Slowly but Surely

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

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!

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!

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

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...

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

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

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

A New Life

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!