Fifteen Months Since Surgery

Drama, trauma, bloodwork and visiting Comfort Food Land

September 6 was my 15-month surg-i-versary so I am a few days late writing this post.  But I waited on purpose so I could share an update from my last bloodwork.  I had blood drawn twice last week, once at Dr. Gut-Check's office, my GI doctor.  We have been watching my liver levels for a while and done various tests since my physical in January, when a couple of my levels were elevated.  Good news from Dr. Gut-Check!  My liver levels have improved since my last check in July and are almost completely back to normal.

My second blood test as for nutrient levels, specifically protein, iron and vitamin K.  All those levels are still low since my last check 3 months ago, but no lower than they were, so while they have not improved, they are no worse, either.  The nurse called and told me to go ahead and increase my vitamin K, and she wants to talk to the doctor to find out how to proceed with my iron supplementation.  Protein is always an issue, as it is hard to get in 100 grams daily while staying within my calorie allowance.  More shakes are probably in my future.  A shake made with skim milk is 160 calories and 23 grams of protein, definitely my biggest protein bang for the calorie buck!

Elsewhere, my world has changed dramatically and traumatically.  Just a few days after my last post, my precious Aunt Ruby suffered a massive stroke.  She was taken to the emergency room, evaluated and treated with TPA, a powerful and risky clot-busting medicine.  There was really no option but to go ahead ith the TPA because the stroke was completely debilitating.  The following morning she suffered a brain bleed and she passed away that night, surrounded by her family.  Anyone who has followed this blog has read about Aunt Ruby, and knows what a loss this is for our family, and for me.

This is my first major loss since surgery, and I have found myself returning briefly to some of my old, eating-for-comfort habits.  I have known exactly what I was doing each mouthful of the way, so it's not as though I have been unaware of my actions.  As a result I packed on a few pounds.  I learned something from this little detour into Comfort Food Land.  The comfort that comes is only temporary, but if I am not careful, the weight gain could become permanent.

So I am still weighing myself every morning to keep myself accountable, and this week I lost back down to where I was.  Surgery has not made me bulletproof; I know that I can screw this process up if I am not careful.  Because of this awareness and the fact that I am at increased risk right now because of my emotions, I have taken a break from hospice volunteering.  I need to work through my own bereavement before I go back to face the grief of other people.  I am considering participating in a grief group at church.  If I need counseling, that is a possibility as well. 

I'll be OK, eventually.  We all will be OK, eventually.  My cousins, my brother and I will all need to work through our grief individually, each of us being careful to care for our unique concerns and issues in the process.  For me, for right now, I need to be diligent in taking care of myself, physically, emotionally and spiritually.  And part of that means feeling the feelings of grief as they come and not trying to anesthetize myself with food.  I can't be taking too many detours to Comfort Food Land.     

Fourteen Months Since My Surgery

Vital statistics, "wow" moments, and welcoming new friends on the path

Today is my 14-month surg-i-versary and as of this morning I have lost a total of 136 pounds.  I guess that is "wow" moment number 1!  Never in my wildest dreams could I have imagined that this much weight would be gone at this point...or ever, actually.  It was more than I could conceive or wrap my head around when this whole process began, and I am grateful beyond measure for the gift of feeling better.

The past month since my last update here has held several "wow" moments.  Most people would not place wearing heels in that category, but I do.  A couple of weekends ago, I met up with my dear, longtime friend Mary K. for our annual girlfriend getaway.  We worked on scrapbook and Christmas card projects, visited and caught up on each other's lives, work, families and whatnot.  And there was shopping!  (Last year's getaway for us was much different.  I was less than a month out from surgery and still feeling pretty rough around the edges, so it was a very quiet weekend.)  Anyway, back to the shopping.  There is a huge outlet mall where we were staying and we did a little damage there.  We went to a shoe place and I found, and bought, 2 pairs of shoes with heels.  As a heavy woman with very small feet and weak/injured ankles, I have worn nothing but flats for a very long time.  Imagine my surprise and delight when I tried on some cute heels that were also fairly comfortable, and that I could walk in without looking or sounding like a herd of cattle!  And they were on sale at a ridiculous discount!  Epic win.  I wore the taller pair to work one day last week and made it through the whole day with them.  I could tell that my leg muscles were working, which is a good thing, and I think I burned extra calories as well.  Since my working day is basically 12 hours from leaving to coming home, heels for church should be no problem, Lord willing and knock wood.  I also scored a killer denim jacket that I wore the same day with the killer heels.  It's the first denim jacket I've owned that really fits well and looks good.  Another epic win.

A couple of people at work who had not seen me in a while had some really nice things to say about the changes in my appearance and improved well-being.  One lady said she almost didn't recognize me.  A fellow who comes in to do maintenance on some of our systems commented that it looked like I had taken off a lot of weight, and I explained that I'd undergone weight loss surgery last summer.  He said, "Well, you must feel so much better, and you look fantastic!  If it's OK for me to say that..."  I laughed and told him that yes, it is totally OK to say that.  And I may have blushed a little.  It's kind of funny, and kind of sad, that people feel so paranoid about paying a compliment anymore, for fear of harrassment complaints.  Mostly sad.  The most interesting of these encounters was when a guy I see every day remarked that I was looking thin, asked if I was feeling well and healthy, and said he wouldn't want me shrinking too much.  Excuse me?  I could not possibly have heard that right!  (This was the day I wore the heels and killer jacket, by the way.) 

I am always open now about having had surgery.  Some people have the surgery and never tell anyone.  I certainly appreciate and respect the right to keep these matters private.  I didn't tell a lot of people what I was planning until shortly before the surgery actually happened, after all.  Once surgery was completed, I knew that I'd rather tell people how the weight loss was happening than to have them speculate about what I might or might not have done.  Last week, two lady friends of mine underwent their own weight loss procedures.  Their procedures were different from the one I had.  I don't know how private they are going to be about their respective journeys with recovery, weight loss and all that goes along with this process.  I admire, respect and support them in whatever way they choose to proceed.  I empathize with them for the guts needed to take the step toward well-being, the discomfort they will endure as they heal from surgery and the many changes they will experience in the coming months, positive and negative alike.  I pray for them on their journeys.  A third lady friend is planning her procedure for the fall, and she is in my prayers while she continues the preparation phase.  For each of these brave ladies, I pray most of all that they will realize that they are already beautiful!  I pray that they each will be glad they did it, that they will recover well, that they will feel wonderful and bloom into the vibrant, healthy, strong women they are meant to be.

Thirteen Months Since Surgery

Tests, more tests and, did I mention there were tests?

Today is my 13 month surg-i-versary, and in the past month I have undergone some medical testing related to my still-elevated liver enzymes.  My surgeon referred me to my GI doctor, Dr. Gut-Check, who examined me, ordered 11 vials of blood drawn to check for everything from various types of hepatitis to hemochromotosis, and scheduled an ultrasound.  The ultrasound was fine, as was the bloodwork, with one exception.

My blood workup showed Celiac sprue.  I freaked out and started doing research to see exactly what that could mean.  Celiac disease, an intolerance/allergy to gluten, would mean a radical change in my diet, which has already undergone plenty of radical changes in the last year and a half, thank you very much.  Celiac disease destroys the villi in the intestinal tract, which are little fingerlike projections that help the body absorb nutrients from food.  I am already at a higher risk for nutritional deficiencies because of my surgery. 

Celiac would also be a logistical nightmare.  Separate shelves for food storage (upper shelves for gluten-free foods to keep them from having gluten-food particles fall on them), costly gluten-free shopping, more fine-tooth-comb label reading, constant fear of cross-contamination...the list of concerns is endless.  Dr. Gut-Check also scheduled an upper endoscopy to go into my stomach and small intestine with a lighted scope to look around in there for more information.  The endoscopy was this past Wednesday. When I awoke from the procedure Dr. Gut-Check told me that she took tissue samples to biopsy because she "couldn't really tell anything by looking".  I said, "You mean I still have villi?"  And she responded that I do indeed still have villi, and my paperwork said my mucosa was normal.  Encouraging signs for sure.  But I am still waiting for the biopsy results with some nervousness.

I don't want to have to deal with Celiac disease for about a dozen different reasons, most of which I listed earlier.  The logistics of it are just staggering.  Plus, I am nervous about the possible organ damage that can come from this condition, including liver damage.  My liver levels are where this whole thing started.  I just want to be OK.  I pursued surgery to gain a healthier, stronger life.  And I know that people with Celiac disease can live healthy, strong lives...with LOTS of adjustments.

I am praying that the biopsy results are normal and my liver levels are just a blip on the radar that we'll keep an eye on.  I am praying that Celiac disease is not an issue for me.  I am praying that my intestinal villi stay strong and functional.  Mostly, though, I am praying for the grace to accept whatever comes...the serenity to accept the things I cannot change.

Size, Shape, Compliments and Fruit Salad

Why labels are pretty much meaningless...


It has been a good week.  I was able to reconnect with some of my CPE peer group, including our supervisor, for dinner and a little time to visit.  What a joy to see these beautiful faces and to bask in their company for a few hours!  They were intimately involved with my preparation for weight loss surgery and poured such love and support into my life during our time together.  I am convinced that they were an integral part of my pre-op success and that period would not have been the same without them.

It was also a week of compliments around the workplace.  It is nice to receive affirmation on positive changes, and most of the time I am really grateful.  Occasionally, though, someone's attempt at a compliment seems awkward, or overly familiar, and ends up making me feel a little uncomfortable.  Case in point: a lady whose face I had seen before but who I don't really know, saw me and rushed over to comment on my changed appearance, grabbing my hands and gushing about how great I looked.  I was thinking, "Have we actually ever met before?"  She felt like she knew me, obviously.  A different time someone commented on my weight loss, and, as always, I explained that I'd had weight loss surgery (I am always wide open about that, with everyone).  She said it was great that I did it and had "learned how to stop..." and then made the gesture of hand-to-mouth, as if shoveling in food.  She also apparently felt familiar enough to talk to me like that.  She is not that familiar, and this exchange was not OK.  A gentleman in the break room complimented me this week and it was kind of humorous.  We have actually had conversations before so I didn't mind him mentioning it.  He said I looked "good, I mean, healthy...I mean, it's hard to compliment somebody without being afraid of saying the wrong thing and ending up in HR."  I laughed my head off and assure him that he was safe.  If he'd said something like, "I wish I had a swing like that in my backyard!" we might have had a little problem, but he was nice and I appreciated the compliment.

I have an appointment with Dr. Gut-Check (the gastroenterologist) in a couple of days to try and determine the source of my elevated liver enzymes.  When I learn more, I'll write about it here.  I still want to lose a few more pounds, and I have a few that I can lose before getting to my dietician-recommended minimum.  The fact that I even have a minimum still feels crazy to me.  My size and shape will probably continue to settle and change a little over the coming months. 

I've been thinking a lot about "size" this week, especially how clothing sizes for women don't make any sense.  This week, I wore jeans in sizes from 12 to 18, and they all fit me.  What's up with that?!  I bought a pair of vintage Levi's on Ebay a few weeks ago that are an 18, but the waist measurement is the same as the new size 12 Levi's I just bought last week.  The only thing I can do now when shopping is to go by the tape measure numbers, because they are objective.  It just goes to prove that size labels don't mean much.  The Hubs said that he never understood why women's clothes didn't come sized the way men's clothes do, with simple measurements for waists, chests and inseams.  I wonder about that too.  Fortunately for my Ebay hunting adventures, many sellers now include that information for jeans in addition to the size on the tag.

Because I was curious about how my various-sized jeans look, I had The Hubs take some photographs, specifically of the rear view.  I can't really tell what looks good from back there, after all!  I am still adjusting to my changing body's shape and size.  The last time I was at my current weight, my shape was way different than it is now.  I have a much more defined waist than I ever have before, which is nice for a change!  I also now have a little bit of "junk in the trunk", which I  never had before, either.  My fanny has never been anything to write home about, and it still isn't, but it is nice to have curves both above and below the waist for once.

It's also a little weird.  Size labels on clothes don't make much sense, but the "fruit salad" descriptions of body types do.  My weight loss from surgery may have shrunk different parts of me than doing it non-surgically in the past did.  It may be somewhat related to my age and hormones as well.  My whole life I've been an "apple", carrying my weight around my midsection, belly and chest.  Now, suddenly, I look more like a "pear", with a smaller, more defined waist and curvier hips.  I'm not complaining;  it's just going to take a little getting used to.  When/if I pursue excess skin removal on my abdomen, my size will change again, and my shape might change along with it. 

If it seems like I am obsessing, I probably am.  It's just a whole lot of change in a relatively short time.  It will just take more time for my mind and heart to catch up with the changes in my body, and I will get there. 

Now What?!

Reflections as my 1 year Surg-I-Versary approaches


This week has been extraordinary.  Hearing at my doctor's appointment that I am now at a good weight and BMI is still sinking in gradually.  I still feel fat, as I mentioned in my last post.  Old habits and thought patterns die hard.

Now that I am basically at goal weight, I am wondering, now what?  I still have a lot of work to do on both my mind and my body.  "Shrinking" now is less about what I weigh and more about toning my muscles and firming up the areas that I can.  The exercise I've been doing to this point has not been especially strenuous, and I guess it's time to ramp up the activity while getting enough calories to keep my weight more or less stable. 

Yet another dimension of The New Normal.

I am also considering slowing down on this blog and beginning a new blog that is focused less on the weight loss journey and more on the rest of my life.  This Diva has so many stories to tell... memories of the people I have loved who are no longer with us in this physical world, stories of the people who are still with us and the lessons they teach, stuff that makes me laugh and cry and think.  I am wondering what those who have been reading this blog would be interested in reading about in the next one.  Because, while I began this process simply as a way to document my weight loss journey for myself, I have discovered that I gain great satisfaction both from the writing process and from the input I receive when people read my posts. 

So, Now What?

Some titles/premises I have considered for the new blog are:

In My Maker's Hands

Random Acts Of Living

Patchwork and Potpourri---Pieces of Life


If you read this post and have thoughts about the new blog (including whether I need to bother with doing it!) I would love to know them.  I have appreciated, and benefited more from, people reading and responding to my writing much more than I ever thought I would.  And I have a lot more to say, whether anyone reads it or not.  So I will continue to write, and to post on Facebook when I've written something new.  That way when there is something new, at least people know it's there, even if they opt out of reading it. 

Will anything come out of all this writing?  Who knows?  For me, something valuable already has come from it.  It has helped me to work a lot of my "stuff" out, and enabled me to share this part of my journey.  For that I am profoundly grateful.

Good Right Now, Where I Am

Shifting Paradigms and New Math Revisited


Although my actual Surg-I-Versary is not until June 6, I had my official 1-year checkup today at the surgeon's office, meeting with the exercise physiologist and the dietician.  As of today, I have lost 78% of my excess body weight and my body mass index is down a staggering 22.2%.  At the 1-year point the desired percentage of excess weight loss is 66%, so I am 12% ahead of that.  The overachiever in me is delighted!  According to my scale, I have lost 127 pounds total, 100 of that since surgery.  My blood pressure today was 94/62.  The exercise physiologist took it and asked me if this is about where it tends to run now, and I assured him that it is.  Part of The New Normal.

Results from my 14-vial blood draw last week were mixed, but mostly good.  My iron is improved but still a little low, so I am still on extra iron, for now.  Protein is also a little low, but just by .1%, so I am not worried about that.  It will be an ongoing process to make sure my protein intake is adequate.  Vitamin K is low this time, so the dietician has added a vitamin K supplement to my routine.  No biggie.

The liver enzymes that my family doctor found to be elevated a few months ago at my annual physical are still elevated.  So I am being referred to a gastroenterologist to check into that more thoroughly.  While I am not thrilled with this development, I am also not really worried about it.  I'm not having any pain or symptoms, so I am hoping this will turn out to be no biggie as well.  I'll update here when I have seen Dr. Gut-Check (nickname for the GI doctor) and have something more concrete to report.  I feel fine so I'm not going to be freaking out about it just yet.

My appointment and discussions today, especially with the dietician, were great indicators of progress made and a wake-up call about where I really am in this whole process.  I am basically at an acceptable weight and BMI, right where I am.  I thought I had a lot more weight to lose, but the dietician told me I am at a good place now, and if I lose more than 10 more pounds, I need to come see her for closer monitoring and ADDING calories to my daily intake.

Excuse me, I could not possibly have heard that correctly.  I am good right now, where I am?  Really?

I am having some trouble absorbing this, because in my whole life, I have never been good right now, where I am.  Never.  When I was in 6th grade, 5 feet, 1 inch tall and wearing a junior size 11 jeans and a 34-B bra, I was "too fat."  At least, that's what I was always hearing.  Looking back as an adult, I can realize that I was just fine at that size, and the Fatophobes in my life saying I was fat were lying.  I was just an early bloomer.  If I had been told just once by the right people that I looked good at that weight and size, I might have been able to stay there.  But I wasn't.  I was "too fat", and my life from then on became a struggle with ballooning weight and size, diets, shame and never measuring up because of my measurements.

I grew up in a world of extremes and judgments.  There were fat people and skinny people.  Skinny people were better than fat people.  And I was fat people.

I still feel fat, to be honest.  I see loose skin and wiggly-jiggly stuff on my body.  I don't have a textbook tummy or firm, flat abs.  But I am less large than I used to be, and now that the number of pounds I need to lose is minimal, I can start working on toning my body and investigating skin removal on my abdomen, if my insurance will cover that.  Making the transition in my mind from "freakin'-HUGE" to "Good-right-now-where-I-am" will be a big paradigm shift for me.

After my appointment I stopped to pick up my new vitamin K supplements and, on a lark, did a little shopping.  I thought I was in the mood to look for shoes, but nothing in the shoe store appealed to me.  Turns out there was something else I was meant to do.  I found my way into a department store and, out of curiosity, I picked up an armful of different jeans in several sizes to try on.

Today, after being told that I am good right now, where I am, I zipped myself into a pair of size 12 Levi's.  I did a happy dance in the dressing room, cried a little and then texted my cousin Judy to share the news with her.  She understands my issues with weight/size/self-image in a way few other people do, and she rejoiced with me on this milestone.  I can't ever remember wearing a 12 in jeans.  I remember going from an 11 junior size straight into 14's and up...and up.   I realize it's just a number on a label, but it still feels like a victory somehow.

New math for me indeed.

The Scales Of Justice

Tallying up the totals from vacation


The Diva has survived her first post-surgery vacation without doing too much damage to her program!  In fact, I am pleased to report that when I got on my scale this morning, I somehow actually managed to lose about half a pound while we were gone.  It's not much, but considering the variation in routine and the fact that I did not have my trusty scale with me on the trip, I am counting a half pound lost over vacation as a big victory!

There are other tallies to be added up, and a big one will get done tomorrow.  I am going in to get my big 1-year labs drawn at the weight loss center tomorrow, and while I am hopeful that everything turns out well, I am also a little nervous.  I'll go and do that right before I head to the hospice for my Monday afternoon at the front desk.  I won't be donating a pint of blood, but I will get several vials drawn to check nutrients, protein, iron and various other levels to make sure I am getting what I need from both supplements and food sources. I am especially hoping that my iron is better, maybe even in the normal range by now.  If you're a praying person and you read this between now and in the morning, a small prayer for good blood work for me would be more than welcome!

My actual appointment for the 1-year checkup is next week, when we will discuss my progress, my percentage of excess weight lost to date and the results of my big blood draw that happens tomorrow.  (They need about a week to process those results.)  And there might be a photo-op.  I know that right before surgery they took a "before" picture, so the 1-year checkup might involve an "after" one.  Which is fine.  While we were on vacation, I did something that The Hubs said took guts---I posted a waist-up swimsuit picture to my Facebook timeline.  The photo I posted is not pristinely clear, and there is a piece of wall art behind me that makes me look like I have spikes growing out the side of my head.  But it gives a good representation of the progress made since the weight loss journey began, both in the actual change in size and in the fact that I was willing to post a picture like that in the first place!  It's not indecent or anything, and there's not a foot of cleavage showing.

The Girls, however, are still very much present and accounted for.  Once the losing process is done and the maintenance phase is underway, there may be some body work ahead for me, depending on what my insurance will cover.  Years ago, when a co-worker's wife had weight loss surgery, insurance covered her tummy-tuck procedure after she had achieved goal weight.  That is something I would consider.  And there might still be room (and insurance coverage) for The Girls to have their own reconstruction/reduction.  While there has been significant breast loss as I have shrunk, The Girls are still large...and heavy.

Lots of things are sagging and bagging.  I have wing flaps on the backs of my arms and sagging thigh skin that exercise won't really address because it is skin and not muscle.  There is wrinkly-crinkly stuff under my chin and on my neck now that bugs me.  But, these things are just vanity and nothing that I will pursue surgical correction for.  Tummy reconstruction is somewhat different because there are literally pounds of skin in that area, just hanging there.  Not to be graphic, but folds of skin hanging like that can trap moisture and harbor infections if a patient is not careful, which is why loose belly skin becomes a real health issue, and why, I suspect, insurance often covers a tummy-tuck.

But I am getting ahead of myself.  Goal weight is close, but I'm not there yet.  Once I get there, then we'll start considering what else might need to be done for the sake of my health and well-being.  For now, let's get me through the next couple of weeks, the big blood draw and the 1-year checkup.