Lynda D.
And it continues...
Feb 09, 2016
Haven't been here in forever! Quick update. I am still fat. The end.
Yes, I am still fat. No, I will likely not ever be able to have the surgery I want (need). My husband lost his job two years ago. He found a new one, but it has no benefits. No insurance. No surgery. Also, I was diagnosed with Sjogren's Syndrome and, frankly, it's kicking my butt! I have become disabled because of it and I cannot work. So maybe surgery wouldn't be a good idea? Maybe it would kill me? Maybe it's best for me to remain obese and just try to cope as best I can? Sometimes, in life, you're faced with things that you can't control and you just have to endure. You just cope. Day in. Day out. You deal with each trial as it arises and, above all, you trust in God -- there is always a reason for things and most of the time they are for your benefit. Think about it. Haven't most of us become better people because of what we've had to endure? Aren't we more understanding, less judgmental, more patient, wiser? For those reasons, isn't suffering a good thing? When I leave this life, I want people to say that Lynda was so funny, smart, talented, loving, patient, and strong. I want to be thought of as a good mother and a good friend. That I always had a kind word and was always willing to share my knowledge, my wisdom, my support, with others. I want to be spiritually strong. I want to develop my character and my talents. Those are the things that endure long after we leave this life. Not our bodies. That's nothing. That is nothing more than material made from earth that will return to earth. Temporary.
I can't develop my body anymore. I can't force it to become what I want it to become. I have Sjogren's. I am hypothyroid. I have non-alcoholic fatty liver disease. My body is shit and my looks have been destroyed. So I have changed my focus. I'm in school, majoring in English and I have some high hopes of becoming a writer. This, I can do.
I can't change my body, but I can change my character.
I absolutely love learning. I love literature. Bring up the subject of Charles Dickens with me and I. Will. Nerd. Out! Mentally, I am in my element. Spiritually, I am appreciating what really matters. Emotionally, I am becoming stronger. But physically...physically I'm decaying. But that's okay. That's to be expected. I'm almost fifty, what should someone who has lived for five decades expect?
Life isn't like a video game, where you improve and level up and become stronger with the passage of time. Life is more like an exchange: you gain spiritually but pay a price physically.
Alrighty then. I have been morbid enough, I guess. I'm talking as if my death is imminent. It isn't but let's face it, when you are almost fifty, morbidly obese, and beset with other illnesses, can you really expect to live another fifty years? I'm guessing I have about twenty years max, probably more like fifteen. That really isn't much time -- we all know how time has an absurd tendency to speed up the older we get -- so I'm focusing now on what really matters: not my body, my being.
Thank you for staying with me while I plumb the depths of my psyche. 
Still Twiddling My Thumbs While Life Passes Me By
May 24, 2013
Good Lord Almighty, I can bitch here can't I? Well I think I can so I'm gonna bitch.
Still sick. Still can't get out of bed. Still can't be a wife and mother. I don't shop or cook or clean or go to church anymore. I go to the bathroom, and I go to the doctor. That's it. And I hate this.
So much of my life has been in upheaval the past few years. My husband was laid off in '06. He found another job but had to take a HUGE pay cut. We struggled, but I was working and we scraped by. Then the economy went to hell in '08 and I lost my job. We tried to refinance our house around the time but, to our horror, our house was no longer worth what it should have been. We ended up owing more on the house than it was worth. We owed A LOT MORE. Like a lot. Like enough to make you ill a lot. We're talking tens of thousands of dollars here. I'm still disgusted by that. You work your whole damn life to buy a little parcel of land, and it gets ripped out from under you. 
So then my hypothyroid problem spiraled out of control, and my doctor put me on steroids because we thought it was adrenal insufficiency, and then my insurance dropped my doctor (It had something to do with narcotics) and I didn't have anyone for a long time, and the steroids ruined my teeth so that I was constantly in pain and running a fever from my rotting teeth, and we had to file bankruptcy because my medical and dental bills were so high, and we lost the house as part of it and...blah, blah, blah, and so forth and so on. Whew! I'm out of breath! I think I already detailed what's been going on in another post, so I won't go into it here.
Oh, and then my husband got laid off again the other day. No warning. No nothing. He went to work, and they told him he was laid off, and he was escorted out of the building by security. They had just had a performance review and gave my hubby a raise! Then they lay him off?? WTF?
Throughout all of this I haven't felt right about getting the surgery. I want to do it. I really do. But there's something holding me back. Part of it is because we aren't settled in our lives. We have no idea what's going to become of us. In some ways, we're free. We're no longer tied to a mortgage, and we have no lease on the house we're currently renting. We could pack up and leave anytime. We can go anywhere to get a job. Out of state. Anywhere.
And then of course there's the fact that I won't have insurance for much longer, and who knows what kind of insurance we'll have in the future.
But I was just diagnosed with nonalcoholic fatty liver disease. My doctor says if I don't lose weight this will kill me. It will just take twenty years to do so, and my quality of life will be poor in the meantime. I don't think I can lose this weight on my own. It's not an excuse. It's reality. My body wants to be fat.
I have to do something to make things better!
But first I need to be secure. Secure in a place to live. Secure in an income and insurance benefits, secure in getting my health stabilized. I can't even think about a revision until I have more security and stability in my life.
So I twiddle my thumbs and I wait...
My Exciting, Fun 3 yr. Adventure That Wasn't Exciting OR Fun.
Mar 28, 2012
Hi all. Sorry I haven't been here in forever. I've been dealing with my health issues and have been simply too weak to be on the computer much.
Quick recap: I started getting sick in the spring of 2009. At the time I believed it was low cortisol. I went to my doctor, who put me on hydrocortisone. Three weeks later, my insurance dropped my doctor, and I spent the better part of a year trying to find a decent replacement. During this time, I was taking way-too-high doses of hydrocortisone; I didn't have a doctor and I was having to make my own medical decisions. I was making some crappy medical decisions.
The hydrocortisone interfered with my calcium absorption, which, combined with my gastric bypass malabsorption, caused my teeth to rot and break off. I spent about a year and a half (and thousands of dollars) getting root canals and crowns only to have the root canals fail.
In addition, during the past three years, all my thyroid blood tests kept coming back abnormal. I tried different meds and different doses, but nothing helped. I didn't really pursue the problem during this time, I was too busy with my dental emergencies (abscesses) and trying to wean off the steroid. You can only fight so many fires at once, right?
I've managed to solve some of my health issues. I broke down and had my rotten teeth pulled. I wear dentures now. It sucks, but it's better than being sick all the time. I'm off the steroid and have been for more than a year. But I wasn't able to get the thyroid problem resolved.
I did some research on the Internet and discovered a couple of important things. One, Armour changed its formula and began adding cellulose to the mix. It seems the cellulose binds to the thyroid hormone making it difficult to be absorbed. I've been reading many, many accounts of people who saw their hypothyroid symptoms return after Armour's formula change. When did Armour change its formula? Spring of 2009! When I first got sick! Coincidence? I don't think so! Oh, and Armour didn't bother telling anyone about this change. Nice of them, huh?
I also learned of Reverse T3, but I'll get to that in a minute.
After thinking of this, I believe what happened was that Armour changed its formula in 2009, I couldn't absorb it and began having symptoms of both low thyroid and low cortisol. I say low cortisol because the body needs cortisol to help utilize thyroid properly. If you aren't getting enough thyroid, the adrenals will try to compensate, and that can lead to low cortisol symptoms. I really believe that was the case with me, though I'll never know for sure. I also believe some of my symptoms at the time were low thyroid, as I've already mentioned, but I didn't recognize these symptoms for what they were. Why should I suspect low thyroid symptoms? After all, I was on Armour, the miracle drug!
As stated, I learned of the existence of Reverse T3. When the body converts T4 (a storage hormone) to T3 (the biologically active hormone) some Reverse T3 is made. This is normal. Sometimes, however, the body can make too much Reverse T3. This can happen, for example, when a person has had long-term exposure to infection (my rotting teeth), and to high levels of cortisol (the two years I spent on hydrocortisone). The body responds these types of stressers by increasing Reverse T3 and thus decreasing energy production. Why? I don't know. Everything I've read says the body thinks it needs to conserve energy to deal with the stress. Seems counterproductive to me. Basically what happens is that the excess Reverse T3 binds to the cells so that T3 can't get to them. You can have plenty of T4 and T3 in your bloodstream, but if it isn't getting to your cells, you're screwed.
I went to my doctor, who is an osteopath, and who thankfully just happened to do his thesis or dissertation or whatever on this very problem. Here's a link if you want to learn more: www.wilsonssyndrome.com/ I had a blood test, which confirmed my suspicion, and started treatment at the beginning of this year. It's not been easy. You have to do these cycles where you take increasing doses of T3 only (taking T4 only leads to more Reverse T3) for a period of time, then wean off in preparation of a new cycle, all the while keeping careful track of your body temperature. The goal is to force the body to clear out the excess Reverse T3. I've done three cycles and I think I'm finished. I'll know more tomorrow when I see my doctor again.
If I am finished I can't go back on Armour. Armour is ruined now. So is Naturethroid and Westhroid. They both have cellulose in their formula as well. I can't do compounded, my local compounding pharmacy uses cellulose too. And Synthroid has never, ever, ever done a single damned thing for me. Ever.
One option is a compounded formula made in Canada, that is exactly the same formula as the old Armour. The problem is that Canada has a different health care system than ours, and the pharmacy that makes this medicine doesn't accept insurance. It's out-of-pocket and can be pricey.
That leaves NP Thyroid, made by Acella Pharmaceuticals. Thankfully Acella is in the US, insurance covers NP Thyroid, and it's considered a generic of Armour so it's inexpensive. It's almost exactly the same formula as the old Armour. It has one more type of dextrose than the old Armour. Obviously NP Thyroid is what I'm going with.
Once I get my thyroid — and my general health — where it should be, I can then begin focusing more on getting a revision. And going back to school!!!
I'll be so glad when this is all behind me. I've learned a lot from this experience, and it's made me appreciate life so much more, but I never, EVER, want to go through this again!
Why I Haven't Had My Revision Yet
Sep 13, 2011
Dr. Simper is apparently intent on sending me on a wild scavenger hunt that consists entirely of me collecting OKs from various specialists.
I need an OK from my cardiologist, because of my Mystery Tachycardia, who says (My doctor, not my Mystery Tachycardia) my problem is due to dumping.
Then I need an OK from my endocrinologist. I need to do a test to see if my adrenals, which have been sleeping for two years, are awake enough for me to have surgery. The problem with this test is that I have to get up early for it, and I just don't do mornings well. All my life I've been accused of being a vampire...just not a sexy or powerful or rich one who sparkles. (And I don't drink blood. You do believe that, right? Right?) I've been thinking of changing continents, thinking that maybe I'd become a morning person, but I'd probably just get my days and night mixed up there too.
Now I need an OK from my gastroenterologist, due to my stomach acting up. My PCP says my problem is yeast overgrowth, which I believe is caused by the Florinef my cardiologist prescribed, to fix my Mystery Tachycardia, which is caused by dumping.
I wonder who I'll have to get an OK from next? Maybe my mom? She'll have to sign a permission slip, maybe? I'm thinking it would read like this:
Dear Dr. Simper,
My daughter is good to go.
Love, her mom
Oh, and then I get to do some silly diet to prove that I can eat right. Or something like that. I don't know. I haven't got that far into this yet and apparently the rules are just a tiny bit different for revision patients. I get the impression that it's all up to whatever Dr. Simper feels like making me do that day.
Wanting to get this show on the road? Frustrated about it? Me?
In Dr. Simper's defense, I can understand his caution. Revision carries a host of potential complications and really, I'd like to be in the best possible physical condition before surgery as well. And let's face it: my adrenals may not be strong enough yet. I'd heard it takes a year for the adrenals to start functioning after long-term steroid use. Of course at the rate I'm going...
The Difference a Pyloric Valve Can Make, Part II
Sep 13, 2011
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DISCUSSION
This report describes a safe treatment that reverses the metabolic disturbances characterizing post-RYGB hypoglycemia. Current treatment options are unsatisfactory, with patients experiencing fatigue from extremely low carbohydrate diets and minor improvement from diazoxide, acarbose, and octreotide, all of which have unpleasant side effects and/or health risks. For severely affected patients, subtotal pancreatectomy (partial removal of the pancreas) is often performed, but this procedure carries a 2–9% mortality rate and hypoglycemia may recur. Placement of a GT is relatively low risk compared with subtotal pancreatectomy and, as described herein, effectively reverses both the early hyperglycemia and the late hypoglycemia. With a substantial portion of nutritional requirements administered via GT, our patient attained superior nutrition, infrequent hypoglycemia, and major improvement in quality of life.
In summary, the results in this case suggest that generalized β-cell overactivity (pancreas cells pumping out too much insulin) due to either GLP-1-mediated hyperplasia or failure of islet regression after surgically induced weight loss is not responsible for post-RYGB hypoglycemia. Rather, it appears that inappropriately high insulin concentrations result shortly after meal consumption, but only when food transits through the bypassed gastrointestinal tract. As such, the data obtained in this case study suggest that altered nutrient transit is responsible for this phenomenon. Although an exaggerated incretin response is one possible explanation, further studies are needed to prove causality. From a clinical perspective, placement of a GT in the original stomach appears to have the potential to completely normalize highly abnormal, undesirable, and potentially dangerous metabolic responses to ingested nutrients in post-RYGB patients. (This is saying that when food enters the intestines more slowly, like when you have your pyloric valve in use, you won't have the blood sugar swings). We recommend consideration of this intervention for others with severe postbariatric hypoglycemia refractory to diet and medications.
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I've posted fragments of this article only, as the article is long and quite technical in its wording. In essence, it's stating that the rapid movement of food into the intestines–which is what happens with the RNY gastric bypass–causes a whole lot of metabolic changes that can result in severe reactive hypoglycemia. I think it's interesting that with this particular case study, not only did the woman's hypoglycemia improved, but her nutrition as well, once she was getting her feedings through her old stomach. The reason, because the old stomach has a pyloric valve!
I've included my comments in an attempt to make the article a little more user-friendly. If I've gotten anything wrong, please feel free to correct me.
Interesting Article of the Difference a Pyloric Valve Can Make
Sep 13, 2011
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We present a patient with severe post-RYGB neuroglycopenia (Not enough blood sugar to fuel the brain) who had gastrostomy tube (GT) placement in the remnant stomach during hospitalization for small bowel obstruction. She experienced markedly reduced frequency of hypoglycemia and improved nutritional status. Standardized administration of identical liquid meals orally (via surgically altered gut) vs. GT (via nonbypassed gut) was conducted to determine metabolic correlates of improved symptoms.
SUBJECT AND METHODS
The subject is a 35-yr-old female with a history of morbid obesity who underwent RYGB 3 yr earlier, at which time her weight was 96 kg and BMI was 38.9 kg/m2. Twelve months after surgery, she had lost 45 kg, and despite improving dumping symptoms, she was experiencing symptomatic hypoglycemia, with tachycardia, diaphoresis (Sweating a lot because of shock), and a loss of consciousness episode when plasma glucose was 32 mg/dl. Symptoms were worse after carbohydrate intake, ameliorated (made better) by fasting, and minimally responsive to acarbose, diazoxide, and octreotide 1000 μg/d (These are medication to treat the low blood sugar problem). Postprandial (after a meal) plasma glucose, insulin, and C-peptide concentrations were documented as 15 mg/dl, 33 μU/ml, and 7.5 ng/ml, respectively. Radiological imaging was negative for pancreatic mass (I think this means there was no tumor or mass on her pancreas that would explain her low blood sugar problems), and antiinsulin antibodies and sulfonylurea screen were negative (Basically they couldn't find anything that would explain the low blood sugar issue). After the patient developed a small bowel obstruction, a GT (a feeding tube) was placed in the original stomach for decompression and nutrition. The patient requested to maintain the GT for nutrition after discharge because she noted decreased frequency of hypoglycemia. Improvement in hypoglycemic symptoms and energy status continued, and she was ultimately able to return to work. She continues to take overnight GT feedings, decreasing her reliance on oral carbohydrates during waking hours, and consequently, hypoglycemic episodes. No hypoglycemia occurs during overnight feeds, and weight is stable at 4 kg above pre-GT weight.
To formally assess the metabolic basis for improvement in hypoglycemia resulting from GT feeds, standardized testing was conducted in the Stanford University General Clinical Research Center. Written informed consent, approved by the Stanford Human Subjects Committee, was obtained. After an overnight fast, the subject was admitted for blood sampling via iv catheter. One 240-ml can of Ensure liquid formula (250 kcal, 6 g fat, 40 g carbohydrate, 9 g protein) was administered over 15 min by mouth. Blood samples were obtained at baseline and 30, 60, 90, 120, and 150 min afterward. The following morning, after overnight fasting, the procedure was repeated, but the liquid meal was delivered via GT. For comparison, insulin and glucose values were obtained from 10 healthy nonsurgical females matched for BMI and age, and to six healthy females with normal fasting glucose but who had attained glucose elevations (>200 mg/dl) similar to our subject 30–60 min after oral glucose challenge (75 g). Of note, the latter subjects, hereafter referred to as “glucose controls,” were all overweight/obese [BMI, 28.0 ± 4.4 kg/m2) and extremely insulin-resistant [top 5%). Glucose concentrations were measured via oximetric method and insulin via RIA. Total GLP-1 and GIP were determined using C-terminally-directed antisera (code 89390 and R65), which detect the sum of the intact peptides plus the primary metabolite. Glucagon concentrations were determined using antiserum 4305, which is specific for glucagon of pancreatic origin.
RESULTSAt the time of metabolic evaluation, the subject weighed 47.2 kg (BMI, 19.0 kg/m2). Compared with the GT liquid meal, oral ingestion produced a peak glucose at 30 min twice as high (243 vs. 129 mg/dl), followed by symptomatic hypoglycemia at 90–120 min (60 vs. 80 mg/dl) and continued lower glucose levels throughout the 180 min test (77–78 vs. 92–106 mg/dl). Insulin concentrations at 30 min were 8-fold higher (406 vs. 48 μU/ml) but dropped rapidly, reaching 19 μU/ml at the onset of hypoglycemia. In comparison, at the time glucose peaked in the six glucose-matched controls, insulin concentrations were 166 ± 80 μU/ml. Thus, our subject’s peak insulin was 144% higher than similarly hyperglycemic controls, despite the fact that the controls were obese and insulin resistant, and thus expected to have higher insulin responses to oral glucose. In the 10 BMI-matched controls, insulin and glucose responses were essentially identical to values in our subject when the liquid meal was administered via GT.
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Part two of this article is on another post. For some reason I couldn't copy and paste anymore on this post.
Articles About RNY and Reactive Hypoglycemia
Mar 13, 2011
I have found that taking chromium helps things.
Anyway, I was doing some searching on late dumping, or reactive hypoglycemia, and I came across these two articles. I've decided to go ahead and just copy and paste the articles right here. I've highlighted in red the parts I found the most interesting and put my comments in blue. Here they are:
ASMBS: Gastric Bypass Linked to Abnormal Glucose Tolerance
By Charles Bankhead, Staff Writer, MedPage Today
Published: June 26, 2009
DALLAS, June 26 -- Patients who undergo gastric bypass surgery often have undiagnosed glucose abnormalities that can lead to bad eating habits and regained weight, a small clinical study suggests.
Almost 80% of the patients had glucose abnormalities, including hyperglycemia, hypoglycemia, or both, Mitchell Roslin, MD, of Lenox Hill Hospital in New York, reported here at the American Society of Metabolic and Bariatric Surgery meeting.
Patients were alarmed by the weight regain, but at the same time, they often had a ravenous appetite soon after a meal, accompanied by an almost uncontrollable urge to eat. (This happens to me quite a bit.)
"Our hypothesis is that . . . patients may have an enhanced insulin response," said Dr. Roslin. "They have rapid emptying of the pouch that leads to reactive hypoglycemia. The combination of an empty pouch and low blood sugar leads to hunger."
Reactive hypoglycemia manifested as a rapid upsurge of glucose levels that correlated with a rise in insulin and then a rapid decline during the second hour after the glucose challenge.
Patients with both hyper- and hypoglycemia had even more pronounced swings in glucose and insulin levels, said Dr. Roslin.
The most dramatic rises and falls in blood glucose have been associated with small pouches and wide anastomoses, he added. (Though I haven’t had it checked out yet, I believe my pouch and/or stoma has stretched. I feel as if everything I eat and drink passes right through me. I rarely full and in fact, I feel empty much of the time. Edit: I've since had a scope [in August of 2011] and yes, my stoma has stretched).
The findings suggest a need to consider alterations in the standard gastric bypass procedure, such as use of valves, or possibly abandonment of the procedure in favor of another approach.
"I believe that vertical-sleeve gastrectomy and duodenal switches that are not severely malabsorptive will be the best options in the future," said Dr. Roslin. (Why does he say that a DS procedure that is not severely malabsorptive is the best option? What does he consider severely malabsorptive anyway?)
Primary source: American Society of Metabolic and Bariatric Surgery
Source reference:
Roslin M, et al "Abnormal glucose tolerance testing following gastric bypass" Surg Obesity Related Dis 2009; 5(3 Suppl): Abstract PL-205.
Low blood glucose levels may complicate gastric bypass surgery
By Joslin Diabetes Center, [RxPG] Physicians monitoring patients who have undergone gastric bypass surgery should be on the alert for a new, potentially dangerous hypoglycemia (low blood glucose) complication that, while rare, may require quick treatment, according to a new study by collaborating researchers at Joslin Diabetes Center, Beth Israel Deaconess Medical Center (BIDMC), and Brigham and Women's Hospital (BWH) and published in the October issue of the journal Diabetologia. (Unless I’m mistaken, this study was done on October 12th, 2005. My surgery was on November 5th, 2005. This was published just a little over three weeks before my surgery. There is no way I could have learned of this study in time, and no way I would have been reading that journal anyway. But oh, how I wish I'd known this then). The paper follows on the heels of a Mayo Clinic report on six similar case studies published in July in the New England Journal of Medicine. About 160,000 people undergo gastric bypass surgery every year.
The study details the history of three patients, who did not have diabetes, who suffered such severe hypoglycemia following meals that they became confused and sometimes blacked out, in two cases causing automobile collisions. The immediate cause of hypoglycemia was exceptionally high levels of insulin following meals. All three patients in the collaborative study failed to respond to medication, and ultimately required partial or complete removal of the pancreas, the major source of insulin, to prevent dangerous declines in blood glucose. (Removal of their pancreases??? Seems extreme to me when what's needed is the restoration of their pyloric valves).
"Severe hypoglycemia is a complication of gastric bypass surgery, and should be considered if the patient has symptoms such as confusion, lightheadedness, rapid heart rate, shaking, sweating, excessive hunger, bad headaches in the morning or bad nightmares," says Mary-Elizabeth Patti, M.D., Investigator in Joslin's Research Section on Cellular and Molecular Physiology and Assistant Professor of Medicine at Harvard Medical School. "If these symptoms don't respond to simple changes in diet, such as restricting intake of simple carbohydrates, patients should be evaluated hormonally, quickly," she adds. Dr. Patti and Allison B. Goldfine, M.D., also an Investigator at Joslin and Assistant Professor of Medicine at Harvard Medical School, were co-investigators of the study.
The study reported on three patients, a woman in her 20s, another in her 60s and a man in his 40s. All three lost significant amounts of weight through gastric bypass surgery, putting them in the normal Body Mass Index (BMI) range. Each, however, developed postprandial hypoglycemia (low blood glucose after meals) that failed to respond to dietary or medical intervention. As a result, all patients required removal of part or all of the pancreas. In all three cases, it was found that the insulin-producing islet cells in their pancreases had proliferated abnormally. (Their pancreases had enlarged to accommodate the sudden need for insulin due to dumping.)
A potential cause of this severe hypoglycemia in these patients is "dumping syndrome," a constellation of symptoms including palpitations, lightheadedness, abdominal cramping and diarrhea, explains Dr. Patti. Dumping syndrome occurs when the small intestine fills too quickly with undigested food from the stomach, as can happen following gastric bypass surgery. But the failure to respond to dietary and medical therapy, and the conditions worsening over time suggested that additional pathology was needed to explain the symptoms' severity, Dr. Patti adds. "The magnitude of the problem was way beyond what doctors typically call dumping syndrome," she says.
Other causes of postprandial hypoglycemia can include overactive islet cells, sometimes caused by excess numbers of cells, a tumor in the pancreas that produces too much insulin, or familial hyperinsulinism (hereditary production of too much insulin), which in severe cases can necessitate removal of the pancreas.
In patients following bariatric surgery, additional mechanisms may contribute to overproduction of insulin. "First, insulin sensitivity (responsiveness to insulin) improves after weight loss of any kind, and can be quite significant after successful gastric surgery," says Dr. Patti. "Second, weight gain and obesity are associated with increased numbers of insulin producing cells in the pancreas, and so some patients may not reverse this process normally, leaving them with inappropriately high numbers of beta cells." (Insulin resistance disappears after gastric bypass, but because some patients already have enlarged pancreases due to their pre-surgery insulin resistance, their pancreases “overreact” to rises in blood glucose; too much insulin is pumped out, the cells are no longer insulin resistant so they take in too much glucose, and severe hypoglycemia is the result. That’s how I understand this, anyway.)
Finally, after gastric bypass surgery, GLP1 (glucagon-like peptide 1) and other hormones are secreted in abnormal patterns in response to food intake, since the intestinal tract has been altered. High levels of GLP1 may stimulate insulin secretion further and cause increased numbers of insulin-producing cells. "In our patients, the fact that the post-operative onset of hyperinsulinemia was not immediate suggests that active expansion of the beta cell mass contributed to the condition," Dr. Patti adds. (As time goes by, the body adapts to dumping by increasing the size of the pancreas. Which, of course, complicates things. Does it lead to type 2 diabetes???)
Other researchers participating in the study included S. Bonner-Weir, Ph.D., of Joslin; E.C. Mun, M.D., J.J. Holst, M.D., J. Goldsmith, M.D., D.W. Hanto, M.D., Ph.D., M. Callery, M.D., of Beth Israel Deaconess Medical Center. Collaborating investigators from the Brigham and Women's Hospital included R. Arky, M.D., who also is a Joslin Overseer, G.T. McMahon, M.D., M.M.Sc., A. Bitton, M.D., and V. Nose, M.D. All participants are on faculty at the Harvard Medical School. Funding for the study was provided by the National Institutes of Health, the Julie Henry Fund of BIDMC and the General Clinical Research Centers.
Besides helping afflicted gastric bypass patients, the research has hopeful implications for treating people with diabetes, says Dr. Patti. The gastric bypass patients have what many of those with diabetes lack—ample insulin—and perhaps an understanding of this phenomenon could be harnessed to help those with diabetes. "If we can understand what processes are responsible for too much insulin production and too many islet cells in these patients, we may be able to apply this information to stimulate insulin production in patients with diabetes, who lack sufficient insulin," Dr. Patti says.
Climbing my way out of Hell...
Mar 07, 2011
I've suffered from migraines since I was twelve years old. As I've grown older, they got worse. Eventually, they became almost daily and they were debilitating. I was on preventatives, but I was still suffering. I finally went to a pain clinic in mid 2004 and they put me on a narcotic patch that I wore 24/7. It's called Duragesic patch and it's fentanyl, which is a powerful narcotic and hard to wean off of. Of course I didn't learn this fact until much later. My doctor was kind of flippant about weaning off. He told me they would just reduce my dose gradually and everything would be hunk dory. Uh huh.
Also, six months before my weight loss surgery I was diagnosed with hypothyroidism and put on Armour Thyroid. Armour works the best for me. But I'll write about that later.
On November 5, 2005 I had my RNY.
At first it was difficult. I'd just had surgery and felt like I'd been hit by a truck then dragged by a train. I had a real hard time getting my fluids in and taking calcium was a nightmare. I'd take one and be stuffed. I vomited a lot, things got stuck, I was tired and I wondered what the hell had I done to myself.
At the same time I was having trouble with low blood pressure, blacking out and even fainting at times when I stood up, fatigue and weakness. If I felt any stress, I got weak and nauseated.
I did a ton of research on the internet and concluded that the problem was low cortisol. In case you don't know, cortisol is the hormone that the adrenals (which sit right on top of your kidneys) pump out in response to stress. Any stress. From a car accident to spilled milk to constant stress overload from work and/or life in general. When the adrenals don't put out enough cortisol, the body reacts oddly to stress. You get weak and lightheaded, you vomit, and sometimes you can lose consciousness. In fact, not having enough cortisol can kill you. Naturally, I was concerned about myself.
I went to my doctor about this. They said my problem was low blood volume and to increase my salt intake. I did and it helped but I still had problems. I went back to my doctor again and insisted they do a cat scan on my abdomen to see if there was a problem with my adrenals. I had the scan done and what was found was a gigantic, nasty cyst on my left ovary that looked suspicious. All attention was then diverted to that. I feel it was a red herring. The cyst was funky looking, almost like it had walls within it, and the word cancer was being used in connection to it. My doctor insisted it had to come out and I agreed.
I went to my ob/gyn and was scheduled to have surgery in June of 2006, just nine months after my WLS. I was losing weight rapidly, struggling nutritionally and with hydration, having issues with my cortisol, and suddenly I was plunged into surgical menopause.
I got sick in earnest then. I couldn't sleep, had terrible headaches, weakness, fatigue, low blood pressure, blood pressure drops when I stood up, hot flashes, trouble thinking clearly...all kinds of fun stuff. My ob/gyn tried all different kinds of hormone replacement therapy, but I wasn't doing too well with them. He kept telling me it would take one to five years for my body to adjust. Five years??!! That’s actually about how long it’s taken.
Two weeks before my surgery to remove my ovaries my husband was laid off from his job. This was actually a good thing in a way because I was totally bedridden and someone needed to keep things going.
The following December, I went to an endocrinologist (there were only two in my town) and had an ACTH Challenge test done. ACTH is the hormone the pituitary gland puts out to stimulate the adrenals to pump out cortisol. The tests consists of taking a baseline blood sample, administering a synthetic ACTH, then checking the blood every fifteen minutes to see how the adrenals respond. The results were that my adrenals responded fine, but that my pituitary wasn't putting out enough ACTH. I was told it was because I was on a narcotic patch and that there was nothing that could be done. So nothing was done and I just tried to survive.
The following spring (2007) I went off the patch. Our insurance had run out at the first of the year, and my husband hadn't found a job yet. I had to quit the patch, it wasn't helping with my headaches anymore (probably due to hormone issues), it was messing with my pituitary function, and I just plain couldn't pay for them anymore. I went through horrible withdrawal. I swear to god that I will never judge a heroin addict again. When people say you're "kicking" the habit, it means just that...kicking. You lay in bed exhausted because you cannot sleep for days, but you can't lie still. You kick and kick and toss and turn. You just can't stop moving. So you get out of bed but then you're so fatigued you can't stay standing up. You have headaches, diarrhea, you're vomiting all the time — which is what you do with RNY anyway — and you lose any desire to eat or even drink water. I had lost a lot of weight and I just generally felt like there was nothing for my body to draw on to keep itself alive.
Later that spring my husband found a new job. We had to take about a twelve thousand dollar pay cut, and that hurt, but it was a job and we had insurance again.
I ended up going on Suboxone that summer, which is a partial narcotic designed to treat opiate addiction. And let's face it, I was addicted to narcotics. I struggled with that too. It wasn't easy to go off of. I tried several times but would get so sick and had such cravings I'd chicken out and go back on it. I was a bit gun-shy about the horrors of withdrawal by that time.
My adrenal insufficiency problem eased up with the Suboxone, but it was still a problem.
By 2009 I was doing pretty well. I was still on the Suboxone but wasn't having too many low cortisol symptoms. I had lost all my weight, had gotten into a good supplement schedule, I had good energy, and had found a good source and dose of estrogen. My headaches had eased up quite a bit as well. Without my ovaries and the constant up and down of my hormones, my migraines were few and far between and easy to treat. They still are.
Money was tight but I was working at my kid's elementary school and we were doing ok.
Until...
In the spring of 2009, I started having these weird episodes that would come on fast and left me weak, shaking, and sweating. I had a lot of confusion when these strange attacks hit. It was like I would look at something and wouldn't recognize what I was seeing. Like I was disconnected from reality. My tongue would tingle. I would feel faint. It was strange and frightening. No one had any idea what was happening. I did notice, however, that eating something helped.
Of course now I've learned about reactive hypoglycemia and I believe that's what those episodes were. I still have them and I can't figure out what triggers them. They seem so random.
I also began to feel a lot of fatigue and would literally black out when I stood up. My blood pressure began to be low again. To me, it felt as if the low cortisol issue was back. It felt familiar. I went to my PCP and he decided to put me on prednisone to see if it helped. It did. Tremendously.
My doctor was an osteopath and he was very familiar with bio-identical hormones and the treatment of adrenal insufficiency. He put me on Cortef, which is basically hydrocortisone, and we made a plan to help me fix what was wrong and get back off the steroid.
Three weeks later I got a call from my doctor’s office telling me that my insurance had dropped him. I don't know why. The people at his office wouldn't tell me and my insurance wouldn't either. My doctor had been my doctor for more than twelve years and losing him was devastating. It took months to find a doctor who was any good. You know, if all you have to deal with is the occasional sniffles, getting good health care isn't a problem. But when you're like me, and you have hypothyroidism, nutritional issues, hormone replacement therapy needs, chronic migraines, and problems with cortisol production, that's when you begin to see the laziness, greed, lack of caring, and just plain incompetence of some doctors.
I had no medical care to speak of. I was making my own medical decisions and I had no clue about what I was doing. I was going from doctor to doctor and was either being blown off or told that I had too many things for them to deal with, too many perplexing symptoms, and I needed to find someone else. I was asking for higher doses of hydrocortisone, believing that I needed it, and they were writing thirty day prescriptions to help me get through until I could find a doctor to take over my care. At one point I was taking seventy mgs of Cortef! To put this in perspective, my current endo told me the human body normally puts out the equivalent of fifteen to twenty mgs of Cortef each day. I was taking about four times that amount.
I know I was stupid. Please don't judge, ok? I seem to be one of those people who have to learn everything the hard way. Believe me. I learned a lot from all of this and I'm a better person for it.
As I said, I wasn't getting the help I needed. I had began shaking very violently, all the time and I made the decision one day to go to an urgent care facility. I discovered from that visit that there had been a misunderstanding in my thyroid med dosage, and I was taking double the dose I should have been. The thing that really ticks me off is that the doctor I was seeing at the time knew about this, but didn't bother to tell me. If I wasn't in the habit of getting copies of all my labs, I wouldn't have discovered this lapse of theirs. Honestly, this doctor has got to be the worst doctor alive.
I was experiencing thyroid toxicity and I believe that the extra thyroid medication was putting a strain on my adrenals. I had had my ACTH levels looked at again around the time all this started and my levels were still very low. Low normal but right on the bottom. The Suboxone, being an opiate, was still suppressing my ACTH production, just not as severely as the Duragesic patch had been.
As usual, I had no real medical care, so I had to make my own decisions regarding my thyroid medication. I found that if I took even a small dose of my thyroid, I began to shake violently and just get very ill. I really don't know why this was the case, but I decided to go off the thyroid for awhile.
Then, not long after (this was summer of 2009) Armour thyroid wasn't available anymore. Don't know why. I went back to the original endo who diagnosed my pituitary problem and she put me on Synthroid. Well, Synthroid doesn't work well for me. For a long time my dosages were getting tweaked. Every time my dose was changed, we had to wait four to six weeks to see if it helped. My labs just kept coming back abnormal. When I finally found my fabulous current doctor, Dr. David Voss, I switched to a T3/T4 med that was made at a compounding pharmacy, but that didn't work well either. For a long, long time it was this formula, that formula, this dose, that dose, off meds, back on meds. It was nuts.
Also, around summer/fall of 2009 I began to have a lot of trouble with calcium. Apparently, hydrocortisone interferes with vitamin D absorption, which in turn interferes with calcium absorption. With my steroid dose being as high as it was, I had basically developed Cushings and was ravenously hungry all the time. Especially for sugar. I was constantly eating and I was eating a lot of sweets. My teeth began to rot quickly and severely. It took months and thousands of dollars to get this problem under control. I had ten root canals at about the same time. I was in tremendous pain and, because hydrocortisone lowers the immune system, I had infection all throughout my gums. My dentist kept prescribing antibiotic after antibiotic, then I’d always develop a fungal infection afterward.
I was in pain all the time, as I said. The Suboxone only helped so much and I began taking a lot of ibuprofin to deal with it. Which worries me a little. Sometimes I have pain in my stomach after I eat and I worry about ulcers since hydrocortisone thins the skin. I need to get that checked out.
Every time I had a root canal done, my dentist gave me pain medication. Well, the doctor prescribing my Suboxone wasn’t thrilled with this and forced me off the Suboxone. I’m actually quite thankful for that. I’d been trying to go off it for almost a year but, at the first sign of withdrawal, I’d get scared and go back on it. This time, I had no choice and really, the withdrawal wasn’t as bad as I thought it would be and I’ve been opiate-free since June of 2010!
I had to do the hard work of weaning myself off the hydrocortisone and it hasn’t been easy, to put it mildly. Every time I drop a dose I go through the whole gamut of low-cortisol symptoms. And I have to wean slowly or else I get extremely ill. Now that I’m below twenty mgs, It’s been even harder and I’ve had to wean more slowly. I’ve been working on weaning now for about nine months.
As I stated earlier, I was eating all the time when my hydrocortisone dose was so high. I never felt hungry. Not ever. I’d get so hungry that my stomach would ache. And the sugar cravings! Out of control! Combine this with the fact that malabsorption of the RNY slows down at about the two year mark, and the fact that I didn’t have my hypothyroidism under control, and the fact that I was too sick and fatigued to be physically active, and you can see how I gained back all my lost weight.
At of this writing, February 28th, 2011, I’m taking 2.5 mgs of hydrocortisone and my dental problems have slowed dramatically. I’ve increased my Vitamin D and calcium and it’s helped quite a bit. I still have cavities in every single tooth left, but I can deal with that. My thinning skin is thicker now, my weight gain has stabilized, and I no longer have a moon face. Armour is available again and I’m back on it so my low thyroid is under control. I still have trouble with infections, and I imagine I will continue to do so until I’m entirely off hydrocortisone, which I hope I will be by April 1st. I’m fatigued all the time but I’m hoping that will ease up once my “sleeping” adrenals begin to work on their own again. Being on hydrocortisone causes the adrenals to shut down.
Once my adrenals start to function again, my next step is to get this weight back off again. I don’t really believe that my RNY is going to do it for me. That’s why I’ve decided to revise to a DS. Another reason I want the DS is to stop this reactive hypoglycemia.
A little back story...ok, A LOT of backstory
Feb 13, 2011
I belonged to a large family; I was the fifth of six kids – three boys, then three girls. Just like the Brady Bunch, we used to joke. *Sigh* I was Jan, stuck in the middle and mediocre, with the beautiful and talented older sister, and the cute and adorable little sister. Yeah, I can really relate to Jan Brady. There are a lot of years that separate me from my other siblings. My younger sister, the baby of the family, is seven years younger than me, and my older sister, the fourth child, is seven years older than me. I always felt a little bit of isolation because all my siblings were so much older. My two oldest brothers were married and out of the house before I was even eight years old. I love them and they love me, but I'm not very close to them.
I had a great dad. Warm, loving, supportive and understanding, the kind of dad every girl should have. That's not to say he was perfect, of course, he let me down and failed me on many occasions, but he was truly a wonderful father to me. Sadly, he died just three day after Christmas in 1989 from Multiple Myeloma (a type of cancer). I will miss him always.
I didn't have the greatest relationship with my mother. I know now that she loves me, but didn't believe it while growing up. She had a problem with my weight...well, actually, she had a problem with me. She was never satisfied with me. I never felt like I could do anything right. To this day, I struggle with my self worth and I'm sensitive to criticism because of my harsh upbringing. My mom had more of a problem with my weight, I think, than I did. I didn't like being "chubby" of course, was envious of the thin girls in school, but I think I was more accepting of myself than my mom was. When I was about 14, almost 15, years old, my mom put me on Dexatrim. Looking back, I think it was a highly irresponsible thing for a parent to do to a child and it's something I would never do to my children.
Dexatrim was/is basically caffeine and I found myself bouncing off the walls and never hungry. Within a month or two I had lost around fifty pounds.
Suddenly, I was getting noticed—in a good way. Suddenly, I was getting compliments. Suddenly, the boys I liked, liked me back. They would come to my house to see me, and we'd talk and joke around while sitting on my front porch. I loved that. It was flattering and it was fun. I got no more insults and teasing.
I craved more of this good stuff so I went nuts with dieting. I went days without eating, exercised like crazy, constantly obsessed over how much I weighed. I'm 5' 3" and at one point, when I was fifteen, I weighed just a little over one hundred pounds. I was bony and I felt like crap much of the time. I remember every time I used the bathroom, I would turn sideways and look in the mirror to see if my stomach was flat. If it wasn't, I would panic and quite eating for awhile. Dexatrim was my source of food.
Gradually though, I mellowed out on the crazy dieting and I gained weight until I was up to around 125 lbs at the age of seventeen. I really feel that was when I looked and felt my best. It was still a ton of work to maintain that weight. I exercised obsessively and really watched what I ate. I was hungry a lot but I ignored it. I dropped the Dexatrim habit as well, good thing. But I had such a tendency to gain, it was frustrating and I had to work and work.
Once I got married my weight creeped up. My husband loves good food and so do I. When I was single it was easier to control what I ate and what food was allowed in my house. Once I was married, however, that changed. I still continued to exercise. I took long walks, I worked out on my stair climber, I recorded exercise shows off of ESPN and worked out with them. I tried to control my weight. I joined Weight Watchers and gained eight pounds! Are you kidding me?? I decided I could gain weight on my own, thank you very much, and for free, so I quit Weight Watchers. I looked into other programs like Jenny Craig, but I just couldn't afford it. They were all so stinkin' expensive and we were in school and broke.
After the birth of my son, I gained more weight and it wouldn't come off (Surprise, surprise). I joined a gym and during my lunch break (I was in college), I used to go and workout. I loved weight lifting. I loved the way I felt afterwards—tired, but a good kind of tired. I loved the toning and definition it gave to my muscles. I was heavier than was good for me, but I was toned and I still looked good. I worked hard to keep my weight down. I usually ate just one meal a day, with maybe a salad for lunch once in a while. I got hooked on Diet Coke. What is it with me and caffeine?!!
I got pregnant with my daughter and actually lost some weight. Then after she was born my appetite went nuts! I was hungry all the time and couldn't stop eating. I ended up gaining back what I'd lost during my pregnancy, and then some. I wonder if my insulin was doing weird things after pregnancy. Dr. Atkins mentions something about this in his book, that insulin levels can spike after a pregnancy. I don't exactly remember what the book says, however, it's been too many years.
This pregnancy pattern continued with the birth of each of my children. I'd get pregnant, lose weight, have my baby, my appetite would hit the roof, I'd gain all the weight back plus more, and so on. And the extra weight would not come off! By the time my youngest was born I weighed 250 pounds. It was getting harder and harder to control my weight. At one point I did Atkins for six months and lost 45 pounds. I gained it all back of course. Later, I tried Atkins again and nothing happened!!! Even on induction!!! I decided then that this was it for me, there was nothing I could do and I would just have to make the best of it.
And then I began to hear about the RNY gastric bypass surgery.
There was a lot of hoopla about it at the time. Carny Wilson had written her two books, Al Roker had gastric bypass. It seemed promising. I began to look into it.
Now when I say "look into it," I mean I looked into it. I looked into it for two years before actually having the surgery. I didn't just jump into it. I spent hours here on OH, asking questions, reading people's posts and profiles. I read the studies, I talked to people in real life who'd had the surgery. I prayed about it. I prayed a lot about it. I thought and thought and thought about it constantly. It looked so promising. There was a typical weight gain at about two years out, I'd read, but it was just 20% or so. That added up to about 20 pounds. I could live with that, no problem. Sounds great. There was dumping when you ate sugar and that made people not want to eat sugar. I have a real problem with sugar. I'd love it if something made me give it up. Sounds great. You lose the weight so fast. It just melts off. And it's easy to lose any regain. No more stubborn pounds not coming off. Sounds great. It all just sounded so great.
I'd heard of the DS, of course, but what I heard wasn't good. Admittedly, I never really looked that hard into it. My insurance didn't cover it and I'm not wealthy. Self-pay was out of my reach (still is). My insurance said the DS was experimental. That scared me and made me think it was a deadly surgery. I didn't want something unproven. I do remember a silly, gushing post that I read here on OH. Some silly-headed girl wrote something like, "OMG, you should get the Duodenal Switch like I am! You can eat anything you want and still lose weight!!!" Eat anything you want and still lose weight? No way. Sounds too good to be true. If life has taught me one thing, it's that there is no such thing as a free ride. There had to be a catch. The catch? Uncontrolled bowels. Bad gas. Horrible nutritional deficiencies. That was what I'd heard about the DS and there was no friggin' way I would consider anything that dangerous. Besides, my insurance wouldn't pay for it, and like I said earlier, I just didn't have the money to self-pay. I put the whole idea out of my head and pursued the RNY with a vengeance.
It took me two years to get approval for my RNY. I did everything my insurance required and then some. I waited and I worked. And worked and worked. I lived and breathed the RNY and getting insurance approval. Finally, I got approved for surgery for the day of November 5th, 2005. I chose Dr. Legrand Belnap because he is such a skilled surgeon. He does organ transplants and is accustomed to working with very ill patients. I was pretty healthy then, aside from my obesity. I didn't have any co-morbidities other than fierce migraines and problems with sciatica. I knew I was in good hands.
But Dr. Belnap didn't have any aftercare to speak of. He gave me guidelines to follow, but nothing else. The doctors over at Rocky Mountain Associated Physicians have a much better aftercare program, but they wanted two hundred dollars out of pocket. Remember what I said about never having enough money? Yeah, that little fact got in the way again.
The almighty dollar rules my world.
I used OH as my support system instead. I had problems with my health from the get-go. But I will detail that another day, it's late and I'm tired. Stay tuned...
