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I can't believe it's more than two years since I posted last.  I want to keep this blog alive just to let folks know what RNY is like years out, because at least at the time of my surgery there were few "old' timers.  I'm hardly that at two years, but I've passed the golden phase where, theoretically, my surgery both restricts my eating as much as it ever will, and malabsortions waves goodbye at 18 months. 

While I have to yet to see my NP in a few days, when I'll get the results of my ultrasound and my labs (and if there are any issues I'll post again - if not you can assume everything is ok until next year!), I want to say I've been blessed with a completely complication-free post-op experience.  I continue to take bariatric vitamins and calcium +D3 supplements.  Miraculously my D remain at the higher end of "normal."  Everything else appear fine.

I continue to lose weight.  I'm at 151 now.  Basically if i exercise or if my appetite drops off, I lose weight.  Otherwise, I seem stable.  I've had no "bounce back" ten pound gain.  It's just been steady, slow loss with long, long plateaus.  I don't exercise regularly--my regular life includes a fair amount of acitivity, and frankly I'm both lazy and broke.  I can't afford the gym.  I could walk, but I hate the area I live in and most of the time it's too damn cold (incoming autumn blues).  Time is not the issue fortunately.  I took a job walking dogs and boy that walked my damn ass off for a few months and I lost ten pounds.  Lately my appetites dropping off, probably because of my meds, and I lost another ten pounds.  All in all as I said I'm down to 151.

It's not about the weight.  I mean from a social, self-esteem aspect, I definitely feel better and get treated with more respect.  I'll never forget I was once morbidly obese.  My doctor is quite heavy.  She knows I've had a bypass.  I don't say anything to people who don't ask.  My sister in law doesn't ask either; she knows.  Who else knows I could care less.  Interestingly nobody has remarked on my weight loss.  They tell me intead how good I look.  It's a taboo subject socially, at least the mingled white italian-american working class and professional circles where I mingle.

It's little things, like fitting through doorways, sitting in seats that fit, using towels I can wrap around my body, and because i've become a tmi kind of person, wiping back to front again.  I am thankful for everything that's been given back to me, and everthing that's been taken away.  The contempt; the judgement; the unintintentional and often intentional cruelty, the difficulties negiationing a world designed for smaller people.

There is not one second I regret having my RNY.  I guess I was not a food addict, but I also have to say the surgery did something more than just cause me to have to eat less.  My appetite for a long time seemed endless, but now I hardly think of food.  A bite of something I enjoyed is enough.  I am content to stop when I start to hiccup.  I am content to always eat protein first (althought i don't always!).  I have my numerous cheats and they don't hurt me a bit.  But my appetite has an END to it and the foods I like and don't like have changed enormously and, apparently, permanently.

I still love fats and I fearlessly eat high fat meals.  Sorry guys.  My ideas of healthy eating are much deviant from the norm.  I cook with the healthiest, purest fats I can find -- animal or vegetable -- and I eat all kinds of meats with abandon.  Then I have a few bites of veggies and if I can fit them without making myself uncomfortable, some carbs.  I can eat ANYTHING.  I mean really, almost anything.  A very few high-sugar items make me dump, and occasionally regularly food in normal amounts will unexpectedly put me in food coma.  That's unusual.  I know how to portion my meals by eyesight so I can enjoy eating normally, get what I need, get what I enjoy.  I eat more refined sugar and flour than I should.  Not in amounts, but by my standards of healthy eating.

I feel normal.  Since I lost the last ten pounds rather unexpectedly, I think it's possible I might even reach my surgeries goal of 145 lbs.  My personal goal of 124 is probably not good for me.  I suspect I will settle somewhere between 136 and 146.  I have a picture of myself at 150 pounds in my early 20's and I look awful.  I don't think I look anything like that now.  I think I look awesome.  I'm having fun with my hair and my clothes I never used to do, and I know much better what looks good on my body.  I feel so sad for that young Elena.  She had so many years of misery and obsessing over her weight ahead over her.  Losing and gaining, and ultimately losing the battle.

I've said it in the beginning (I think) of this blog and regardless I'll say it again.  I saw a special on bariatric surgery and suddenly realized that i probably finally qualified.   I always knew there was just something wrong with my body.  Fuck all those peope who say it's not medical.  I know it is because my tastes, appetite, and attitude toward food transformed overnight when I had that surgery.  And when I realized I might qualify, there was never a moment of doubt in my mind.  I called my insurance carrier as soon as possible, and got the information I needed to find a surgeon.  I did not want to go through any 3 month or 6 month program.  I was  'lightweight" (heading toward heavyweight, but why wait ten years for the inevitable to happen and go through all that pain and loss?).  I just wanted a great surgeon and no program.  I found that at Lahey Clinic in Burlington Massechusetts.  They didn't cover the sleeve and there were no surgeons in state who performed that or or DS.  But RNY - no problem, it was just finding the right fit and Lahey had what I want and presumably still does.  I even by chance or universal design met his ex-RN from his old office and she had nothing but golden things to say about him.  I can tell you now without compunction he was an arrogant asshole, but he was an excellent surgeon.  Within TWO WEEKS I had a date for surgery and the insurance approval. I jumped on that horse and rode it as fast as I could. 

No complications.  At all.  Very little dumping.  Nothing but intermittent, consistent weight loss.  Even when I was far from my goal I was happy.  I felt so much better being lighter.  It really is a burden.  Everything my life improved.

Today I am a happy, healthy, "normal" somewhat overweight citizen who probably sees herself about twenty pounds lighter in the mirror than she really is (except when trying on clothes, yuck).  I don't know if the flesh around my middle is skin or fat.  I thinks it's both.  I have stretch marks on my hips and I love them.  They are badges of the weight I've lost.  I would kiss them if they were more convenient, I would kiss them every day.

2 years and almost 4 months out, I can unquestionably say I love my RNY, even though I really wish I could have gotten the sleeve.  Eventually it will be more common and I think a superior choice.  But I can't say I have a single regret so far.  I've developed the habits that go around it and am reminded of it so rarely I actually forget I ever had surgery most of the time.  I actually only came by the site to grab some old pics (avatars) I can't find on the internet anymore and realized that it was just about a year since I'd posted last.  My intention has always been to provide as much useful information as possible to people researching this surgery.

As far as Lahey Clinic in Burlington Mass, and I'm going to finally write my review of my experience there, I want to say that at last at the time I got my surgery, in 2009, they provided excellent surgical staff.  Absolutely top-notch.  My surgical experience going in was a dream.  At everything else they pretty much suck or just don't offer services.  I would recomment Lahey wholeheartedly to anyone who, like me, is completely proactive about their own healhcare and very well researched.  If you want real support before and after your surgery, go somewhere else.  Really.  The staff there always seems like they either don't care or are so overworked they are too dazed to help you.  I have had to walk in to empty hallways, call for a nurse in the department, and tell them my NP had ordered some tests because there was literally noon around anywhere.   And, while the poor RN was trying to enter the tests into the system, who shows up but my rock star surgeon, who starts berating the nurse for not being in a staff meeting he is about to enter.  She tries to explain why but he is insulting and insistent.  This with a patient--HIS patient if he gave a shit, and he did recognize me--standing RIGHT THERE.  She finally got the tests entered (incorrectly) and we parted ways.  I will allow them to do annual follow-ups--for instance, this year Dr. N ordered an ultrasound, which is new--as long as I live in this area.  But I have already switched to Mt. Auburn and they are VASTLY superior (I have no idea if they offer bariatric services).  I had to pay to have my medical records transferred to my new PCP.  Soon my insurance carrier will cover my Mt. Auburn service but will up my copay dramatically (they are part of hospital network and are trying to force everyone to use their network, so their insurance is gradually changing).  If you are not that good at research and self-advocacy then BY ALL MEANS GO ANYWHERE BUT LAHEY.  Ok?  don't be lulled by fast service.  If I were not serious about research and nutrition, I would have had serious post-op problems.  NOT because of the surgery I picked, but because of the post-op support.

Comprende'?  I love my RNY.  Do your research.  Remember you are putting your life in your surgeon's hands.  If you know your lifestyle and your issues fit your surgery and your support system, then I say GO FOR IT!!!!  Get your natural life back!

Continuing iron supplementation more aggressively.  I still don't know if it's placebo or not, but I feel 100% better.  Added vitamin C to enhance absorption.

So I am now supplementing:

2x batriatric multi daily
2000mg calcium citrate + D daily
@250mg iron daily (going for 300, but working up, hard on pouch)
@300-600mg vit c daily
zinc and magnesium daily (have to check amounts)
B12 & folate (considering niacin)

plus, 100mcg levothyroxine for thyroid in the a.m. (before i take any calcium or iron).

the biggest pain is everything interferes with everything else, but especially calcium and iron.  SO I take my levothyroxine in the morning with B12 and folate, zinc and magnesium.  Then a few hours later i take my iron in 2-3 separate doses.  then coming into late afternoon i start my multis and my calcium.  I was never very good at being regular about anything, so i'm pretty proud of taking my vits and minerals so reliably for the past 16 months.

also mindful of fluids and protein consumption - still do protein first with virtually every meal.

Well, severe depression has dogged me daily since the surgery (parathyroidectomy this year, not RNY last year).  My test results are all normal for thyroid function, parathyroid function, etc (and in fact my calcium is now maintaining at 9.5 which is perfect).  It could be something physical the tests don't see, but personally I think it is a combination of a biochemical reaction to the percosets they gave me for post-op pain, and a psychological reaction to that and to losing my job.

The fatigue that dogged me for many months prior to RNY and returned in the last 6-8 months may be related to the depression, or the depression may in part arise from the fatigue!  It's a bummer, because I felt like a million bucks for months after RNY.  I can't help but think that it's coincidental that I felt that could while I was in ketosis and not after, but I always think I"ve got it figured out (like with the parathyriod) and then it turns out I haven't.  Going with chronic fatigue or fibromyalgia - might be accurate but doesn't really help because there's not much they can do for that, and the origins are mysterious, which I find frustrating.  I feel like I haven't turned over every rock just yet.  I know they have meds for CFS and FM that might help, but only if i actually have the disorders (and no guarantee then), and i hate being on meds.  to me it's still treating symptoms and not the underlying problem.

my iron levels since surgery (and possibly before) are at the very low end of the range, and my RDW (red blood cell width) is at the high end of the range.  Neither is off range, but those ranges are arbitrary.  Both kind of generally pointn toward some mild anemia, cause unknown but could be i need more iron.

My RNY RP tells me not to worry about it, because the values are "in  range," but she's not the one walking around feeling like shit all the time.  Pretty much all my doctors just look at me and shrug.  They don't like mystery fatigue, it appears.  I had been avoiding iron supplementation because i have asmptomatic hep C and iron levels in the blood can trigger activity in that chronic disease.  However, I'm at the point (have been for a while) where the degree to which this fatigue is interfering with my ability to function (e.g. work, and function at home) so severely I don't care.  So I started supplementing iron at 75-100mg daily a few days ago.  I actually feel better, but that could be placebo.  We'll see how I do through the next few weeks.  I start a 2nd job November 8th and how I handle that will be pretty telling.

since i started supplementing the iron, though, i've gotten a little constipated and now--suprise!--a little rectal bleeding for the last few days.  i'm keeping an eye on it hoping it will go away, and taking magnesium to loosen up my bowels, which usually works well.  yes, i should get it checked out regardless.  i should get an endoscopy.  a lower GI.  i'm overdue.  i am stubborn and resistant to doing anything that takes up large amounts of my time and promises to be uncomfortable, even if that means taking stupid risks, what can i say.  assuming this doesn't progress in to something that need immediate attention - i will make some calls to schedule the test.  the problem is my day job is not very forgiving of time off.  and right now i need the money.  not want; need. 

on the up side, i've been walking dogs for the last couple of months and that means walking roughly two or more hours a day, sometimes briskly, often uphill.  i enjoy the work, i don't make a fortune doing it but it gets me outside and active and i love the dogs.  and, i've lost at least ten pounds since i started it.  i get paid to work out, that's how i look at it.  which is probably the only way i am every going to get this level of activity going in my life!  it's part-time, takes about 25-30 hours of my week, and leaves me pretty exhausted is the only problem.  but, being over a year out from surgery and having been stalled quite a while, and finally dropping some more baggage -- very exciting stuff.  so i'm very attached to this job for more than the meager paycheck it provides!

i have a 2nd job in the works for three evening shifts a week working resi with recovering addicts.  it's a good environment, i believe is going to be low-key, and i believe if i take really good care of myself i can manage the two jobs.  that means staying on top of my hydration and supplements, eating enough protein, etc etc.  and hopefully this iron supp will make a difference.  another things i can try, is folic acid supplementation; folic acid can also help with anemia, if in fact i am experiencing fatigue due to borderline anemia.  everything i have seems to be just inside the boundaries established by medical science as diagnostic - my weight pre-RNY, my thyroid, my parathyroid, etc. etc.  The only that matters to me is how I feel.

Anyway this is life One Year and 4 months out (roughly). 16 months.  If you ask me, I would do RNY again in a heartbeat.  I have struggles.  I do dump, and i do get reactive hypoglycemia, but only when i eat much sugar.  I didn't want that, but as it turns out it does help me make better decisions about what I eat.  I do struggle some with feeling physically uncomfortable eating some foods, although I rarely ever get nauseous or "stuck" anymore, I feel hungry a lot and yet don't want to eat much when i do.  Food often turns me off.  So I've learned to live feeling somewhat hungry and unsatisfied much of the time.  The key is I've learned to live with the feeling.  I accept it. It doesn't bother me like it would have pre-op, and food doesn't rule my consciousness.  I'm not ravenous, and I'm able to eat a lot of foods - really almost anything.  I have iron pouch.  Given the choice between the constraints on how I live now, and what it was like pre-op, and my weight loss, I'll take this lifestyle in a flat second.  I'm only 16 months out - not years - I know that.  I'm just glad I have no regrets.  

well, the surgery went very well, smoothly, etc. but i've had a really terrible time since.  not really sure what's going on.  i fully expected to feel either significantly better, more energy, etc. or feel the same - but not WORSE, and i feel awful.  Now, the first thing i think of is, i haven't slept much in 3 weeks.  That's pretty much guarenteed to plunge me into deep, deep depression.  I'm averaging maybe a couple of hours a night and when i do sleep, it's fitful and i don't wake up feeling rested.  so at this point i'm horribly sleep deprived.

i took an ambien a few days ago and slept one night through and felt fantastic the next day, but that could be either the sleep or a biochemical reaction to the ambien, which does work on certain related receptors in the brain.  i'm at a point where i don't care anymore, i have a long history with insomnia and iknow at a certain point it takes on a life on it's own and just snowballs.  so i'm going for another rx for ambien until i can get restablized. 

doc says it might be i went temporarily hyperthyroid after the surgery.  we've done some post-op bloodwork to check that and other related levels (calcium, PTH, and including double-checking a hgh DHEA saliva test I got a few months ago, another story). 

It may also be simple stress from losing my job AGAIN 3 days before surgery, a whole nother issue.  I got a good reference, it's not about attitude or unwillingness to work, but i am apparently even less detail-oriented than i would have believed, i make a lot of mistakes, and this is not the first job i've lost over it.  Just the first boss who didnt' treat me like an asshole over it, believing i did it intentionally.  I was crushed - i loved that job. 

on the upside, i'm being considered for a job walking dogs, which would not only be fun and give me exercise, but actually pays about the same :P

so that's the report for now.  my weight is holding around 164 lbs, which is still wonderful after years over 200, but still only half-way to goal.  i'm still on metformin for insuline resistance and it's possible the high DHEA, if verified by the blood test, may again point to PCOS even though i'm mostly asymptomatic.  could also be cushings or another adrenal gland malfunction.  i do think having a more active job would be a really great asset to my health and furthering my weight loss at this point.

it's a challenge to write it, let alone pronounce it, but that's what i had done yesterday, finally got that bad boy out.  Doctor said when she removed it, they saw an immediate drop in my PTH levels (which means they got the right one).  Today i am tired, my throat is sore - mainly from the tube they put down it, the incision hardly hurts at all.  i am looking forward to recovering and getting my energy back and getting rid of the brain fog that's been plaguing me for a long time.  this may also resolve my migraines.  I just want to be able to be active without feeling like i've been hit by a truck.

the next step will be to follow up on the high DHEA levels i discovered recently.  according the published symptoms, i may very well have Cushing's D/O, which means my adrenal gland is malfunctioning.  Since so far everything is on the same axis, my endocrine system - hypothyroid, hyperparathyroid - it's not really surprising if my adrenal gland is "off" as well - could be another benign tumor.  quite frankly it's great to get something concrete i can point to and say THAT is causing my malaise, because i'm tired of trying to explain it to doctors and friends and getting that "crazy lady" look.  

one thing that may well improve also is the high levels of anxiety that have followed me for many years.  i used to get depressed, now i get anxious, or i get this miserable anxious state that has no beginning and no end.  that could be the parathyroid, or the cushing's (if that's what i have), or the elevated GABA i found on the same test with the DHEA.  what's awesome is i finally have a chance of getting these addressed successfully.  i am still a strong believer in therapy and support, but also in the body-mind connection, i believe it's foolhardy to treat either one without the other.

i weighed at the hospital - no changes.  which, being over a year out and not losing, of course my main fear is *gaining*, so that's a good thing.  i really believe before the end of this year i will be able to drop another ten pounds.

  the brocolli / mushroom / thyme / egg / mozzerella skillet i did like this:

1 bunch brocolli - like maybe 3 heads - used just the crowns, cut into bite-sized pieces
maybe 6-8 large mushrooms, sliced thin (how thin is preference)

i heated up a little olive oil and threw in 3 cloves of garlic, let them sautee a bit to flavor the oil and then pulled them out so they wouldn't burn and make everything bitter. then i tossed in the brocolli and mushroom, and about a tablespoon of fresh thyme. if you haven't cooked with fresh thyme, you will never want to stop using it after this. don't bother using the dried stuff, it doesn't taste at all the same.

i covered it and let it cook on low heat for about 5-10 minutes so soften all the vegetables and then took the cover off and let it cook some more until the mushrooms were all reduced and the brocolli was cooked but still crisp. I took it all out of the pan and put it aside on a plate.

put some butter in the pan, then threw in 6 eggs and another handful of fresh thyme (it's hard to over-season with thyme) and just broke up the yolks with my wooden spoon and stirred periodically until the eggs were cooked through and mixed well yolk and whites. 

Then i threw in the broccolli and mushrooms, and then i cut up a tomato and threw it in, and then lastly and just for a couple of minutes, some cubed fresh mozzarella (i am a freak for this stuff), a little lemon juice, a little salt and pepper, turned off the burner, stirred everything well and the mozzarella was just warmed through and getting slightly gooey and took it out and that was dinner.

would have been nice over some brown rice if you want a carb.  

 WELL it looks like i haven't posted in a while.  I haven't been by OH as often since my old computer died.

My weight is still hanging around 165.  I have picked up my activity level some, but still nothing like vigorous exercise.  My sense of fatigue and general malaise is still an obstacle.  Yes, I know that exercise is supposed to make you feel better.  In my case, I feel physically better, but it knocks me out energy-wise for days, something I can't really afford when I'm working.

However, I haven't given up on finding a solution to this problem.  As my prior entries indicated, I have discovered I likely have a problem with hyperparathyroidism, meaning one (possibly more, but likely just one) of my parathyroid glands is enlarged and malfunctioning.  This leads to "moans stones and groans" which pretty much describes how i've felt for the last ten years or so.  Older than my age, which is frustrating especially when I have a very active and healthy husband.

Well, since discovering I had "mildly" elevated calcium levels even before surgery (hovering around 10.5, dropping down to 9.5-9.9 when i stop supplementing, whereas it should be much lower due to malabsorption), i've been to two endocrinologists, had a "sestami" scan to identify the offending gland, met twice with a surgeon, and now have surgery scheduled for July 30th, just two weeks away.  YAY!!!!!  it may sound wierd to be excited about and look forward to surgery, but i feel the same way about getting this gland out as i did about RNY - going to solve problems in my life.  the risk (which is not great in this case) far outweighs the potential benefit.  Could these powerful chemical

One of the reasons i switched endocrinologists - and insisted on seeing one, period - is that i could not get my regular treaters to look past the fact that my PTH hormone levels were normal.  They see high calcium (and to the untrained eye, 10.5 doesn't seem very high) and test for PTH (parathyroid hormone) and if it looks normal (as it does in my case) they shrug and say, we'll check i in a year and see if it's gotten worse.  WHich is a horrible idea.  The fact is, IF your calcium levels are high (and remember, for RNY the "normal" range is unpredicably lower), your parathyroids should be *downregulating* to try to reduce the calcium levels, so your PTH should actually be abnormally low.  Dr. Norman, who developed the parathyroid surgery now in widespread practice, is very clear on this point and it makes complete logical sense, but try talking logic to a doctor who doesn't want to hear it.  Hence my 2nd endocrinologist.  I had  to argue (logically) with the surgeon a bit, but her reticence to do surgery had some reasonable cause (if she can't find the malfunctioning gland, scarring could make a 2nd surgery harder and riskier) i felt i could work with, and ultimately once she scanned my neck she felt 80-85% confident that they had identified the gland that was enlarged.  Not greatly enlarged, but definitely not right.

She also asked me if there was a sudden change a few years ago.  Well, i haven't felt really right since my late 30's and to some degree that's been progressively getting worse.  She said well that probably isn't your parathyroid, usually there is a sudden shift, maybe after a shock to the body.  Then I realized days later - I started interferon therapy (for the uninitiated, a form of chemo) around 2005 which I was taken off almost immediately because I had such a strong adverse reaction to the medication.  And ever since then many of the symptoms I experienced have never left me.  Namely - extreme fatigue, migraines (which I had before but never as many or as often), and chronic pain (basically fitting the description of fibromalgia).  I've been diagnosed with a few different problems since then, several of which almost certainly predated the interferon (sleep apnea being one, hypothyroidism being another) but my body took a definite and so far permanent turn for the worse after 3 weeks on pegulated interferon and ribaviron.  Could these powerful chemicals have thrown my parathyroid(s) for a loop?  It seems entirely possible to me!

Dr. Norman says that while 70-75% of patients presenting with hyperparathyroidism (try typing that twice) complain of symptoms, up to 90-95% report feeling significantly better once their parathyroid is removed.  Seems like pretty good odds to me.  Hence my excitement.

overextended + brain fart = missed appointment.  so i had to call and rescheduled the dexa bone scan, which is now going to happen this coming wednesday.  after that - referral to surgeon, hopefully.

apparently i can spell "subclinical hyperparathyroidism" but not "verdict" (see previous post).

dexa bone scan scheduled for this coming Monday.  That's a simple procedure that will asses the state of my bone density and propensity to osteoperosis (which could have been complicated by hyperparathyroidism, which will cause calcium to be drawn from the bones).  I think it measures the diameter of my bones.  I hope they are ok, i tend to assume the positive, and i actually would rather know than not.

after that, appt with surgeon will be scheduled for first consult to remove the malfunctioning gland(s).

I weighed in at Endocrinologist #2, looks like i've lost a pound in the last month: 162.4 - I'll take it.

Virdict is: subclinical hyperparathyroidism.  Recommendation is: I can have the surgery if I want (and I do).  Process: first I get a bone scan (non invasive outpatient procedure) which is more informational since I already qualify for the surgery due to my age, but still good for me to have.  Assess any osteoperosis or tendencies thereto.  And then schedule surgery.  She is referring me to someone who by reputation is excellent in this field.

More bloodwork taken.  Love this doctor, but lab techs kind of rude.