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14 Years.

I didn't make a 12 or 13 year update?  Really?  It might be the distracted distraction: 
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It occured to me that I don't have photos to share, partly because I have been sitting at the same. exact. weight. (within five or so pounds) for two-and-a-half years (*see distraction) and there's really nothing to update in that aspect.  
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I started "this journey" more than 15 years ago.
 
My highest weight was 320 pounds.  I have reached a low weight of 145 lbs, once.  I gained over 210 lbs. while pregnant in 2006 and 2015. 
 
I have spent the majority of the last 14 years at or about 170 lbs.  
 
All of this is in the history here on the blog.
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Self – last week
 
I would say that 170 is my eat-what-you-want and "don't do jack shit for cardio aside from chasing a hyperactive toddler/house cleaning and seizure" weight.
 
What do I eat?
 
Old-lady food.  I still loathe cooking.  I would not cook a thing, ever, if there weren't kids here.  I don't cook much anyway, since I was told "not to ever use a knife unattended" or "a stove," so, I just … do, but I don't.  If money were no object, I'd be all over home delivery.
 
Coffee with almond milk, tea, whole grain toast, probiotic cottage cheese, frozen meals, chicken salad.
 
I mix it up with a take out meal about once a week, usually a cold sandwich like roast beef and all the veggies or a BLT.  
 
I regret most meals eaten away from home, so I am careful about food choices if we go out.  I trust no one not to kill me.  I dump on the most random things, or have awful reactions later, so I stick with what Should Work.  
 
I'd say I take in 1500 or so calories most days. Today?  
  • Dave's Killer Bread + Light Butter
  • Two bites protein cookie, the rest donated to the kid
  • Frozen chicken a la king, tossed some of the chicken away
  • And it's nearing 5pm.  Typical.  I'll eat dinner at bedtime.
 
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Bob and I at his police graduation, 2017, his 14 years is next month
 
I have that excess 20- 25 lbs hanging around.  I know how to lose it. I don't do it. At least I have not in the last few years. With my last (POST WLS!) baby who is now eleven, I would get walking for miles, but I don't anticipate that happening anytime soon with my special-fall-on-the-ground-head-crack seizures that developed in the last few years (*see the timing correlation?) Well, at least I did it back then and did not realize I was falling down.
 
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Christmas Day, 2017 – Myself and all the "kids"
 
I have two cardio machines in the house. I'm not using them and my excuse is the youngest child that climbs on them with me. (YOU HAVE TO KNOW HIM.  HE IS THAT CHILD.)  Getting up before he does or climbing out of bed after he sleeps to exercise is … not tempting. I'm just not that into it, yet.  Clearly exercise is not a priority. 
 
I think that remaining upright — is?
*On that topic which some of you don't like to read, but it's a huge part of my life/day — I'm taking lots of medications, which need a little tinkering (again, usually once a year I'm in the hospital for a tune up) since I am obviously having lots of seizure activity.   I currently take ONFI, Topamax, Banzel, and as needed Lorazepam.  They are treating my various types of seizures.  I just tapered off of a huge amount of Keppra. I suspect these will change in the near future, because me.
 
People ask me if I blame my gastric bypass for this "condition" or it's increasing changes/etc.  No.  I was born with the brain malformation that causes seizures, and at this point in my life I believe I had seizure activity longer than anyone knew (maybe since I was very small, in the form of smaller seizures that no one noticed, I understand the symptoms now) — but the gastric bypass caused a trigger by changing my gut.  The science shows that the gut can affect the brain — and I feel that in some way the WLS lowered my seizure threshold by altering my gut, and making my malformation — "turn on" and show it's full power.  I feel that there's a cure in my lifetime, if it's fecal transplants, brain stimulators or who knows what else – because there are many of us out there with post WLS seizures
 
What do you want to know about "long term" post weight loss surgery life?  
 
Any questions, I am a too-open book.  Ask here or Facebook.  Just don't sell me anything unless you plan on sending it to me free.
 
 

Food intolerances two years after gastric bypass (PS – No, really?)

Apparently this concern with gastric bypass patients hasn't been "well-studied."

Hey researchers – PLEASE SEEK OUT PATIENTS WHOM COMPLAIN OF EXACTLY THESE ISSUES FROM DAY ONE.  

Because, uh, *putting on my Dr. Google Hat* they're totally normal and expected, or so we thought?  Or am I living under a rock where it's that we're not supposed to live with digestive distress most of the time?I suppose this is my bias because I live as a distressed patient, with a distressed patient, and know mostly only distressed patients?  And WHAT IS GOING ON WITH THE FOODS LISTED IN THIS STUDY!?

I am using a lot of question marks lately.  I need to stop that.

Discuss.

Study blurb via Reuters –

(Reuters Health) – A common weight loss surgery is associated with long-term gastrointestinal problems and food intolerance, a recent study suggests.

Researchers examined data on 249 extremely obese patients who had what’s known as laparoscopic Roux-en-Y gastric bypass, which reduces the stomach to a small pouch about the size of an egg.

Two years after surgery, these patients had lost about 31 percent of their total body weight on average. But compared to the control group of 295 obese people who didn’t have operations, the gastric bypass patients were far more likely to experience indigestion and an inability to tolerate multiple foods.

“It was already known from previous studies that the Roux-en-Y gastric bypass might aggravate gastrointestinal symptoms after surgery,” said lead study author Dr. Thomas Boerlage of MC Slotervaart in Amsterdam.

 

 

Worth a read. New York Times article about a year in the life of bariatric surgery

Worth a read, and worth a watch.  This mimics a bit of my experience, my family's experiences, and brings up some (deeper) questions.  As someone who's had gastric bypass in 2004, I'm always intrigued at any new science that's discovered about the gut – brain connections.

"Nearly 200,000 Americans have bariatric surgery each year. Yet far more — an estimated 24 million — are heavy enough to qualify for the operation, and many of them are struggling with whether to have such a radical treatment, the only one that leads to profound and lasting weight loss for virtually everyone who has it. Most people believe that the operation simply forces people to eat less by making their stomachs smaller, but scientists have discovered that it actually causes profound changes in patients’ physiology, altering the activity of thousands of genes in the human body as well as the complex hormonal signaling from the gut to the brain."

Article – New York Times

©geballe-sitting

A very powerful self-photography project of weight loss surgery.

Finally.  Something I can post.

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"Currently, Samantha's work focuses on conceptual portraiture, allowing her to explore human emotion from the inside out. She is working on an on-going self-portrait series focused on body image and healing that challenges viewers to question what is means to accept oneself. "

©geballe-stomach

 

Her photos are shocking if not absolutely realistic and raw if you have lost hundred(s) of pounds with weight loss surgery

If you have yet to do so, I would not be alarmed.  Question the photos.  Dig into them.  Feel it.  This is is what we know.

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Cropped image. 

Before You Spend $26,000 on Weight-Loss Surgery, Do This – What?

Agreed.

It was the first thing we all did BEFORE weight loss surgery 13 – 15 years ago ANYWAY. Because, it works.



The problem *is* the flipping ________ is addictive and NOBODY GETS THAT PART OF THE EQUATION, and until THAT is figured out?

THE ANSWER IS WEIGHT LOSS SURGERY.

New York Times Op –

Before You Spend $26,000 on Weight-Loss Surgery, Do This

Download Before You Spend $26,000 on Weight-Loss Surgery, Do This – The New York Times

Earlier this year, the Food and Drug Administration approved a new weight-loss procedure in which a thin tube, implanted in the stomach, ejects food from the body before all the calories can be absorbed.

Some have called it “medically sanctioned bulimia,” and it is the latest in a desperate search for new ways to stem the rising tides of obesity and Type 2 diabetes. Roughly one-third of adult Americans are now obese; two-thirds are overweight; and diabetes afflicts some 29 million. Another 86 million Americans have a condition called pre-diabetes. None of the proposed solutions have made a dent in these epidemics.

Recently, 45 international medical and scientific societies, including the American Diabetes Association, called for bariatric surgery to become a standard option for diabetes treatment. The procedure, until now seen as a last resort, involves stapling, binding or removing part of the stomach to help people shed weight. It costs $11,500 to $26,000, which many insurance plans won’t pay and which doesn’t include the costs of office visits for maintenance or postoperative complications. And up to 17 percent of patients will have complications, which can include nutrient deficiencies, infections and intestinal blockages.

It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.

Once a fad diet, the safety and efficacy of the low-carb diet have now been verified in more than 40 clinical trials on thousands of subjects. Given that the government projects that one in three Americans (and one in two of those of Hispanic origin) will be given a diagnosis of diabetes by 2050, it’s time to give this diet a closer look.

When someone has diabetes, he can no longer produce sufficient insulin to process glucose (sugar) in the blood. To lower glucose levels, diabetics need to increase insulin, either by taking medication that increases their own endogenous production or by injecting insulin directly. A patient with diabetes can be on four or five different medications to control blood glucose, with an annual price tag of thousands of dollars.

Yet there’s another, more effective way to lower glucose levels: Eat less of it.

Glucose is the breakdown product of carbohydrates, which are found principally in wheat, rice, corn, potatoes, fruit and sugars. Restricting these foods keeps blood glucose low. Moreover, replacing those carbohydrates with healthy protein and fats, the most naturally satiating of foods, often eliminates hunger. People can lose weight without starving themselves, or even counting calories.

Most doctors — and the diabetes associations — portray diabetes as an incurable disease, presaging a steady decline that may include kidney failure, amputations and blindness, as well as life-threatening heart attacks and stroke. Yet the literature on low-carbohydrate intervention for diabetes tells another story. For instance, a two-week study of 10 obese patients with Type 2 diabetes found that their glucose levels normalized and insulin sensitivity was improved by 75 percent after they went on a low-carb diet.

At our obesity clinics, we’ve seen hundreds of patients who, after cutting down on carbohydrates, lose weight and get off their medications. One patient in his 50s was a brick worker so impaired by diabetes that he had retired from his job. He came to see one of us last winter, 100 pounds overweight and panicking. He’d been taking insulin prescribed by a doctor who said he would need to take it for the rest of his life. Yet even with insurance coverage, his drugs cost hundreds of dollars a month, which he knew he couldn’t afford, any more than he could bariatric surgery.

Instead, we advised him to stop eating most of his meals out of boxes packed with processed flour and grains, replacing them with meat, eggs, nuts and even butter. Within five months, his blood-sugar levels had normalized, and he was back to working part-time. Today, he no longer needs to take insulin.

Another patient, in her 60s, had been suffering from Type 2 diabetes for 12 years. She lost 35 pounds in a year on a low-carb diet, and was able to stop taking her three medications, which included more than 100 units of insulin daily.

One small trial found that 44 percent of low-carb dieters were able to stop taking one or more diabetes medications after only a few months, compared with 11 percent of a control group following a moderate-carb, lower-fat, calorie-restricted diet. A similarly small trial reported those numbers as 31 percent versus 0 percent. And in these as well as another, larger, trial, hemoglobin A1C, which is the primary marker for a diabetes diagnosis, improved significantly more on the low-carb diet than on a low-fat or low-calorie diet. Of course, the results are dependent on patients’ ability to adhere to low-carb diets, which is why some studies have shown that the positive effects weaken over time.

A low-carbohydrate diet was in fact standard treatment for diabetes throughout most of the 20th century, when the condition was recognized as one in which “the normal utilization of carbohydrate is impaired,” according to a 1923 medical text. When pharmaceutical insulin became available in 1922, the advice changed, allowing moderate amounts of carbohydrates in the diet.

Yet in the late 1970s, several organizations, including the Department of Agriculture and the diabetes association, began recommending a high-carb, low-fat diet, in line with the then growing (yet now refuted) concern that dietary fat causes coronary artery disease. That advice has continued for people with diabetes despite more than a dozen peer-reviewed clinical trials over the past 15 years showing that a diet low in carbohydrates is more effective than one low in fat for reducing both blood sugar and most cardiovascular risk factors.

The diabetes association has yet to acknowledge this sizable body of scientific evidence. Its current guidelines find “no conclusive evidence” to recommend a specific carbohydrate limit. The organization even tells people with diabetes to maintain carbohydrate consumption, so that patients on insulin don’t see their blood sugar fall too low. That condition, known as hypoglycemia, is indeed dangerous, yet it can better be avoided by restricting carbs and eliminating the need for excess insulin in the first place. Encouraging patients with diabetes to eat a high-carb diet is effectively a prescription for ensuring a lifelong dependence on medication.

At the annual diabetes association convention in New Orleans this summer, there wasn’t a single prominent reference to low-carb treatment among the hundreds of lectures and posters publicizing cutting-edge research. Instead, we saw scores of presentations on expensive medications for blood sugar, obesity and liver problems, as well as new medical procedures, including that stomach-draining system, temptingly named AspireAssist, and another involving “mucosal resurfacing” of the digestive tract by burning the inside of the duodenum with a hot balloon.

We owe our patients with diabetes more than a lifetime of insulin injections and risky surgical procedures. To combat diabetes and spare a great deal of suffering, as well as the $322 billion in diabetes-related costs incurred by the nation each year, doctors should follow a version of that timeworn advice against doing unnecessary harm — and counsel their patients to first, do low carbs.

Sarah Hallberg is medical director of the weight loss program at Indiana University Health Arnett, adjunct professor at the school of medicine, director of the Nutrition Coalition and medical director of a start-up developing nutrition-based medical interventions. Osama Hamdy is the medical director of the obesity and inpatient diabetes programs at the Joslin Diabetes Center at Harvard Medical School. A version of this op-ed appears in print on September 11, 2016, on page SR1 of the New York edition with the headline: The Old-Fashioned Way to Treat Diabetes.


Study – Weight-Loss Surgery Linked To Increased Suicide Risk

Another OBVIOUS. 

Reuters –

“These findings suggest that more effort may be needed to improve access to mental health care services in these patients should they need them, and perhaps some screening in the second year and onwards,” Bhatti said. 

During the first three years after surgery, 111 patients received emergency care for self-inflicted injuries, or roughly 1 percent of people in the study. While small, the risk of these emergencies was 54 percent higher after surgery than it was before.

Study – JAMA

Importance  Self-harm behaviors, including suicidal ideation and past suicide attempts, are frequent in bariatric surgery candidates. It is unclear, however, whether these behaviors are mitigated or aggravated by surgery.

Objective  To compare the risk of self-harm behaviors before and after bariatric surgery.

Design, Setting, and Participants  In this population-based, self-matched, longitudinal cohort analysis, we studied 8815 adults from Ontario, Canada, who underwent bariatric surgery between April 1, 2006, and March 31, 2011. Follow-up for each patient was 3 years prior to surgery and 3 years after surgery.

Main Outcomes and Measures  Self-harm emergencies 3 years before and after surgery.

Results  The cohort included 8815 patients of whom 7176 (81.4%) were women, 7063 (80.1%) were 35 years or older, and 8681 (98.5%) were treated with gastric bypass. A total of 111 patients had 158 self-harm emergencies during follow-up. Overall, self-harm emergencies significantly increased after surgery (3.63 per 1000 patient-years) compared with before surgery (2.33 per 1000 patient-years), equaling a rate ratio (RR) of 1.54 (95% CI, 1.03-2.30; P = .007). Self-harm emergencies after surgery were higher than before surgery among patients older than 35 years (RR, 1.76; 95% CI, 1.05-2.94; P = .03), those with a low-income status (RR, 2.09; 95% CI, 1.20-3.65; P = .01), and those living in rural areas (RR, 6.49; 95% CI, 1.42-29.63; P= .02). The most common self-harm mechanism was an intentional overdose (115 [72.8%]). A total of 147 events (93.0%) occurred in patients diagnosed as having a mental health disorder during the 5 years before the surgery.

Conclusions and Relevance  In this study, the risk of self-harm emergencies increased after bariatric surgery, underscoring the need for screening for suicide risk during follow-up.




Link – http://archsurg.jamanetwork.com/article.aspx?articleid=2448916

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Year Eleven, Plot Twist.

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Oddly enough last year was my best in terms of weight loss and weight maintenance after my roux en y gastric bypass now eleven years ago.

I just searched the blog for my yearly *cringe* “surgiversary” updates and it appears it really was.

 “Best.”  I maintained a nearly-normal bodyweight for half of the year, guys.  If I look back on my averages over the last ten years, the weight is smack-dab in the middle of average.  I am just that.  

Super-average.  

I started out the year at my near lowest, while using the gym and eating decently.  My goal had been to continue that – and ignore weight if I could add muscle tone.  

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One of the most common questions I get inboxed to me is:  What Do You Eat Everyday – What Do You Do?!  Here is the thing:  PEOPLE VARY DRASTICALLY.  I realized that my intake vs. output is a delicate balance.

Here’s my intake for the most part of the last 90 days:

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This looks mostly like this, with days of “Want pizza for dinner?  Who wants mozzarella sticks?”  Once a week.  I eat very little meat, though I am still cooking it a couple times a week for the family.

Breakfast – 

  • Coffee – unsweetened almond milk – cocoa powder
  • Frozen tofu based meal, other

Lunch –

  • Leftovers from dinner or
  • Soup or salad or
  • Bread + cheese

Snack – 

  • Chickpeas, whole grain crackers, cheese, veggie burrito

Dinner – 

  • Protein, veggie, carb – whatever is made for the family or…
  • Frozen vegan meal

Snack –

  • More dinner, usually, I honestly don’t eat at dinner time… I eat before bed.  I might have a few bites at dinner time, especially if I am cooking, and then I don’t want anything.  

This isn’t much different than my eating of the year before – and I maintain my weight at this level of calories.  I would assume I eat about 1500 – 1700 most days with days lower, and days higher (rare).  

I actually lose weight at this intake if I am moving enough.  

Disclaimer, BMI SUCKS and I have NEVER been in the normal category for more than two minutes because I am SHORT AND I AM SHRINKING so if I want to EAT, I HAVE TO MOVE MY ASS.

I was.  I’m not.   No excuses.  

My intentions were good, but life always seems to have different plans.  

I developed some super fun back pain that coincided with less time at the gym (…yes I think movement HELPS pain, but getting past pain to MOVE is now the problem!) and was diagnosed with some degenerative disc disease.  My time working out was cut drastically with my spouse’s work schedule changing – kid’s school schedules and just having no means to go.  Adding the lack of gym time to pain = Beth not moving her ass because it hurts = Beth not moving.  I started slugging out at home from August (…when the schedule changed) to this winter.  I hate to whine because Everybody Huuuurttttts.   I’m also super realistic and I know I’m getting older, and it is unlikely that my back will Get Better at this age.  It isn’t going to benefit me to complain about it now because it’s going to get worse with time.  

Grinding along through back pain is difficult though, when it makes every part of your day a little more complicated – you’d think just sitting would be restful – easy.   Sitting here is the most painful part of my day aside from attempting to sleep laying down, I live in a series of twitchy z-z-z-zaps.  If I could pace all day long, I’d be fine.  

And I just may start doing that.

Why?  *changing tenses, writing badly but writing*

There was a single motivation — I got on the scale after knowing that I was not fitting in my size medium running pants.   THEY SQUISHED ME LIKE A SAUSAGE.  I knew I had gained weight, I could see it – but – I kept squishing into them.  So what if my legs are more puffy?  Whatever.  

And then my boobs.  MY BOOBS.  I didn’t HAVE ANY, and a few weeks ago I’m all – O – O – and WHY DO THEY HURT I’d better start my cycle RIGHT NOW or I am going to cry and I just might cry right now or throw up.

Oh.  

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I’ll save you the dramatic implosion that occurred after three of those, but I’ve been to the MD twice, and I see a maternal-fetal medicine doctor tomorrow.    I was not planning this, obviously, nor was I telling anyone, but a certain spouse outed me – and a lot of people took it as a joke.  

I don’t find it funny.

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I’ve got this.  I have never had a pregnancy WHILE on anti-epileptic medications, so that is of course of concern as I CANNOT be unmedicated and live safely.  If you recall, my seizure activity became evident during my first post-RNY pregnancy and it was undiagnosed for a very long time.   Also, apparently, I AM OLD.  I am “Of Advanced Maternal Age.”  

ADVANCED.  AGE.   3-5.  This was the year, that I told my husband, I think we are old enough to have kids now.  Forget that my oldest is the same age as I was when I got pregnant with her.  

She said, “Well, at least it isn’t me.”  Yes, thanks for that.

Grandma MM doesn’t really have a ring to it.  And I think my mother would explode.