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!

Adjusting

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

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...

...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

Babymoon

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

She's Here!

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

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

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

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

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

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

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

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

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...

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

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

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!

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...

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)

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)

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

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

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

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