Gastric bypass and alcohol article

I found this article today in the Los Angeles Times online and wanted to make sure you saw it too. The information is amazing and important for all bariatric patients to know. This study used the same group of patients to measure breath alcohol content -- from pre-op through six months post-op. At 3 months out, alcohol content is double than pre-op. But at 6 months out, that number triples. But the "feeling" of being drunk in that same time frame seemed to drop among the patients studied. 

Read this carefully and follow the links in the article. Then share this information with your WLS friends. 

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Gastric bypass and alcohol: mix with caution

Melissa Healy, Los Angeles Times

March 10, 2011, 4:35 p.m.

Alcohol can be a minefield for anyone trying to lose weight. But for bariatric surgery patients, drinking can become increasingly problematic, a new study has found.

Changes in the way the body absorbs and metabolizes alcohol after gastric bypass mean these patients need less alcohol to register intoxication on a breathalyzer, says a study published recently in the Journal of the American College of Surgeons. After drinking a single 5-ounce glass of red wine before their surgery, the study's 19 subjects had an average breath alcohol content of .024% -- well below the level at which most states consider a driver intoxicated.

Three months after surgery, the same glass of red wine resulted in an average breath alcohol content of .059%, and six months post-surgery, the group averaged .088%, which surpasses the .08% widely recognized as the legal threshold for intoxication.

It also took longer for patients to return to complete sobriety in the wake of that drink: Pre-operation, it took subjects 49 minutes to return to complete sobriety after a glass of wine; three months after the operation, it took  61 minutes for that to happen, and six months after surgery, it took 88 minutes.

The study -- the first to compare the same group of subjects pre- and post-surgery -- found a potentially insidious change, as well, in how patients experienced alcohol consumption. Before surgery, 58% reported a feeling of euphoria after a glass of wine -- a number that shot up to 88% at three months post-surgery, and then dropped to 50% at six months on. Sensations of dizziness and warmth -- rare before surgery -- were commonly reported six months after. At that point, one in four subjects also reported experiencing double-vision after drinking a glass of wine--a sensation none reported before. 

The researchers, from Stanford University School of Medicine, expressed concern that bariatric surgery patients' different experience of alcohol consumption might result in confusing signals. "Patients feel different effects of alcohol intoxication postoperatively, and this can lead to over-indulgence to achieve the same symptoms of intoxication that they experienced before surgery," the study's authors wrote.

There are lots of reason to forgo alcohol in the wake of a gastric bypass the authors warned: Bariatric patients that have unresolved binge-eating issues, in particular, are at risk of "transferring" their food addiction to other substances, including alcohol. And even those without such issues raise their risk of weight regain after surgery, and of deficiencies in thiamine (vitamin B-1).

After obesity surgery, patients should never drink and drive, wrote the authors. They should also limit their alcohol consumption to a maximum of 1 unit of alcohol (a 5-ounce glass of wine, 12-ounce beer, or 2-ounce serving of distilled alcohol) in any two-hour period.

Copyright © 2011, Los Angeles Times

Bariatric Emergency Care Chart

A big thanks to Andrea at WLS Vitagarten for bringing attention to this important document. The WLS community is all a-buzz with links to this chart, and for good reason.

The American Society of Bariatric and Metobolic Surgery (ASMBS) has published a chart for use by Emergency Room professionals to help properly diagnose bariatric patients. This information is NOT for the patient, it's for your doctor. So if you find yourself on the way out the door to the ER, grab this chart (along with your medication / supplement list, doctor names/numbers, etc.) and be sure your treating physician understands how best to treat you. Make sure your family members know about this chart and that it needs to go with you to the ER if you ever need to go.

Click this link to download a full-size copy of this chart. ASMBS Emergency Care Chart

PRINT THIS TODAY!!! 

Dreamfields Pasta

When you look at this photo you're probably thinking: "Pam has lost her mind!" Yes folks... what you see before you is pasta! Whoa! Can you believe it! Pasta in a recipe on a WLS blog by a self-professed-pasta-avoider. But your eyes are not deceiving you. That's real pasta right there!

But before you get the recipe, I want to tell you about the pasta and my little experiment. So let's talk about Dreamfields Pasta. Even though the nutrition label looks exactly the same as normal pasta, they have something called Protected Carbohydrates which reduces the total digestible carb count to a ridiculously low number. How does that work, exactly?

From the Dreamfields website:

While the total number of carbohydrates is the same as traditional pasta, our patent-pending formula and unique manufacturing process protects all but 5 grams of carbohydrates from being digested. The Dreamfields fiber and protein blend creates a protective barrier to reduce starch digestion in the small intestine. The unabsorbed, or protected carbohydrates then pass to the colon where they are fermented, providing the same health benefits as fiber. Dreamfields Pasta is the only pasta clinically shown to have a lower glycemic index than traditional pasta . (Dreamfields GI=13; traditional pasta GI=38). This blend also protects all but 5 grams of the carbohydrates per serving from being digested and therefore lessens post-meal blood glucose rise as compared to traditional pasta. We carefully monitor and clinically test our pasta on healthy people to ensure accuracy of its stated GI level.

 OK, you all know me well, right? I'm the biggest skeptic there is! If I don't understand the science behind something, I won't accept it until I figure it out. And since this manufacturing process is "patent-pending" the Dreamfields folks they don't give much detailed information about how it actually happens - just that it works and that they've tested it, etc.

Here's what a nutrition label looks like on the elbow macaroni I bought for this recipe:

Obviously they have to list the traditional nutrition stats on the label until the FDA gives them permission to do otherwise. So it looks like you're getting the full 41g of carbs with each 2oz serving and a whopping 190 calories. But if you do the math and calculate calories based on the claimed digestible carb count, then you're at:

Fat 1g = 9 calories
Carbs = 5g = 20 calories
Protein = 7g = 28 calories
Total = 57 calories

So I decided to give it a try with my own blood glucose levels and see what happens. I ate 2oz of pasta (measured dry, then cooked according to the box) and added just a bit of extra virgin olive oil for flavor and sprinkled in some Italian Seasoning mixed herbs. I started on empty - hadn't eaten anything for 3.5 hours before this experiment. I tested my blood sugar and this is what I found:

• Before eating - 77
• 30 minutes after - 134
• 60 minutes after - 118
• 90 minutes after - 115

These number are pretty much in line with a normal meal that's balanced with protein, fat and carbs. No reactive hypoglycemic blood sugar crash at all! And most importantly.... no tummy ache! I still don't understand the science and will remain a skeptic until more information is published about how they make undigestible carbs and stuff.... but for now, Dreamfields passes the Pam Test!

Side Note -- 2oz of pasta was not very much food for someone 3 years post-op. It was barely enough to pass as a small snack for my mature pouch. So right after that last blood test, I went and found some real food to satisfy this hunger. :-)

And what does this mean for you? It means new types of recipes will be coming your way... including the one pictured above - the One Pot Dinner which I'll post in a day or so.

~Pam

Alcohol and Gastric Bypass

The information below is a repost from two outstanding resources in the WLS world. The words below are from Beth - Melting Mama - as she wrote on her blog a couple weeks ago and again on Obesity Help the other day. I actually missed the original discussion thread but found the reposting on Rob's blog - Former Fat Dudes - when he published it here.

Drinking alcohol after gastric bypass surgery is very serious and being educated about the biological, medical and emotional risks is essential. I love that this heavy topic with very deep scientific information is still so "Melting Mama" in the way she presents it. Having met Beth in person, I can tell you that she speaks the same way she writes ... with passion!

This post is very long with many outbound links to medical reviews, articles and research. But please read it all.

Melting Mama Wrote:

A few month gastric bypass post op writes 

“Can I have a glass or two of wine? I used to have a few glasses when I had a drink, would it be okay to just have one, or two now?”

No. 

(Bold for impact here. You DO NOT NEED ALCOHOL AT TWO MONTHS POST GASTRIC BYPASS.)

I won’t pussy foot around and say, “You’re going to do what you want, but always listen to your surgeon! How about a sugar free cocktail?”

Can I drink alcohol after weight loss surgery? – Dr. Garth Davis

We recommend waiting one year after surgery before consuming alcohol. Then, with your surgeon’s approval, you can enjoy a glass of wine or a small cocktail. Remember to be careful because even the smallest amounts of alcohol will affect you differently after obesity surgery.

That is obviously not working for us.

*Disclaimer - “But, MM! You’ve been photographed with The Drink! How dare you preach about the drink! I’m going to drink it anyway! Nanananana!” Yes. I have. There are lots of photos, mostly Facebook-style, one time taking one sip and having a seizure! The others? Totally product placement. I did not drink. Do as you please, but here is my truth. I am nearly seven years post gastric bypass, and I choose to have a sip or three on social occasions. This includes: weddings, uh, once a year, and perhaps a drink at an event. I typically regret imbibing even a sip or three quite immediately. But, just like food: I have selective memory. I get the “just a taste won’t make me sick” idea and it fails me, my gut, my brain. Are we clear? And, to be clear as mud, the more I learn, the more I know, and opinions change. Also, I will sip. I am SEVEN YEARS post gastric bypass. 

Absurdity, n.: A statement or belief manifestly inconsistent with one’s own opinion. (Ambrose Bierce)

“Why can’t I have a drink, MM?”

Because I said so.

Imagine if curing addiction were that easy? I’d like to see it done this way -

Early post op, you absolutely, positively do not need alcohol coursing through your new, altered guts. There is NO excuse for it. Zero. None. Zip. NADA. (I left out Zilch, ’cause that’s a product for mixing sugar-free alcoholic drinks.)

This should be common sense.

You just had your intestines surgically re-arranged. You have a fresh stomach pouch that needs to heal. Do you really want to send alcohol through your raw piping? You wouldn’t send certain foods through there, why would you consider something so caustic as alcohol?

Seriously, “OMG! I totally swallowed a piece of gum, will I die?” But, “Tequila is low carb!”

The months pass, and you’re no longer a newbie, and make you feel like you can handle a little drinkie-poo.

“I am an adult! I deserve it! Damn it I am going to drink if I want to, I had this surgery to be normal!”

You might start researching drinks, you might hit up the Google for “sugar-free alcoholic drinks” wondering what’s good.

You may ask your pouched peers when they had their first drink, and what it was, and did they “get sick?” You might consider, “What if it makes me dump? What should I drink so I won’t dump? How much should I have?” completely ignoring the actual nutrition of most alcoholic beverages.

You decide it’s time.

Because, it’s “Christmas! And, I just saw this great recipe/idea on a WLS website so it must be okay for Bariatric patients.”

This is where MM has the DUH realization (again) that people do take advice from the internet. BLINDLY. EVEN. “So and so said it’s good for me, so I will do it!” It doesn’t even MATTER if the information sucks.

Please do not take advice or suggestions from non-professionals on the internet. We are typically only patients, peers, bloggers or sales people with zero medical expertise. You are a big girl, you can make your own decisions. People on the internet with big mouths can only offer suggestions, but you must make solid, rational decisions based on what is GOOD FOR YOU. What is good for you must include input from your doctors, nutritionists, and your COMMON SENSE.

You’re feeling a bit powerful, ’cause you have a TOOL. And since you had WLS, you HAVE POWERTOOLSMM! This means you are magically cured from any and all prior addictive personality traits! You may feel that you “never had a problem with food anyway,” so you will maintain FULL control of yourself when tempted. You might tell folks you were never an addict, and you were just an over-indulgent eater. Super.

Your pouch and you head to a holiday party and you are at least, partially successful in avoiding the 12 foot buffet table filled with pastries, and then you see the libations.

You are socializing and talking, and fill your little cup up with some wine, maybe even half of what you might have drank pre-op, you sip. The first sip hits you like a bomb, it burns all the way down into your pouch. You feel like you swallowed a Brillo Pad, if even for a second.

Then, maybe your ears get hot, maybe your face flushes. In the average non-WLS person, alcohol takes ONE MINUTE to hit the brain. You have a straight shot from MOUTH > SMALL INTESTINE, guess how fast it hits your brain?

INSTANEOUSLY.

Whee. “I think I already feel it. Holy shit, two sips and the room feels a little, whoa….”

“When consumed by the gastric bypass patient, alcohol readily passes through the stomach pouch largely unimpeded and into the jejunum where, due to its large surface area, it is rapidly absorbed. Research has shown that gastric bypass patients—even those that are three or more years postoperative—have a more rapid absorption of alcohol and a peak in blood alcohol content that is considerably higher than that of someone with normal gastrointestinal anatomy. (Bariatric Times)

You might “like” this. This might be tipsy, tipsy might be good. It might feel really good.

For some people it doesn’t feel good at all, and they are quite turned off by alcohol post WLS. (Ironically, this feeling now bothers me, because it feels like an oncoming seizure.)

Perhaps you enjoy it and soon, you’ve finished that glass and “Maybe just a little more?”

The buzz you had a short time ago, feels like it’s gone, even if the alcohol is still coursing through your blood. You are still drunk. You might drink more to reach tipsy again.

Patients should be warned about drinking alcohol too quickly because even relatively small amounts of alcohol, such as two small glasses of wine (0.3 g kg−1) might produce unexpectedly high BAC shortly after the end of drinking. Also when other surgical procedures are performed on the gut such as gastric resection and gastrectomy, a more rapid absorption of ethanol can be expected. The present experiment with alcohol as a model substance might have implications for the absorption and pharmacological effects of other drugs or when prescription drugs are taken together with alcohol. (Wiley Online Library)

This effect of alcohol on our post bypass systems is dangerous. We may not have ANY IDEA how DRUNK WE ARE, until we are passed out, in a coma, or driving home and crashing.

“You’re too dramatic, Beth, that won’t happen to me.”

Sure it won’t.

We aren’t talking about binge drinking here (although it happens), this can occur with relatively SMALL amounts of alcohol. I am pointing to the casual drink or two that hits too hard. I could potentally kill myself with one martini. There is NO WAY that I can drink hard liquor in one sitting. MM + Martini = Fun Down The Escalator! BOOM!

...Gastric bypass surgery may enhance alcohol sensitivity by altering the rate that alcohol is absorbed or metabolized. Such changes in alcohol sensitivity and clearance significantly increase the risk for alcohol toxicity and its deleterious consequences (i.e., liver disease, cardiomyopathy, loss of muscle mass and strength, neuromuscular and cognitive defects, gastritis, pancreatitis, acid reflux, and specific vitamin deficiencies) (Bariatric Times)

You’ve stopped drinking, either because you’re toasted, or you are AWARE you have had enough and made a choice to stop. Make sure to give a warm welcome to hypoglycemia!

Alcohol use may also adversely affect the health of the bariatric patient by increasing the risk for hypoglycemia and its potentially negative influence on cognitive function and neuromuscular control. (Bariatric Times)

Recognizing and treating hypoglycemia with a gastric bypass is hard enough, and it is a known side effect of the surgery. However, recognizing a low blood sugar and treating it effectively while you aren’t AWARE of it? That is “fun.”

Drinking, especially binge drinking, can cause hypoglycemia because your body’s breakdown of alcohol interferes with your liver’s efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be very serious and even fatal. (Islets of Hope)

Those of us with diagnosed reactive hypoglycemia post roux-en-y gastric bypass probably shouldn’t drink at all. The risk of dropping our glucose levels so low, and not being aware enough to fix it? Sure a couple glucose tabs and crackers will help you, but again, NOT IF YOU AREN’T AWAKE, dear.

Another problem with hypoglycemia due to the excessive consumption of alcohol? HYPOGLYCEMIA LOOKS LIKE DRUNK. I live with this, I know this.

Generally, symptoms of hypoglycemia include:

Mild Hypoglycemia

• Increased or sudden hunger
• Feeling shaky, dizzy or nervous
• Pounding heartbeat
• Drowsiness, feeling tired
• Sweating (cold and clammy)
• Numbness or tingling around the mouth
• Headache or stomachache

Moderate Hypoglycemia

• Any of the above mild symptoms, plus:
• Headache
• Personality change
• Irritability
• Confusion and/or difficulty concentrating
• Headache or stomachache
• Slurred or slow speech
• Poor coordination

Severe Hypoglycemia

• Any of the above mild or moderate symptoms, plus:
• Loss of consciousness
• Seizures and/or convulsions
• Death

You make it through the holiday season, and navigated your way through a few drinks, and you seem to be okay with handling yourself and alcohol. But, maybe you find a new craving for that “glass of wine with dinner,” and it becomes a pattern. Two or three nights a week, you’re having a glass of wine (other libation…) and soon you’re having it nightly.

Maybe then, you feel that a little “mommies’ sleeping pill” might help in addition to dinner, and you’re sipping wine to help you fall asleep. But, remember, you are still a gastric bypass patient, and maybe you feel normal, look normal.. but… this behavior may quickly NOT be normal. 

BIG RED FLASHING WARNING SIGNAL HERE.

Bariatric patients with pre-existing addictive behavior toward food could, with food restriction, transfer such addiction to alcohol. All of these observations point to the likelihood of alcohol use having a more negative influence on health status postoperatively than was previously recognized. (Bariatric Times)

Research is limited, but I implore you to ask around and find peers you can trust to discuss this issue with. Your friends are addicts. Old statistics, one via an old episode of Oprah stated 30% of us “find a new drug” post operatively, but I would bet my $15Kworkneededteeth that it is vastly understated.

Weighty Secrets -

I drink because it keeps me from eating. I look forward to eating and it has become the high point of my day. I know exactly how much to eat now before I get sick. I’m gaining weight and just keep telling myself that all I have to do is quit drinking to lose it. I'm lying to myself and I know it. Hate myself. Go figure. Life just sucks ass huh?

I would say that this issue, of alcoholism (and the whole myriad of addictions… drugs, shopping, gambling…etc.) in the post op community is not discussed, nor researched enough at this time.

“…lifetime rates of substance use disorders among candidates for bariatric surgery are substantial, but rates of current substance use disorders prior to surgery are low.” (American Journal of Psychiatry)

There isn’t much research to say, either, but what is seen in our communities is enough to warrant a larger scale look. For instance – studies show that WLS patients are less likely to die from the co-morbid diseases of obesity, BUT, have a higher rate of death from accidental deaths and suicide.

“Reports reveal that a substantial number of severely obese persons have unrecognized presurgical mood disorders or post-traumatic stress disorder or have been victims of childhood sexual abuse. Data on the association between presurgical psychological status and postsurgical outcome are limited. Some centers for bariatric surgery recommend that all patients undergo psychological evaluation and, if necessary, treatment before surgery and psychologically related surveillance postoperatively. Although research has shown an improved quality of life after gastric bypass surgery, certain unrecognized presurgical conditions may reappear after surgery. The results of our study suggest that further research is warranted to explore the optimal approach to evaluating candidates for surgery, including the possible need for psychological evaluation and psychiatric treatment before surgery, and aggressive follow-up after surgery. (NEJM)

Transfer addictions are real after weight loss surgery, and can stem from the innocent (Hello internet!) to illegal drugs.

What Causes Addiction Transfer and Cross Addiction?

Psychologists originally developed the phrase “addiction transfer” because of a trend they observed: Drug addicts and alcoholics in treatment recovered from an addiction to one form of drug only to swap it for another type of drug or other compulsive behavior. Because these patients still feel a void or haven’t fully addressed the underlying reasons for their addiction, they find new ways to escape or numb their emotions. For those who thought life would be perfect if only they could overcome an addiction, the reality sets in that life is still at times difficult, boring and hard to manage. 

Addiction transfer also has a neurological basis. Research suggests that the same biochemical processes are at work in multiple types of impulse-control disorders, such as compulsive eating, alcoholism, smoking, compulsive gambling and drug addiction. Each of these behaviors triggers the same reward sites in the brain, resulting in cravings that are difficult to resist.

Addiction is a brain disease, and the brain is immensely complex. “The brain may be the most difficult puzzle in the universe,” says Graham. “The brain is hard to study, and it gives up its secrets slowly. This is the main reason that neurology and psychiatry have not necessarily kept pace with the progress of other areas of medicine.” (Drug Addiction Center.com)

Everyone has an opinion on how much is too much alcohol after weight loss surgery. But, only you know what you’re really doing. All the explaining in the world does not discount the fact that alcohol is dangerous for you with your new anatomy. Trying to validate WHY you have to have it doesn’t change anything.

Ask yourself why you have to have alcohol. Do you really require a cocktail at dinner every single night — or to bed — and on the weekends — and? Are you prepared to pay the consequences of your actions? Are you aware that the consequences might involve you, blacked out, on the floor with no help? Yeah. That’s sexy. You did this for your health, right?

RESOURCES:

• Weighty Secrets - Addictions, Alcoholism
• Weighty Secrets - Video Posts from 20/20 Moms and Alcoholism
• Intervention - Amber, Eating Disorder and Alcoholism
• Is Alcoholics Anonymous for You? 12 Questions Only You Can Answer:Alcoholics Anonymous asks drinkers to honestly answer 12 questions about their drinking habits. If you answer “yes” to four or more questions, alcoholics recommend seeking help. 
• Rethinking Drinking is an outpost of the NIAAA where drinkers can assess their drinking habits and learn to spot warning signs.
• What’s Your Drinking Pattern? Find out how your drinking habits compare to those of other adults in the United States at the institute’s website.
• NIAAA’s Cocktail Content Calculator can help you keep track of how much alcohol is in your drink. How strong is your mixed drink or cocktail?

RESOURCES - GETTING HELP:
More than 1 million people submit to detox and rehab programs for alcohol addiction every year in this country.

• National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number, 1-800-662-HELP (4357), where you can find information on treatment options and facilities.
• For local information on treatment available in your city and state, check out the Substance Abuse Treatment Facility Locator through SAMSA.gov.

Vocabulary Lesson

Noncompliance: The failure or refusal adapt one's actions to a rule or to necessity.

Misbehavior: To behave badly or in an inappropriate way.

Naughty: Behaving disobediently or mischievously

Imperfect: characterized by defects or weaknesses

Perfectionism: a disposition to feel that anything less than perfect is unacceptable

Consequence: Something that logically follows from an action.

Punishment: a penalty inflicted on an offender

Penance: An act of self-mortification performed voluntarily to show sorrow for a wrongdoing

Rehabilitation: to restore to a condition of usefulness and constructive activity

Compliance: to act in accordance with rules

Seeing a pattern here? Yeah... someone hasn't been following the rules like she should be and suddenly she's paying the price. She's highly pissed at herself. She'll be reporting in later this week with the details (after finals week) and what she plans to do about the naughty behavior.

~Pam

 

Guest Post: Self Worth and Sexuality

Matt Phillips is a young professional who has found his voice in advocating for women's health issues. Below is an article he wrote for you, my readers, about how we must learn to value ourselves in the context of a healthy lifestyle and how it relates to our sexuality, birth control choices and self-esteem.

One thing Matt doesn't touch on that's essential for WLS patients to remember is the importance of TWO forms of birth control after surgery. It can be dangerous for our health as women to become pregnant within the first 18 months after weight loss surgery and with rapid weight loss we become highly fertile. So we must take the appropriate precautions to protect our delicate health.

Respecting Yourself Means Respecting Your Sexuality
by Matt Phillips

Starting on the road to total health involving the body and mind requires you to look deep into your life and correct the aspects that hold you back.  Unfortunately, a poor self image and lack of self-esteem can wreak havoc, leaving you emotionally battered and willing to compromise yourselves physically. This physical compromise, which can devastate your self-esteem, manifests itself clearly in the form of sexuality you share with others and exhibit in your own life.

An important aspect of your wellbeing resides in a healthy sexual outlook on the world and yourself. That means valuing yourself as an individual and recognizing your needs and desires as a human being. However, in the attempt to please your partner, you can sometimes fall into the trap of compromising yourself. This compromise is often accompanied by a greater loss of self respect and a digression into other poor lifestyle choices that can pollute your mind and body.

Whether this self compromise is a result of low self-esteem, guilt or an overwhelming desire to please others, it is not healthy. One serious way this compromise can manifest itself is through unsafe sexual practices, such as having multiple partners, not using adequate protection or using unsafe contraceptive methods. Sex without properly valuing yourself becomes a way to maintain a relationship or win cheap affection from your partner. Instead, sex needs to be seen as a mutual activity meant to increase a bond, not maintain or create one.

For obvious reasons, having multiple sex partners is a poor life decision. Besides the emotional toll and lack of fulfillment, having multiple partners leaves you at risk for acquiring any number of sexually transmitted diseases. In addition, engaging in this risky practice puts others at risk as the spread of these diseases is accelerated. Even early intimacy, before you have fully gotten to know your partner, is a compromising act because it is used as a way to win affection.

Not using responsible contraception, or failing to use any at all, also indicates a lack of self-esteem and the presence of those feelings of worthlessness you must fight to overcome. By apparently making sex more enjoyable or “spontaneous” for your partner, you actually make it more dangerous and demeaning for yourself. Sex at this level is a base, physical act, carrying with it physical consequences.

Even some contraceptive options, meant to make sex safer and less risky, carry with them serious results. Oral contraception, while effective in preventing pregnancy, in no way stops the spread of disease. However, some young, inexperienced women might be misled into thinking they are protected and free to engage in risky sexual acts. Obviously, this is a dangerous misconception that can have tragic results.

Even if women are using oral contraceptives correctly, the type they choose might carry serious health consequences that weren’t properly studied or made known. The sheer number of Yaz lawsuits, where users have experienced side effects as serious as heart attack, stroke, blood clots, pulmonary embolisms, and gallbladder disease, highlights the danger in hastily choosing an oral contraceptive because of its popularity or marketing. Choosing the right form of contraception involves taking the time to choose the safest product on the market.

The final indication of self esteem and positive feelings of self worth is the ability to resist pressure from others. Only when you have mastered control over yourself, your relationships and, finally, your insecurities, can you say you have fully embraced yourself as worthy. Very often, abstinence is the right choice in the early stages of a relationship or when you do not feel comfortable. Respecting yourself means putting your needs over the desires of someone else.

Developing a healthy lifestyle involves adapting all aspects of your life, including your sexuality. When you have developed a positive sense of self, you no longer feel pressure to conform to traditional relationship roles, to stereotypes or to those around you. True self-worth involves knowing yourself and refusing to compromise. You place a higher value on your body when you find this self worth and stop polluting or compromising it with risky sexual habits or oral contraceptives.

It’s important to note that none of us are born with high self-esteem. We must spend our lives earning it. Indeed, for those who have compromised themselves in the past, winning back that self-esteem is a process. However, developing a healthy self-image, especially in regards to sexuality, is especially important because of all we have to lose when we don’t properly value it.

The Pre-Op Liquid Diet

So I was just reading a study that was published back in 2005 in the Journal of Obesity Surgery. I've had this document bookmarked for a while, but just now got around to reading it. You know I'm a geek, right! But seriously... this study got me excited. So I'm sharing it with you!!

Here's the link to the study

The Impact of Preoperative Weight Loss in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass

Study Results:

Preoperative loss of 1% of initial weight correlated with an increase of 1.8% of postoperative EWL at 1 year. In addition, initial BMI correlated negatively with EWL, so that an increase of 1 unit of BMI correlated with a decrease of 1.34% of EWL. Finally, preoperative weight loss of >5% correlated significantly with shorter operative times by 36 minutes. 

In Layman's Terms:

• For every 1% of your weight you lose on your pre-op diet and see an increased weight loss of 1.8% over non-losers at 12 months post-op. So if you weigh 300 pounds and lose 1.5 pounds (1% ewl), that means at 1 year post-op, you'd lose an extra 3 pounds over friend friend who didn't lose anything pre-op. 
• Gain 1 BMI point pre-op and see a reduced weight loss of 1.34% at 12 months post-op over the losers.
• Lose more than 5% of your excess weight pre-op and you're on the operating table for 36 minutes less than other folks. 

Isn't that exciting news! Makes that horrible pre-op diet worth it!

~Pam

Reactive Hypoglycemia after Bariatric Surgery

Reactive hypoglycemia is becoming more and more commonly diagnosed after Roux-en-Y gastric bypass surgery. Doctors and research clinics are recognizing this trend and are studying the phenomonom. But if you research online, you'll find that the published information is going to discuss extreme cases of "severe hypoglycemia" in patients being studied at the Mayo Clinic and elsewhere.

Most of us post-op folks don't have the "serious" kind of reactive hypoglycemia that requires removal of parts of our pancreas or study in a clinic. Most of us have a form of reactive hypoglycemia that is easily managed through diet changes and close monitoring of our condition, symptoms and habits. It seems that this type of reactive hypoglycemia is showing up around 12-24 months post-op in many people I've talked to on the forums. I was officially diagnosed with reactive hypoglycemia about 15 months after my RNY.

Reactive hypoglycemia is scary. It sucks big time and it's definitely no fun to have. Waking up in the middle of the night with a blood sugar crash is pretty horrifying. It's happened to me a couple times and I have since taken steps to make sure it doesn't happen again. But it takes some work to figure out how to control the crashes and some planning and discipline to make sure the plan works. You CAN live with it and it can be managaed through some diligent lifestyle adjustments and careful attention the detailed signals your body gives you.
This article is going to be a long one... so grab a cup of tea and prepare for an educational session.

What is Reactive Hypoglcemia?
Reactive hypoglycemia or Postprandial hypoglycemia (low blood glucose after meals), is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring 2–4 hours after a high carbohydrate meal (or oral glucose load). Symptoms vary according to individuals' hydration level and sensitivity to the rate and/or magnitude of decline of their blood glucose concentration. Some of the food induced hypoglycemia symptoms include:

Mild Hypoglycemia

• Increased or sudden hunger
• Feeling shaky, dizzy or nervous
• Pounding heartbeat
• Drowsiness, feeling tired
• Sweating (cold and clammy)
• Numbness or tingling around the mouth
• Headache or stomachache

Moderate Hypoglycemia

• Any of the above mild symptoms, plus:
• Headache
• Personality change
• Irritability
• Confusion and/or difficulty concentrating
• Headache or stomachache
• Slurred or slow speech
• Poor coordination

Severe Hypoglycemia

• Any of the above mild or moderate symptoms, plus:
• Loss of consciousness
• Seizures and/or convulsions
• Death

 
Do I Have Reactive Hypoglycemia?
Many doctors will want to do a "Glucose Tolerance Test" on you to find out if you officially have reactive hypoglycemia or not. This is a very bad idea! It has been determined by the science people that a glucose tolerance test on post-gastric bypass patients will not give an accurate test result. Even for those who don't experience dumping syndrome (or who have a high threshold for sugar before dumping is induced) the glucose tolerance test is too excessive an amount of sugar for RNY folks. The test gives you an 8oz glass of pure glucose to drink before the test and contains about 70-100g of sugar. Yikes!

Landsberger, et al., suggested using modified glucose testing. They recommend obtaining a fasting blood glucose level and a two-hour postprandial level after consuming the most carbohydrate-loaded breakfast the patient can tolerate. source
 
So if your symptoms match all or some of those listed above and you suspect that you have reactive hypoglycemia, definitely see your doctor. And discuss alternative methods for testing your condition for an official diagnosis.

Marathon Blood Testing Week
When I suspected I had reactive hypoglycemia I did a whole week of marathon blood testing so I could learn what my body was doing with various types of food or meals. Here's the deal. You need to understand what's going on with your body. You need to learn what foods or activities trigger a crash and what makes you feel good and sustains your blood sugars. It's different for everyone so you'll have to do the work to figure it out for yourself.

Here's how the blood testing marathon went for me...

My brother has had Type I diabetes since he was 10 years old. So I borrowed one of his blood glucose monitors and bought a container of test stripes for it. I later bought my own glucose monitor. When you're shopping for one, look at the price of test strips and supplies, not the monitor itself. Most insurance companies won't cover these supplies for hypoglycemia, so this will likely be an out-of-pocket cost, so shop wisely. I bought the ReliOn brand from Walmart.

I tested my blood sugar several times a day. An hour before a meal, a few minutes after eating, an hour afterward, two hours after, etc. Then after seeing what my blood sugar did with good, healthy, balanced meals.... I did a bit of naughty experimenting. What would happen to my blood sugar if I ate chocolate? ice cream? pancakes? pasta or crackers? What happens after coffee? milk? fruit juice? How does the number change over time.... 5 minutes, 20 minutes, 60 minutes, 90 minutes after eating.

Guess what I found out about chocolate? Starting from a normal blood sugar reading of about 100, my glucose level will spike to about 215 within 20 minutes of eating some chocolate (about half a Hershey's bar). Wow! And I'm a non-dumper, remember... so I was never even aware that my glucose spiked that much, I felt no symptoms of a high blood sugar count or dumping at all. But within 90 minutes of eating that chocolate my blood sugar crashes down to a level of 50. Same thing happens with ice cream, except the crash comes faster.

I also tested whenever I FELT different which helped me recognize what my signals were for a low blood sugar count. For me it's an overheated feeling, lightheadedness, shakiness -- those are my primary signs of low sugar. But I can also get the signal of a strange feeling on my tongue -- like my tongue is fuzzy or swollen or something or my lips tingle. I also can get a super cold nose while the rest of my body is overheating. Each person is different, so you need to test based on what you think is an off feeling for you and see if that "feeling" is really connected to blood sugar or if it's something else (like mere head hunger or a craving or whatever).

Make notes of your discoveries. Keep a food log and keep track of your blood glucose readings at all the various times before and after meals. Also track your symptoms (or off-feelings) and what your glucose reading is for those symptoms. Over time you'll be able to spot trends and understand how your body  is working a bit better.

I found that if I eat a balanced meal of protein, complex carbs and good fats that my blood sugar remained stable for hours and hours. I could go 6 hours without eating and never have a low blood sugar count if I eat a healthy meal. It was only after a meal or snack that was based in simple carbs and not enough protein that I saw my crashes. And sometimes with meals out of balance with too much protein and not enough carb or fat to balance it out.  I also found that coffee is a trigger for me and if I'm going to drink my morning coffee (which I still do), then I need to make sure I have a snack or meal planned within an hour after drinking it.

I also experimented with which foods would raise my blood sugar out of a crash and keep it stable without causing another crash in an hour. So often you hear of diabetics eating candy to bring their blood sugar up quickly -- that doesn't work well in our situation, that will just cause a new cycle of crashes and spikes. We need a BALANCE of nutrients, not sugar! For me it's peanut butter crackers - or - a handful of grapes and a slice of deli turkey or cheese. Basically a bit of simple carbs to bring the crash up quickly, then a balance of protein and fat to keep the numbers up.

So you'll need to play around with foods and figure out what YOUR triggers are, and what foods work best to bring you back from a crash. You'll also need to figure out which foods should be with you at all times (I carry a granola bar in my purse for emergencies and have an extra stash in the glovebox of my car).

It's a process and it takes patience and experimenting -- and you'll go through a whole jar of test strips. But it's worth the effort and you'll learn to recognize a low blood sugar count well before it becomes an emergency. I can now catch a dropping count when I'm in the 60's or low 70's. It's rare for me to hit the 40's or 50's anymore.

Reactive Hypoglycemia IS Manageable!

Make sure you are eating according to the RNY Laws - protein first, moderate complex carbs and healthy fats. Figure out an eating schedule and stick to it. You'll want to make sure you have a planned meal or snack every 3 to 4 hours. You'll also want to keep a food log including the times you eat and also keep track of any blood sugar highs or lows on that same log so you can spot any patterns that might develop. Pay attention to what your body is telling you and adjust your new schedule accordingly.

~Pam

What is Dumping Syndrome?

I've written about my own experiences with dumping syndrome a couple of time -- The Sugar Surprise and details about the fact that I Don't Dump. But I don't think I've ever explained what happens inside our body when dumping is happening. So here we go...

Each person is different when it comes to dumping. The scenario below outlines the typical biological reactions of dumping syndrome – but any one of these steps might be skipped or intensified in each different person who dumps. For some people dumping will last 20 minutes and they instantly feel better. Some people suffer for hours or even days. Nikki proclaims she’s a three-day-dumper as it takes her body a full three days to get back to normal afterward. We’re all different and each one of us won’t know what dumping is like until we actually experience it for ourselves.


Here's a pretty good explanation of dumping syndrome:

When stomach contents are literally "dumped" rapidly into the small intestine. Sometimes triggered by too much sugar or fat in food. Dumping symptoms aren't fun: nausea, cramping, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding offending foods after surgery.

Let’s break it down into steps.

1. We eat some type of food with too much sugar or too much fat – it’s the content of the food that is the trigger for dumping, not the texture or consistency of the food. 
2. In a normal stomach (before surgery) simple carbohydrates like refined sugar are broken down within the stomach with enzymes designed specifically for that taste. But after surgery we no longer have a normal stomach and because we have no pyloric valve to keep food in the stomach pouch until it’s been broken down with gastric acid or enzymes, these foods are emptied from the pouch into the small intestines fairly quickly.
3. Once this food reaches the intestines, the body is unable to break down the sugar/fat so it tries to get rid of the offending food as quickly as possible. The body literally goes into panic mode.
4. Fluid from all over the body is rushed to the intestines to help flush the food out – this causes intestinal cramping and a bloated feeling.
5. The body is in panicked survival mode or fight-or-flight mode, so it releases endorphins to help ensure its survival – this causes rapid heartbeat and sometimes increased blood pressure and often sweating or an overheated feeling.
6. The body realizes there’s too much sugar in the system – this will show as a spike in your blood glucose levels. Because of these elevated blood glucose levels, the body then releases extra insulin to help “soak up” some of that sugar and process it as quickly as possible – this will often show as a dramatic drop in blood glucose levels and may result in a hypoglycemic reaction.
7. As a result of the excess fluid in the intestinal tract and the body’s all out effort to rid itself of the offending food, we’ll often end up with diarrhea or an urgent need to use the bathroom. Some people also report an excess amount of urination after a dumping episode.

But how many people actually dump after RNY? Is it everyone or is it only some people?

According to the ASMBS:

About 85% of gastric bypass patients will experience dumping syndrome at some point after surgery.

Ok... so to me the key phrase there is "at some point". Let's take the Sugar Surprise story - I dumped that once when I was about 4 months post-op after I accidentally drank a million grams of sugar (80g or so, actually). So yeah, I dumped bad on that mistake. But I have never dumped since that day. Not because I've never eaten sugar again, but because I have such a high threshold for sugar tolerance that I consider myself a non-dumper. I can easily eat about 35g sugar in a sitting and not dump. So even though I'm a non-dumper, I'd still contribute to that statistic of 85% because I did dump once after surgery.

Ok... so then there's the other school of thought based on a study by Braghetto, et al where about 41% of people dump on sugar or fat (combined). And notice that 41% was considered non-severe dumping. Those 3-day dumper are rare (about 5%). So, I am more inclined to subscribe to this notion instead of the 85%. Here's an article about dumping syndrome in various sets of patient population -- because dumping is not exclusive to RNY, it happens with other people too.

In persons with long segment Barrett esophagus treated with a truncal vagotomy, partial gastrectomy, plus Roux-en-Y gastrojejunostomy, 41% developed dumping within the first 6 months after surgery, but severe dumping is rare (5% of cases).

Some people don’t have a problem with sugar but dump on too much fat and vice versa. Many people who don’t experience physical symptoms may actually be experiencing medical symptoms though.

As I mentioned earlier, I consider myself part of the 59% of patients who do not dump. However, because I do experience dumping symptoms if I push my limits too far, technically I guess I am a dumper. My threshold is about 30g sugar before I start to feel the effects. That's a package of peanut M&M's or a whole slice of cake. Yes, I've eaten both of those things. No I don't eat them often … in fact it's rare for me to ever get up to that 25g limit. I'm perfectly satisfied with 2 bites of birthday cake and my chocolate craving is easily satisfied with three M&M's or one Dove Chocolate. Even though I have a high threshold for sugar, I still behave as if I do experience dumping syndrome and limit my sugar intake like any other RNY patient.

Most commonly the doctor recommended limit for sugar intake per meal is “single digits of sugar” – so 9g or less is a good rule of thumb.

Blood Glucose of 40

Around midnight last night I got out of bed to test my blood sugar.  I was lying in bed reading when I realized that my heart was racing and my tongue felt fuzzy and my lips were tingling. I wasn't shaky or light headed at all, though, (my typical crash symptoms) so I wasn't expecting a low count - I was just curious and wanted to know what it was.

A blood glucose count of 40 surprised and scared me! Oh the joys of hypoglycemia. I have trained myself well enough to be able to catch a low blood count before it it gets this low - I can usually catch it when I drop down into the 60's or somethings into the low 70's. It's highly unusual for me to get down to 40 or below.

So what caused this blood sugar crash?

As I said before, I absolutely wasn't expecting a crash. Afterall, I'd had a mug of protein chai tea before I went to bed.... who has a reactive hypoglycemic crash after pure protein anyway?  Apparently I do. Here's what yesterday's eating looked like.

• Commute to work (about 7:30am) -- Kristy's Vanilla Caramel Protein Tea
• Breakfast (about 10am) -- Carbmaster yogurt with sliced fresh strawberries
• Lunch (about 1pm) -- leftover Chinese food. Unfortunately, I'd eaten most of the chicken on Monday, so Tuesday's lunch was lighter on protein and heavier on carbs than I normally would have chosen. But it wasn't horribly out of balance with mostly veggies and some light noodles.
• Afternoon Snack - nothing
• Dinner (about 7:30pm) -- leftover slice of pizza (x2) with sausage, pepperoni and mushrooms. Yes, another kinda-heavy-carb meal, but the crust was fairly thin and the toppings were mostly protein. Out of balance on nutrients, but again, not horrible.
• LNS (about 10pm) -- Protein Chai Latte - I knew I was light on protein for the day so I added a second protein drink before bed
• Post-Crash Food -- 2 cheesesticks, handful of grapes.... then a bit later peanut butter crackers.  The fruit and cheese didn't raise my numbers like normal, so I had to do the crackers for an extra boost. The process of getting my numbers back to the 100-range took about 40 minutes.

Let's also look at the overall stats (this is before the "post-crash food"). My goal is 1200-1400 calories a day with 40% protein, 35-40% carbs and 20-25% fat.

Calories: 1,145
Fat: 26g (20%)
Carbs: 134g (46%)
  Fiber: 12g (definitely a bad fiber day)
Protein: 99g (34%)

So what happened?

My only guess is that I crashed because my indivdual meals were out of balance. Sure, at the end of the day my numbers came out pretty good for a carb-heavy day and things weren't too far off if you look at the overall numbers.  BUT the problem seems to be individual meals.  Both lunch and dinner were way out of whack with too many carbs and I attempted to make up for it by adding straight protein with shakes to keep things in balance. But my body is smarter than me, apparently. It wants balance at every meal, not just for the day as a whole. I need to focus on the 40/35/25 balance on my plate everytime I eat.  Of course - this is just a theory, who knows what the real reason might be.  Anyway, I'll do better in the future with keeping each meal in balance to avoid the scary situation of a crash so low. 

The aftermath...

I had a difficult time waking up this morning because of the aftermath of such a low crash. My limbs are heavy and my head is foggy and I have a general feeling of shakiness today.  I tested my blood this morning before I left for work to make sure I was safe to drive. My fasting glucose this morning was 79 - which is in the normal range but my typical number is usually around 90. So the drive to work was a bit nerve wracking because I was dealing with the fear of another hypoglycemic crash on my 1.5 hour drive -- which was not a logical fear since I was eating breakfast on the drive. But still, the mental aftermath kinda sucks just as much as the physical aftermath.

When I have a crash that is as low as 40 it takes a few days to get my body back to normal.  So for the next several days I'll cut back on carbs and increase fat and protein - for a balance that is more like 45% protein, 25% carbs, 30% fat.  Fat makes my body happy and when combined with protein things are much better. I'll focus mostly on dairy, veggies and low-gylcemic fruit for my carb intake and cut out most flour-based foods for the next couple days. Once I go a few days without another low count my body will get back on level footing again.

It's always one adventure or another, right?

~Pam

I hate when that happens

-- Sent from my Palm Pre

52 in Hardware

Last night I had a blood sugar crash in the hardware department at Walmart. Low blood sugar is nothing new, it happens and I deal with it - it's just part of having reactive hypoglycemia after RNY.  But last night was a bit different. Here's the deal...

After class last night I stopped for gas and grabbed a small hot cocoa. Yep, a full-sugar hot cocoa. So yes, I brought this whole incident on myself because of a poor food choice - but that's not the point of the story.  So I knew that I if I was going to drink that hot cocoa that I would need to eat some protein within 90 minutes to soak up the excess carb/sugar intake.  No problem, I'd be home by then and would have my planned evening snack anyway. 

But then I decided on the drive home to stop at Walmart for a couple things.  Suddenly it was 11pm and I'm standing in the hardware department and realize that I should have had a blood sugar crash about 30 minutes ago.  But I don't feel anything. No shakiness, no light-headedness, no overheating or rapid heart rate --- I feel fine.  So I decide to test my blood just to see what was going on with my blood sugar levels. 

My blood glucose was 52! 

So I hightailed it across the massive store to the grocery department.  It's always interesting to see the looks employees give you when you're standing in the middle of the aisle eating a granola bar straight out of an open box from the shelf.  Finished up my shopping and headed out not long after. I tested again before I drove and my count was back to normal within about 20 minutes. 

Typically when I drop into the low 70's or high 60's I have learned to recognize symptoms of a crash coming on and can catch it in time to fix it.  But typically when my count is down in the 50's things are already way beyond bad and I get pretty confused and can't really concentrate or focus. I've ended up in the 40's a couple times and I can tell you that once things drop below 50 it's a very bad situation. 

So for me to be at 52 and have no symptoms at all ---- yeah, that seriously freaked me out!  How many other times has my count been that low and I never noticed it before?  What if it happens again when I'm not as in-tuned with what I'd eaten and how I should be feeling and I end up passed out somewhere - or worse yet, what if I'm driving at the time? 

So I'm slightly freaked out today.  Just thought I'd share...

Pam

Endocrinologist & Adipex - Part 2

In  Part 1 I promised I'd finish up my thoughts in a Part 2 post. So here it is.  Here's what I'll discuss:

• Dr. Diet Pills FIRED me before I could fire him. Damn it!  Apparently I need counseling for my emotional problems and I also need a medical team who can hold my hand since I'm not capable of doing this weight loss diet thing on my own.

• My discussion with Nurse Linda -- she's an amazing woman and I trust her judgement. So glad she had sane things to say to me last night and confirm that I'm not an emotional wreck.

• Who to see next?  New Endocrinologist or Hollistic expert to look at the big picture? No matter who I see, I want to get a full work up of labs including hormone levels and determine if I'm insulin resistant or not and whatever else needs to be looked at...

I'm MUCH less passionate about this topic now that I've had several days to cool off.  I feel more resigned, I guess. Anyway, here's the scoop:

THE DOC DISCUSSION -- Yep, I want into the appointment a week ago with the intention that if the doc didn't do anything "endocrinologist-y" that I wasn't going to see him anymore. The appointment started with seeing his PA.  She asked, so I gave her a quick overview of everything and why I was there and how the Adipex was working and what was going on with the glucophage. I told her I didn't want to take the drugs anymore and she asked what else I wanted done.  I laid it out to her --- said I'd expected that I would have been treated or tested or looked at in some special way like a "specialist" typically does. But instead of actually looking at my endocrine system, I was prescribed diet pills from the get-go. I asked why I was never tested for insulin resistance before I was put on a drug to control it -- she said that it wasn't typical to test insulin levels, that it's a "clinical diagnosis" not a lab test.  Which is fine, but the problem is that my clinical diagnosis came when I was 300lbs and before RNY.  And no matter how many times I said RNY eliminates insulin resistance, I was looked at as if I'd grown an extra head. Studies here and here and here and here.   So I asked of the PA - what else could be done to determine why my body wouldn't allow me to lose weight on my own, without diet pills.   That's when she said she'd go find the doctor.... and that's when I started crying... she couldn't retreat fast enough, of course. 

Doc comes in with the PA and immediately asked if I wanted to continue the pills. I told him no. He asked why. I told him I didn't want the crutch of the pills and that they didn't make sense to me and I didn't want to deal with the emotional side effects (which I didn't elaborate on).  He asked me if I wanted to continue the glucophage, I told him no and explained the dramatic increase in low blood sugar crashes. He immediately asked what simple carbs I ate. As before, I patiently explained that after RNY that reactive hypoglycemia is not always related to simple carbs and that for me personally, just like many RNY'ers, that a crash happens when a meal is not balanced with protein, carb and fat.  For instance I can crash after a protein shake if it's 100% protein.  He obviously doubted me, because that goes against what he thinks he knows.  He tried to express his doubt. Thankfully the PA seemed to understand (because she's listened?) that I was strict with my diet and that it was not a compliance issue -- she started to speak up and point to her notes on the conversation we'd just had... but wasn't allowed to talk since the doctor was blubbering about "not possible... blah blah blah."  

FIRED -- so the conversation turns to the fact that I don't want to continue with the diet pills or glucophage/metformin.  And I'd asked if he felt there were any tests that needed to be run to look at how my hormones or insulin levels were and how it might relate to my inability to lose weight.  He said no, there's nothing to check.  And went on to say something to this affect:

Since we've been seeing you, you've lost 10 pounds. But obviously you have higher expectations than what is possible in reality. You also obviously need counseling to help with your emotional problems and would probably do better with complying with a diet if you were part of a team.  You need a team approach for your diet and your exercise because you can't do it on your own.  I'll send a recommendation to your primary doctor that you need to see a different doctor - someone who is able to hold your hand more than I'm able to.  Someone who can follow you more closely and make sure you're complying with the diet and exercise portion of this plan. 

Dang it!  He fired me!  Before I could fire him.  I've never had a doctor fire me before... but geez, he was pretty mean about it, huh?  

Yep, I cried when I left his office.  And the first person I went to was my friend Nikki and immediately asked her: "Do I need therapy so I can lose weight?" ... she laughed because she thought I was making a joke.  Guess that's a big fat no, huh?  I also don't need a team approach to anything - although I'm part of the WLS community, I don't feel that I lean on my friends or the community for my success.  I also don't think I need any doctor to hold my hand to force me to be compliant with a diet and exercise plan.  

NURSE LINDA -- The evening of that doctor appointment was the support group meeting at my bariatric clinic and I attended.  I spoke with a nurse at the clinic, Linda, whom I have grown to think of as a friend. I told her about my experience and asked her advice. I was still in a hyper-emotional state at the time of our conversation, of course.  She knew the doctor by reputation and was shocked by what he'd recommended (from the diet pills all the way down to therapy and hand holding) because she'd never heard but amazing things about him from his diabetic patients. And maybe that's what my problem was, I'm not diabetic.  Thankfully she talked me down from most of my emotional angst and gave me some very sound advice. She's the one who suggested I seek the consultation of a holistic practitioner for a "full work up" and a "complete review of my overall medical situation". Which makes so much sense to me -- individual doctors seem to be looking at individual issues and not putting all the issues together into a "big picture" type of diagnosis.  She also was shocked that I'd been on diet pills for 3 months and couldn't believe that any doctor would recommend that for a RNY person. I think hearing her say that was a comfort to me -- maybe because I was having some of the same thoughts but assumed the medical community didn't think that way since it was his first recommendation, blah, blah.  Anyway. I love Linda and I"m thankful for the conversation we had. 

WHAT'S NEXT? -- I have a follow up appointment with my PCP scheduled for the first week in June. By then he'll have the notes and recommendations of Dr. Diet Pills and we'll discuss some of the changes we made back in December when I saw him last.  That same day I also see my GYN for a review of how my menstrual issues are going since stopping the Depo Provera in January. (Let's just say this:  "Aunt Flo is the devil!")  I'm not going to do anything until I talk to my PCP and we can discuss what should be done next.  I also talked to my brother today and asked about his endocrinologist and if he thought she'd be better than what I'd experienced... he said she's definitely not a "diet pill pusher" and that she's very thorough when it comes to testing and such.  She might be an option. But for now I'll wait.  

PART 3 -- dare I say there'll be a part 3 to this post?  Nah, not really a part 3, exactly.  But coming soon will be my thoughts about where I am right now.  How will I feel if I never losing another pound and this is where I'll be for the rest of my life?  Will I be satisfied?  What if I start to gain weight and have no ability to make it stop? How will I feel and what will I do? Will working out harder make the scale move, like my best friend seems to think it will?  So.... not exactly a part 3, but more like a pondering of how part 1 and 2 relate to where I am today and how I feel about it all. 

~Pam

My 3 Month Experience on Adipex

This morning I threw the remaining 6 Adipex pills in the trash. Followed by the nearly-full bottle of metformin. Today was a good day. Yesterday.... not such a great day. I've got a lot to cover - I'll try to be brief (this might end up being a 2-part post, we'll see).

WEIGHT LOSS - First let's get this part out of the way... what does the scale say?

• Start Weight (February 10) - 193lbs
• End Weight (May 4) - 186.5lbs
• Theoretical Weight Loss = 6.5lbs

Just for the record, the doctor's weight records are not the same as mine - he claims a 10-pound loss - but I will use my own scale for record keeping, just like I have since my journey began. The doctors' scale doesn't matter to me. When I made my first Adipex post back in February I reported that my weight fluctuated between 193-196... so even though I started at 196 on the day I took the first Adipex pill, I'm using 193 as my official start weight since I technically did weigh 193 the following day.  Today's weight is slightly lower than it's been earlier this week, but since it is what I weighed this morning, we'll use it. So there you go - 6.5 pounds lost in 3 months with the aid of diet pills. WhoopDeDoo!  Sense my excitement? In all honesty I do not feel excited about the 6.5lbs. In fact, if I feel anything, it's probably closer to "resentment" or "skepticism."  I don't trust the numbers just yet. I don't think of these pounds as real. A month from now if the scale still shows the same weight, then I'll rethink it. 

THE MENTAL STUFF - Choosing to use a diet pill after weight loss surgery is not an easy decision. I agonized over this decision in the past 3 months more than I ever agonized over having weight loss surgery in the first place. The only time I was at peace with the process was when I was not thinking about it. Not only have I dealt with the emotional side of "needing" another tool to help me lose weight, but also the medicine itself had a significant affect on my emotional state simply by the way in which the medicine works in the body.  There's a lot more to say here, but I still can't seem to put it all into words. So just know that things have been pretty tough on me the past 3 months. I'm a pretty stable person, so I can't imagine how this drug would affect someone who already had underlying issues then had this piled on top of it all.  I have some opinions on using diet pills after WLS .... I hope to write about it one day. Soon, I hope. Still can't seem to find the words though.  (After re-reading this section, I find that it doesn't really convey my true feelings. It took me a long long time to write this short paragraph because I can't seem to find the words to express my true feelings - this part of the process really screwed with my head and I'm still struggling to get past it.)

APPETITE SUPPRESSANT - So the main work of Adipex is to suppress your appetite. And yes, it really does do that.  But for someone who doesn't have an issue with over-eating or uncontrolled binges or a ravenous appetite... why would a doctor ever recommend this drug?  Even after I specifically told the doctor that I don't get hungry and over eating was not a problem for me, he still said I should do the drug.  Anyway.  For the past 2.5 years I have eaten on a schedule because if I don't, then I forget to eat.  In the past 3 months I still attempted to eat on that same schedule... but early in the process I found that when it was meal time I'd have no desire to eat and the thought of food was repulsive.  Or I'd be working away and totally forget to eat at the scheduled time. When you're already on a low-calorie diet, missing a couple meals during the day is a very dangerous thing.  Taking in 700 calories a day is very bad. And when that routine stretches over several days, you find yourself weak, foggy and bewildered with why you have no energy -- until you realize you haven't eaten enough to sustain your body.  So I had to get even more strict with my schedule and ate even if I didn't feel like it. Eventually I got back to my normal eating plan. To me my health and nutrition is of the utmost importance, so I ate what I needed to eat for my body even if my brain didn't feel like it. But yes, if you're taking in 5,000 calories a day and can't stop yourself, then Adipex might be a good option to suppress your appetite. But for someone who barely gets 1200 calories and needs to set alarms to remember to eat certain meals.... it's just plain dumb.

METFORMIN / GLUCOPHAGE -- So the doc had me start on metformin after the first month of the diet pills. He was "sure" that I still had insulin resistance because I have PCOS and that the new Rx would help regulate that imbalance.  No testing to see if I still had insulin resistance, of course.  And no research on his part, apparently, because even a cursory review of the medical journals would have shown him that RNY eliminates instances of insulin resistance and metabolic syndrome in about 99% of patients. I took the metformin for about 6 weeks -- trying to be a good patient and giving it the old college try.  Over that period I had more low blood sugar crashes than ever before - 3 to 5 crashes a week. So someone who has normal insulin levels and also battles hypoglycemia.... doesn't seem like a good candidate for a drug that regulates insulin, huh? Doc claimed this would help with the weight loss.  But then again, this is the same doctor who said I wasn't hypoglycemic because that's not really possible after RNY -- that should have been my first clue, huh? 

WHAT NOW? -- Now I go back to normal, I suppose. I've been told (by a doctor that I trust) that going off Adipex can have adverse affects on my appetite -- making me abnormally ravenously hungry. So I'm aware that it might happen and I'm going to keep a tight reign on it. I'll continue eating like I have been and be vigilant about staying on plan. And now that I've got my first 5k of the season under my belt, I'll sign up for more and get the training in that I need to. If the 6.5lbs stays off for the next month, I'll count it. If it creeps back on, I won't be surprised and I won't allow guilt to rule the thought patterns. I'll just play it by ear and see what happens while remaining on plan and living my life. 

PART 2 -- Yep, this got long (were you surprised?).  So in Part 2 I'll tell you about:

• Dr. Diet Pills FIRED me before I could fire him. Damn it!  Apparently I need counseling for my emotional problems and I also need a medical team who can hold my hand since I'm not capable of doing this weight loss diet thing on my own.
• My discussion with Nurse Linda -- she's an amazing woman and I trust her judgement. So glad she had sane things to say to me last night and confirm that I'm not an emotional wreck.
• Who to see next?  New Endocrinologist or Hollistic expert to look at the big picture? No matter who I see, I want to get a full work up of labs including hormone levels and determine if I'm insulin resistant or not and whatever else needs to be looked at...

I'm glad I'm off the diet pills. It's like my emotional self took a deep sigh of relief this morning as I dumped the remaining pills in the trash. I might not know why my body won't let me lose weight yet... but I know for sure I don't want to use diet pills as a tool to get to my goal weight. 

~Pam