just a fill....

2009-08-20T18:34:00.000-07:00

I went to my (new) band surgeon today, because of course, as I have been posting for some time now, I am gaining and feeling out of control and needing help. It had been over a year since my last appointment, so I needed to be seen anyway.

I saw the PA (his name is Brian) and explained briefly what is going on. We went over how much I can eat, my exercise etc. I explained that my lowest weight was 13 pounds less than I am today, and the last time I was in my weight was about 15 pounds higher than it is now. (So, slightly better than I was then, but definitely lost some ground.) Yep, we both decided, let's do a fill.

Now, let's see...

The band was empty. Completely. Should have had 2.5 cc. Nothing.

Well, that explains a bit. And it isn't great news. Despite what a lot of band folks say about band leaks, bands really don't leak just part of their fluid. If there is truly a leak somewhere in the system, they go flat, just like a tire, because it is under pressure. Sometimes a little bit of fluid "goes missing" and no one is really able to adequately explain that. But a completely empty band that should have had fluid in it, that was known to have a certain amount of fluid in it at the last visit, is not a very good sign for the integrity of the band.

He refilled me to 2.5 cc, since I tolerated it fine last time. (I've never, ever been overfilled. Ever.) That's a big fill for one shot, but since I have had more and been fine in the past, and since I have never been too tight, barfed, PB'd, had any reflux, or anything, I agreed that it should be fine. He told me to come back in 2 weeks and he would recheck the level. If it needs to be filled again, he will fill me without extra charge. If I lose restriction prior to that, call the office.

If the fluid leaks out, we try replacing the port. (My understanding is that this is an in-office procedure.) If that doesn't work, I need a revision. I had already decided months ago that if I ever needed a revision, I was converting to a sleeve. BUT. My insurance doesn't cover bariatric surgery (or even medical weight loss). Even if I had the money now, I don't have the time, with 8 months left of school. And by the time I have a job, I am hoping to be pregnant, which delays this even further. (But also allows me to have more cash for this thing.) So, all around it is pretty sucky timing for me.

Here's hoping that I don't have to go down that road. I'd really rather not, at all. But if it comes to that, I know what I want to do, and it will be affordable (for me) by the time I have both the time and the ability to pay for it.

Meanwhile, it's not all about me. My hubby has some serious things going on with his child--nothing I want to talk about here on the blog, because it is not mine to share with the whole world. But any extra nice thoughts coming their way would be much appreciated. And yes, I am concerned, on multiple levels, and we will get through this together.

Control

2009-08-19T11:19:00.000-07:00

Okay, actually, I do remember one thing I was going to blog about.

In the past several months, one of the things that I have been learning about is control: specifically, the illusion of having control. Just like any other codependent, I have survived by trying to exert control in areas that I truly have no control. Mostly this is about other people's behavior; we (I) think that we can control other people's behavior, but we can't. We have no control over what other people do. In fact, there is very little in life that we really have control over. It's a rather revolutionary idea, because at least in the US, a lot of our culture revolves around creating your own destiny, which implies that you have much more control over what happens in life than you really do have. Learning to let go of this idea and accept that we can't control others, or the future, or very much at all other than our own actions, is a big part of becoming more satisfied with life.

Yesterday it dawned on me that there is another area of life that I do not have control over: my own body! Now, hear me out, because I know that most weight loss gurus, of the diet/exercise variety and WLS both, tout the idea that we do have control here. But the only thing we have control over is our own behavior: what we eat, how much we eat, how and when we exercise. What our bodies do with what we give them is NOT in our control.

Think about it: studies have proven over and over that after a major weight loss, formerly obese people's metabolic rates plummet. This is why diets don't work: our bodies try to conserve by dropping our metabolic requirements dramatically, so if you start eating more food you will easily regain, even if it isn't much. There are lots of calculators available online to determine your metabolic rate based on height and weight and gender, but none of them account for your body type or any factors that mitigate your own metabolism. How could they? There are so many. It is false to believe that all women who are 5'5" and 150 pounds have the same caloric requirements; a woman who has always naturally been that size can consume more calories without gaining than a woman who got to that size after a 2 year major weight loss. We all know this instinctively, but yet are told otherwise.

My point is that we tend to believe that if we eat what we have figured out is the right amount of food and exercise the right amount, we can force our bodies to lose a particular amount of weight. In reality, we do not have control over what our bodies do with the energy we put in and use. We have a good idea of the effect we can have by doing certain things, but we do not have that control. That's why it takes trial and error to actually lose weight. Yes, we have control over what we DO. NO, we do NOT have control over what happens after that. Usually it works out the way we think it should, but we don't have that control, we only think we do. Our bodies are ingenious in altering cellular energy requirements to maximize its ability to store fuel for future use, especially among those of us more prone to obesity, and especially among those of us who have recently lost a large amount of excess weight.

This realization helped me to gain a little perspective on my recent regain. It's not a moral failing--I knew this intellectually, but not emotionally. After all this time, my body has dropped my metabolism even more, and my habits have slipped so that the combination of the two made a regain pretty easy. It makes the road back seem a little easier. I can change my behavior, and my body should respond. But I can't actually cause my body to lose the weight. Maybe this distinction seems entirely semantic, but I think it's a big difference. If I worry less about the things I can't control, I can focus more on the things I can--my behavior.

Unwelcome Souvenirs

2009-08-19T11:12:00.001-07:00

I just got back from a nice week at the coast for our anniversary trip. Going to the Oregon coast has become a tradition for us--our 3 wedding anniversaries have all been spent there. It's affordable and relaxing, what's not to love? It's one of my favorite places.

Upon returning from the coast, I discovered I had gained 5 pounds. I despaired. After two days of eating carefully, the 5 pounds are mysteriously gone. So, clearly, water weight, but still. There was a number on my scale that I haven't seen in over 18 months, and I'm still too close to that number for comfort. Fill tomorrow, and much more careful eating from here on out.

It's my birthday today, and we are planning on sushi for a birthday dinner. This can be done without loads of unnecessary calories, plus it is one of my favorite foods, so that's what we'll do.

I've had a lot of blog ideas lately, but at the moment they escape me, so perhaps there will be a flurry of new posts soon? Let's hope...!

Habit is the Enemy of Progress

2009-08-03T10:46:00.000-07:00

I don't know if I read that somewhere or I made it up, but that is what came to mind when I started this morning's run. This, after stepping on the scale and discovering I have regained 14 pounds since my all-time low in late January.

(Here's the rationalization paragraph, brace yourself.) I will say that the way I got to my all-time low weight might have something to do with the regain. It was during that month when my personal life blew up and I was under even more stress than I have been since starting anesthesia school. The stress caused me to stop eating (I just wasn't hungry and couldn't make myself eat) and I was running to combat the stress, and I lost 12 pounds in 2 weeks. Slowly, in the 6 months since then, I have regained them, plus a couple more for good measure. Also, probably 2 pounds of this is hormonal water weight.

Still, it's not just that. I'm running more in the past few weeks, but this entire spring and early summer I have slacked off in the exercise department. And my eating goes from okay to abysmal. I went over what I ate yesterday, and I can't even record it here. It's awful. No bandster should eat as much sugar and junk as I have been eating. A fill won't fix that. That's my brain.

I think long-term weight loss success is a personal experiment. I have a scientific background, and I believe in the scientific method. For the past year I have been testing the hypothesis that I can rely entirely on my band to maintain my weight loss. I think I have established that this is not a valid theory. So it's time to come up with a new hypothesis (on purpose, this time!) and make this thing work.

I've wanted to believe that somehow, since my WLS, I could eat and act like a normal person, and maintaining my weight would become natural and easy. But I now accept the idea of food addiction, and the fact that I am a food addict. I need my band because, left to my own devices, I will eat myself to death. But even with it, I have to make some changes in my brain and keep working at them. They don't have to be hard, but the thing I have to fight is falling back into bad habits and thinking. I've developed some good eating habits, riding the wave of easily following them, and then not noticed when they slowly eroded into my old ways. Habit is the enemy of progress.

I want progress. I want to reach my goal. I want to change my brain. So how can I do that, in small, easy-to-implement steps?

1. Start noticing not-hungry again, and don't eat when not hungry
2. Start noticing 'satisfied' again, and be vigilant when eating; stop eating when satisfied.
3. Serve myself my own portions (I will eat everything on my plate, so must be more careful about this)
4. Focus on protein again

This is a start. There are a lot more things I want to change about my thinking, things like the idea that if food shows up in an unexpected place (i.e. in my classroom, at a meeting) then it's "free" and I can eat whatever it is, whether I'm hungry or not, whether it's in my plan or not. And I do need to get back to planning out my meals, the very thought of which just makes me tired and annoyed. This is much more about eating and thinking than it is about exercise.

Right now I am frustrated and tired of all of this. Why can't I be a normal person? But then, who is normal these days?

Born to Run

2009-07-29T21:07:00.001-07:00

The scale is fickle and stubborn. Or else, it's stuck. Seeing how it's a digital scale, I doubt it's the latter, although it would make me feel better. It might have something to do with the pies I baked over the weekend...nah! Couldn't be. I made an appointment for a fill, and they rescheduled it for 3 weeks later...bleh!

For us in the eastern part of the state, the temps have cooled down a bit to the high 80s, while the West Side (i.e. Seattle) is sweltering this week, with over 100 degree temps. They are in a temperate weather zone, and are unaccustomed to temperature extremes over there. Few homes have AC, even a window unit. People are scampering to get the last fans at the hardware stores. It's a similar scene to 7 months ago, when they were trying to get by with 2 snowplows for the entire county when they had a rare snowstorm. But here, people are more used to the hot summers, and it is a little less humid (not that it's very humid in Seattle). It makes evening running a lot more pleasant, anyway.

I'm still trying to get my mileage back up after a long spring and early summer of slacking, mainly due to scheduling problems. My school schedule is now a bit unpredictable, and when I am working evenings it can be hard to get a run in before the temps are over 85 degrees. But I was looking back at my running logs over the last 18 months and while it feels like I am stuck in a rut, I have made some progress. My times are much better than last year (although still slow). For someone who isn't "built like a runner", I still get a lot of enjoyment out of it. I have legs that are much more buffalo than gazelle, and even after a breast reduction FOLLOWED BY a 70 pound weight loss, I'm still more generously endowed than Marion Jones (or even Venus Williams, probably). But still, I have to say, the number one reason I still run is simple: because I can. It isn't enabling me to eat like a beast, or lose weight like crazy. My heart rate is much lower since I started running (it's in the normal range now, instead of being high) and my BP is lower. But that's not what keeps me going out there. It is just because after feeling like the slow, fat one for my whole life, even as a little kid, I take pleasure in being able to simply do it and not keel over. That's all. That's enough to make it enjoyable for me.

I'm reading Born to Run by Christopher McDougall right now. It is about a tribe of Mexican Indians who are known as Running People. They are like ultrarunners--those guys who run 100 mile races--but even more extreme, running for 48 hours straight. It's in their culture and their blood, they run well into old age, and they have nothing but joy in it--and no injuries--all in handmade sandals. It's a truly fascinating book. I have nothing in common with ultramarathoners. I have no ambitions to even do a half marathon, much less any craziness like the Leadville 100 in Colorado (a distance of 2 marathons plus 2 1500 ft climbs, all at once, all above 10,000 feet elevation). None! But those people are damn interesting, and I love to read about them. It gets me a little more excited to go out and get in 3 little miles up the South Hill.

Endless Summer

2009-07-18T08:48:00.000-07:00

The summer heat has me eating a lot less and drinking more. Both are good things for me. I love summertime--love the heat, playing outside, wearing summer clothes. Even when I was obese, I loved it, though not as much since I felt less comfortable in shorts and totally uncomfortable in swim suits. But summertime just feels like freedom to me. One think I like about where I live now is that summer is hot, punctuated every couple weeks by a storm, and then is immediately hot again. There isn't a lot of humidity here. When I lived in Portland and Seattle, there was always the sense that you had to hurry up and go do something fun when it was nice out, because the rain would be back any moment. (Of course, that was tempered by the fact that on a beautiful summer day, there is no place more lovely to be than Portland or Seattle.)

Last summer, most of my free time was spent in Portland. I didn't really explore Spokane very much as a result. This year I am trying to get out more in this area and check out what there is to do here. I've spent a lot of time at the Spokane River this week, which has been lovely. I drove out to Lake Coeur D'Alene as well, but didn't find the park I was looking for.

One of my favorite things about summer is fruit...I love it when all the berries are in season, and fresh watermelon, and cherries. I eat my fill of them with zero guilt.

Hopefully the scale will reflect my reduced summertime eating, although it hasn't very much yet. Everybody get outside and enjoy summer while it's here!

Band Thoughts

2009-07-11T22:11:00.000-07:00

Today I was surprised and pleased to see MSNBC.com post an article about The End of Overeating, the book I just finished reading by Dr. David Kessler. Looks like he is getting some good press.

This weekend I am taking a class for my program called Law and Medicine. It is 3 days, 8 hours each day. This year because of scheduling conflicts, our last day of class is tomorrow, which is Sunday. We're pretty unhappy about that. The class is useful, but long and not terribly dynamic. Our instructor was the first CRNA in the country to earn her JD, and is very knowledgable about the subject. Amazingly, my program is the only one in the country that includes a class on law and medicine in the curriculum. Our final class will focus on how to read and negotiate an employment contract.

We get a make-up day off on Thursday, but that's not the same. Today I did a little reading, went to the gym, and spent the evening at Riverside State Park, hiking and cautiously playing in the river, which is notoriously dangerous. I stuck to parts that seemed still, avoided the current, and stayed by the bank. The park is huge and I drove out much further into it than I have before. It's such a beautiful park, I hope to have time this summer to play in it some more. My legs are tired, in a good way, from my run and from several miles of trekking.

I finally made an appointment with my new band surgeon for later this month. I will probably have to reschedule it but at least I'm on the books. Interestingly, this summer we start going on "field trips" to small CRNA-only practices in the area, and one of the places we go is the surgery center where my band surgeon operates. So once I find out when I am scheduled to go there, I'm going to see if I can schedule my appointment for the same day, for the sake of convenience. I didn't have surgery there; I had surgery in Portland, at a hospital that only has anesthesiologists (like most in Portland). But it's cool that this surgeon works exclusively with CRNAs. Anyway, I need to see the surgeon and probably need a fill. I just can't decide. I haven't been seen for my band in a long time, over a year, so I should go in anyway. I weigh about 2 pounds less than I did a year ago. I want to lose about 20 more.

At just under 2.5 years post-op, I'm a little frustrated, either with the band or with myself. I do believe that getting control of the psychological issues of weight loss are key to getting to goal for me, and would be no matter what surgery I had had. Perhaps if I had done something really major, like duodenal switch, I would have gotten to goal pretty definitively, but then I think maintenance might have been an issue, not to mention the issues associated with long-term malabsorption. But if I had it to do over again, I would probably have the sleeve gastrectomy. I have already decided that if I ever needed a revision or re-op due to a problem with the band, I would have the VSG. Why? It works like the band, but nothing needs adjusting, and there's nothing to slip. No wringing of hands trying to figure out if you need a fill or not, no convincing a provider that you really do need one. Yes, the initial attractiveness of the band was that it can be removed if necessary, and there was no permanent rearrangement of my anatomy. But, I dunno, there's just a lot to be said for having that angst taken out of the picture. I guess you have staple lines that could potentially leak, but I've seen this surgery done, and the staple lines created by the tools they use today are pretty solid, 3 rows of tiny staples. With a good surgeon, leaks are extremely rare. Any other post-op lap banders have this thought ever?

That's not to say that I haven't been happy with my band. It has served me well as the tool it was intended to be. At the time I had surgery, I wouldn't have considered amputating my stomach. Now I think it isn't as big a deal. But at the same time, since hunger isn't really the issue with me, it might not make a bit of difference, except that I wouldn't have to worry about fills or whether I have insurance to pay for them. I'd just have a smaller stomach with no moving parts. I could still eat ice cream and milkshakes and other things that would go right through. It wouldn't be any guarantee that I would be at goal now, or that I wouldn't regain.

I don't know. I wouldn't call it buyer's remorse. I'm not sorry I was banded, and I'm glad I've lost 60 lbs. (65 on a good day.) I have work to do on my eating, and thankfully, my band has helped me stay around the same weight for a year--but I am frustrated that I'm not getting any more headway in the direction I want to go. It's still a lot of work. Getting rid of hunger is only the first step, the thing that allows you to do the rest of the (much harder) work of controlling weight for life. It's still a work in progress.

Food Rehab

2009-07-01T14:26:00.001-07:00

I've gotten to the "meat" of my book I have been reading, "The End of Overeating." The first two-thirds of the book are dedicated to exploring the science behind what makes certain foods irresistable, or "hyperpalatable" as the author calls them. He explains that the restaurant and prepared foods industries have sort of "stumbled" on how to exploit this science, without necessarily knowing the science behind it, through trial and error, finding what it is that people buy and eat, working hard to make a product that customers will consume compulsively. It's not surprising or necessarily that sinister that they do this; this is business, and they are in the business of selling as much of their product as they can. When your business is food, you make more money if you can get people to come back over and over for your food, and eat more than they should. If it is actually addictive--and the science indicates that compulsive overeating is at least very similar to substance addictions--it just makes the stuff sell better. It took something like 80 years or more to condemn the tobacco industry for doing the exact same thing.

The last third of the book talks about how to deal with our problem of compulsive overeating. (or "conditioned hypereating" as the author calls it). It's a chronic problem, and many, many of us have it. It (probably) can't be "cured," but we can learn how to deal with it, through cognitive behavioral therapy techniques and support and practice.

Wouldn't it be great to be able to relate to food like a "normal" person? There really is such thing as a normal person when it comes to food, although at least in the USA, it seems like normal is now overeating and obesity. A truly "normal" eater doesn't eat the cookies on the table if they already ate a meal and are full. A "normal" eater doesn't think about eating when they aren't eating--like thinking about what you'll have for dinner when you just finished lunch. A "normal" eater doesn't obsess about the donuts in the break room, trying to resist an irresistable urge to go eat one, or two, or four. A "normal" eater can eat just one or two cookies, and stop, even though there are more cookies sitting right there in the package. Those people really exist!

In terms of addiction, alcoholics call people who can drink one beer and stop "normies." Some people can just have one beer, others can't resist the pull to keep drinking after just one. That's how many of us are about food. We aren't "normies". A lot of things are happening in our environment that condition more and more people to have abnormal relationships (and obsessions) with food. I like the idea that there are things we can do to combat this conditioning.

The book has a section toward the end called "Food Rehab." (I think that's awesome.) I wanted to directly quote the book on the essential principles, but I don't want to commit copyright infringement, so I'm going to paraphrase the ideas in my own words. Really, do read the book, it's very interesting.

Essential principles of Food Rehab:

-We are biologically driven to overeat. It's not a character defect or a matter of willpower. We can only get better when we stop seeing ourselves as failing at willpower.

-Treating this overeating problem is a chronic problem that can only be managed, not cured.

-Every time we eat one of our "trigger" foods, filled with sugar/fat/salt, we reinforce the habit and the reward system in our brains and make it more likely that we will do it again the next time. The way to treat this is to stop the cycle of urges and rewards.

-Diets make this problem worse when they leave us feeling deprived.

-The treatment is learning a new way to respond to food. It can only be learned when it generates a feeling of satisfaction. If the change leaves us feeling hungry, unhappy, angry or resentful, the new ways will not stick.

-To regain control, the approach has to address all the different elements that go into our overeating. It is a multi-step process.

-We won't always be perfect in this new behavior, but we can learn from our mistakes so we are less likely to repeat them.

-We can learn a new way to think about food and put it back into its proper place in our lives.

Dr. Kessler put it much better than this...check it out.

I have identified some of my own specific triggers and some ways to start learning how to avoid them. In another post I will talk about them some more. I really feel like this mental and emotional work is the key to losing my last pounds and getting to a managable, healthy weight. All the fills in the world, and all the running I can do, will not help me if I don't learn how to control my subconscious drive to eat inappropriately. I think Dr. Kessler's methods are one way to help me work through this.

We Are Different

2009-06-28T09:56:00.000-07:00

I am still reading "The End of Overeating" and it is quite fascinating. The premise is pretty simple--that the food industry has contributed greatly to the obesity epidemic in the US by creating "hyperpalatable" foods that (some of) our brains basically can't resist--and most of the book is describing the science behind it, which those in research and development within the food industry most likely weren't even aware of, at least at first.

One thing this book states over and over is that people who have a tendency towards obesity have different brains than those who tend to be thin. This is both genetic and environmental, and it can be enhanced by childhood experience, i.e. eating a lot of these hyperpalatable foods as a kid, learning eating habits from our parents, etc. One interesting thing about the book is that he writes from a first-person perspective; the author is in the entire book, which makes the whole thing seem a lot less judgmental of "us fat people". He describes the development of several foods, like Oreos, Cinnabons, and certain milkshakes, going through the characteristics of each one that make them so hard to resist. I realized through reading this that all of these things are things I, too, find impossible to resist, and so I simply never eat them, or buy them. If they are around, I know I will eat them. But even so, avoiding these strongly triggering foods hasn't meant that I don't still overeat, or that I no longer have a weight problem.

But, I don't drink milkshakes, because I don't go to places that sell them. Just the idea of going through a drive-through or into a restaurant that sells them (the good ones) is enough to stop me. Okay, there is an exception: I will go to Burgerville USA (in Oregon) and have a shake while I am driving a long distance. There are lots of subconscious cues and triggers that make it very hard for me to resist it in this circumstance.

I think it has been several years since I bought a package of Oreos. I can't resist them. I haven't had a Cinnabon in at least 5 years, because HELLO! And I've changed more things too. I almost never watch TV, because the commercials are too triggering for me. We do watch some shows on DVD, without commercials. Even so, some of the shows themselves contain a lot of food triggers. I rarely go out to eat anymore, because even though I eat a lot less than I used to, I still eat too much, and it's better and cheaper to cook at home. Also, my hubby is a great cook and likes making dinner. We go out for breakfast once a week, because I love breakfast so much. That's about it, and it's a vast improvement from a few years ago.

Our brains are different. That is one thing that the past year of my 2 1/2 years post op has really taught me. There are people who can sit in front of a whole plate of Oreos, and if they aren't hungry they won't eat any. If they want a snack, they might eat a couple, but not the whole plate. Many others of us aren't like that. Even if we are full, we will eat them until they are gone. Period.

Having surgery did what I wanted it to do: it took away my physical hunger, which was real. It left me with all the other reasons that I was overweight, including compulsive overeating and emotionally conditioned eating. This past year has really opened my eyes to this reality.

This book doesn't make the food industry into the big excuse for obesity. It simply shows how the foods that were developed because consumers like them and buy them and can't resist them have contributed to our drive to eat highly caloric foods, too much of them, and too often. It's one more key to understanding how to get control of our eating, our weight, and our lives. It also points to one of the reasons that WLS is not a magic bullet, and without attention to all of our habits that contribute to the problem, we will not reach and stay at our goal long-term.

The End of Overeating?

2009-06-19T10:38:00.000-07:00

My weight is coming down a bit. I've been able to be a bit more intentional about my eating lately, which surely has helped. Oddly, I've taken the last 2 weeks off from running because my right Achilles tendon was sore. Last night was the first time I had run in over 2 weeks, and my weight was already down 2 pounds by then. It's encouraging, but I want to see more movement than this.

I am reading a new book called "The End of Overeating" by David Kessler. It's a promising title...too promising, of course, but the premise is basically that America's overeating problem is (at least partly) caused by the manipulation by the food industry of the proportions of sugar, salt and fat in foods we commonly eat. The author argues that certain proportions of these basic ingredients trigger our brains to eat beyond our satiety. The book seeks to explain how we lose control over our eating, and promises to reveal how we can regain it. (I am thinking the answer will be in preparing more of our own foods, from scratch.) It is interesting. I'm not sure it's going to tell me a lot that I didn't already know, but even reading about overeating helps me be more conscious about what I do, so even that helps.

From the outset, this book reiterates what recent research has confirmed over and over: that we gain weight because we eat too much. It's such a simple idea, but we have fought the idea for a long time. I fought it, before I had WLS. Now I realize that I did eat more than I realized, even if the amount I ate might not cause another person to gain weight. It wasn't massive amounts, but it doesn't take much of a calorie excess to cause a lot of weight gain over time.

The book also talks in the beginning about the "setpoint" theory, that our bodies naturally maintain a certain weight range and somehow that setpoint gets messed up in people who are overweight. In fact, the author states, the setpoint, or homeostasis range, is only one factor in our weight. A lot of other things happen that override our body's weight homeostasis, and when we gain a lot of weight and then try to lose it, our setpoint often gets moved a little higher than it was before. We've all noticed that in our yo-yo cycles in the past. We blame it on dieting. It might be the actual weight gain that causes it, not the diet that revealed that changed setpoint.

I'm still fighting this seeming "setpoint" that I have reached of about 170 pounds. My body seems to want to stay here. Interestingly, it's exactly where my surgeon said I would land. But I could easily stand to lose another 20 lbs, and even 10 would make me happy. As tempting as it is to try to get there quickly through a "diet", I am resisting this urge, partly because I was always a terrible dieter, and partly because I want a more lasting weight loss. So I still work on this every day.

On the school front...I have 10 1/2 months left and I am very happy about that. The hardest part is behind me. It's nice to realize that by this time next year I will be graduated and will already have taken (and hopefully passed) my boards. We are finishing up our bioethics class next week. It's been a very interesting class. Then we will take Law and Medicine in July. Meanwhile, we are working about 30 hours/week in the OR. Tonight I am on from 3-11, which should be in OB rather than the OR--placing labor epidurals and providing anesthesia for C-sections. I enjoy OB anesthesia, and I also enjoy not getting up at 5am.

I am thinking of making an appointment to see the surgeon sometime this summer, just to check in and make sure everything is okay. I don't know if I need a fill or not. Sometimes I think I do, sometimes I don't. Since it's been over a year since my last appointment, I should go in either way.

Hope everyone is enjoying the summer!

Food Junkie

2009-06-08T20:37:00.000-07:00

I never used to believe in food addiction. I didn't understand how anyone could be addicted to something you need to live. Isn't that like being an oxygen addict, or a water addict?

Well, no, I am realizing. It is not. We don't become addicted to the stuff we actually need to live, like whole grains and protein. Too bad! It is not very different from becoming addicted to gambling, or sex, or anything that produces a "high" in your brain. We actually aren't addicted to the food (or sex or gambling), we are addicted to our own brain chemicals that make us feel good. It is a pattern that we learn from childhood, for most of us. That is what tends to make it addictive: early on, we learned that certain foods make us feel good, comforted, loved. Our parents gave them to us to reward us, or we would eat them when we heard our parents fighting in the other room, or we observed other family members compulsively overeating and learned the behavior. Early on, eating certain things became associated with positive feelings, and they become our most powerful coping mechanism.

I know this isn't news to anyone reading this who has had WLS, or who has ever had a weight problem.

I am doing my own recovery work, unrelated (so I thought) to my eating, because I am married to a man with addictions. I'm learning that it was no mistake that I married an addict--wonderful person though he is. I was raised by parents who were at least food addicts, and I don't mean that in the sense of people who claim to be "addicted" to chocolate or Coach purses or Carmex. I realized when I first started goint to Al-Anon that the families people were describing were alcoholic families, and they were exactly like mine, except no one in my family drank or did drugs. They did, however, have an exceptionally unhealthy relationship with food, so much so that I believe they acted like any other addicts, and we all learned to respond to the addiction like any other codependent does. It sounds crazy if you haven't lived it. But I am certain that some of my readers have experienced the very same thing.

It has been through working my own recovery that I have realized how much I use food to cope with stress. STILL. Now that the blush of new WLS has worn off, 2 1/2 years after surgery, I don't have that "high" to keep me strictly adhering to my food plan. Like I described before, my days go pretty much according to plan, but I get home and I am "hungry" and foraging. Where I used to be able to listen to my stomach and stop if I wasn't physically hungry, now I am finding that to be much harder. I can actually notice now that eating sugar calms my anxiety and stress, something I didn't used to really be aware of. It is scary to observe this happening, and feel powerless to stop it.

I am undecided on how I want to try to get a handle on this. I feel pretty sure that I am not going to get to my goal weight (or really lose any more weight at all) if I don't get some better way to handle life than overeating. If it weren't for my band, I would be eating much more than I do now, and would have regained more than the 5 pounds I do have. I know the usual strategies, like exercising more, drinking tea, journaling, seeing a counselor etc. But I feel like this problem is much more core to who I am as a person than these simple behavior changes. I feel like something much deeper has to change if I am going to have a lasting way of maintaining my weight. It may involve going to OA meetings, although frankly OA scares me, with their Gray Sheets and eating soberly. And I don't know what their relationship with bariatric patients is like: are they accepting? Surely there must be many WLSers in OA meetings. I will probably just start by talking to our counselor about this and getting an idea from there on how I want to deal with this problem in a real and lasting way.

How have you all dealt with these kinds of issues? Any suggestions?

What I Am

2009-05-25T10:59:00.001-07:00

A happy Memorial Day to you all, especially those who serve in our armed forces. I extend this to everyone, not just Americans.

I'm enjoying a lazy Monday holiday. Hubby is still sleeping, I have coffee, and most of a day yet to determine how it will be spent. We went out to see my brother's family on Saturday and came back last night. I haven't seen anyone in my family in a very long time; we were supposed to go there for Christmas, but then the Great Blizzard happened and I couldn't go anywhere, and my hubby barely made it to our home from Portland, at 10am Christmas morning. So it has been a long time. It was nice seeing everyone, especially my nephews, who are getting big and sassy. It's a long drive, about 5 hours if you take the correct freeway and don't misunderstand the street name on the phone. My brother moved last year so I hadn't been there yet. But the drive was beautiful and enjoyable. We spent yesterday afternoon playing frisbee in the park with 4 kids, 3 frisbees and several adults. My legs are mysteriously sore today.

My weight remains undeniably higher than the beginning of the year. I have some good reasons/excuses, but still, I want to get it under control before I am writing here about regain and complaining that the band doesn't work. I am approximately 5 pounds higher, on average, than I was six months ago. Looking at my stats (which I keep on my running log), it seems that it started around March. This isn't terribly surprising given all that has happened this year, but again, time to fix it. The crisis is past, we are living our lives the way they are going to be for at least the next year, and I want to get closer to goal, not further away.

There are some obvious things I need to fix. My eating is great in the morning and during the day, especially when I am at the hospital for the day. I rarely have anything I didn't pack, and I pack well for the most part. The trouble comes when I get home. I tend to graze for sweets. I've tried my old tricks: have a protein snack, have tea, brush teeth. Sometimes they work. Unfortunately my hubby has been eating sweets in the evening as well, which he never used to do, so we often unravel each other's intentions. I know on my part it is emotional eating, stress relief from the day or the like. Because it isn't only my own behavior and a lot of it is subconscious, it's not easy to fix this. My hubby tries to support my efforts to get back on track by trying to block me from eating something, which just pushes my buttons and makes me angry. I know he is trying to help, but I feel parented and it makes me feel worse. So it's something we'll have to work on together.

I think probably increasing my running mileage again could help. I'm running less than 10 miles per week, as opposed to last summer when I was running 12-15. This could help some, but isn't going to be the magic bullet here.

I have tended to think that the answers lie in my own "working the band" rather than in getting a fill, but now I am starting to think that I do need a fill. I haven't had one in a very long time--maybe since last September or so? I don't even remember. No, I just checked my stats: it's been since early May of last year. Over a year. I have ALWAYS been able to eat more than I should be able to, and have never tried to get such a tight fill that it forced me to eat a tiny amount. But I tend to get hungry in about 3 hours after a good band meal--solid protein, then veggies or fruit, no liquids. This is especially hard in the OR, when I don't get a break for a long time (or like last Friday, at all). My original band surgeon told me that often when you find yourself grazing a lot or thinking about food when you aren't eating, it can be a sign that you need a fill. I'm paying out-of-pocket now for fills, so I have to have about $200 to get one, and we still have no source of income other than unemployment and student loans, so I do hesitate to spend money on a fill. But it's probably a good idea to do it, and check in with the surgeon since I haven't in over a year. While I am at it, I should go back to my NP and get some labs done--nutritional status, esp Vit D which I am sure is low.

What I really notice more than anything is that my old eating habits have come back since my stress level has increased this year. I eat less mindfully, and I eat more foods that produce good feelings for me: mostly sugary stuff, which triggers endorphins and such. When I talk about stress being higher this year, I am not only talking about my hubby. Yes, his difficulty in finding work, his legal troubles, his recovery as well as mine and ours together as a couple, have been stressful, but school has been at least as stressful as that as I became a senior. I have more freedom in the OR, but with that comes a constant level of stress that wasn't so great or noticable when I was being directly supervised. I don't know the docs as well as I knew the CRNAs so I don't really know what to expect, and I'm in a lot more situations where I'm out of my comfort zone. This is how it is supposed to be, and I'm learning a lot, but it really ratchets up the stress. So when I talk about "stress" that is not code for my personal life. It's interesting to me how old coping mechanisms get triggered by emotional situations, and we don't realize it consciously until it has been going on for a long time.

I guess I'm still on the WLS journey, and while I've done pretty well so far, at 2+ years out I'm still not at goal. I am a few pounds less than this time a year ago, a few pounds more than six months ago, and I'm right where my surgeon predicted I would be after my surgery. But I think I can do better, and I know what to do. I just need to do it.

Moving on...

2009-05-10T11:19:00.001-07:00

Well, it's been a week since Bloomsday, and I planned on running after a few days' rest. But then I got sick, and I've been out ever since. I'm hoping to get in a short run today, if I don't cough too much.

School has been busy, and the scene is changing for my class. This week we became "seniors" which means that instead of being with a CRNA for every case all of the time, two of us are supervised by one MD, which of course means that we spend most of the case by ourselves in the OR. It differs from program to program how this is done. Some programs have this kind of supervision (2:1) from early on in the clinical rotation. Many others never go to 2:1 at all. I like how our program gets us a good clinical foundation before giving us an entire year at this supervision level. Our graduates are always able to start working right away upon graduation, with no lag-time for getting used to working on their own. Still, at 2:1 we have the MD there at the beginning of the case and at the end, and they come in periodically to check on us and if we call them with a problem. They are generally pretty vigilant about making sure we are supported, especially in the beginning. And it's the only way to learn how to administer an anesthetic on your own, making those moment-to-moment decisions without someone behind you putting in their 2 cents.

We've also been in OB, placing epidurals and doing anesthesia for C sections, which is pretty fun, and in pediatrics, which we have been doing for a little while now. The class above us just graduated on Friday, and we had a big banquet and ceremony for them, which was a lot of fun. My hubby helped put together a nice slideshow presentation for them which was a big hit, although he couldn't actually attend with me. And now we are the senior students at school. It's hard to believe, and yet I don't really feel like the last 17 months have exactly flown by.

I am struggling with about 7 pounds still that I can't seem to lose. I gained a few more in DC but have managed to shed a couple of them. I'm trying to get my eating back where it should be--less sweets, more protein. It's the snacking that kills me. This far out post-op, I think it should be about having a daily maintenance plan for eating, not going on a "diet" to lose weight and then changing our eating back. That's the kind of thing that caused the overweight in the first place. So I'm trying to just cut out the sweets and snacking. It's difficult, especially when stressed. But it's something I have to conquer if I want to maintain my weight loss, and reach my ultimate goal.

Yesterday I worked my first Saturday shift, and we were quite busy. Saturdays we do mainly emergency/urgent cases. My last case was a man with an incarcerated hernia, that is, an opening in the muscle wall of his abdomen that created a pocket for his abdominal contents to leak into. He was having pain because part of his bowel was in there, and starting to have its circulation compromised. I calculated his BMI at about 59. This presents a problem for his safety both in having the surgery itself--it's a much more complex surgery at this level of morbid obesity--and in receiving the anesthetic. I was unable to intubate him (the anesthesiologist could though) despite doing everything I've learned to do to optimize my view of his airway. Once anesthetized and in position, he was very difficult to ventilate. The surgeon who performed the surgery was on call for general surgery, but most of his day-to-day practice is bariatric surgery (mostly RnY). One of the techs asked if he'd be doing a RnY on this patient later, but the surgeon said that the patient seemed to have no idea that his weight was even a problem. Of course, we know that if the patient doesn't accept any ownership of the problem of morbid obesity, bariatric surgery isn't going to help in the long run. He reported having excellent health, even though we discovered that his blood pressure was quite high and he almost certainly should be sleeping with CPAP at home, at the very least. I am sure he doesn't see a doctor very often if at all, and if he's anything like many of us who had bariatric surgery, it is at least partly because he doesn't want to hear them lecture him about his weight. The patient seemed like a really good guy, and I thought about all the reasons he might not be taking care of his health, and felt really badly for him. Surgery went fine, though, and he was starting to recover well when I dropped him off.

Today is a lovely day, and I'm hoping to go for a run. Happy Mother's Day, everyone!

I'm a 2009 Bloomie!

2009-05-03T15:29:00.000-07:00

The race was today. It started off cold and cloudy, but at least yesterday's wind was gone and conditions were not bad for running 7.46 miles. Well, I'm overstating a bit. I probably ran about half of it.

Bloomsday is a fun race. They had over 30 live bands along the route, so there was always music to run to, no need for an iPod, and every genre from rock to country to bluegrass. There was more than one group with an accordian. People line up along the way just to be a part of the event. Parents bring their kids out to slap hands on the side of the route. Some of the bands were middle school age kids, which was fun (and they were pretty good, too). This year, as part of their effort to make the race "greener", they plan to compost the water cups; they expect to haul over 500,000 to the composting center.

I got shin splints in the beginning for the first time in over a year. I think that's because it was early in the morning, earlier than I run anyway, so my legs weren't very warmed up. They eased up by 2.5 miles or so. I ran off & on, pacing myself by my heart rate. It's a big race; there were close to 50,000 participants, and 8 starting groups (timed with RFID chips), so you can't always run when you want to, and you have to be careful of people cutting you off as they pass you. I walked a bit more around mile 4 than I had been, leading up to Doomsday Hill since I wanted to run as much of that as possible. And I ended up running more than half of the hill, which I felt pretty good about. I hit a nice stride at the top but then made the mistake of stopping for water, which totally threw me off (and which I didn't need anyway). The last mile was long, but the final turn is on top of a hill so the coast to the finish line is easy. I finished in a little over 90 minutes, which is slow, but faster than I expected to do it.

Lessons learned from my first race: 1. Wear sunscreen. I didn't think about it, because it was so cloudy, but I know I got a little burned. 2. If I wear a headband again, I'll clip it on with something. I lost it by mile 3, which really bummed me out, especially when the sun came out and my forehead felt warm and vulnerable. 3. Put the chip on my laces instead of my ankle. More comfortable. 4. Bring a jacket that I want to donate, instead of wearing one that I have to tie around my waist when I get too warm. I forgot that they have a tradition of collecting all the discarded jackets and sweatshirts and donating them to Goodwill. (Although many of the ones I saw were not worthy of donation. What are people thinking?)

One thing I did right was leave my wedding ring at home. My fingers were puffed up like little sausages by the time I finished. They always swell when I run, I assume because I have them sort of dangling and all that blood is pumping around. I never would have gotten that ring off if I was wearing it today. The fingers are starting to look more normal now, but they are still a bit swollen.

Another thing was taking the bus: good move! Very easy from where we live, better than walking home would have been, and parking would have been a mess.

So there's my wrap-up, Bloomsday 2009 is in the can, and I have next year to look forward to. Racing isn't really something I'm compelled to do, but when it's an event that I really want to participate in, it's good to know I can do it.

Home,again, home again....

2009-04-27T20:43:00.001-07:00

I've been out of town for the last week-plus. I spent 5 days in Washington DC, then came home for 12 hours and left for Seattle for 4 more days. The trips were great, but I am glad to be home. DC was our Mid Year Assembly for the national organization for nurse anesthetists. There were a couple days of conferences, mainly prep for going to Capitol Hill. Then there were a couple of days of each state's delegation going to visit its legislators and discuss various issues with them. It's about visibility for our profession, especially in light of health care reform that is happening as we speak. It was very enlightening to see how Congress actually works, and see that senators and representitives are actual people and there is no need to fear contacting them and telling them how you, their constituent, feels about issues. They actually do listen. In between all of that, we met lots of CRNAs and student nurse anesthetists, went to lots of fabulous dinners, and saw the sights in DC. It's a lovely city, and I hope to return someday and see more of it.

The Seattle trip was for our state organization. They had their spring conference this past weekend. I wouldn't have gone, except that I am the student representitive from my program for this year, which meant I needed to go to their board meeting. It's an honorary thing; no vote, and no responsibilities, just mentoring really. The conference itself was interesting, lots of good speakers and topics. I also saw some friends in town, which was great.

Now I am back into stress-mode for school. I feel like I've fallen behind in my studies; I've been away for over a week, and we have an exam tomorrow in OB. We are going to 2:1 supervision next week and becoming "seniors" which is a big deal and marks the final 12 month sprint to graduation. For our first year in the OR, we are supervised on a 1:1 basis, meaning that there is a CRNA in the room with us at all times. When we go to 2:1, we are supervised by the docs, and one doc watches a student nurse anesthetist in 2 different OR rooms. It's great experience because we get to develop our skills and our style of delivering an anesthetic, make more decisions ourselves, but the MD is present for induction and emergence, and if we have questions or problems at any point during the case. But it's a big shift, and it's a bit scary.

On my run tonight, I realized just how much negative self-talk I still have. I was telling myself how much work I have to do, how much studying, how I'm not ready for Bloomsday, how I'm not doing well enough in my recovery, I still haven't lost the 10 pounds I want to lose...and then I finally stopped and realized what I was doing. Learning to be kinder to myself doesn't come easily. I've got a lot going on, and I'm keeping my head above water. I'm very tired, and stressed, but really I'm doing okay. I've got to learn that a bit better.

I gained a few pounds while gone. But between all the restaurant eating, and no running all that time, I think I got off easy. Here's hoping it comes off without too much struggle.

Doomsday

2009-04-15T21:59:00.000-07:00

I ran Doomsday Hill tonight. It's actually Pettit Drive, but the organizers of the Bloomsday Race I think were the ones to christen the hill, perhaps for a little more publicity for their very popular race. Anyway, I was concerned about it. The race is in 3 weeks.

It's funny, I started running a little over a year ago. I have never had any desire to race. I still don't. I haven't done a 5K or a 10K and I have no plans for a half or a marathon. I just wanted to do Bloomsday (12K) because it's here in Spokane and it's a huge event: it used to be the largest footrace in the world, until last year when I think Dubai or someplace got 80,000 to run in their race. Bloomsday still attracts around 50,000 runners (and walkers) every year.

I'm going to be starting in the slowest group, with my hubby and some friends from school (I think). I have no plans to run without walking, or beat any particular time. I really just wanted to be part of the event.

Doomsday turns out not to be that terrible. I did walk a little midway through. It isn't much steeper than the hill I normally train on. The only terrible part is that it's almost a mile long and it's a steady grade, so there is no respite until the top. And it's around mile 5, so you're already pretty tired by then. But I was pretty pleased with the run anyway.

I didn't run the entire route; I only ran 4 miles today. I heard a long time ago that it's not great to run the race course while training for the race because it's a letdown on the day of the race--you've already run it--and you'll have adrenaline to carry you through the unexpected rough patches. I don't have any idea if that is true or not, but it does make sense. I KNOW I can walk 7.7 miles, so it's not a question of finishing. And I know I get a boost when I am running with other people around; I do have a tiny bit of competitiveness in me.

I'm looking forward to it!

Good News....

2009-04-13T19:30:00.000-07:00

3 pounds decided to leave. Don't know why they suddenly left, but I hope they stay gone. 3 more to go...then I can get back to losing the last few to goal. grr, regain sucks!

But, I've managed to stay within an 8 pound range for almost a year now, and very close to my goal, which could only be possible with the Band. Even though my eating habits are far from perfect, I've been able to do it for longer than I have EVER done it in my entire adult life. I've never stayed at any weight this long, really. So it's still a victory. I'll feel a lot better when I'm back down a little lower, though.

Today I planned on a run after clinicals, but was greeted by a real hail-storm. We've had several hail-storms this year, but usually it's just tiny hailstones. This time they were up to the size of a Gobstopper, like a centimeter or more in diameter, which is VERY unusual around here. Luckily they weren't that hard, and they didn't do any damage that I have seen. But they did dissuade me from running Doomsday Hill today. So I am off to the gym, to the Dreadmill. Hopefully tomorrow I can get in some outdoor mileage.

I'm trying to structure this week effectively. I am doing a 2 week rotation at our local VA hospital, which is an all-CRNA practice, and has a much slower pace than our usual clinical site. As such, I'll have a little bit more time, so I'm making an effort to get caught up on studying OB and finishing my portion of the lit review for our research project before leaving for DC on Friday morning. I have not studied nearly as much as I would like to have done this semester...my head hasn't been in the game, and there isn't as much pressure to do so, which is good and bad. But today I've been pretty good, spending some hours in the library studying (and very little of it on Facebook!). Tomorrow should be even better, fingers crossed...

Time Flies

2009-04-11T22:20:00.001-07:00

I've been working away, and now it's already the middle of April. Where does the time go?

Here it is, Easter tomorrow. I used to celebrate it in high-church style when I was growing up. I grew up an Episcopalian, so High Church meant "smells and bells:" incense, 3 choirs singing, trumpets, lots of acolytes and priests in their finest regalia. When I was a girl, my mother would make me a new Easter dress every year. Usually she would play violin at church, as she did for most holidays and other Sundays, and when I was a teenager I often played with her. Of course, we also did the usual Easter things like baskets full of candy and dyeing eggs, and the occasional Easter egg hunt at church. In the afternoon, we'd go to my grandparents' house for dinner, which was pretty traditional.

These days, I get back to Easter's more pagan roots, celebrating the beginning of spring and the end of winter. And eating a lot of candy, of course. I try to do some of those little things for my husband, who grew up not celebrating holidays and never had those little things growing up. So we have Peeps, which I love but he does not. (Mmm, crunchy sugery outside, marshmallowy inside.)

This seems like an appropriate time to mention that I've regained about 6 pounds. They seemed to show up mysteriously over the last 6 weeks, or more like over 4 weeks, and have hung on the last 2 weeks, despite cleaning up my diet and running more. I don't know if it's the low-level chronic stress I'm now living in, or if I just haven't done as well as I thought. But there it is, staring at me every morning.

Still, I plan on running Bloomsday in about a month, even though I haven't run more than 5 miles in 6 months and it's a 12k. I won't end up running it all (I always walk/run anyway) but I'd like to kick things up over the next month, and hope it improves my weight as well.

That's it, not much exciting going on around here. Oh, wait...I am going to DC next week, that's pretty cool. Anyone know what the weather's going to be like?

Running on Empty

2009-03-25T19:31:00.000-07:00

I went home sick yesterday, and stayed home sick today. I'm feeling better, but started going stir crazy tonight. As the remains of a beautiful sunny day faded away, I looked out the window (making beads for the first time in months) and had to go run.

I hadn't run in 6 days. I started getting sick on Saturday, and that was going to be my next run day. Tonight I didn't care if I barfed up a lung, I had to feel the pavement under my feet. I just couldn't stand it any longer.

I only ran about 1.5 miles, but it felt great. I wasn't 100%, by any means, and my cough was a little ragged by the end, but it was still better than it has been the last few days, and I got out of the house and stretched my legs a little bit.

I'm so glad that I can go outside to run again. I'll still hit the treadmill when it's too rainy to run, but I have to distract myself so much just to get through 30 minutes on the hamster wheel. Outside I can run without any headphones, just my own thoughts. It's usually a very creative time for me. I can get a fresh perspective on whatever has been rumbling through my mind lately, and really enjoy the feeling of being alive and moving my body outside.

I realized this evening that I do need more solitary time than I've been getting lately. I'm used to having a lot more. I just need a bit of space and time to think things over and relax. That's what my runs are great for, that creative alone time to work things through in my head.

So, I'm off to wrap up my evening, in a better frame of mind than I was in this afternoon.

Vincible

2009-03-24T10:26:00.000-07:00

I got the crud. Don't feel too bad for me, though. This is my first cold since 2007. In fact, I can't remember being sick since being banded that March, although I think it MUST have happened...

Anyway, I tried to go to clinical today. I did go, and made it through one case (internal defibrillator placement) before realizing that it would be very embarrassing to pass out in the angio suite. The hacking, sneezing, and nose-blowing I can handle, but the dizziness had me worried. So I came to my senses and sent myself home.

I'm all hooked up now with some Benadryl, Kleenex and Throat Coat tea. I always go to Walgreens when I am sick (mainly an excuse to go to the drug store...for some reason I love going to the drug store; office supply store too...) but it's funny because I refuse to take most cold remedies. I can't stand anything with menthol in it, so Halls and Vicks are out. I can't swallow any kind of syrup without gagging. I can't stand how Sudafed feels, even if I could actually get it without an act of Congress. So I get by with ibuprofen and Benadryl and Jolly Ranchers for my throat. It's not that bad. This time I bought some TheraFlu and Mucinex (pills!), but will see if I take them more than once.

Oh yeah, now I remember my last cold. It was November 2007, right before I moved to Spokane. Maybe the Inland Empire is good for my health? Or maybe there is less mildew here and I don't get sick as much. I remember having my baggie of Jolly Ranchers and my Kleenex in our empty Portland apartment after we had moved most of the furniture to Spokane.

I think colds are kind of like life's speed bumps. They force us to slow down when we should have had the sense to do so already. It's no great surprise that I would get sick now; I'm sure my immune system has been limping along for the last two months, waiting for some drop in my cortisol levels indicating that Orange Alert stress levels had finally dropped. And I've finally started feeling somewhat less stressed in the last few weeks, which is when we seem to get sick after prolonged stress.

Anyway, my last run was Thursday, and I'm not taking it up again until I'm sure I'll keep both lungs inside my body for the duration. Also, passing out on a treadmill (or in the street) might be embarassing. I'm all about sparing myself public humiliation. But I am planning on doing Bloomsday this year, which is in 5 weeks. It's 12K (7+ miles). It's huge: until last year it was the world's largest footrace, with around 50,000 participants each year. (Last year, 2 races had over 70,000 participants and surpassed Bloomsday. But it's still the largest in America.) I don't really desire to run any other races, and I've never even run a 5K. But this one is so big that unless you are in the first starting groups, you really can't run the entire distance (at least without being a giant a-hole). So even though I'm not back up to running 7 miles a day, I think I'll be okay with running and walking this.

Bloomsday is huge in Spokane; it's one of the largest tourist events here, and they make a whole weekend of it, with a trade show and several events around town. The run itself is well-supported, and there is live music all along the route. The one thing I must do in my training in the next month is run Doomsday Hill, which is the famous part of the route that I've never tried before. (Check out this cool slideshow from Bloomsday 2006.) Several of my classmates want to form a team to do this run. We're toying with team names: Team Sweet Dreams, or maybe Gas Passers? We're too poor to make T shirts, though. I have to get well enough to run again this weekend if I hope to run even half of this event. I'm excited about it, though!

Bloated

2009-03-18T16:45:00.000-07:00

I've been feeling bloated the last couple of days. We ate really poorly this weekend, for a variety of reasons, and I gained a few pounds. It's weird how gaining just a couple of pounds brings me from feeling pretty thin and successful right back to "fat". I feel like I can see it all over, I feel like none of my clothes fit me or look good on me. 3 pounds did that...wtf?

Those 3 pounds feel like they are right in my belly, my #1 problem area anyway. When my belly feels fat and bloated, there is no way to feel good about my appearance. I feel like I can hardly move. It's so psychological.

Lately I've been examining the way my parents used food when I was growing up. As I think about it, they both really abused food--one parent is a compulsive overeater, the other had a variety of eating disorders all through my childhood. There was no chemical dependency in my family, but there was this kind of addiction. Odd that I didn't really confront this head-on when preparing for bariatric surgery. I looked at my own relationship with food, and decided that I had a tendency to misuse food, and knew I needed to work on that. And I have worked on that; it's not "cured" by any means, but it is better and I have more awareness when I am eating for reasons other than being hungry. But I think there is a bit more work to be done if I am to maintain my weight loss. I think this family history is what made me attracted to a person with addiction issues. Since we didn't have any obvious chemical dependency in my house growing up, it was a bit of a mystery how I could end up this kind of codependent, yet I am.

Things are going better, though. Recovery is happening in our home, slowly but surely. There is no cure, but we can be happy again, and we are.

Moving on to OB

2009-03-18T16:29:00.000-07:00

We have finished our pediatric anesthesia unit and have moved on to obstetrics. OB always scared me the most when I thought about anesthesia prior to starting school. Now it kind of excites me. Still scary, having 2 patients to think of instead of one. And of course, when things go wrong in OB, it gets bad fast.

Oddly, listening to our OB lectures makes me want to have a baby more. One would think it would be opposite, since we are talking about all the things that can go wrong. But it makes me think of what I would want.

I have baby anxiety. I'm getting older; I will be 36 years old this year. Yes, I know plenty of people get pregnant and have babies around this age. I hear it all the time. But until I get pregnant and deliver a healthy baby, all the reassurances in the world aren't going to take that anxiety away for me. With all the major revelations that have occured in my marriage this year, it would be best to wait at least another year before considering having a baby. But I am not getting any younger, so this fall is when I will consider whether I can start trying. Come about October, I may decide that it's better for our lives and our marriage to wait longer. But I have so much anxiety that I'm not going to get pregnant, I suspect that I will try anyway at that point. I graduate in May, so getting pregnant anytime after September would probably be okay for finishing school and taking boards and starting a job.

It would be perfect if I could revisit this whole thing a year from now and see what state my marriage is in at that point. And I could do that. But I will turn 37 next year...not when I want to START trying. The few people that I talk about this anxiety with (mostly my hubby, but a few other friends too, mostly ones my age) don't really like to hear about my anxiety. So I don't talk about it much anymore. But it is there, I really want to be a parent, so I will have to make some sacrifices in some areas to ensure that it happens.

Meanwhile, we start practicing epidurals next week (on lab dummies). We've already been doing spinals for several months; I have about 20 so far. Epidurals aren't drastically different; they are a little more difficult. But one nice thing that I never thought about before now is when we do spinals in the OR, say for a hip or knee replacement, the patient is not in pain to start with, so they are more sensitive to the pain of injecting local anesthetic and inserting the spinal needle. Versus a pregnant, laboring woman, who may be sensitized to needle pokes and all that, and may have a difficult time getting into the right position, but if you place a successful epidural, you've just become that woman's new BFF. They start out in pain and end up comfortable, as opposed to the surgical patient who wasn't in a particular amount of pain to start with when you started stabbing their back. (That's said tongue-in-cheek. If done properly, a spinal shouldn't hurt except for the initial local anesthetic injection. Only maybe 2 of my spinal patients have had any pain at all when getting their block. But sometimes it's very hard to do "properly", depending on the patient's anatomy.)

I never realized that there are quite a few options for anesthesia for labor before now. I guess I had the idea that you either get a full block, numb from the waist down, or no anesthesia at all. But in fact, depending on what the mom wants, there are a lot of variations and options, from just "taking the edge off" to complete anesthesia. I think that's pretty cool.

Happy Bandiversary

2009-03-14T09:58:00.001-07:00

I knew there was something about yesterday's date that was striking a bell, besides being Friday the 13th. It was the 2 year anniversary of my band surgery.

At 2 years out, I am just about exactly the weight my surgeon said I would be, having lost 70% of my excess weight. I have been maintaining this weight, within 5 lbs either direction, since last June. I still want to get to 160. Today I am 168. But I'm pretty happy where I am.

The other day I was giving an anesthetic for another band surgery. I have done about 3 or 4 bands so far since I started my clinicals last July. The CRNA I was with asked the surgeon--who has only recently started doing bands, he's mostly a bypass surgeon--about how the band worked and the surgeon was explaining. He ended up saying that gastric bypass patients tend to lose about 70% and band patients lose about 50% of their excess weight. I asked him about the 5 year studies that show the weight loss is the same between the two groups, and he said that those studies were small and he didn't think they were reflective of actual results. I tend to disagree, but I'm not 5 years out yet.

I don't wish to lose 100% of my "excess weight". I think my actual excess weight is a bit less than what they calculate with BMI charts and other methods. If I had a tummy tuck, I don't know that I'd actually want to lose any more weight than where I am now. I'm wearing size 6 jeans (4 different brands, and not stretch either). My tops are either smalls or mediums. I have flab, but that isn't going to get much better without plastic surgery. Most importantly, I'm able to run and do things that were never possible for me before.

I haven't had any heartburn since those 2 times a few months ago. And those were the only 2 times in the past 2 years I have had any. I can eat more than I should be able to. But I think if I was more careful about stopping sooner, I would still stay full at least 3 hours. I can still stop myself when I find myself looking for food and ask, "Am I actually hungry?" Usually, the answer is no, and usually I can redirect myself. Sometimes I still eat something. Old habits die hard. But I'm at least aware that I am eating when I am not hungry, that I'm eating for other reasons.

It's not normal to lose 30 lbs in the first year of anesthesia school. Most people gain at least 10. I had lost 40 before starting, and I'm thankful for continuing to lose despite some good reasons not to. Losing these last 5 lbs is a struggle, and I hope to be successful in the quest. If I am not, if this is the weight that I am able to maintain comfortably, then I can live with that.

Being banded was one of the best things I've ever done for myself. Yay for 2 years!

Desire and Suffering

2009-03-08T17:00:00.000-07:00

In most Buddhist teachings that I have been exposed to, suffering is said to be caused by desire. This is a universal human condition, and one that can be broken, according to the teachings. Thinking of human suffering being caused by desire is a concept that, to me, at once seemed intuitively true and incomprehensible. On the one hand, it is easy to see that the kind of desire that begets mindless consumerism and even addicitve behaviors like overeating, alcoholism, and sex addiction could be the source of suffering. On the other hand, what about the suffering caused by things like physical pain or illness? What about suffering caused by abuse at the hands of another person? These things don't seem as obvious to me, but Buddhism teaches that all suffering is caused at its root by desire.

There is one view that says suffering that we don't obviously cause our selves is caused by desire in others who inflict the harm on us. I think the point of the teaching is not this, though, but rather that we can choose not to desire that things did not happen this way, choose not to see ourselves as something separate from the world and therefore when illness, abuse, harm etc happen to our "selves" this is just a construct of our minds. This is a very esotaric concept, not one that I am at all versed in or experienced in, and one which I think is a rather advanced human condition.

What I CAN see is how my own desire causes suffering for me. First there is the endless desire for things, which always begets more desire for things. I get an idea in my head that I need a new pair of jeans, for example. I think about it for a while, decide exactly what to look for, and where to get it. I finally go and get the pair of jeans. You would think that my desire would thus be sated. But no, soon I am finding myself desiring some other thing. There isn't relief from this desire, only repeating of the cycle.

This happens to us with food, too. We decide: I want some ice cream. We obsess about it for a while, think about which flavor and brand we want, when and how to get it. We get the ice cream, and we eat it. And soon we are finding ourselves not fulfilled by having this desire met, but rather, right back in the throes of a new food craving. Sugar totally does this, for reasons that science has at least partially explained with insulin levels and other hormones. But anything that can be craved can cause this same reaction, with or without fluctuating levels of insulin.

Other kinds of desire can cause or perpetuate suffering. I am learning recently that one kind of desire is the desire for a different reality. Wishing that something was not true so much causes us to become stuck in the bitterness and anger and resentment that goes along with that desire. It can even cause denial of reality, which creates another kind of suffering.

I often find that I desire to be seen a certain way: as the winner of the argument, the "better" person, the morally or intellectually superior one. My desire to not have my flaws seen is, of course, useless: not only am I creating my own suffering by holding onto that supposed superiority, but my flaws are seen in sharper relief as someone who thinks she is better than the other person, and I create suffering for the person I am trying to seem better than.

Samsara is a state that is referred to in many different religions. Often it is described as the cycle of suffering and reincarnation. The idea of reincarnation itself isn't really what I used to think it was, literally being born again as yourself but in another form. If you're "good", you are reborn as a more evolved being; if you are "bad" you are reborn as something lesser and further away from nirvana, like an insect. I guess first you have to sign off on the idea that there is a hierarchy of beings that are certain distances away from nirvana. Then you have to accept that we have a bank of good and bad karma and the end of our lives is an accounting of what your balance adds up to. I don't think this is really the essence of samsara. It seems to me that it is more like the effect of desire and longing and suffering in the world. These things are self-perpetuating and affect the entire web of existance. I don't know how to reduce suffering in human existance, but I do find that being mindful of my own desires and how they are harmful to myself and those that I affect helps me.

If you are thinking that this is some radical new direction that my blog is taking, please take heart. These aren't radical new thoughts for me, only new blogging topics that seem more relevent to my life these days. It's not becoming a spiritual or religious or Buddhist blog. (Although if it did that would be fine; it's my blog after all.) I'm just feeling a little more contemplative today than usual. It is so much better than some of the mental spaces I've been in so far this year. I hope it is interesting or helpful to someone.

The White Path to Recovery

2009-03-08T13:31:00.000-07:00

Today we went to our local Buddhist temple again. It was a simple service. Our temple does not have a dedicated minister; instead, a minister from Seattle flies to Spokane once a month for an afternoon service. The rest of the month the services are "MC'd" by members of the temple. An assistant minister gives a dharma talk (like a sermon, sort of) and there is chanting and a few simple rituals.

The dharma talk today detailed the parable of the White Path, as taught by Shao-tao. It is somewhat lengthy, so I've included the link. It is basically about reaching the place of enlightenment via a narrow path that separates two rivers, a river of fire and a river of water, and connects the east bank, which is our world of samsara, or suffering, and the west bank, the Pure Land, or afterlife. The river of fire represents our anger and resentment, and the river of water represents our unceasing human desire, which continues our suffering (as the Buddhists teach that desire is the source of human suffering). The character in the parable is urged along the path by two voices, that of Shakyamuni Buddha, the historical Buddha, calling from within the river and telling him not to fear, and that of Amida Buddha, from the West Bank, urging him forward. From the East Bank, there are bandits and wild beasts pursuing the character in the parable, from which he is trying to escape. These bandits and beasts represent essentially the elements of what we call "self".

This parable is described to represent our movement through this life towards enlightenment. I think it also serves as a good metaphor for recovery. You have to get through the anger and resentment and the desire for things to be different than they really are in order to reach the place of serenity. The path is narrow but can be traversed if you approach it with purpose.

I take a lot of comfort in Buddhism, a tradition that I am just beginning to learn about. I was raised a Christian, but eventually I realized that it doesn't feel true to me in my mind or in my heart. Still, I am a spiritual person, as I think most people are in some sense.

Buddhism isn't a theistic tradition and many would say it isn't even a religion. Buddha isn't a god. In fact, Buddha simply means "awake" or "enlightened". It is said that upon his enlightenment, Siddhartha, the prince who became the Buddha, was asked if he was a man, and he replied "no". He was then asked if he was a god, and he again replied "no". Then he was asked, "What are you?" And he replied, "I am awake." Hence he became known as Buddha, and he has a few other names: Shakyamuni Buddha, and Gautama Buddha are a few of them. He is not worshiped, but rather his example is followed and his teachings are studied in order to learn how to live this life and attain enlightenment. This sounds much more lofty than I think it is in practice. In reality, the Buddhists I have read and met seek simply to live without increasing or causing suffering in anyone, and to follow the teachings, which are fairly common-sense and practical.

The temple we go to is the only one in Spokane, and it is in the Jodo Shinshu tradition of Buddhism. There are so many different schools and traditions in Buddhism that I haven't even begun to understand the exact workings even of the one we attend, but the one difference I do know is that Jodo Shinshu discarded the monastic tradition. They do not have any monks; all lay people have direct access to all the teachings. The beliefs that tie all Buddhists together are the Four Noble Truths and the Eightfold Path. These are the things that all Buddhists agree upon.

This year has presented me with some tremendous challenges, and many of those I think are spiritual challenges. I have been trying to meet these with a spiritual tradition that feels honest and practical to me. In all Twelve Step programs, they speak of "the God of our understanding." This can be a real stumbling block to those of us who consider ourselves atheist, or agnostic, or are just turned off by religion. But one thing they teach is that it doesn't matter what that "God" is or even if it is a "God", just that you acknowledge that there is something outside of yourself that can restore you to sanity. To me, that is the Universe. Reading about these teachings and hearing the simple, profound Dharma at the temple really helps me to focus and strive to see the world outside of myself and my seemingly important problems that really are just a part of this world of samsara.

Fatigued

2009-03-07T10:48:00.000-08:00

I'm getting used to living in post-crisis now. It's not the same as pre-crisis, when I thought things were pretty normal. Now I know they aren't, and my life is different in a number of inconvenient and irritating, and in some cases frightening, ways. Looking toward the future, I'm uncertain of what it holds. But I am working on living in the moment, being appreciative of 'now'.

I'm thankful that the crisis has passed. I know what is going on now, and it's better than waking up every day uncertain of what else is going to happen or what else I am going to discover that changes everything. I think I'm so thankful to be out of crisis mode that I might accept anything else that passes for normal in my life, which is a risk. I want to decide what is acceptable in my life.

What is left for me now is a deep fatigue. I am tired all the time. My days are filled with administering anesthetics and getting through school. My nights are filled with studying or going to meetings. People ask me normal things, like "how are you", and I am too tired to answer. I try to deflect the conversation back to them as quickly as possible, asking about their kids or anything I can remember that is going on in their lives.

In recovery-speak, this is a family disease, and I am in as much need for recovery as my husband is. But I am often resentful of how consuming "recovery" is, especially since I haven't yet reconciled myself with my own need for recovery. I feel like my circumstances are special or different: how can I be enabling behavior when I wasn't living with the addict, and couldn't see anything happening? Yet I don't think I am logically any different from the other spouses, so I am trying to analyze my situation and see what I can improve in myself--after all, this will only make my life better. But it's exhausting.

I run for stress relief. My eating is not great this week; I've been eating more sugar than I should, and bread and carby stuff. I've been noticing that I get hungry sooner than I used to, like 3 hours after eating. I haven't been super careful about stopping eating after a "small" amount of food, and it's possible that I've dilated my esophagus or pouch or even had a small slip. But I have no other symptoms. Or do I? Sometimes I get kind of a "cramp" in my stomach, not exactly a sharp pain. It doesn't seem to be related to anything I do or eat. Twice I've had a sour stomach when I wake up in the morning, but both times I had eaten right before going to bed, a big no-no for banded folks. I can't see my surgeon until my husband is working again. Hopefully this isn't anything serious.

Four Things

2009-02-28T17:13:00.000-08:00

Four names that people call me (other than by my first name):
1. Gwendy: my nickname growing up
2. Gwendolyn: my father calls me that (my actual, given name)
3. Paltrow: my friend Kerry calls me that, and I call her Strug.
4. Gwennie or Gweneth: some of my friends use those interchangably

Four jobs I have had:
1. Farm labor, when I was 13
2. Delivering pizza, when I graduated from high school
3. Home health aide, at many places, the longest being an AIDS hospice while I was in nursing school
4. RN: I’ve been a ortho/trauma floor nurse, a burn ICU nurse, PICU, trauma ICU, medical ICU, and a traveler doing most of those things. And trauma resuscitation nurse in ED. And charge nurse. I’m tired now.

Four movies I would watch more than once: (I have seen all of these at least 5 times)
1. Bull Durham
2. Shawshank Redemption
3. Green Mile
4. The Color Purple

Four places I have lived
1. Fort Lewis, WA
2. Seattle, WA
3. Las Cruces, NM
4. Portland OR

Four places I have been:
1. Placencia, Belize
2. Florence, Italy
3. Vancouver Islands, British Columbia
4. Isla Mujeres, Mexico

Four Animals I have known or had in my lifetime
1. Buffy, my first cat (he was a boy)
2. Houdini, a mouse
3. Sissy Hankshaw, the first cat that was mine after I moved away from home
4. Sophie, my kitty now

Four of my favorite foods:
1. Salmon belly (saketoro) nigiri sushi
2. Gelato--my current fave flavor is honey lavendar
3. apple pie (made by me)
4. fresh baked bread

Four places I'd rather be right now:
1. Mexico
2. Sauvie Island, OR, in the summertime
3. Somewhere where there is no snow on the ground
4. Talking to my grandma

Four things I am looking forward to this year:
1. Getting close to graduation
2. The summer
3. Going to DC in April
4. Improving my marriage

Four TV shows that I watch:(All on DVD, not real time)
1. Mad Men
2. 30 Rock
3. The Sopranos, even though I have seen every season more than once
4. Sex and the City, still watch it from time to time although I’ve seen them all many times as well

Four Songs that I love
1. Beautiful World, Colin Hay
2. Sleep Don’t Weep, Damien Rice
3. Landing Gear, Ani Difranco
4. Constellation, Jack Johnson

Four modern conveniences I wouldn't want to live without
1. My laptop
2. My iPod
3. My Lapband—is that a “convenience”?
4. Microwave

"Sisters", You've Been On My Mind...

2009-02-24T23:05:00.000-08:00

Let's talk about the "girls". I noticed in my last post about clothes that I mentioned my breast reduction but had never really talked before about what a good decision this was for me, or about the thing that a lot of MO ladies worry about.

For many of us, one "silver lining" of being morbidly obese (MO) is having large breasts. We worry about what will happen to our shape when we lose weight. Indeed, what will happen? It depends entirely on what is IN your breasts. If you are young and the tissue is firm and not very fatty, not much will change. The older we get, the more fat is deposited there, and the more the size changes with weight changes.

When I was in my 20s, I gained weight and lost weight, but my girls just got bigger. As I mentioned in the previous post, eventually I outgrew all the "standard" sizes and had to be fitted at Nordstrom, where I was deemed a 38H. There in the fitting room, I decided that my idea of having a breast reduction was going to become reality. To me, H meant "Have to have a breast reduction." Things were outta control. I was tired of people staring at my chest, not in any sort of admiration but in freakish amazement. And I was sick of not being able to really exercise without pain in my shoulders, neck, back and chest. It was too much. I really felt like I couldn't lose weight if I didn't do something about this situation.

So, I went to a surgeon that a coworker of mine had gone to. His name was Dr. Kropp, in Seattle. I would refer everyone in the area to him if I could, but he is retired now. He related to me and my friend Val because we were burn nurses and he had done much of his training in reconstructive burn surgery. He had a special place in his heart for burn nurses. He was also extremely kind and caring. When he did my consultation, he took measurements, had his female nurse take photos (this is routine; the photos do not have your face on them, and go to the insurance company for approval), and then met with me, telling me "If you were my daughter, this is what I would want for you." He explained the 2 different ways that he could do the procedure. He assured me that there was no chance my insurance would not cover the procedure, given how much there was to remove, and he was right.

I knew how good he was from Val. She had been a 42MM prior to her reduction. (They used to call her Valcano.) She was reduced to a C cup. She told Dr. Kropp, "All I want is to be able to jump rope again!" She told me all about her surgery, and her results were beautiful. So I felt very confident in his abilities. I scheduled my surgery for late September 2001--about 2 weeks after 9/11, it turned out.

When he did my surgery, he was able to explain why they had never gotten smaller when I had lost weight. I was 28 years old, and there was almost no fat tissue in them. He took about 1000g (1kg) off each side. (The most expensive 5 lbs I ever lost.) There were no drains, but about a zillion tiny sutures. When I went to have them removed in the office 2 weeks later, it took him and a nurse about 20 minutes, and they looked like tiny insect antennae. He told me to wear a sports bra (one the office provided) after my dressings were removed, and I wore it at all times except when showering for 3 months. This is very important for shaping. When I first saw them post op, they looked completely flat, and there was a lot of tissue around the sides. Wearing the sports bra causes the side tissue to mold into the reconstructed breasts and creates a nice shape.

As an ICU nurse I have seen numerous women post breast reduction (for unrelated reasons, mostly because they have been in car accidents and such). My results were much nicer than most others I saw, so I would recommend that anyone looking for a surgeon shop around, get someone with a lot of experience, and talk to other patients. It makes a big difference.

I am very glad I had the reduction before WLS, because I've been able to exercise vigorously the entire time, and was exercising for over a year before WLS. When I lost 35 lbs in 2003-2004, nothing changed at all. However, when I gained weight again, and got older, I did start getting more fat in there. They are now a bit deflated, enough so that I am considering some additional work whenever I get around to getting a tummy tuck (in a few years most likely). The shape is still pretty good, but there is definitely less volume. You can't really tell when I am dressed and wearing a good bra. My initial post-op size was 38C. Now I am 34D.

Everyone I've ever talked to about having had this surgery has said the same thing: she wishes she'd done it years earlier. Truly, if you have very large "girls" that are impairing your ability to exercise or are causing you neck and back pain, and you have health insurance, I'd encourage you to consider it. It was an emotional decision for me, but ultimately a very smart one. My health has been immensely better since doing it, since I have been able to be so much more active. The scars are not bad. It took about a year for them to start really fading. They are definitely still visible, but they look better than what I had pre-op.

A lot of women worry about what their mates will think if they have a reduction. To that, I'd say that most caring partners will want what is best for your health and happiness, when it comes down to it. They might like the large breasts, but they'll like the active, comfortable you more. My hubby didn't know me pre-op, but has been very happy with what I have post-op. It's not worth suffering over any longer than you have to, or not losing major weight over. That's my perspective, anyway.

How To Shop For Clothes While Losing Weight

2009-02-17T16:57:00.000-08:00

It seems that sooner or later, you are going to have to face this question if you are undertaking a major weight loss project--whether by surgery or not. After all, you have to stay covered. First off there is a practical matter--jeans simply won't stay up if they are 3 sizes too big, and stuff starts to look ridiculous. Then you have to decide how important your clothes are. This is a big question for anyone who has been morbidly obese; after all we don't have a lot of selection or choice when we outgrow the "normal" sizes in the stores. If you have a job where you have to keep up a certain dress code or appearance, you are going to have to budget in some new clothes in sizes that you might not live in very long. Consider this when you decide if you can afford WLS; we don't get to jump from size 20 to size 6 overnight, no matter what your friends might think. Still, there are ways to make this a little less painful and expensive.

I think it helps to decide what is the most important thing in your wardrobe. For me, while I was in active weight-loss phase, it was very important to me to have jeans that fit. They didn't have to be expensive or any designer brand, but they had to fit, so I committed to buying 1-2 pair of Old Navy jeans in a cut that flattered me in each size. That was 5 different sizes once I started losing weight, at $30 per pair (unless I found them on sale). Not an insignificant expense, but one that I decided was worth making. I spent anywhere from 3-6 months in each size; for people losing more rapidly, this might not be practical.

Beyond this, I stuck to a few basic rules:
1. Skirts are forgiving, and often can be worn simply lower on the hips when they get loose, or can be altered.
2. Dresses in knit fabrics work for a lot of sizes.
3. Knit fabrics in general allow for a lot of use while losing weight.
4. A good belt goes a long way.

One thing that I don't think some people plan for is the fact that buying clothes becomes dangerously fun once you really lose some weight. Even when you aren't near goal, just looking and feeling so much better, and being able to fit into smaller sizes and new brands, can make shopping addictive. I think it helps to set your ground rules and your budget for transition size clothes. I accepted the fact that I would buy some clothes that I wouldn't wear very long, and tried my best to hunt for bargains and minimize wasting money.

Some things that people losing weight have done to keep things cheaper include:

-shopping cheap stores and sales (duh, I know)
-exchange clothes with other people losing weight--message boards like LBT or OH are helpful, and others I'm sure, as well as support groups
-thrift shops and consignment shops
-having a good tailor alter clothes that are too nice to just give up. Some items are too complex for this, but having a waist taken in on a skirt or pair of pants is pretty simple. This isn't necessarily cheap, though, so I save this for really nice things I can't part with. If you can do it yourself, great--but even though I'm a pretty good seamstress, there are many things I'd just rather pay a pro to alter.
-Ebay can be a big help, or not. I have found that I can do okay when I am looking for very specific things, but if you frequent Ebay, you know not everything there is a good deal. If you like to sell there, you can unload your stuff that no longer fits. I don't have time for Ebay selling these days, but I used to do it, and it's okay--it never made me so much money to make it really worth putting the effort into.

A lot of this is kind of obvious, I guess, but I think just thinking about the issue of clothes is important when preparing to lose significant weight (or once you've started and realize the problem). Shopping in your own closet is fun, digging out old things that ceased to fit when you gained weight--but for most of us this only takes us so far, until we either surpass our previous lowest weight and run out of old things, or get to the stuff that is just too old and out of date to wear. I eventually got to the old shirts that I bought several years ago that did fit again, but were purchased in that (painfully long) era when all shirts were shorter, even if they weren't midriff-baring exactly (and how happy I was when they finally started making shirts a little longer again, more suitable for us larger-breasted and larger-bellied ladies!). I was so happy to be able to buy shirts that were a longer length and toss those shorter ones to Goodwill.

I discovered some interesting things when I went through this process, too. For example, I found a lot of skirts that I liked but were just a little shorter than I was comfortable wearing nowadays--but if I bought a size or two larger, it would just sit lower on my hips and appear longer, and I could just wear a top over the lower waist. My waist has always been significantly smaller than my hips, so this works great for me. I also discovered which styles of inexpensive knit dresses were easily taken in at the sideseams to make them fit when I got smaller. Overall, my wardrobe became a lot more versatile as I had to change it around to accomodate my changing size.

Shoes and purses and accessories are the main shopping obsessions of obese ladies who like to shop but don't like to suffer the indignity of shopping for clothes. I found as I bought more clothes in transition sizes, I had to stop buying shoes and purses. I just couldn't afford it. Luckily, I had a lot of years to collect nice ones, so it wasn't that hard to do. I'm a lot more intentional now about buying things in general--I shop for a specific item that I need (especially now that I don't have my own income). I'm also lucky that my shoe size didn't change when I lost weight; this does happen with some folks, especially if losing more than 100 lbs total.

Underwear becomes an issue, too. I'm addicted to Costco's Itsee Bitsees panties, and bought them in mediums, then smalls. So I have about a million pairs of them in 3 sizes total; oh well. I have one style of Victoria's Secret bra that I love, and have had pretty good success getting them cheaper on Ebay. Don't forget to be refitted. The sisters shrink for most of us when we lose weight; we need to give them as much help as possible by making sure we wear bras that fit. Especially if your shirts aren't perfectly sized, it really helps to wear bras that fit underneath. I know this is a challenge when you are starting with very large bra sizes. Years before my WLS, I had breast reduction surgery, and I remember how expensive those H cup bras are. (Once I reached "H", I only bought one bra, and immediately pursued breast reduction surgery. The bra was $60 back in 2001.) So this might not be practical to keep up with perfectly if you start out a 44J or something. But again, Ebay can be your friend here, especially if you have a specific brand that consistently fits well for you. I've heard some people swear by some of the bras at Walmart; I don't shop at Walmart myself, so I can't help you there, but if you do, I'm sure you can save a ton of money doing that. Just be sure you know how to fit it properly.

What do you do with your bigger clothes? Well, for most things, I actually have kept them. The reason is that I hope to be pregnant in the next year or two, and I think I'll be able to wear a lot of it as maternity clothes. After I am done with childbearing, I will get rid of the big stuff. Things that I am pretty confident I won't be using again, I donate to Goodwill. If you are a part of a clothing exchange group, you're all set. And if you have really nice plus-size clothes, you can make pretty good money on Ebay, as that stuff is hard to find and a lot of us hated shopping in stores when we were morbidly obese. Consignment would work well for the good stuff, too. The undies are a loss, but that's why I don't spend a lot of money on them. The bras should be donatable, or possibly resale-able if in very good condition. Unless you think you have a good reason to need bigger clothes, like an upcoming pregnancy, it's usually considered best to let go of them when you reach goal and are maintaining it for some time. I had a few times before my surgery where I lost weight and thought I'd never regain, got rid of things, then had to buy them again, in shame, when I regained. So I would not be the one to tell you to chuck it all as soon as you shrink out of it. I'd make sure that you are really maintaining, at least within a few sizes of wherever you end up. But some people would say that is just allowing yourself to regain. Choose for yourself.

I hope this helps pre-ops and non-surgical folks (or recent post ops, or anyone really) at least in starting to think about how to tackle the problem. Nothing about major weight loss is cheap, although I'm sure there are ultra-frugal ways of doing it like there seems to be for everything else, if you want to put in the effort. Having a game plan and sticking to it is what worked best for me.

Karma, no drama

2009-02-16T20:40:00.000-08:00

I am missing my boring, normal life I used to have. It seemed boring and normal to me--in fact a lot was going on without my knowledge, but I miss the ignorance-is-bliss part, anyway. Even though I am all about the Truth these days and knowing what is really happening, tonight I'm having a weak moment and wishing for what I don't have.

Legal troubles abound for hubby. He's in serious trouble, without going into details. It's hard to watch him go through this, and hard to have all this uncertainty for us both. I am afraid of the financial fallout for us both over the next several years. Whatever he has to do as the consequences of his actions, that is just what it is. Karma is a real thing, and I'm grateful that he is facing everything with a clear head and no illusions (or delusions) about it. He's trying to remind me that while a lot of bad things are happening right now, some good things will happen too. I do appreciate that.

I've missed more school time--Friday and Monday--and I hate that. I feel so behind, even though I'm not really, and I hate for the CRNAs to frequently see me marked off the schedule. I think I'm not that much fun to hang out with in the OR, either, because I'm so freaking stressed about things these days that I don't make any small talk or chit chat while we sit together (not all of anesthesia is exciting or busy stuff, surprisingly). I don't have energy for it, and so be it. Mostly I try to lay low and get as much out of my clinical time as I can.

There is something good coming up. I am going to D.C. in April for our national organization's annual political meeting. We meet with senators and talk about healthcare and nurse anesthesia. It's pretty cool. I discovered, upon looking through my closet last week, that none of my business clothes fit anymore. The suit I interviewed in for school is a size 18. Needless to say, that isn't going to work this year. So, despite both of us being unemployed, I had to find some business clothes.

I got some good deals at the outlet mall (Presidents' Day sale) and got some pants on sale elsewhere. All in all, I actually got quite a bit for the amount of money I spent, and now I have two suits (size 8) and all I need to meet Congresspeople and the leaders in my profession. The trip itself is paid for by our state organization, WANA, which generously allots money in their budget each year to send students from our program to this meeting. One great thing about our professional organizations is that they work hard to include socialization and political education about our profession when we are in school. It's very important to maintain our profession and assure that quality care is going to continue to be available to people who need it. There are other groups that would like to see us limited in scope of practice, which would put a lot of people whose areas are served only by nurse anesthetists at serious disadvantage. So the political stuff is important, and I'm excited to go to this meeting. Plus I've always wanted to go to DC. There will be lots of pictures!