Kat C

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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 [email protected]. 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.

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.