Once again it's been awhile. Now YEARS since I checked in here. I have not been to my local support group in quite some time either.

So I developed suspected NIPHS (non insulemic pancreatagenous hypoglycemia syndrome) and went through an awful time where every time I ate, even if it was solid protein, I had a terrible blood sugar crash within a couple of hours. I ended up seeing an endocrinologist at UAB who specalizes in metabolic disorders, and he has been awesome. I was afraid for awhile there that I would have to stop driving! Passing out in the car is not good, and I did that once, though it was just after I had parked the car. Still...

That may be old news. I haven't looked back to see where I actually left off but that was diagnosed in 2007. It's been a very long, slow process of relearing my body and my metabolism, and to some extent, retraining my body. After WLS they tell you that "grazing" is a sure fire way to gain your lost weight back. Of course, the prescribed way of eating for my blood sugar is what amounts to GRAZING in the WLS world. I struggled with making good choices several times a day. And some of my choices were fear-driven. I had to work my head around that. If I had the slightest inkling that my blood sugar was dropping, I'd go for sugar or carbs to keep it up. This choice might make me feel better quicker, but over and over got me back up to 240 pounds.

My WLS surgeon, much as love him, really kind of pissed me off by being so dismissive of my blood sugar problems as "late dumping" or "reactive hypoglycemia." I didn't feel right about his response, and neither did my primary care doctor, who read up on NIPHS and referred me for more complete diagnosis and treatment. Even after my diagnosis, my WLS surgeon completely dismisses the whole thing. WHATEVAH.

My father died in 2008, and the year leading up to his death was one of the most awful of my entire life, maybe the worst. He was supposed to have a minor procedure and be out of the hospital in a day or two, but an unfortunate series of events landed him on life support, and he clung there for several months. He'd been taking care of my mother, so I basically moved to Atlanta to care for mom and dad, while trying to do my job, and deal with my mother in law who freaked out about me abandoning my own husband.

It was a rough time.

Then I sold a house, bought a house, and had 2 car wrecks in which I injured my neck.  So the stresses were high, and the pain from my neck injury added to that, and interfered with exercise. In getting the neck injuries attended to, I learned that I have a severe degenerative condition in my neck, and right down my spine, and out into my hips and knees. I am covered up with bone spurs, and will probably develop rhuematoid arthritis, or so they tell me, given that the marker shows up in my bloodwork.

Gah. I didn't like that news about my spine condtion, there's nothing they can do about it, so I just pretend I didn't get that bad  news. Until I develop any issues from it that CAN be treated I guess.

LIfe just kind of piled up on me for awhile there, and the pounds came right along with it!

In May of last year, 2009, I saw 250 coming way too damned fast. My endocrinologist was also watching the pounds pile on, and he referred me to the EAT RIGHT program at UAB. They have been awesome to basically design a post-op support program for me. I have bi-weekly appointments, one is just a weigh-in, the other is a weigh-in PLUS visit with the nutritionist, exercise physiologist, and the doctor who runs the program, Dr. Ard.

I'm supposed to keep a food journal and.....I don't. But other than that, I have worked hard to retrain myself once again and to change my life habits. I go over my food choices with the nutritionist and tweak things here and there. I went from using 2% milk to fat-free and since I am still drinking at least one Unjury protein shake a day, plus home-made SF latte shakes every day, that actually helped. I moved my computer from the breakfast bar in the kitchen to the living room or my office - and what a difference that made!

I am still totally involved in sports car driving with the 1988 Porsche 911 that I got in July 2008. I compete in Autocros with SCCA, and I also do High Performance Driver's Education events at Barber Motorsports Park with the Porsche Club, National Autosport Association, and some other clubs.

My latest exercise obsession is ZUMBA. I love to dance, and it is a seriously good workout. I hate getting in the floor to do ab work, and come to find out, you can work your abs just fine standing up. WHO KNEW. I started going to Zumba in May of last year, thinking I'd get back into the habit of doing SOMETHING 3-4 days a week, then get back into the gym and get serious. Well, here I am almost a year later, still with the Zumba! Mainly because it's fun, and it works.

As of today, I'm working my way back down, currently at 217. My goal now is to get back under 200 pounds, and then I am making my appointment with the plastic surgeon and finally getting this size 5X flap of belly skin taken OFF OFF OFF!

I don't check in here much - best way to be in touch if you want to be is email kathycha@bellsoiuth.net. And I'm still posting photos here http://www.flickr.com/photos/kathycha and will eventually figure out how to link them here.

I don't look all hat much different from my "after" picture here, EXCEPT I quit dying my hair and it's almost solid white!

http://www.flickr.com/photos/47341438@N00/2096745123/" title="CIMG4266 by atlantagrrl, on Flickr">http://farm3.static.flickr.com/2414/2096745123_9346ac7b4a_m.jpg" width="180" height="240" alt="CIMG4266" />

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.