Wednesday, December 03, 2008

Doctors, Labs, Calories, Weight Goal

Lots happened today .... so I have lots to share. 
My some act of God I actually was able to schedule 3 of my annual doctor appointments all in one day.  I'm amazing!  LOL! 
So the least exciting appointment today was the bi-annual dental cleaning.  That was easy and pretty boring.  I'll spare you the details.
I started my day at the surgeon's office and met with the PA and the NUT.  (For those who are acroynm challenged:  Physician's Assistant and Nutritionist.)  The PA was great and very informative.  The NUT advised me to increase my calorie intake and gave me info on my goal weight.  
Later I met with my PCP (primary care physician) and got some valuable information that the PA didn't share.  Also got some advice on my sort ankle and knee which should help resolve those issues.  
Ok... let me back up and tell you about what I've learned today.  
LABS --- My Vitamn D has been low since my 6-week draw and been on a Rx strength dose for nearly a year.  My levels haven't jumped like it should with such a high dose.  The results on my D is still pending.  I'll report in when I hear anything.
Most of my other labs were good.  Here's the exceptions:
B-12 -- My level is at 1915 which is about 1000 over the top of the range.  So my PCP has cut my dose in half for now.  I've been doing 2500mcg every other day ... now I'll be doing that dose just twice a week.
Iron -- I am not on an extra iron supplement since I do not have periods (Depo Provera).  Since surgery my numbers have gradually increased with each draw.  Last draw 6 months ago my number was 91.  Today's number is down to 61.  Still well within the normal range, but I'm concerned about the dramatic drop.  But the PA, NUT and PCP seem to think it's fine.  So I'm still not going to do an iron supplement but I'll be anxious to see what my labs look like in 6 months.
Zinc -- My number is 64.  Normal range is 60-130.  Lately I've noticed a sudden change in my fingernails - they are brittle and cracked.  A few weeks ago I tried to figure out what could cause it and all signs pointed to low zinc.  Ha!  Kind of cool that I figured that one out on my own, huh?  The NUT thinks that number is perfectly fine and I don't need any extra supplement.  Not sure I agree with her and I forgot to ask my PCP about it.  I'll do a bit of research and put in a call to my PCP to see what I'm going to do.  
PTH -- Parathyroid and Vitamin D results give a good picture of how well you absorb the calcium your take.  I've been on Depo Provera for 4 years and it has been shown to leach calcium from bone.  Add RNY to the mix and the liklihood of bone density loss is high.  So when my PTH came back perfect I was thrilled.  Good news here!
DIZZYNESS -- For the past few months I've been dizzy when I stand up suddenly after being seated for a while or when I first get out of bed.  Seems to be worst in the mornings.  PCP and PA both believe it is low blood pressure with some minor dehydration.  
So here's the fix:  Drink more water. Eat more salt. Get up slowly and carefully. Make sure my breakfast is high in sodium and that I get lots of water first thing in the morning.  
PCP suggested canned soup for breakfast - combo of salty food and liquid.  Umm... doesn't sound delicious, but I understand his point.  I know I don't eat enough first thing in the morning and like I mentioned a week or so ago, I need to adjust my eating plan to fix this.  
CALORIES & SLOW WEIGHT LOSS -- Since mid-August I've lost a mere 8 pounds.  It feels like the wieght loss has stopped and it's so frustrating.  I should have been posting about this in the past few weeks, I'm sorry I haven't shared these thoughts with you.  So the NUT said it's normal.  The closer I get to goal, the slower the weight will come off.  
We also talked about how many calories I should be eating each day.  After discussing what I'm currently doing, how much exercise I'm doing and how I'm feeling on what I'm eating now ... she says I'm not eating enough.  Right now I'm averaging 1,100-1,200 calories/day.  She wants me up to 1,500-1,800 calories/day.  Yikes!  It's always scary to think about adding calories when all our lives we have been brainwashed to think we couldn't eat anything.  So I'll add calories slowly.  Maybe 100 calories extra per day for a couple weeks to see what happens, then another 100/day a few weeks later.  I'll let you know how it goes.
GOAL WEIGHT -- My own personal goal weight has always been "160-ish" with the understanding that as soon as I hit 169 I'll be at my own goal.  Back around the 3-month mark my NUT told me the surgeon's goal weight for me was 135.  Turns out that wasn't true.  135 is the "ideal weight" for my body and if I reach 135 I would have lost 100% of my excess body weight (EBW).  
However, their goal weight for me is based on losing 75% of my EBW which is 171 pounds.  So pretty much right in line with my own personal goal weight.  I'm actually pretty relieved to know that's what they expect.  Right now I'm sitting at 63% lose of EBW with just 20 pounds to go to hit their goal.  
As I've always said .... once I hit that initial goal weight (160-ish) then I'll reevaluate my goal and determine if I'm happy there or feel like I should lose more.  I won't know the answer to that question until I get there.  So my original goal still stands.  169 here I come!
Ok, I think I've rambled on for long enough.  Some of these things will get longer posts as I progress and make decisions.  But if you've made it this far with a long boring post... WOW!  You're a tropper!

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