cajungirl

Send Message

Block

Add Friend

Good health, energy, self-confidence and excitement are words that come to mind today as I reflect on the past eight years.  I still remember the day I went to my first consult and the day of surgery like they happened yesterday.

I’ll always be grateful for an amazing surgeon who expected me to give it 100% to be successful.  I remember the shock I felt when he said his goal for me was to be 130 lbs.  I’m sure he could see the expression on my face; I didn’t think that was doable.  Well let me say it was not only doable but I did it within 10 months and another 10 lbs. in the next two months.  So by January 15, 2006 I was weighing 119 lbs. from a high of 260 lbs.  It was exciting, amazing, and so rewarding.

I did gain a few lbs. back rather quickly by adding other foods to my day.  Let me back up here, for 10 months I literally ate nothing but lean meats and green leafy vegetables with an occasional egg or some cottage cheese and protein shakes.  The shakes were against his wishes as he didn’t want us to get our nutrition from shakes but it was necessary to be able to get in calories and protein.

In April 2007 I had plastic surgery.  I had a fleur de leis tummy tuck, brachioplasy and breast lift with implants.  I had a fair amount of skin but nothing that bothered me medically.  However, mentally I needed to proceed.  It was another AMAZING moment to see my plastic surgeon reveal the results,

Then in 2007 I was laid off and moved back to Louisiana.  With all the changes and not taking care of myself I gained a little weight, actually saw 137 lbs. for one day and thought nope I’m not going there.  Thankfully I took control and lost back down to 130 lbs. (goal weight) rather quickly.

Lots of other things have happened in the past couple of years including going through a divorce and losing both my father and grandmother within 4 months.  These contributed to me losing additional weight, getting to an all-time low of 109 lbs.  I looked sick; no matter how much I tried to eat I could eat a couple of bites and be done.  This started in March 2010 with the last family death in April 2011. 

Today I’m very happy to say I’m maintaining between 119-121 lbs. fairly easy.  My restriction is still good and I don’t struggle with food much, when I find myself wanting to graze it is definitely in the evenings so I allow myself to eat smaller portions in the day and eat the majority of my intake in the afternoons and evenings.  This works for me.

So in closing, I’m very grateful for WLS and the wonderful people I’ve met through the years.  I’ve met many, many people from OH from California, Colorado, Texas, Louisiana, Tennessee, Massachusetts, New Jersey, New York and Rhode Island just to name a few.    

I have zero regrets about having surgery.  It was one of the BEST things I’ve ever done for myself.

START OVER!
If you've started out in pursuit of your goal
And you've really tried with your heart and your soul,
but somehow things got out of control ---
START OVER.
When you've tried your best to do what you should
And you thought this time that you surely would,
But once again, you didn't do good ---
START OVER.
When you've worked so hard to follow a dieter's way
And you fought to win a victory each day
But one more time you went astray ---
START OVER.
When you've tried so hard to yourself to be true
And do the things that you know you should do
But once again you failed to come through ---
START OVER.
When the road to success seemed much too long
And each temptation was oh so strong
And once again you gave in to wrong ---
START OVER.
When you've told your friends what you planned to do
And trusted them to help you through
But soon discovered it's up to you ---
START OVER.
When you know you must be physically fit,
But your hope seems gone and you're stuck in a pit
That's not the time for you to quit ---
START OVER.
When the week seems long and successes few
And at weigh-in time you're feeling blue
Remember tomorrow is just for you ---

START OVER
To start again means a victory's been won
And starting over again means a race well run
And starting over again proves it can be done
So don't just sit there ---
START OVER. (Author Unknown)

Video:

http://vimeo.com/25570146 

Transcript:

Hi, I’m Dr Mitchell Roslin, Chief of Bariatric Surgery at Lenox Hill Hospital in NY and Northern Westchester Hospital in Mt Kisco, NY.  The title of this talk is, “Revisions – Does the Patient Fail the Procedure or Does the Procedure Fail the Patient?”  This is a copy of a talk that I gave at the ASMBS in Orlando in 2011 and I was asked by many of the attendees at the session to see if  I could record the talk and place it online. 

The purpose of the talk is to try to explain some of the physiology behind bariatric procedures and weight regain or inadequate weight loss following bariatric surgery.

 

When I started doing bariatric surgery 17 years ago I really thought it was simple.  I thought when we did a gastric bypass what we did is that we made the stomach smaller so that people were forced to eat less.  Then we added an intestinal bypass so that some of what was eaten was passed into the fecal stream.  I now know that bariatric surgery is far more complex.  The stomach is far more than just a storage organ, it actually produces certain hormones that regulate hunger and satiety.  As a result I think concepts like restriction (making the stomach small) or malabsorption (bypassing part of the intestine) are rather simplistic and instead we need to think of bariatric surgery as gastric and intestinal.  What I’ve learned is that one of the major aspects of the gastric part of the operation is suppression of hunger, especially through  the reduction of the hormone gherlin.  In addition, instead of a malabsorptive component probably what the intestinal component of the operation does is it increases the work of digestion therefore increasing the metabolic rate.  

 

 

Frequently, patients who haven’t done well with the various bariatric procedures have been labeled as non compliant, or not following directions.  One of the things we have to realize is that if it were simple to follow eating directions nobody would have ever required bariatric surgery.  Another thing that we have to realize is that obesity is not a single disease.  Obesity occurs where there is inadequate regulation or inadequate balance between the amount of energy taken in and the amount of energy that is expended.  As a result, the defect can be anywhere in the process, so that any no two patients that we see may have the same defect, yet we all treat them similarly.  So when somebody doesn’t do well with an operation we tend to say that it’s because they haven’t followed the directions, or they’re noncompliant.  An alternative explanation is that the operation doesn’t change or alter the physiology that caused their obesity and is not effective in their particular case.  I think that if we’re going to take credit for bariatric surgery causing weight loss and being the most effective treatment of obesity, when patients regain weight the operation also has to be a part of the burden.  We have to realize that there may be a physiological reason for weight regain, not just behavioral changes and lack of compliance.  The purpose of this talk is to try to explain what we’ve seen in the two most common procedures performed in bariatric surgery – laparoscopic adjustable gastric banding and gastric bypass.

 

As mentioned, obesity occurs when there is any breakdown in the negative feedback system that controls energy balance.  Human energy intake is mainly controlled by hormonal factors   There are several key hormones that control hungry, satiety, as well as early energy and long term energy requirements.  Ghrelin which is produced primarily in the stomach is considered the hunger hormone.  PYY which is produced mainly in the intestine is considered the satiety or fullness hormone.  Insulin is the short term energy hormone and it works along with GLP.  Leptin is the long term energy hormone and is mainly produced in fat cells.  But even this is relatively simplistic and leptin and insulin actually complete sometimes for binding in the hypothalamus of the brain.  As a result a lot of patients who are insulin resistant also have excess leptin but leptin cant tell the brain that you already have too much fat tissue.  So there is a breakdown in that regulation.  As opposed to the input for energy intake which is mainly hormonal, the output is mainly through the nervous system.  When the body wants to conserve energy it increases the tone of the parasympathetic system, reducing the heart rate and the metabolic rate.  And this is what occurs when people try to reduce their caloric intake.  When the body wants to produce more energy it activates the sympathetic system.  The bottom line is that energy balance is a rather complex process and a deficit anywhere either in the input or the output or the afferent or efferent system or as well as in the brain or central nervous system and the hypothalamus can cause obesity because of the energy imbalance.  

**Video clip of Jassira, an OH'er talking about her LapBand and DS revision

After watching the previous video of the patient who struggled with the Lap Adjustable Gastric Band, and has done so well with the Duodenal Switch, it’s obvious that there different physiologic factors that occur following the bariatric surgical procedures  As mentioned the input for human energy intake is mainly hormonal.  Laparoscopic adjustable bands don’t reduce ghrelin or increase PYY thus its not surprising that a number of patients are still hungry following lap adjustible banding.  Thus instead of giving patients labels like noncompliant, or suggesting that the patient failed the operation because they didn’t work hard enough we need to understand the physiologic differences that our operations cause.   And in addition we need to begin to gain insight into why the particular patient is obese and what their particular deficit is in energy imbalance. Unfortunately we’re not able to do that at the present time and we continue to treat patients with these broad operations.  But it’s really important to realize that failing one bariatric procedure  doesn’t mean that you’re going to fail another bariatric procedure, and there is a lot more than just restriction and malabsorption.  The most important thing that we can offer our patients in bariatric surgery is hunger suppression.

 

 

 

While Lap Band appears to be an attractive alternative for many patients it also has many limitations.  The advantage of banding is the fact that the operation is relatively simple.  The complications and the risk of serious early complications are lower than other bariatric or stapling procedures.  The disadvantage of lap adjustable banding is the results are more variable and approximately 20-25% of patients, if not higher, will be dissatisfied with their weight loss.  A major reason is because that while can always increase the work of eating, making you chew more and eat slower, it frequently doesn’t make patients less hungry.  I often say a lapband is a diet with a seatbelt, and what I mean by this is that the band doesn’t affect ghrelin levels, doesn’t increase PYY hormone or PYY levels, and as a result really functions similar to a diet accompanied by a restrictive device.  Many patients do well with the band and patients who are most likely to do well are also those that are most likely to do reasonably well on a diet.  They’re younger, they’re more active, and they have lower BMI’s, or are in the lower part of the morbid obesity scale.  Patients that seem to do less well with LapBands include older patients, patients that have a BMI that approaches or above super morbid obesity, and there is now a suggestion from George Washington University that there may be ethnic differences, and African Americans seem to have lower overall weight loss as well as a higher failure rate.  Thus patients that are determining what bariatric procedure they want to undergo need to understand the probability that they have a higher chance of having inadequate weight loss with a Lapband or a realize band, as well as a higher chance of requiring reoperation and extraction of the band.  This is offset by a lower early serious complication rate.  But people have to understand that not all patients that have a Lapband have hunger suppression and in fact a significant amount never ever have any reduction in hunger, or for that matter, satiety.

 

Thus the major issue with Lap Adjustable Banding  is inadequate weight loss.  Another thing that frequently occurs s that we make the band tighter hoping to achieve restriction and force a smaller amount to be eaten and patients to be less hungry.  And what we’re successful in doing is creating a high pressure zone where patients don’t get hunger suppression and they continue to eat and we see dilation in the esophagus and changes in the motility of the esophagus itself.  So when you look at the Xray on the left side of this diagram you see tremendous dilatation of the esophagus above the level of the band.  When fluid is removed you can see that the esophagus becomes smaller and the band wide open but there are still these scalloping figures in the esophagus which is a signal of a motility disservice.   What you realize is that when you make the band tighter you make it harder to eat, you also make the esophagus work harder and you take the risk of having permanent motility disorders to the esophagus, but you don’t necessarily make patients less hungry.  The patient in this picture here actually came to me with the picture on the left because he started to regain weight because he was storing food in that large esophagus.  So it’s very, very important to understand the role of fills in Lap Adjustable Banding.   The role of fills is to create some level of restriction but if that pressure gets greater than what the esophagus can pump, then there can only be harmful side effects to the esophagus.  And just making bands tighter does not make all patients less hungry.  Frequently on the internet we see something called the Green Zone, which is a place where people who have bands eat less and are less hungry.  Unfortunately, on diagrams the Green Zone always exists, but clinically it’s often very, very difficult tot find a therapeutic window where patients eat less,  are less hungry, and where we don’t create a high pressure system that has an adverse effect on the esophagus.    

 

Whereas inadequate weight loss or extraction are the main problems of Lap Adjustable Banding, gastric bypass is an outstanding weight loss operation.  What I’m not convinced of is that it’s a great operation for the maintenance of weight loss.  An increasing problem in bariatric surgery is the number of gastric bypass patients that have regained weight 3-10 years following the operation.  We’ve done an awful lot of research on this topic and are beginning to form an understanding of why we believe this occurs.  Over the course of time what we see happening is food, or in this case contrast as shown in this diagram, passing immediately from the esophagus into the small gastric pouch, and then going straight into the intestines.  The food doesn’t remain in the pouch long because there is no restriction left between the gastric attachment and the intestinal bypass that was created.  As a result as soon as the patient eats the food goes into the intestine.  With this you get a rise in satiety factors followed by a rapid fall.  Thus what we believe happens following gastric bypass is there’s a return of inter-meal hunger so that when you actually question patients what you find is that while they can still eat less than they did prior to the operation but the problem is that they’re hungry one to two hours after eating.  If they eat foods that are higher in the glycemic index, or simple carbohyrdrates what happens is they have a very rapid insulin response followed by a low sugar, and this makes patients develop a maladaptive eating pattern. So what we are seeing is numerous patients with gastric bypass that have lost a considerable amount of weight, but approximately 30% of our post bypass patients we’re seeing regain a significant amount of the weight that was originally lost.  

Thus we believe the major problem in gastric bypass surgery is weight regain with a return of inter-meal hunger.  As a result it’s been our hypotheses that better bariatric procedures would have a valve at the end of the gastric pouch. And we believe that the best vale is the pyloric valve which is the normal valve of the stomach which controls emptying of food in the normal stomach.  There are two operations that now exist that allow us to preserve the pyloric valve.  They’re the Sleeve gastrectomy and the Duodenal Switch.  In order to test this hypothesis we have designed a prospective trial that we received grant for that examines the weight loss as well as response to glucose challenge in sleeve gastrectomy, gastric bypass, and duodenal switch. This is the first 6 month data from that perspective trial. And you can see that all of the operations cause effective weight loss, with duodenal switch causing the most weigh loss in the first six months.  

 

The purpose of the study though, was to compare the effects of a glucose challenge on the various operations that we perform.  This shows data when glucose is given both preoperatively, as well as 6 months following from surgery.  And what we do following the glucose challenge is we measure the insulin levels.  What we can see is a vast difference between the different operations.  With gastric bypass what happens at six months is that the insulin level goes down, but when challenged with glucose the insulin level actually goes up so high that it exceeds its preoperative value at six months. We don’t see this in sleeve gastrectomy and duodenal switch.  When you get such a rapid rise in insulin what happens next is a rapid fall in the sugar.  And we believe this rapid rise in insulin followed by the rapid reduction in sugar glucose level leads to inter-meal hunger.  Because we know when people become hypoglycemic in order to relieve the symptoms of the low sugar they become hungry and forced to eat.  So we believe what is happening in gastric bypass is that since there is no valve there’s rapid emptying and when there is rapid emptying there s rapid rise in the factors that determine fullness such as insulin as well as the other gut hormones, followed by a rapid fall. And when that rapid fall occurs patients become hungry.  What is really fascinating is that we don’t see the same response in duodenal switch which also has an intestinal bypass.

 

This diagram shows the 6 month results for insulin levels.  You can see that all the operations cause a reduction in fasting insulin level, which is very important and demonstrates an improvement in metabolic function.  However, gastric bypass causes a rapid rise when stimulated with glucose, much greater than sleeve gastrectomy or duodenal switch.  We believe that this rapid rise in insulin is a hallmark of a rapid emptying of food as well as the rapid distribution of nutrients to the intestine, and that this rapid emptying then leads to a rapid fall in glucose level and causes the inter-meal hunger that we think is responsible for a significant amount of weight regain following gastric bypass.

 

This diagram shows results that were determined in the RESTORE trial.  The RESTORE trial was the first multi-center trial to look at endoscopic treatment for weight regain following gastric bypass.  The idea was to try to reduce the anastomatic size so that patients could regain restriction.  Unfortunately to date none of the endoscopic trials have been shown to be effective to provide long term weight loss. There are some suggestions that short term weight loss could be achieved.  When we went back and looked at all of the data from patients that were eligible for the trial, and this means by definition that they have to have normal pouch following gastic bypass, no evidence of fistula, and an anastomatic size that was  >2CM, which we estimated approximately 70% of post bypass patients would have. We found that the most significant factor that would determine weight regain was the time from surgery.. Thus we felt that this was evident that the weight regain was physiologic, and was steady and progressive over time, especially in patients that have an anastomatic size >2CM.  When surgery is first done the anastomosis is made approximately 1.5CM, or slightly less. Unfortunately what we’re finding in time is that in time the anastomosis spreads to a greater size.  What we found looking at the data from the RESTORE trial is that once it got to 2CM, it didn’t make a difference if it was 2CM or 3CM, there was already a loss of restriction and weight gain was steady and progressive.  We believe that means that this is going to be very, very difficult to treat by an endoscopic procedure.  

 

While weight regain following gastric bypass is becoming a much more common clinical problem, with the average patient regaining approximately 30% of the weight they lost and approximately 20-30% regaining a significant amount more, the options for patients remain limited. 

 

They include 

 

1)      obviously dietary adjustments but many patients feel that we’re kind of like Indian Givers, because at one point in time they had no hunger, they had early satiety and now they’re hungry all the time.  

 

2)      An increasingly investigated option is endoscopic suturing but there is no long term data.

 

3)      Band over bypass works for certain patients, but has many of the same problems that primary banding has 

 

4)      the most aggressive option is to convert the operation to a Duodenal Switch but this is a rather large operation, requires multiple anastomosis, and is an option that we reserve to patients that have considerable problems because of their weight regain.  

 

Thus it’s important to realize that…

1. Our operations have limitations and that inadequate weight loss and weight regain cant just be blamed on the patient. 
2. Bands have no effect on Ghrelin, PYY, or GLP.
3. Gastric bypass has no valve and this can lead to inter-meal hunger.
4. The fact that the weight gain is steady and progressive over time I think is indicative that it is physiologic
5. We believe that increased insulin secretions after glucose challenge in bypass is indicative of the rapid emptying that occurs and the cause of inter-meal hunger. 
6. Additionally, failing one operation should not preclude consideration for another bariatric procedure.
7. Obesity is a chronic disease and therefore we’re going to have to be prepared to treat our patients on a long term basis and realize that bariatric surgery is not a cure for obesity but merely a control mechanism. 
8. We need to critically analyze our procedures
9. My opinion is that pyloric preserving procedures such as the sleeve gastrectomy and especially the duodenal switch, and maybe future varations of these procedures will replace gastric bypass as standard.

I never expected it to get to here but I am now divorced as of this week after 16 1/2 years of marriage.  It wasn't my choice, I really wanted to continue to work through our differences and attend marriage counseling, the ex didn't although I'm not surprised since he's NEVER really given much to the marriage anyway.  Add in he moved out and IN with another woman within a week to 10 days, yeah he cheated on me, good riddance asshole.   I've always given and given and tried and tried and the past few years it's become really hard to give any more.  My ex was/is an alcoholic and decided the past 2 years (after not drinking for 8 or so years) that alcohol was more important than his family.  After many conversations and trying to live through it, the marriage wasn't salvageable I suppose.  I DO understand addictions as I grew up with an alcoholic father, BUT until an addict accepts they have to make changes then there is no change and family dynamics crumble for the other spouse and children.

I'm ok with it now that I realize how unhappy we've both been and how our lack of communication and the tension in the family was affecting our boys more than us staying together for the sake of the boys.  They seem happier and less stressed, as am I.  We stay busy with kid activities (baseball and karate currently).  They appear to be dealing with the separation and divorce much better than I anticipated.  Of course, I expect at some point they'll have more questions and concerns and we will address those too. 

So life continues to evolve.  I'm dealing with it my way and going forward.  Looking forward to my glass half full and no longer half empty.

 

It's hard to absorb in my mind that WLS took place 6 years ago.  I oftentimes have forgotten what life as a MO person was like.  I DON'T want to forget but I guess it is true that life becomes "normal" at some point.

I have truly been blessed with WLS, a fantastic surgeon, lots of determination and will-power and the support of my OH friends.  I look forward to the next 6 years to see where my new life takes me.

Pre-op Weight:  260.5  (January 14, 2005)
Surgery Weight:  239.8 (February 21, 2005)
Goal Weight:  130 lbs
Met goal weight on November 17, 2005! Actually 129.8

6 Years later on February 21, 2005:  127.8

I had a slight regain from my lowest weight of 119 lbs, it was WAY to small for me.  I loved the number, I looked sick.  Then there was a time about a year ago that I got sidetracked, not even eating large amounts (I can't) but grazing entirely too much and saw 137 lbs for ONE day.  It took that number for me to freak out a bit and buckle down.  Stayed around 132-134 for a period of time then late 2010 I decided I'd played around enough and thanks to the support and challenges of a few OH friends I really buckled down on choices.  I DID NOT cut back how much I eat, again I eat small amounts still but I started logging my intake to find out I wasn't eating enough calories and protein.  I started planning better and lost from 133.8 to 127.8 in less than 2 months.

I'm playing with trying to get to 125 lbs, why because I want to challenge myself to do it.  I still thrive on the scale number, the size I'm in doesn't impact my mojo but dangit the scale number does :).  I'm not obsessed with getting there or staying there just something I want to try to do. 

Ultimately the only thing I FEEL I need to do is to continue taking my vitamins, eating healthy 90% of the time, staying accountable to myself only and LIVE, LIVE, LIVE life. 

Let the journey continue, I'm ready!

Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients

 

 *80053          Comprehensive metabolic profile (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase)  (10231)

* 84134          Pre-albumin

* 7600             Lipid profile (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256          Hep panel, includes ALT (SPGT) & GGT)

* 593               LDH

* 84100          Phosphorous - inorganic  (718)

* 83735          Magnesium

* 84550          Uric acid  (905)

* 7444             Thyroid panel (T3U, T4, FTI, TSH)  (84437; 84443; 84479; 84480)

* 85025          Hemogram with platelets  (1759)

* 7573             Iron, TIBC, % sat

* 83550          Ferritin  (457)

* 84630          Zinc  (945)

* 84446          Vitamin A  (921)

* 82306          Vitamin D (25-hydroxy)   (680)

* 84052          Vitamin B-1 (thiamin)  (4052)

* 84207          Vitamin B-6 (Pyridoxine)

* 7065             Vitamin B-12 & folate  (82607; 82746)

* 83970          Serum intact PTH

* 31789          Homocysteine, cardio

* 83921          MMA

* 367               Cortisol

* 84255          Selenium

* 83937          Osteocalcin

* 84597          Vitamin K

* 82525          Copper

* 84590          Vitamin E

 

 

 

For diabetics: *496 - HEMOGLOBIN A1C   

An Old Cherokee Teaches His Grandson About Life.
"A fight is going on inside me," he said to the boy. "It is a terrible fight and it is between two wolves. One is evil - he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego....   The other is good - he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith.

This same fight is going on inside you - and inside every other person, too."

The grandson thought about it for a minute and then asked his grandfather which wolf would win.

The old Cherokee simply replied, "The one you feed."

So many WLS patients just aren't given proper education about vitamin deficiencies, thankfully some of us care enough about our bodies and WLS buddies to continue researching and learning.  Andrea U is a WEALTH of information for post-ops, she's experienced some deficiencies so she knows what you might experience without proper supplementation.

I am scared to experience such severe problems because I'm not willing to learn and listen to my body, get labs drawn and being an advocate for my health.  People listen to those that are wanting to educate you, I have friends IRL that are not doing so well because they knew but felt good and didn't follow a health post-op supplementation plan. 

Get copies of your labs and track them yourself, you will find trends before your doctor is concerned.  They look for deficiencies not future problems.



Posted 5/22/09 by Andrea U
So deficiencies in the following can result in:

B1 or Thiamin
 - irreversible neuromuscular disorders
 - permanent defects in learning and short-term memory
 - coma  (aww.. this isn't so bad..)
 - death  (Nothing worth worrying about, right?)

B9 or Folate (Folic Acid)
 - forgetfulness
 - irritiability
 - hostility
 - paranoid behaviors

B12 or Cobalamine
 - neurologic sumptoms
 - numbness and tingling of extremeties
 - difficulty walking
 - memory loss
 - disorientation
 - megalobalstic anemia
 - permanent neural impairment
 - extreme delusions
 - hallucinations
 - overt psychois
+ Permanent damage can occur if treatment doesn't start soon enough!

Calcium
 - chronic low intake creates metabolic bone disease presenting as
  - osteoporosis
  - osteomalacia
  - hypoparathyroidism
  - combo of above
 - muscle cramping
 - hypotension
 - bone pain

Vitamin D
 - rachitic tetany
 - mucle pain and spasms
 - weakness
 - bone pain
 - decrease in daily calcium absorption
 - rickets (osteomalacia)
 - osteoporosis
 - concentrations in blood greater than or equal to 80nmol/L, there was a 50% reduction in colorectal cancer rates
 - concentrations in blood greater than or equal to 50nmol/L, there was a 50% reduced risk of prostate cancer
 - risk for type 1 diabetes increased dramatically in vitamin D deficient children
 - higher circulating levels of vitamin D linked to a significantly lower Multiple Schlrosis risk

Iron
 - anemia
 - fatigue
 - hair loss
 - feeling cold
 - pagophagia (constant desire to eat ice -- pica)
 - decreased immune function

Zinc
 - decreased sense of smell
 - altered taste
 - poor wound healing
 - poor appetite
 - hair loss
 - low libido
 - lethargy

Vitamin A
 - problems with skin and mucous membranes
 - dry hair
 - broken nails
 - increased risk of infections
 - linked to anemia and iron absorption
 - ophthalmologic consequences such as night blindness

It’s been 4 years today since I had WLS. Where has the time gone? I feel absolutely blessed, no doubt about that!

So where do I begin? I’ll make it short and sweet! Life has been wonderful for the most part, emotional sometimes, exciting most of the time!    I’m still hanging in at goal and still learning to accept where I’m at. Many days I see the new and improved me and other days the mirror isn’t my friend. I’m still addicted to the scale, albeit it’s getting better.

I’ve met some amazing people that I consider true friends and I’m blessed to have so many of you in my life. What would I do without you? I DON’T want to know! A big thank you to all of you, my true friends!  

The challenges have definitely increased the past 18 months. Making good choices becomes harder, doing what I committed to do and told myself I’d do for life has slipped to the wayside sometimes and I have to reign myself back in.   I know I’ll slip up again, I’m human BUT for me if I continue to remember where I came from and the fear of never going back (bearing any surgery malfunctions) I do feel I’ll remain a successful post-op, I’m that determined. I’ve seen the creep-ups and with one week of good choices I still see a 2-4 lb drop in weight. Thankfully I’ve not allowed myself the mentality that it’s ONLY XX lbs. My goal is my goal for life and venturing above that number is something I’ll fight tooth and nail to not go nor stay above should it happen.   

My advise to others is if you haven’t ventured into untamed waters and you’ve been doing what your plan entails, do your very best to follow through on your plan. I did my plan 98% of the time and was very successful with it and until I was given the go-ahead to eat what I wanted but to be aware of how much, how often and to focus on protein first, I had really no troubles at all.   

I know we all hear “you took the easy way out”. Depending on what each of us defines that quote as I guess I’ll say yes I did take the easy way out, losing it was easy, keeping it off is work, HARD WORK.  

So I’ll end on this note: This is a JOURNEY that never ends, the fight never ends, but the joys of living healthy and experiencing life are well worth the ups and downs of WLS! Keep believing!  

Love, Dana