Speculating on Cascade Effect

I cannot help but wonder if my gastric bypass which I had in 2011 is to blame for so many of the problems I am having:

• Thyroid nodules (Possible new diagnosis I anticipate coming: Hypothyroidism)*--I don't recall having them (or as many of them) prior to the bypass. Surely, losing weight made detecting the nodules more obvious; however, I wonder if this is the result of the excessive amounts of calcium citrate my bariatric surgeon insisted I take daily (2000 mg). I only cut it down to about 800 mg about 3 years ago, so I cannot help but wonder.
• Proteinuria--I don't recall having this big of an issue with protein in my urine like I do now. I vaguely recall "microalbumin" but it wasn't anything my endocrinologist would remark upon. I cannot help but wonder if this is the result of my diet being protein-focused, and I'm considering dropping my daily protein shake (23 gm).
• Hyperuricemia--I don't recall being diagnosed with gout or borderline for gout, prior to my bypass. I know I was being monitored for it, but I don't recall all too many months where my lab reports documented levels in the 6-7 range. Again, too much protein? Or some other root cause? Between the proteinuria and the hyperuricemia, I am TERRIFIED of kidney failure.
• Chondrocalcinosis (Possible new diagnosis I anticipate coming: Pseudogout)*--Last year I had an MRI of my knee and the notes had a remark about chondocalcinosis present. This is above-and-beyond osteoarthritis, and from what I can determine from just a preliminary skim, the chondrocalcinosis is calcium crystals, whereas “gout” is urate crystals.  I have sought out a rheumatologist for a consult, and found a new endocrinologist and hope to get this mystery figured out.
• Post-Prandial (aka "Reactive") Hypoglycemia--It seems in my zeal (and terror) to reverse my risk factors for Type II Diabetes, I have traded it off for post-prandial hypoglycemia. I am not on medication for this, and manage it by eating multiple smaller meals throughout the day, and avoiding excessive consumption of refined carbohydrates. Even things like fried chicken could be enough to make my glucose dip a bit. I do love crunchy pretzel thin crackers (not more than 1-2 oz), but you gotta live a little--right? Mama needs flavor and texture.
• Enthesitis*

*I have noted these three with an asterisk as they could very well be linked or otherwise inter-related. I have my suspicions of the hypothyroid, as I've got a lot of symptoms that could be related to hypothyroid (which could have been dismissed as symptoms of my PCOS). 

Also, it'd be nice *IF* hypothyroid *IS* the culprit rather than pseudogout or RA, or Psoriatic Arthritis. Given the choices of medications, I'd say Synthroid is the lesser of the evils (evils being things like methotrexate, Colchicine/Allpurinol, and other medications that carry with it more unpleasant side effects).

I have highlighted in red the hypothyroid symptoms which I currently am experiencing:

• Fatigue
• Increased sensitivity to cold (more pronounced after my gastric bypass)
• Constipation (more pronounced after my gastric bypass)
• Dry skin
• Weight gain & inability to lose weight (See also: PCOS symptom)
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods (See also: PCOS symptom)
• Thinning hair (See also: PCOS symptom)
• Slowed heart rate
• Depression
• Impaired memory

In the interim, between seeing my rheumatologist on 5/23/18 and when I see him again for a follow up on 6/18/18, I have held off on taking my resveratrol and cherry extract, and I have cut my alpha lipoic acid in half. 

The alpha lipoic acid and the resveratrol might be impacting the conversion of T3 to T4 (and I don't know enough about what testing that was done in the past to know to what level or generation my thyroid function was being tested). But I figure it was worthwhile holding off on these particular supplements until I see the rheumatologist and the endocrinologist on 6/18/18.

Additionally, I am holding off on taking my cherry extract, as I am suspecting that there could be a possibility I was over-doing my anti-oxidants and perhaps my constant pain/discomfort might be the result of a pro-inflammatory effect. I figure a month without these supplements might be enough to see if my theory proves true. I just worry about the impact of going without will have on both, my cholesterol levels and my uric acid levels.

Almost 6 Years Out: Adventures in Post-Op RnY Blood Chemistry

I had my RnY bypass in 2011, and ever since then, several things have been weird. 

Over the past five almost six years, on occasion my RBC and Hematocrit would be a bit high. Next blood tests, back to normal. However, over the last year (so the last four blood tests, my RBC and Hematocrit has been high, a few points outside of normal range. Couple this up with my hereditary Factor Five Leiden Mutation, I'm always vigilant about minimizing my risks for clots, DVT and stroke. 

Three months ago I discontinued my iron supplement to see if that impacted anything. My iron levels all remained normal; however, my RBC and Hematocrit are still on the high side.
Additionally, my blood pressure (though treated with medication) hasn't really gone down all that much (not that it was super high, while medicated either, but I really want to get my bp down to 120/70, and before/after my bypass, it has remained around 138/80). My elevated bp is treated with an ACE inhibitor.

Another weirdness is, I've been watching my uric acid, for signs of gout. My normal is around 5; however, without changing ANYTHING, my uric acid on my last test jumped to a 6.3--I think a 7 is actually entering the realm of gout.

Up until about a week ago, in addition to a prenatal gummy multi vitamin I take (it doesn't contain iron, but does contain b12) I was blasting myself with KAL brand sublingual b12 spray, which contains 2500 mcg of b12 with each spritz. I was in the habit of blasting myself with two spritzes each day for a total intake of 5000 mcg daily.

For the last week I've been researching this, and managed to find some useful information on the topic, and I really feel that the nutritionists who counsel us as part of the surgical pre-screening process etc, should really be more well-read on the supplementation, especially since they all seem to tout the same top four items: iron, calcium, b12, and d3. Yet, I do not recall if I got any specific information about WHICH specific formulations are best for post-oppers, as well as dosing (the only thing I recall being specific was 2000 mg of calcium citrate daily).

Anyway, the Mayo Clinic's website provided some good information on the risks of b12, so, here are the caveats for b12:

1. If you have a blood clotting disorder--see a specialist to find out how much b12 is too much for your purposes. EXCESSIVE b12 coupled up with a blood clotting disorder could be dangerous.
2. If you are hypertensive and being treated with an ACE inhibitor, speak to whomever is treating you for your hypertension to find out how much b12 is too much for your purposes.
3. If you have elevated uric acid or actually have been diagnosed with GOUT, talk to whomever is treating you for your gout to find out how much b12 is too much--as too much b12 can exacerbate gout flares.
4. Not to sound alarmist, but excessive b12 can carry a cancer risk. How much is too much? I'm still looking into that! But this is just one of many articles regarding elevated b12 as markers for elevated (certain) cancer risks in legitimate medical journals:
   https://www.ncbi.nlm.nih.gov/pubmed/14636871

RLQ Another Diagnosis Dismissed

During last night's visit with my GP, we were discussing a few things, and I stated how I was still experiencing the RLQ pain, and I asked if he could examine me for a possible inguinal hernia, afterall the issues I've had with impactions and straining, it's *possible.* Doc was "game," and examined me, and well, we're ruling out the hernia.  And I asked if we could get an MRI of the area, which he declined. Perhaps my new pain doc might consider doing this.

Back to square one!  

Hurry up and wait... 10/13 is the appointment with the pain doc. 

ETA: In 2018, I finally got an answer about the mysterious RLQ pain. I was seeing a gastroenterologist due to hitting age 50 and that's the age you get a colonoscopy. 

NEW DIAGNOSIS: When I had my bypass and they punctured my abdominal wall to get the surgical equipment inside, they must have knicked a nerve. 

The gastroguy showed me the film of my colonoscopy, and everything is healthy and pink in my pipes. Each of my concerns and questions: cecal volvulus? Negative. Walking appendicitis? Negative. Malrotated mid-gut? Negative. 

So while it's setting my MIND at ease to know nothing more serious is causing the pain, it still is PAIN. And luckily it doesn't happen every moment of every day. But still!

Note to self: Hyperglucidic Breakfast Test

The more I read, the more inconclusive I think my 2 hour OGTT results are.

Considering my endocrinologist is taking his time replying to my emails (odd for him, actually), and he's not answering everything, especially the million dollar questions of: 1. What should my target be; and 2. How long must I continue to stick myself? I'm holding off on asking the question of the moment: Are we going to do a hyperglucidic breakfast test to confirm the suspected Dx of post-prandial reactive hypoglycemia?

Sticking a pin in that thought and slapping it here, as a reminder for myself.

Note To Self: Glucose Target Range

Screen grab from today: 

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/hypoglycemia/Pages/index.aspx

New Development: Post-Prandial Hypoglycemia

Every time some new development crops up, I am reminded that there are assholes out there who think either I'm a hypochondriac or think I'm imagining this shit (and that sentence is THE ENTIRETY of head space I am allocating to that bullshit). 

I'm now five years out from my RnY, and some symptoms I just thought were related to my hypertension (like lightheadedness) and I was experiencing that heart flutter thing, which we've been possibly incorrectly thinking was hormonal (I'm 47).  

Up until last Monday, I had absolutely no idea anything was wrong. I went for a two hour glucose tolerance test (I'm not sure why, though my insulin has been on the low side of normal, so I thought everything's okay). My fasting glucose was 90 (normal!), and after two hours, it bottomed out at 32. However, mind you, after the test? I honestly felt fine. Had no idea anything was wrong. It was only later on when my doctor called me in a panic, did I know something was going on.    

So, yesterday I had to stick myself six times (when in reality I think I should have stuck myself 12 times) as my doc wanted me to test fasting before each meal and 2 hours after; only problem is, I didn't tell him I actually eat roughly six times a day. So I'm sure all the sticks I did yesterday are probably inaccurate.  

We have been doing a differential, trying to pinpoint what it is exactly that's the cause of  me bottoming out with a 32 at the end of a 2 hour glucose tolerance test. So many variables. It could be a combination of things: 1. I was wearing scopolamine patches on my cruise last week; 2. I drink alcohol on an empty stomach; 3. I was taking evening primrose oil, and relora supplements. Or it could be something neither of us considered: an unfortunate side effect from my gastric bypass: post-prandial hypoglycemia.

Prior to all of this, the only indication I knew something was up was the fact I feel like crap eating something like bagels, pizza, or pasta, so for me, since the bypass, I thought it was a normal progression to get away from those foods--so that's how I manage that (I pretty much avoid them). 

I guess all along I have been managing this without my knowledge by eating smaller meals, focusing on proteins, and avoiding a lot of refined high glycemic carbs.  I ate a piece of rum cake yesterday, roughly 25 gm of carbs, and nearly 2 hours later, my blood glucose was 72--so, not perfect, but also not right at the danger zone either I think.   

I cannot help but be discouraged, as I haven't lost everything I wanted (I lost 100, regained 25), and have worked hard just to maintain what I have, and tried so hard not to become a diabetic, and now THIS. 

I'm regimented.  I pack a feed bag for work, and am pretty regimented with eating six times a day, remaining compliant about the no liquids after eating restriction, as well as staying on top of all my vitamin requirements etc.

Thursday was an emergency visit with the endocrinologist, so on Friday, on a hunch I googled post-prandial hypoglycemia and I'm just really dejected and not sure how to handle the news/possibility of this as a diagnosis. When I came home from the doctor's visit, I pitched the suspected supplements in the trash--in full on revulsion, and wanting to avoid any possibility I'd accidentally take them until we figure this out. Sure, not smart money wise, but I always can buy more if it turns out to be a fluke. 

I was hoping after ditching the supplements and avoiding alcohol for a bit (mind you I do 1-2 drinks a week), perhaps we can re-do the glucose tolerance test.   Nearly all of my readings 2 hours after eating have been normal, as well as my numbers when I wake up in the a..m. (Normal for me: 88-91 have been the norm).

So now, I'm vexxed by all this finger pricking, and my blood isn't cooperating. And thinking of never eating again, given how everything seems so driven by the act of eating. I'm fine when I wake up, as my fasting glucose is between 88-91. It's what I put into my mouth moving forward which is posing to be a new challenge.

Feeling dejected, disappointed and wondering why I've been working so hard just to maintain, only to have a new set back. 

Status Report

Perhaps it's the summertime doldrums, perhaps something else entirely. Who knows. I've been struggling with negative thoughts and depression and anxiety for a while. And in a way, I feel like I'm on a sinking ship, and I'm tossing anything and everything overboard just to stay afloat.

Even though I have been pretty good about my little tweaks and rewards, as it pertains to the bevvy of appointments I find myself attending, and make sure I plan something ELSE in that day, something fun or interesting, almost like a lemony sorbet, to cleanse my day, as if the REAL purpose of my being in the city wasn't for the appointment/s, but for something FUN.

I have even thought outside the box at work, and bought a folding chair (like ones you see at sporting events), so I can sit outside for a half hour and get some sunlight and fresh air while I crochet and decompress. In the course of doing so, I have been getting some positive attention, and it breaks up my day (at least on the days I do this, which is to say, I am not doing this EVERY SINGLE DAY). This helps, but not enough.

I haven't gotten to the point where I'm sitting at my desk sobbing silently to myself, but I'm blue. And I feel trapped and the direct opposite of empowered, and this isn't where I wanted to be at this point in my life. I guess this is what a mid-life crisis feels like. I guess.

Now getting back to the sinking ship and tossing things overboard... In line with my philosophy "keep that which is useful, and discard the rest," after careful consideration, I've decided to discontinue going for my annual check ups with the bariatric surgeon. Bottom line is, I'm not getting anything useful out of it, it is a pain in the ass to get there, and while he was a good surgeon, his follow up such as it is, is lacking.

I feel I wasn't adequately prepared for how radically my bathroom habits would change.
I feel his nutritionist (who I dumped first opportunity I could) was outright lacking and judgmental.
I feel I didn't get the best bang for my buck or efforts, as in the end, he never put the mesh around my pouch, maximizing my weight loss.
I feel that he just wants me to shut up, as was evidenced by my last appointment last year, when I said I was depressed, rather than run a full panel on all my vitamin B levels (instead of just my B12), he was too quick to write a Rx for phentermine--which, is contraindicated, due to my hypertension. I feel he wrote that just to shut me up.

As a result of him writing that, I chased my tail yet again, and arranged an appointment last summer to see a psychiatrist, hoping perhaps we could test my neuro-chemistry to see WHAT EXACTLY is "off," rather than jump through a series of hoops, trying, unsuccessfully, one anti-depressant or anti-anxiety medication after another, just to be informed "We don't do that." Something so simple, a test vs trying one medication after another, just seems futile and ridiculous, and makes me realize that whatever the solution is, all I know is, it won't be found in a yellow pharmacy bottle.

So, I cancelled my appointment in June--and here it is a month later, and no call, not even an email from the NP (of whom I am chummy). 

A sign that I know things are bad for me, mood wise or depression or whatever THIS IS, I want to dump my beloved endocrinologist, who I have seen religiously every quarter of every year for the last eleven years.  I feel I am now coasting on fumes until menopause hits. No baby for me. I feel I am an uninteresting patient. And last visit, he mentioned he wanted to see me lose a bit more weight, which of course, I had a triggery type reaction to it.  I'm just tired fighting the good fight. I wish I could shake this.

I mentioned this to my husband, and he thinks I am nuts for thinking of dumping the endocrinologist, and suggested to me, instead of going there quarterly, perhaps I should discuss with the doctor the idea of seeing him every six months instead of every three. From a metabolic standpoint, everything seems "managed," no radical changes from appointment to appointment. I was considering rescheduling the August appointment to October, which then would have pushed it to 5 months between visits. I think I'll just get off my duff, get my blood work done tomorrow, and keep my August appointment--as it's also on the same day as my kidney guy. 

I'll try to do something productive today, and see if I can find an adrenal specialist, to help me with the elevated cortisol issues, or perhaps some other -ologist to help me with my pain, which is no doubt driving the cortisol to be elevated. 

Between my physical pain, and my anxieties about my job, I just wish I could find some measure of contentment, and living a life that matters. Because at the moment, I feel like I don't matter at all.

Pain Chronicles: Persistent RLQ Pain

Going on for probably a year now.

Gastroenterologist has suggested colonoscopy--and really, I'm just too lazy to go thru all that trouble, plus the indignity of the diagnostic scoping itself. Plus: the inevitable "HANGRY!" of being on clear liquids (and no dairy--UGH).

Appendicitis ruled out, given no fever, no hershey squirts. Just intermittent, acute, sharp pain.

We speculated a while ago it could possibly be an ovarian cyst, since, HELLO! I have PCOS. But this pain is much different than the searing, TAKE MY BREATH AWAY PAIN that comes from a cyst bursting. 

Reading a bit today about the possibility that this might actually be lactose intolerance brought on by my gastric bypass. I'm nearing four years post-op, and only in the last year or so has this pain presented itself.

This a.m., while eating my usual "first intake" which consists of pretzel thins and two Baby Bells, the pain kind of amped up a wee bit. Granted, I woke up with it. As of late, I've taken to eating cheese as a late night protein dense snack. I suspect I might have to curtail this, or cut myself down to one serving of cheese a day. Despite the fact that yogurt and aged cheeses have a much lower volume of lactose in it (due to the bacteria cultures involved), it does not 100% eliminate lactose.

So, doing a differential diagnosis on myself, my first diagnosis will be a mild case of lactose intolerance. My second diagnosis would be something unusual like an adhesion resulting from my adenomyosis. And my third diagnosis would be intermittent appendicitis (not all appendicitis results in an exploding appendix). 

Going to discuss this perhaps at the next visit to the doctor, as I have to follow up about my vaccinations given our plans for a trip abroad in 2015, and I want to make sure I'm up to date on all my shots.

Thinning (of the herd)

I've been on both sides of the social media "thinning of the herd" spectrum this week. 

Just yesterday I had to use the block feature to effectively put up a boundary to someone who had become toxic to me, who had solicited me for advice and support, advice I gave, which he did not take, hence I cannot support the direction he's taking, which is leading him down a path of fail and possible medical complications. 

He's chosen to go for a gastric sleevectomy (100% support the decision; 0% support on the execution of the decision); however, he's on the balls of his ass broke and JUST NOW, three weeks shy of his cut date, he's realizing he cannot afford all the assorted supplements and protein sources needed for a successful recovery, not to mention being post-op compliant. I can't abide that or SUPPORT IT. 

I am who I am. I'm zealous/enthusiastic about remaining compliant and trying to ensure long term success for my own weight and health. I'm direct. I'm blunt. I don't sugar coat things. I anguish over trying to find the  most diplomatic way to convey things, but when something is 100% wrong, it's wrong, and irresponsibly wrong at that. So no, no support is forthcoming. And BLAMMO. Boundary up. Justifiably so. Not just for my own protection, but also really? He doesn't want to hear what I have to say, and that's 100% okay, just don't make me out to be some monster because I'm calling you out on the ASSORTMENT of ways it's wrong. Furthermore, there's no question in his mind as to how or why the blocking took place. 

He said what he said. I said what I said. We're philosophically opposed to what the other has to say. He unfriended me, but didn't block me. I slept on this. I crafted my final thoughts on the matter, which was appended with my usual type of closing statement in these types of scenarios, "Don't go away mad. Just go away." And well, he replied. I replied back. Which then prompted my final reply, "What part of JUST GO AWAY DO YOU NOT GET?" and *I* blocked him. Done. Finito. Yay me, I had the last word. But there's no question of WHY all this happened. No mystery. And at a minimum, I got closure. 

I guess life is like that. Folks drift in and out of our life, some loudly so, like setting off a foghorn, and others just drift silently like a leaf, skimming the surface of the waves.

The Turning Point

I suppose every person who has had WLS comes to this point, much like they came to that "Come to Jesus" moment where they realize and accept that they needed surgical intervention to help their health. I've come to the point in my WLS journey where I have had, shall we say, an "anomaly," aka a "slight regain."

The regain is more than 5 but less than ten, and a wake up call for me to be ever-vigilant. It's made me reassess food I pack, and habits. Check, check, and check! I weigh everything, and if anything, have been short-shrifting myself (volume/weight wise) with what I pack; however, one inclusion in the feed bag could be to blame. Though again, it's in measured amounts: CheezIt crackers. Oh how I loves-me some CheezIts!!!  Perhaps this is the culprit? I don't know.  I've been packing an ounce and a half of them along with two cheese sticks for one of my morning "intakes." Perhaps this is it? I don't know. I've swapped out my yogurt for the CheezIts, so calorie wise, it's not an even swap, this I know.  

I'm otherwise compliant as far as not overloading my system, taking my time chewing, no drinking immediately after eating, and of course, staying on top of my protein intake and especially my vitamin supplement intake. I've also been having some elimination issues, so perhaps that's contributing to the numbers being "skewed."

Perhaps I should hydrate more, too. I'm not big on water. So perhaps brewing up some homemade ice tea might be good, and especially with the theanine, could give me a boost.

This all is further compounded by the mental mind fuck of it all. That I am compliant, and yet, a regain; when I know there are folks out there who are boozing it, and drinking immediately after eating, and who I also know are taking the wrong supplements, and yet... I'm the one experiencing this "anomaly." I know I shouldn't compare my journey with others, but I only do so for perspective.

The lesson for me to learn here, is merely reinforcing what I already knew. That there IS work to be done, even this far out from surgery (now nearing 2.5 yrs). That this is a LIFESTYLE, and a LIFELONG habit of vigilance. 

Yesterday, I went to my internist for Rx refills on scopalmine (yes another voyage is in the works), tramadol (to sub out my vicodin which is now causing me nausea) and Flonase... bleh allergy season. The visit was quick and painless. We talked briefly about everything, and I even remarked on the thyroid nodule, and knowing me as he does, he kind of poohpoohed it, calming my nerves with statistics etc, and he knows I'll be in for an ultrasound of my thyroid in a matter of weeks. 

He remarked how great I look and how much the surgery has impacted me, my appearance, and my health. I said how I really needed to hear that as I've experienced a slight regain. We talked on the elimination issue very briefly (afterall, he IS a gastro guy first, before being my internist), and he told me knowing me as he does, knowing my vigilance and how serious I was going into the surgery and how I remain after, that he has no doubt in his mind that this is a momentary thing, and that I'll be back on track in no time. From his mouth to Gravity's ears!

Not Much to Report

Not much to report. Haven't lost or gained. No complaints. Well, no complaints save for two:

1. While BCBS paid for my surgery, which I estimate cost close to what? $80K? They do not cover the post-operative follow up visits w/my surgeon, despite the fact he's in-network. ($100 a visit); and

2. I'm beginning to get weary of dealing with the Quest lab near me. I hate blood work, which I need to get done every 3 months for my endo, which I usually piggy back with blood work for my surgeon (which I've been doing for 2 years thus far) and suddenly Quest's idiots cannot seem to realize that despite the fact I have two Rxs from two different docs, who request SOME of the same stuff (i.e. cbc, lipids, etc), the doofuses at Quest cannot seem to process that. I recently got a bill for nearly $500 as I was being billed TWICE for the labs for ONE trip to the lab. Apparently there's an issue because neither doc CC's the other and the lab for whatever reason, cannot do that. The wait. The inconvenience of dealing with new technicians drawing my blood, etc. And of course, now, the NP at my surgeon's office (who, granted, is going thru some family stuff w/her mom) has been slipping w/following up about getting me the necessary Rx for my bloodwork. I've been sick with this year's creeping crud and haven't been to the lab yet for my draw, and all things considered, I've had to jockey the appointment to next month and hoping for the best. But really, this follow up isn't really doing much for me personally. Plus? It's a huge pain in the ass to get to the surgeon's office, as there's no direct route via mass transit to get there, and parking is EXHORBITANT. I refuse to pay $30+ in an all day lot for an appointment that lasts less than an hour.

I'm still "compliant" with my eating (no eating and drinking at the same time, eating several times a day, top heavy with protein, no carbonated drinks--tho for new year's I did have some fizzy champagne drinks). Not compliant w/exercise. Too tired and listless and uninspired to get more active. But I walk and take stairs, so I'm not a total slug.

Feeling kind of depressed the last two weeks, perhaps it's the drain the creeping crud has had on me. Perhaps it's SAD. I don't know. I'm compliant with all my vitamins. 

Given I see my endocrinologist every three months RELIGIOUSLY, I don't see much benefit (other than monitoring my compliance) in going to the surgeon's office for follow ups. It's not like it's a "support" or I feel like I get any benefit other than "Oh hey, you're doing good. You haven't regained."  I don't belong to official support groups (too much whining or too much "know it all" from assholes). Just do my own thing w/the information given.

December saw the passing of my grandfather (not especially emotionally invested in him as a person, so it's not like I'm depressed from that--though death IS a downer). December also saw us thru yet another drive-by-drama-ing involving mom and her shitty health and her inability to take care of herself, and expecting us to somehow DO for her what she refuses to do for herself. January saw the sudden passing of a dear friend from years ago. And meanwhile, halfway around the world, my mother-in-law is tending to her mother, who in all likelihood will pass away before spring thaw.

All this on the heels of a trip to South and Central America, which wasn't ideal given my husband had taken ill on the ship. So it's not like there's been a moment since mid-November where homeostasis has been experienced. Burdensome and tedious. But I suppose that's what life is.  I just feel so unsettled with this feeling of dread or anxiety or pensiveness. I've even been having little flutter like palpitations (perhaps anxiety related?), nothing serious, and I breathe myself thru them. But still, it's there. Whatever it is. Lurking beneath the surface. So I focus on Maslow's Hierarchy of Needs, and I'm doing damned good according to that, so there's THAT going for me, right?

Tonight is knit night, I hope, so there's at least joy in the comraderie I have with the two ladies I meet with regularly. Tomorrow is a chiropractic appointment. Friday is my 8:45 a.m. therapy session. So I guess I better give myself a sublingual blast of B12 and focus on something interesting today.

My Monday Musing

12:01 a.m. Monday.

Today (Sunday) I broke the 100# mark. Finally.

If I lose eight more pounds, I will have lost the total sum of what Karen Carpenter weighed at the time of her passing. This is not to be glib. Just stating a fact.

Another fact many folks (who went to school with me, and who *may* have tormented me mercilessly in junior high) might NOT know about me, is during high school, I, too was anorexic.

In 1982 when I started high school as a freshman, my lowest weight was 109#, at 5'7" tall. When Karen Carpenter passed away, she was all of 5'4" and 110. She would have been in her 62nd year, if she were alive today.

30 Years later, AT THIS VERY MOMENT, I finally have the awareness of how very lucky I am.

Rainy Days and Mondays

Iron

My iron levels are still on the low side due to both, the WLS and my adenomyosis. The Feosol isn't cutting it, apparently. Bariatric NP put me on Corvite. I started taking it today. Heaven help my colon. I had impaction issues w/the Feosol. I'm wondering what a heavy duty, Rx iron supplement will do to my ass.

Tablet is big enough I need to split it, and of course, only after I swallowed both halves, did I get the idea that perhaps I should try taking 1/2 a dose at a time, coincidentally w/a chewable vitamin C.

KAL Brand Calcium Citrate (Chewable)

FWIW, I'm mostly a Citracal Petites gal (for tablets) and only prefer "chewy" type chewable calciums (Bariatric Advantage, Calcet are my fave chewies; and Healthy Indulgence by Hero brand dark chocolates are all quite good).

I normally do not prefer the disk/wafer type chews that are usually too tart and too big and sometimes too hard to chew... kinda like a big hard Sweet Tart candy. I tried Bariatric Advantage and I believe Twin Labs brands chewable calcium citrates, both of which were so tart, I couldn't choke them back.

KAL brand calcium citrate, at least in the mixed fruit flavor, are quite pleasant. Much more sweet than tart, more reminiscent of Sweet Tart candies than the other disk/wafer type chews I've tried.

My habit is to take at least two of my doses per day in tablet form, and 2 doses in chewable. I do this for two reasons: 1. Calories (despite it being a mineral supplement, they DO contain calories, so taking tablets cuts down on extra calories being consumed); 2. I like to have something sweet in the afternoon with my coffee, something to feel like a sweet treat. The Bariatric Advantage and the Calcet chews fit that bill. And for when I feel like I need a dark chocolate (and ladies, you know what I mean by NEED chocolate), the Healthy Indulgence dark chocolates are truly delicious--they taste like high quality dark chocolate rather than a mineral supplement.

Oh And For What It's Worth?

Looks like after all the struggling and whining, I may have lost about 7 lbs in the two weeks I've been on a modified fast.

Starving... for seven measley pounds.

::SEETHES::

Last Minute Nesting & Errands

Headed out today for a dental cleaning (and then later, a pedicure & manicure) pre-op, figuring I couldn't do so for at least a month post-op due to the blood thinners. Chiropractor. Grocery. Dry cleaners. Supermarket for things we didn't get at Whole Foods on Thursday night. Japanese market for some stuff. Then off to BB&B for a microwavable rice cooker (one of the best inventions ever). Came home and promptly put up dinner for the husband. Otherwise been vegetating a bit here.

But one good tidbit I managed to get from my dental hygenist was that folks who are on a high protein diet or who use high protein shakes should really use electric toothbrushes, as the proteins fuse to the teeth, thus causing a rapid accumulation of plaque/tartar/calculus/whatever. Useful information! Once I go back to work, I should make a point of brushing after my morning shakes.

Color on toes: Linkin Park After Dark by Opi.

Mood: Resigned, yet relaxed. There will be plenty of time for me to have a HOLY SHIT breakdown before the 19th.

Not sure how much more prepared I should get. Bought more broth, Jello, and some Gatorade. So far this has been a lot of $$$; but fortunately for me insurance covers the procedure, so I guess things could be far more expensive.

Last things to work on:

Overtime report for work (going to compile and format it, then email it to a coworker to print out);
Pack bag;
Phone-in appt w/therapist on Tues;
Drop off paperwork at office on Tues;
Drop off/pick up laundry tomorrow;
Sit and knit with some friends tomorrow;
Clean CPAP, mask and hose to make hospital ready.

Today's Craving

Seaweed salad
Icy cold scallop w/roe sack & connective tissue attached

Intense Cravings I've Had This Week

In no particular order:

Pork shumai dimsum dumplings
Deviled Eggs
Macaroni salad
BBQ Ribs

Something To Be Considered Down The Line

Note to self: Donate professional wear to: Dress For Success.

WLS Chronicles: This Shit Is a Full Time Job

2/3/11 First appt w/Nutritionist
TBA Two week follow up appt w/Surgeon
1/19/11 Date of Surgery
1/15/11 10 a.m. Dentist appt
1/15/11 10:45/11 a.m. Chiropractor Appt
1/8/11 9:15 Podiatrist appt
1/6/11 Start pre-op diet
1/4/11 10:30 Pre-op testing (blood, ekg, meet w/anesthesiologist)
1/4/11 4:30 Therapist appt
12/31/10 Abdominal U/S (gallstones)
12/21/10 Chiropractor appt
12/20/10 Fill Rx for Lovonox (for post-op)
12/18/10 12 noon, ENT appt
12/18/10 10:30 a.m., appt w/Internist
12/16/10 6:45 p.m., Chiropractic appt

Calls I've made thus far today:

Surgical supply co., for supplies for CPAP;
Sleep Ctr., to fwd sleep study to surgeon;
Podiatrist to shift appt to Saturday;
Anesthesiology group to ensure anesthesiologist for surgery is "in network";
RN for insurance who is my case manager re: surgical date

Emails I've made thus far:
Endocrinologist to advise re: surgical date.

Forms filled out today:
New patient forms for ENT specialist.

Possible appt to be made:
Sleep Ctr for possible follow-up sleep study to titrate/adjust settings on CPAP;
Imaging Ctr for abdominal ultrasound re: Gall stones.

Things purchased today:
More protein powder (mocha flavor)
Liquid vitamins: calcium, D3, Geritol w/iron, propolis
Kalhua flavored syrup

OY!