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.

Several of us, MeltingMama leading the way, have been watching the medical literature on a condition called Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome, or NIPHS for short (link may  require signing up for the New England Journal of Medicine). It was first described in 1999 by Service et al. This condition manifests as blood sugar crashes, beginning at around 2 years post-op. It's most often found in post-ops who were type II diabetic pre-op.

Many RNY post-ops who were type II diabetic pre-op experience a complete remission from high blood sugar with their RNY. I was one of those. Then at about 18 months out I started having severe blood sugar crashes. Over time, they have become more frequent and they have gotten much worse in their effects. I now suspect that the fainting incident I had in January was related to this.

My surgeon's initial explanation for the crashes was Reactive Hypoglycemia - described as a knee-jerk reaction of the pancreas to glucose in my system. With Reactive Hypoglycemia, the pancreas anticipates the amount of glucose it had to deal with before our surgeries, and it puts out too much for what we're actually taking in post-op. This overreaction seems to level out over time post-op, and can largely be controlled by modifying eating habits.

However, when the symptoms include blood sugar crashes unrelated to what is consumed, and when the crashes involve confusion and passing out, NIPHS may be indicated. It is now considered a "rare" long-term post-op complication according to the Mayo Clinic's Bariatric Program.

MeltingMama posted a link to this Mayo Clinic article, and I found it very interesting because it's geared toward medical student/residents, and it is presented like a "Dr. House" style diagnostic exercise (with all the correct answers at the end). My PCP kindly agreed to take a look at this article when I told her about it at my visit last week, and she called me after reading it to say that, sorry as she was to acknowledge it, she felt I needed to be checked out carefully for this. Because I fit the profile. I'm just over 2 years post-op RNY and my symptoms are becoming uncontrollable with diet alone.

I underwent the first step of the diagnostic process last week, planning my day so that I made my blood sugar spike then crash, and lab order in hand, showed up at the lab for a blood draw when my blood sugar was down around 50. I went in there holding the lab order and my glucometer in one hand, and a box of fruit juice in the other, so that I could tank up quickly once they got the draw. I feel awful when my sugar's that low. The results will be in sometime this week.

People, I am facing the possiblity that I will have to give up driving for a while. I cried about this all the way to work this morning. I have been adapting and covering up by eating something carby while I'm driving to keep my sugar up, or asking my husband to drive when I don't feel alert enough. But my commute is one hour each way, and I just cannot count on being alert enough the whole way, both ways each day. The lab work will tell us what the next step is.

For the first time since my first few weeks post-op, I am asking myself, is THIS worth it? The treatment for NIPHS is "debulking" of the pancreas. What does that mean? REMOVAL OF HALF OF THE PANCREAS. More recent studies suggest that with strict diet control, pancreas debulking may be avoidable, but this is all so new, the jury is definitely still out.

Even with this, was it worth it? I'll have to get back to you.

Dress I bought for a wedding in a couple of weeks. I will be getting a shrug or wrap to wear over it because while my batwings are not bad, my underarms are just not fit for public viewing due to years of scarring from Hidradenitis Suppurativa.


When last I wrote about doctory things, I was dealing with lower back pain, and the cortisone shot treatments I'd had were finally beginning to work. The pain is now totally gone, but I have followed through with the PT prescription (2 visits/week for 3 weeks) and I've enjoyed learning how to work my back and ab muscles to minimize pain and maximize strengthening to those areas so I can avoid straining it in the future.

One thing they've told me. NO treadmill. NO jogging. If I want to walk, I need to do it outside on a soft surface, or indoors on a quality track. No concrete, no treadmill, no jogging. Too much impact, which would possibly aggravate the joints in my back that we just got pain-free. I'm having to relearn how to lie down and get up from lying properly (laying? sorry, I never got that straight in English class..). I'm having to learn how to bend. I have long avoided squatting because my knees were so painful. Now my right knee is a little crunchy, but with the PT's help and support, I tried squatting. I'll be damned. I can squat all the way down, and even relax my weight from my legs to my backside if you get what I mean...totally sit into the squat. ANYWAY, that was cool. I have not done that in ages. WOohoo! Squatting! Hahaah! It's funny where the WOW moments come from sometimes.

So continuing with the doctory crap, I have been having the most fierce hot flashes. Yeah, yeah, menopause, bla bla bla. I DON'T WANT TO HEAR IT. I had a hormone panel done the last time I went in about this (a year ago?) and everything was normal. My doc explained that hormone levels change so rapidly that a measurement taken at a single point in time really doesn't say anything about what my hormones are doing, how they are going up and down over time. Despite the hot flashes, and the total lack of a menstrual period since...April? (yes, right before my NY trip), she said at that time she didn't think it was menopause. Yet. Then the hot flashes let up for awhile. They've been back with a vengeance, coming once an hour or more often, and totally extreme in their manifestation. I get DRENCHED with sweat. It is disgusting. I hate feeling sweaty. I can't imagine functioning during a trial or other stressful work situation with this shit going on. So I'm hoping to figure this out.

Given all the joint stuff going on lately, I'm going to ask her to order a baseline bone density test.

And we're going to revisit my blood sugar. I have been testing pretty regularly, and working hard at being more mindful of my symptoms, their timing in relation to my meals, and their intensity in relation to my food choices. Food choices don't seem to make a difference. I can count on a severe crash about two hours after I eat, no matter what I've eaten. The symptoms, and my blood sugar reading, seem to be less intense when I avoid white flour/sugar/etc. A meal including a serving of mashed white potatoes? Blood sugar 2 hrs post-meal = 49. Protein heavy/very low carb meal = 65. For example.

I find that I can feel the crash coming on, IF I AM PAYING ATTENTION, when my blood sugar drops to about 80. 90 is considered normal. So I am getting much better at detecting it. Plus, since I have realized from paying attention that the low peaks at about 2 hours, I watch the clock post-meal and do a check on how I'm feeling, including checking my blood sugar often. Every now and then when I'm busy or tired already or whatever, I will suddenly realize that I'm getting "that feeling," my hands are getting shakey, etc.

As long as I'm able to speak, I take the slow recovery route by having a protein shake or a snack with protein and carbs like apple slices with peanut butter. Liquid works faster so when I can, I opt for that. When my sugars drop under 50, it gets weird. I can't think clearly enough to take care of myself properly. Thank God my husband has been around for most of these incidents. When it gets this low, I take a small dose of a very high sugar something liquid - fruit juice, or full-sugar Coke, 4 oz. I cannot function at this point to do my blood sugar monitor and I've had to teach my husband how my glucometer works so that he can help me with it. Tonight I told him how to make my protein shake and showed him where the stuff was (he's so clueless about the workings of our kitchen) so that he could fire one of those up for me next time this happens. As long as I'm not passing out, I prefer the protein shake, because the Coke only leaves me crashing again a little while later.

Wow this is an exciting post. MeltingMama has been having blood sugar problems as well, and she and I have both been following the published research ona condition called NIPHS. Don't ask me to explain it, but it's an insulin production problem caused by a problem with the pancreas that seems to develop in WLS post-ops with much greater frequency than the unaltered population. The cure: REMOVAL OF PART OF THE PANCREAS. Not looking for trouble here, but man, this blood sugar thing can be scary and hard to deal with at times. I have to be constantly vigilant to have snacks on hand everywhere I go, and I have glucose tablets in my purse for emergencies. I'm thinking I may need to wear a medic-alert bracelet that says I have hypoglycemia on it, in case I ever do get to the point of passing out when nobody who knows about this is near me. They do know at work.

OK well I am really pushing it staying up until 2. I had a crash tonight and it left me feeling hyper, I guess from the sugar, afterwards. Off to bed. I'll be back with a report from the doc tomorrow, and a current weight, as it's the last day of the month.

Well, here I am at another new all-time low weight! I could tell my rings felt really loose on my fingers this morning, so before eating anything, I hopped over to my PCP's office to get on the scale, and this is what I saw.

I went by the gym yesterday, the gym I have not set foot into in about two months now? My trainer is no longer doing training so I'll have to hook up with somebody new. I still have to finish physical therapy for my back before I can go back full speed, but there's no reason I can't be doing some cardio in the meantime. Have I been back? Big fat NO. And the steady weight loss has not encouraged me to get back either! I do think that while exercise keeps my metabolism up, as long as I am doing strength training and building muscle, my weight loss seems slower. Of course that's no reason to not exercise! No doubt though, I'll get my groove back.

I'm committing to a date to quit smoking. That'll be October 1. And it feels right around the corner. I have to be smoke-free for three months prior to beginning my plastic surgeries in early January 08, so October it is. It's going to be hard, and I'm going to have to figure out how to keep from gaining a bunch of weight in the process. So I'm glad I'm still slowly losing at this point.

Click this photo to go to the flickr site full of photos!

I wrote this long post to the messageboard - guess I should have just put it here and put an alert on the messageboard. Oh well! Here ya go, the trip report.

Boy did we have a great time at the beach with my sister & her kids! Hubby and I took them to one of our favorite places, Dauphin Island, just off the coast at Mobile. It was sooooo hard to come back home and leave the beautiful beach and the great house we shared behind! I can't believe I'm already back at my same old desk tapping at the same old computer. Would you believe I called Hubby yesterday and tried to convince him that he and I should pack the car right back up and head back down there for a couple of days to ourselves?

The thing is, I was serious! And I was such a baby when he poo-poo'd the idea. SNIFF! Waaaaaah waaaaaah! I was a big old baby! I wanna play on the beach some more! Alas, life goes on, and reason prevailed, and here I am!

TONS of pictures on our flickr page (flickr member name "atlantagrrl"), which I'll link from an update to my profile/blog in a little while. And I'm working on editing some of our goofy videos as well - there are already a couple out on YouTube (YouTube member name "kathycha"). Click HERE.

It was a fantastic time, and gave me a chance to spend time with my sister and her kids who are 18, 14 and 8. They live in Atlanta and I don't get to see them nearly enough since I moved here to Alabama in 2001. My sister's been going thru a really rough divorce and it's been so hard on them all. Beach time together was JUSt what we needed! We walked the beaches, explored the west end of Dauphin Island since Katrina cut it in half, drove around the MS coast (Gulfport & Biloxi areas), swam, played games on the beach, went fishing at Cedar Point Pier, and enjoyed lazy time sitting around in the evenings playing guitars & singing on the patio.

My 8 yr old nephew caught a little 2 lb. speckled trout that we ate for dinner one night (he was SO proud) along with some of the great shrimp available on the coast. The only meals we ate out were breakfast the day we left Tuscaloosa and breakfast the day we left Dauphin Island. The house had a great kitchen, and  I brought some supplies to teach my sis & the kids how to make some traditional Lebanese foods. They really seemed to enjoy that. My father is Lebanese and as the oldest of my 4 siblings, I got all the cooking info and it didn't necessarily trickle down to my "baby sister" at the time! So this was a great way to pass some of that family tradition on to them. My 18 year old nephew can now make Hummus for himself!

I guess the silver lining to coming back was doing my weekly weigh-in yesterday - I found out that I lost a pound this week, so I now weigh 169. When I plugged that into the BMI calculator, it said my BMI was 29.9 - and any of you number-crunchers out there know what THAT means - as of this weigh-in, I am JUST OVERWEIGHT - NO LONGER "OBESE"! Woo-Fa-Reakin-Hooooo!

Funny thing is I'd set my goal weight at 168 because I thought that's what the BMI calculator said would bring my BMI to 29.9, but apparently I was a pound off. So, I guess I have MADE IT to my goal, and YOW I can still hardly get my own head around that concept!

I'm so grateful to have these few days to ease back into my "regular" life and get ready to dive back into my job, which was in crazy-mode when I left, and will be double-crazy when I return, with deadlines bearing down hard on me starting first thing Monday morning! The lower back strain I was getting treatments for DISAPPEARED (thank you God for cortisone shots!) and this week I'll start 2 weeks of physical therapy to learn how to strengthen my core muscles (abs & back) to prevent that from happening again.

So I guess it's time to go shake the sand out of everything and get the car ready for a good clean-up. I almost hate to get rid of the sand, ya know? But I guess I better get on it.