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Well it's been ages since I got on here. I guess it's no coincidence that I've been slowly gaining over the past few months, and have stayed away during that time. I have poked my head out at various support group things, but I have not been active on these messageboards in quite some time. So I'll get the hard part out of the way up front. I'm up to 188 as of Saturday. I had said 180 was my drop-dead-oh-no weight, but lucky for me I have not yet dropped dead. Instead, I've been pumped full of steroids to deal with both my lower back and my right rotator cuff, both in very bad shape. And I've been pumped full of different steroids to deal with my skin condition, hidradenitis suppurativa. I've been way out of my exercise routine because a) I got out of the habit, b) it hurts both my back & shoulder to work out & I have yet to regroup in the gym to deal with this, c) the hidradenitis suppurativa has been flaring up very painfully also, and c) lately, exercise messes up my blood sugar, causing me to crash, sometimes in the gym.

So there are my "reasons." Excuses? Feels that way. I am not going to gain any more weight. I plan to hold on through the holidays, and up my exercise, however I can do that without pain. I have to keep the steroids going, at least for my skin condition, because I really have no other options to deal with the pain right now, and it's been terribly painfully flared up. What I can do is make better food choices at each of my 6-8 small daily feedings. The endrocrinologist I saw about the blood sugar stuff told me that I need to "eat constantly if that's what it takes" to manage my blood sugar crashes. It's good to have somebody following this for me, but the options for dealing with it are pretty limited. And I have been rather grumpy about the whole thing, which hasn't helped me make the best food choices.

All that said, I still have no regrets. I am turning into a compulsive shopper! I have had to make lists of only what I need, or I find myself wanting to just load up. I really need everything at any given moment. I realized last week that I had nothing to wear for cold weather. So I took some time and built up a small winter wardrobe, only to have temps here soar into the 80's, leaving me with nothing to wear! C'est la vie.

STARS of WLS had our annual holiday party this past weekend. If you click the photo above, the link will take you to the rest of the photos on flickr.com. I see my Tusca-loser friends every now and then, and try to keep in touch locally. But overall, what time I spend on the computer, I tend to be working, and not doing much surfing for fun. 

I am still feeling ambivalent about the plastic surgery, but I'm going to see a counselor and work on examining my fears and getting on with it. Having the excess skin removed would probably go a long way toward improving the HS, which seems to be getting worse instead of better. So much for the docs who insisted that all I needed was to lose weight to fix that up!

OK well this is just a quick update. I should go update my stats, which I see I have not touched since July. Eeek! Well, I gotta be real. I'm 21 lbs up from my all-time lowest. Funny, I mentioned this to Dr. Dewitt all down on myself, and he got mad at me for being down on myself. I mentioned my gain and he was all, "So what! Most people have 10-20 lbs rebound from their lowest. You're doing great!"

Still, I don't feel so great about it.

Yes, I'm still here! I had walking pneumonia for a couple of weeks and it really did a number on me the whole time. I'm just starting to feel better. A weekend at the beach helped! My husband and I celebrated our first wedding anniversary with a trip to Dauphin Island. Couldn't have been a better time! Gorgeous weather. Just a great trip. Very relaxing.

I need to get on the scale and see what's going on. I am sure I've put on a few pounds, my black pants were uncomfortably tight. My surgeon told me to expect to gain some weight given all the steroids I was on for awhile, and I ended up continuing on them orally to help clear up the pneumonia business as well. At last check I was 177 I believe. That's ten pounds above my lowest weight. I can live with it.

Funny. They are starting another "Biggest Loser" competition at the office, and they made sure to tell me about it so I could participate if I wanted to. My first impulse (which I did not follow thru on) was to say, "ARE YOU CALLING ME FAT? ARE YOU SAYING I NEED TO LOSE WEIGHT?" Heheheh. For real though, you know, I am not interested! Sure, I could stand to lose a few pounds. But I have spent the last two-plus years of my life all about losing, losing, losing. I have just gotten to a place where I figured I was "done" only to be faced with this question, "Do you want to do Biggest Loser with us?" The answer is going to be "No thank you!" For all kinds of reasons, not the least of which is that I consider myself to have an unfair advantage :-)

OK well I wanted to stop in here and do a little update to say I'm still alive and still doing well. OH medical stuff...

The endocrinologist/diabetes specialist I saw basically told me if my hypoglycemic incidents continue to get worse, to keep tweaking - to keep eating smaller and smaller meals closer and closer together, and to even eat "all the time" if I have to. He used the word "GRAZING" to describe what I should be doing. GAH! But it's OK. I have done well eating about every 3 hours, small meals or snacks. NEVER a full-sized meal, because it seems to be the quantity of food that drives the severity of my reactions, strangely enough. In other words, I have a reaction pretty much every time I eat anything, so I'm minimizing symptoms and frequency by eating very small low carb meals more often. Since seeing the doc, I've only had two crashes, both close together, the night we got back from our trip. I suspect that my lack of diligence on hydration was the cause of that (dosing in the car for long stretches, not drinking anything). 

One thing I'm fairly certain of: a side effect of WLS for me is that it has reduced, if not totally eliminated, my "margin of error" for maintaining a healthy state physically & nutritionally. If I slack on water even one day, I pay for it in some way, whether it be headaches, severe blood sugar crashes, etc. I've got to be more vigilant than ever.

OK gotta run - duty calls. Just wanted to check in!

Me and Jeremy Gentles at the OH Atlanta Event

As usual, I'm up way too late. I'm not lacking sleep, though. I've been sleeping off and on all afternoon and evening. Just took a decongestant that seems to be keeping me up, but I hope to crash soon. I picked up a seriously nasty cold-type thing over the weekend, and I've felt like crap for the past few days. My head feels like a brick. I'm tired of not being able to breath, smell or taste. Let's hope it lets up by the weekend, when I have to spend a very long Saturday at our vending stand for the Crimson Tide home game.

Also, I hate to be burning up my paid sick leave with a cold, when I have all this plastic surgery looming ever closer. I called today to schedule my first set of procedures. I got some available dates, and have to check with hubby and my insurance company before I nail it down. But for the moment, it looks like I'll get this all started on Thursday, January 3, 2008.

In the meantime, I've got an appointment tomorrow with an endocrinologist at the UAB Medical Center. I located him by reading medical journals on diabetes and endocrinology, NIPHS in particular, and sent out a few emails to far-flung scholars asking if they knew of anybody in my area who could help me get to the bottom of my post-op severe hypoglycemia.

I am fortunate to be so close to a pretty big medical school, and by a pretty circuitous route, I did locate a sharp research doc who specializes in just what I need. He told me that they see so many RNY post-ops for low blood sugar issues that they have started including endocrinology in their routine follow-up for RNY patients at UAB. In his first voicemail to me, he said that if my doc thought I had NIPHS, I should go straight to Mayo, as UAB does not offer the treatment that Mayo does - removal of most of the pancreas! I told him I would rather not  have my pancreas cut up, but I still need and want to know what's going on with my blood sugar. So he told me to come on in. I need to remember to bring my glucometer along.

Lately I've managed to avoid any serious blood sugar drops by eating small meals every 3 hours. However, I've found myself eating rather randomly and mindlessly, crossing the line into grazing, and making some pretty rotten choices while I'm at it. I need to get a grip on all that, and I've done better this week by being sure to keep things I can eat in the fridge at work: cottage cheese, apple slices and peanut butter, almonds, SF popsicles, etc. I have a feeling I'm back up a few more pounds, and I'll know tomorrow when I get on a scale, which I haven't done in the past couple of weeks.

A great new indicator of weight gain for me is going to be my resized engagement ring. Woohoo! I got tired of hassling with the ring sizer, and I finally stopped by the jeweller and got measured for the resizing. I don't remember what size it was - I'd had it resized once or twice already - but the measuring doohickey said my ring size is...are you ready for this? I'm a 7. That's SEVEN. My ring size before surgery was 11.5! I got the ring back today, and it's pretty damned snug. I have to fight a little to get it off sometimes. I am going to drop this last 10 pounds and hopefully a few more and it should be fine for the long haul.

Last but not least, I went to the OH Atlanta event last Saturday, and it was lots of fun! The speakers were good, especially Jeremy Gentles, the resident fitness guru. His talk on post-op exercise was awesome. The shrink who talked about post-op emotional issues was good, too. Most of all, it was fantastic to see all the little faces in one-inch avatar boxes come to life right in front of me. I enjoyed meeting Amy Williams at long last - she's been an inspiration to so many. I saw some of her MTV appearance on TV tonight, "True Life: I'm Obese", and it brought tears to my eyes. She's lost over 400 pounds and is looking fantastic. She has her critics, I know, and I have been one of them at times when we've locked horns over stupid OH moderation issues. But she lives and breathes ObesityHelp dot com, and spends all of her time helping others who are on the road to surgery, or recovering. She has personally helped many people navigate insurance and hospital issues to get their surgeries, and I give her massive props for all that she does in that regard.

OK I better end here. Time for some more sleep!

Click the photo to see more photos on Flickr.com

The wedding last weekend was great. The shoes I wore were not good for long-term wear - glad I brought some flat fancy flip-flops! It was so much fun to dress up all fairy-princess like for a night. I loved my husband in his linen suit as well!

The past week was full of doctor's appointments. I had annual check-ups with the pulmonologist and the urologist. I originally saw the pulmonologist for a lung clearance as part of my pre-op testing in 2005. My lung function was somewhat compromised then, so he's continued follow-ups with me. At this point, despite my continued smoking, my lung function is better than ever. So he's released me.

The urologist got into the picture when I had those kidney stones last year. This was my one-year check-up, and he told me that after one more year with no problems, he'll release me from his care as well.

Finally, I had my annual ob/gyn check-up. I'll get my PAP smear results in a couple of weeks, but everything looked okay. I have not had a period since April of this year. So she's referring me to a reproductive specialist to get the final low-down on what my ovaries are doing. We are ambivalent about having children, but open to it. The approach we originally took was to stop using birth control and "see what happens." Well my systems have gone a bit nuts since then, and if it's possible for me to get pregnant with some minor tweaks, it's something I need to explore before I embark on a long course of plastic surgery. It's really kind of now or never when it comes to me and pregnancy. It may already be never, that's what it seems like, but a thorough evaluation will tell the story.

My ob/gyn is also my PCP and she's been following me for NIPHS since reading up on it. She went to an endocrinology conference (in Banff!) last week and talked about this condition with a few of her peers. There's not much out there about it, although the recent coverage in the press from Mayo Clinic press releases has caused some buzz.

The blood testing we have done so far has been inconclusive, as I suspected it might be. I was on the way up from a moderate crash when the blood was finally drawn. C-peptides came up normal, but insulin antibodies were elevated. We suspect what I need is a controlled timed meal study - where I eat a specified meal and have blood drawn every 30 minutes for 3-4 hours afterwards to check blood glucose, c-peptides and insulin antibodies.

I'm still having the crashes, but I do find that I can control them by eating very small high-protein meals very often. I still crash after every meal, but I can keep it from really bottoming out by keeping both quantity of food and percentage of simple carbs way down. If I depart from this, and say, eat a larger quantity meal, crash-city. I made a poor food choice on Thursday night and was rewarded with a crash to 36. Yow. My doctor said if this happened in my sleep, or if I fell asleep before getting it back up, I could wind up in a coma-like state. She's extremely concerned about this, and her concern makes me even more concerned!

Ultimately, my PCP decided we needed to refer me to an endocrinologist or other specialist in diabetes to evaluate me for this. I've shot out emails to the authors of a couple of studies, and they have kindly provided info on such specialists in my area. Hopefully we'll get a referral set up in the next couple of weeks.

Tomorrow I see the dermatologist for some treatment on my HS lesions. I need to work with her to get a letter for my job so that I can continue to do some of my work at home when HS makes it impractical for me to go to the office an hour away.

My weight was 177 at my PCP's office. That's ten pounds above my lowest, and it sure came back fast - much more quickly than I lost it, that's for sure. It seems I can struggle for months losing a few pounds only to see them reappear overnight! I'm not stressing about it. I think my freak-out point will be 180. And I think I'll probably shrink back a bit once I am back to regular exercise again, which I still am not. The back pain is much better, but now my shoulder is more painful than ever, so I need to resume PT for that.

I've put off updating here the past couple of weeks, in part, because my weight has been all over the place. Mostly up.

But here's the thing. I feel like I am supposed to be all distressed about that. Seeking advice. Looking for comfort and reassurance. I am supposed to feel bad about gaining weight. I am supposed to begin immediately to GET IT OFF OF ME. PIck up, dust off, lose that weight, I can do it! With my tool! Right?

Right???

I don't know if this is good or bad, but that's just not how it is for me now, and I have resisted saying much about my weight the past few weeks because I fear the reaction I might get when I talk about how I really feel about it.

First - the numbers. I've got them written on my calendar (I have been keeping track) which is not handy just now. But my recollection is that from 167, I was 173 the next week, 177 the next, then back down to 171. Or something like that. I went up TEN WHOLE POUNDS in a short time, then eased back down to four pounds over my lowest-ever weight.

So there are the facts. And how do I feel about them?

I don't care.

I don't. I am not alarmed. I am not feeling any pressure to do anything aside from continuing to make healthy food and exercise choices. I've put on a few pounds, and it is okay. I don't care.

And now for the "but"s...

OK. I don't care...much. I kind of hate slipping back over that overweight/obese line on the BMI scale. I was grooving on being merely overweight after being various levels of obese most of my life. And I'll kind of hate it if my long losing streak has finally come to an end. Which is what I think I'm dealing with. I think I'm now at that tipping point called Maintenance. My initial reaction to a gain is "bad, bad, bad!" But is it really? I'm told it's just part of the process once a person has lost all their body is going to lose, to bounce back up a few pounds then stabilize.

My surgeon congratulated me for getting to Maintenance several pounds before I got down to 167. His initial goal for me was "anything under 200," where I've been for about a year at this point. Plastic surgery will remove a few more pounds in the coming year. I'm OK where I am. I'll be fine with losing more, of course. Or not. Frankly, I'd like to get to the point where I can pull something I bought 2 weeks ago out of the closet and have it fit properly. I still won't do any major wardrobe rebuilding until after my PS next year, so it's still clearance racks and thrift shops for me. Even then, though, I'd like to be able to rely on a small handful of staple items and be able to count on them fitting when I need to wear them. At any given time, I feel as though I have maybe 2 outfits that fit me properly, and yet, a whole closet full of clothes stares at me, the rest, too big to wear.

Am I insane? Is it crazy that I don't care? I hope not. Now, I'm not stupid. I'll continue to watch my weight, and I will join the ranks of the alarmed if I see a pattern of gradual gaining over time. I know myself well enough to know that I'll always have to be on guard about the return of bad habits, and unhealthy weight gain. But I'm just not going to lose my mind over these fluctuations which I see as pretty normal. I've had steroids coarsing through my system since the treatments for my arthritis problems, and I've been out of the gym for several months now, laid up while I do physical therapy to get my arm and lower back healthy again (no treadmill! no jogging! EVER AGAIN!). When I quit smoking in October, I'll be on guard again, as I expect my reaction will be to want to replace smoking with food.

But for now, I've put on a few pounds, and? I don't care.