Nutritional Update

I got some good news recently that I thought I'd pass along. I've been struggling for a while with getting enough nutrients - probably because food usually goes through me so quickly. Anyway, in order to have enough calcium in my blood for basic functioning, my body was having to steal it from my bones. This is what your body is supposed to do on the short term so that your muscles and everything keep working, but not such good thing chronically as I don't want osteoporosis before I'm 40. Well, I just got the latest round of blood work back and my bones are no longer dissolving! Hurray! On the flip side, I'm now anemic - but that is much less serious. Everything else is good, so I'm pretty happy.

TGFI

No, that's not a typo - it stands for Thank God For Imodium!

I think I mentioned a while back and I had to stop using Imodium because I developed some sort of sensitivity to it where I would get awful pains that made the lack of diarrhea hard to enjoy. Well, I went almost 2 years without taking any and decided to give it another try. I seem to be handling it ok now. I'm very leery of developing issues with it again so I'm careful to not overuse it. It is a fabulous tool though and it has helped a lot with traveling.

Here is an overview of the travels we've been able to do:

We took a road trip out to Glacier National Park. The drive out was about as interesting as the park itself. Back in ice age times, the glaciers in that area formed an ice dam, blocking rivers, and forming a lake over much of the western part of what is now Montana. Periodically, the pressure would build up to the point where the ice dam would burst and the water would all drain out of the lake. The sudden release of water flooded all of eastern Washington and down into Oregon. There are huge gouges in the land and ripple marks so large they just look like rolling hills.

In the fall, we went to western NC to see Mike's family and some old friends.

We also went down to Oregon for a very cold Muddy Buddy race.

All in all - it was a good fall.

Hurray for pants!!!

I put off writing about this for a while due to a general bad attitude on my part that I didn't feel like sharing.

Earlier this summer, I got appendicitis and so had my appendix taken out. Apparently they caught it just in time (not burst but starting to ooze) which is crazy since I went into the OR about 15 hours from the onset of pain. As surgeries go, this is quite minor and I have had no complications - a pleasant change for me. It has re-upset my intestines making all those issues a little worse, but I have been able to mostly correct that by upping my meds.

An appendectomy truly isn't that big of a deal. My bad attitude was about the simple fact that I was in the ER again, having surgery AGAIN. We were joking with the surgeon beforehand about other surgeries he could go ahead and get over with while I was there. I now have a full dozen incisions on my stomach. I'm like a human pin cushion. I just feel a bit like when I start to feel like I'm making real progress, the rug gets pulled out from under me. It's frustrating.

At this point, I think I'm back to a more positive attitude in general. The only thing that has been a lingering annoyance is an inability to wear pants. A couple of the incisions are around my waist and would get sore from waistbands. I've been able to wear some stretchy sweatpants for a couple of weeks now with minimal discomfort. But in just the past few days, I've been able to wear normal pants. I'm very happy about this. I know this doesn't sound like a big deal, and I know that I'm awfully cute in dresses and all, but sometimes it really is a pain to not be able to wear pants.

Overweight!

Over a year out from surgery, I'm finally overweight. To most people, being overweight would be a bad thing. However, since I started out level 3 obese (there is no level 4), I'm pretty happy about it.

Having crossed this milestone, it seemed time to pull out the old pants for a photo shoot.

Ongoing Health Issues

This will be a Too-Much-Information post. Those of you who don't want to know the gorey details might want to skip on down to the next post.

It has been a while since I talked about all my bathroom issues so I thought I would fill everyone in since I'm sure this is a subject you are all just dying to hear more about.

Since I last wrote, there have been lots more tests done. Countless vials of blood and stool samples later - still no idea what's going on. So, the next step was to scope me. They did a colonoscopy and an upper GI endoscopy. The good news is that everything looks fine. The bad news - still no idea what's going on. Interesting side note (and anyone who's had a colonoscopy should appreciate this): Before a colonoscopy, you have to drink this stuff to clean you out. I had heard from people who had had this that the diarrhea is pretty bad. I was really dreading that because I have diarrhea on a good day so I thought this was going to be insane. But, my body didn't react to it like it does to food so there wasn't an additive effect. It was actually WAY better than what I was used to. My doctor said I was the first patient he'd ever had to be happy with the effects of colon prep.

Anyway, since we still don't know what's going on, I officially have irritable bowel syndrome. I really hate this diagnosis on many levels. First of all, a syndrome isn't much of a diagnosis. It is just a collection of observed unexplained symptoms. It means they don't know what is causing it. IBS in particular is even more meaningless as a diagnosis because almost any physical problem down to just being stressed can cause intestinal issues. So unlike say, restless leg syndrome where they don't know what's going on, but it is odd enough that it is most likely the same (albeit unknown) root cause for everyone who has it -- there are no doubt a myriad of root causes among those diagnosed with IBS. Basically, I went to a doctor saying that I had cramps and diarrhea and was told that I had cramps and diarrhea. Lastly, I feel like we sort of do know a cause (the surgery) even though we don't understand how that resulted the mad diarrhea.

That said, Mike found a paper on IBS that sounds a lot like me. They did this study where they measured the gastrointestinal reflect in IBS patients and controls. Normally, when food hits your stomach (and before it gets to your intestines), your intestines start their calm, controlled peristalsis motions which push everything along. In some IBS patients, this normal response was amplified such that their intestines just went crazy. The contractions were stronger and more erratic that normal. Again, still no idea why - but boy does that sound familiar. In fact (and I apologize for the mental image here) I have seen food come out of me less than an hour after eating. At speeds like that - no wonder the process hurts.

The good news is that I am doing better. First of all, as a rule of thumb, I get better as the day goes on. I usually only get really sick after breakfast. After lunch is much better and I'm often fine with dinner. Also, we are trying to manage the symptoms even though we don't know the cause. So, I'm trying different drugs aimed at dampening the muscle or nerve responses along my GI tract. Some have done nothing, some have helped, but we are still looking for that silver bullet that will make things totally better. Realistically, that may never come - but I am still happy to report significant improvement. There is still a lot of variability from day to day - but that variability now includes occasional days where I'm totally fine. I have even had a few solid bowel movements. (Hurray!) And, these days, a really bad day is like a normal day used to be.

A few other random points - I ended up developing a sensitivity to Imodium. I tried really hard not to over use it, but I guess I did. Anyway - it got to where it would make the cramps way WAY worse. As it was hard to enjoy the lack of diarrhea whilst doubled over, lying on the floor in the fetal position - I stopped using it. After going without for about six months, I've started experimenting with using it again in very small doses. The sensitivity seems to have gone away. I'm hoping I can figure out a balance that will enable me to go camping next summer. I was so sad to not be able to go camping (or even hiking!) all last year. This would be a sad thing anywhere, but in the glorious pacific northwest - it is a tragedy.

We went back home for "Thanksmas" this year. (I highly recommend this as an alternative to getting caught in all the awful holiday traffic.) I had been really nervous that this trip - like so many other before it - would include an ER visit. It didn't! Yea! After a few more, I'm hoping I will feel safe traveling again. There are a lot of fun weekend trips we could do from here that I just haven't felt safe doing. (Who would have thought I would one day feel like I couldn't safely go to Canada?) And, I definitely need to feel safe spending the night in a hotel before I can think about camping in the woods.

Well, I think that should have everyone pretty well caught up. Hope all it well with you!

Gallbladder surgery or Why I don't travel

I know it has been a while since I posted anything so I figured I start with the big "news." (Is it news if it happened 2 months ago?)

I had to have my gallbladder taken out. We tried to take a weekend trip to Wenatchee, WA which is on the other side of the cascades. Trips seem to be a bad thing for me. In the past 7 months, I've taken 3 overnight trips. Two have ended up involving an ER visit. Looked at another way, in the past 7 months I've had 3 ER visits, 2 of which involved an over night trip. I don't really see why sleeping somewhere else should be too much stress for my body to take, but apparently I am just that fragile.

Anyway, gallbladder issues are common with rapid weight loss. I was on some medication to lower my risk, but my risk was probably a bit higher than even the average weight loss surgery patient because of all the food issues I've had. So, while we were in Wenatchee I had a gallbladder attack and we decided to rush back to Seattle (~3 hr drive). We didn't know what was going on but figured it would be best to be seen in the hospital that knew the most about me. Michael dropped me off at the hospital before taking puppy home. I actually lucked out in that the surgeon on call does gastric bypasses so he was very familiar with my situation and now I no longer have a gallbladder. This isn't really a big deal. It means I won't digest fat as well which can lead to diarrhea, but with the issues I have already it is sort of a drop in the ocean.

I did have a few surgery side effects. First of all - apparently they were worried I had hepatitis. I'm not sure who heard what, so I just wanted to go on record as saying that my liver is fine. It was just mad because it got banged around during the surgery. (The gallbladder sits right up against the liver.) There is no damage. The other issue is this weird pain that I had. There was this line going from my belly button (where they pulled the gallbladder out) diagonally down to the front of my left hip. There was this divot in my skin that looked like it had been pulled too tight and along the line the skin was numb. At either end of the line - there was pain. It was actually more painful than any of the incisions. Everyone was confused by this on two counts. (I used to enjoy thinking of myself as unusual and interesting, but it gets old when you are unusual and interesting medically.) First of all - the gallbladder is in the upper right quadrant of the abdomen and the pain was on the exact opposite side of where they were working. Secondly - what I just described (numbness combined with pain and a seizing up a tissue) sounds a lot like nerve issues. But, in that part of your body, nerves don't run diagonally. So, for about a month it hurt to do just about anything including just having something touch my belly there. I went around all the time in sweatpants that were 5 sizes too big. Then all of a sudden - the pain was gone. Not coincidentally (I think) a month out from surgery is about when you would expect the dissoluble sutures to let go. My theory is that something got pulled too tight when they sewed me up. None of the doctors (including Michael) put much stock in this theory, but I like it.

Well, that concludes the story of the ill-fated gallbladder. I have more posts planned and hopefully it won't take another three months for me to get around to them. But, now I'm on my way to meet my GI doc to see what he has to say about my other issues.

Health Update: The Good, the Bad, and the Ugly

Quite a few of you have expressed concern over my current state of health - so I thought an update was in order.


The Good:
As we get farther and farther away from my partial bowel obstruction with no similar problems, it is rather unlikely that I will need a follow up surgery to deal with an obstruction.
I don't have sleep apnea anymore, so that's great.
I had some hormonal issues that put me at risk for diabetes and they are correcting themselves.
My doctors are happy with my muscle tone. Also, b12 and iron levels are fine. (These are the two most common deficiencies with gastric bypass.) So, I can only be but so malnourished.
While I do have issues, they are getting better as well, so on the whole I feel really good about how things are going.


The Bad:
I just had my second ER visit. We are currently in NC visiting my god-parents. We flew into C'ville and were able to catch up with a few people over the weekend, but it would appear that I over did it. It was hot and I wasn't as careful as I should have been. I've been flirting with dehydration for a while (more on that later) and I crossed a line. I got a kidney stone and my potassium levels were really low. I recovered quickly, which is good. I had hoped, however, that my previous ER visit would be my last. And, it was rather disconcerting to strike out for an ER in the middle of the night in a town that isn't your own. Luckily, Michael did a rotation in this area while he was in med school, so he knew where to go. I'm still working on the kidney stone, but hopefully it will work its way out soon.


The Ugly:
This is the TMI section of this post - so if you don't want the gorey details - you may want to stop reading here.

The big problem that I have now is that I get sick whenever I eat. I get cramps, diarrhea and sometimes, I throw up. When this first started, I thought I had a stomach flu but it has been a couple of months now and I'm still dealing with it. I'm tried food experiments (like cutting out dairy) but I can't find particular foods that are and are not problematic. What I eat doesn't seem to mater - just the fact that I have eaten. As not fun as all this is, the real problem is that all the diarrhea is leaving me dehydrated. I'm drinking as much as I'm supposed to, but I can tell from how I feel that it isn't enough. I'm also not eating enough (so I'm losing some muscle mass due to protein deficiency) and I recently tried to add in an extra meal, but the extra diarrhea got me notably dehydrated so I had to drop that idea.

At first, I could eat breakfast and I would be sick all day (without eating anything else) and into the night. Now, I'm down to only a few hours of being sick. This is a very significant improvement. For one, now I eat breakfast and by the time I need to eat lunch - I'm no longer feeling sick. As you can imagine, this makes it much easier to make myself eat. Also, I have this little break between meals where I'm ok and can get things done. For a long time, I'm just been spending all day in the bathroom. Now, I can emerge from the bathroom and I have a little time to do some ironing - or write a blog post - before I eat lunch and make myself sick again. This little break has been a huge sanity boost and I look forward to it getting longer. I also have learned a couple of ways to control it. For one - I can just not eat. Now, obviously, I can't do this much (as tempting as it is) but used judiciously it can enable things like flying back to the east coast. I also respond to Imodium. More than getting rid of the issues, it more slows them down. The diarrhea isn't as crazy, the cramps aren't as bad, but food seems to stay in my stomach longer making it more likely that I'll throw up. And, if I take too much I become very nauseated. I also don't want my body to adjust to a constant presence of Imodium. In general, I use it just once a week - but I can make exceptions for special occasions like my cousin Emily's visit.


Well, that's about it. I hope you all are doing well.

Odds and Ends

If you have been to Maxwell Smart's photo album, you know that he recently went to a family reunion. I thought you guys might also like to see a video from the day.



I've added a couple of new things to the blog. First of all- I put a link to my friend Sarah's weight loss surgery blog on the links list to the right. I also added a weight loss tracker at the bottom for any who are interested in following that saga. And, I'll go ahead and say that the goal of loosing 150lbs is pretty close to arbitrary. It is a nice round number. The last time I was at a weight that would be "normal" for me now - I was in elementary school. I have no concept of what a good normal weight is for me as an adult.

With my last post, I realize that I may have come off as not wanting to talk about my surgery, which isn't really true. It is just that it feels weird somehow to bring it up randomly. I've never walked into a room and said, "Guess what everybody! I'm on a diet!" It isn't that I wouldn't want anyone to know that I'm on a diet or not want to talk about it. I just wouldn't bring it up. Now, I know that major surgery is something that people tend to make a point of mentioning to their friends - but in my head, I'm thinking of it like a diet.

One last thing: I've set up a new photo album called Mommy and Max that will have regular photos of me and Max. The idea is that over time you will be able to see me get smaller and Max get bigger. At this point, I don't think either effect is noticeable, but at some point I'm sure it will be.

The Secret

Ok, so it isn't really a secret - I just haven't really made a point of telling people. I think I want to believe that it isn't really a big deal- not worth mentioning. But, I figured it was about time I go ahead and bite the bullet and let the word out.

I had a gastric bypass surgery. For the anatomically curious among you, this is what my insides now look like. There has been a minor complication with a partial bowel obstruction. We are hoping that it is clearing up on its own and in the mean time I'm struggling to find things that I can comfortably eat. I still feel good about my decision. It is important to me to be healthy and I know that these current issues are nothing compared to the long-term health benefits.

So there you have it. Now everybody knows.