Time out.

Sometimes being a growed up stinks. Because.  It just does. 

I was asked to make a choice today. 

Either voluntarily take a pay cut (more than three dollars an hour) to continue working at the level I have been since my health became an issue, or go revert to the job title I was hired at and do it one hundred percent full time.

A little history here if you don't know - I'm dealing with some health issues due to the leech-fetus.  When they presented a few weeks ago, I was cut back on my job duties to cut stress and a few hours each week with a doctors' note, and it was to continue as such until the issues were resolved or I couldn't work anymore or got put on bed-rest.  Obviously my health hasn't changed for the better or worse yet, and I've not been able to put a timeline on my ability to work full time.  Right now, I'm doing an average of 75-80 hours every two weeks, at a slightly different level than I was hired to do - and it's already stressing me out.  I can't imagine taking on more, now, until after I'm no longer pregnant and feeling like dirt.

This isn't a choice I can really make.  I cannot afford to take less pay - nor can my health afford to take on more stress or working hours.  If I take the pay cut, I cannot afford to physically go to work, that's just enough to make it not worth it to leave the house after child care is accounted for.  If I take back my position at the pay I'm already making - and take on more stress and eventually more hours - it's going to suck the life out of me, and I can't afford to quit either.

What would you do?

The DaVinci Code

So, I read the hype, I bought the book, started to read it, couldn't get into it, and decided, "Let's see the movie."  Off to the movie - and how long did it take for me to fall asleep?  Yeah, why bother, right?  I woke during the closing credits, because the husband nudged me, and I wiped the drool from my cheek on his shirt and went home.  So, that's my review of the movie.  By the way, it's his fault that I fell asleep - who takes an anemic pregnant woman to a movie after working eight hours at 7pm?  He enjoyed the movie, though.  I'll try again via DVD when it's released.

Only because it makes me twitch.

But You Must Act Now.  Click on the link that resembles this in the right hand sidebar.  I want you to know I have nothing to do with WHAT shows up in those links.  Especially the ones that read like THIS:

"Buy the the only effecttive weitgh loss products Clenbuterol and Cytomel are most effective products, available without prescription."

Name the fetus.

Here it is, the top 100 boys and girls names list from the the US Social Security Department. We can call this, "The List of Names To Avoid Altogether."   At a quick glance, it looks like I've only used two of these names with three kids, one spelled entirely different and another as a middle name.  One of my current girls picks is in the top 25 of the girls names, so it's probably on the out list now.  Out of the boys' list, none listed are any I've considered, except going with "the third."  Wanna help?

1		Jacob	Emily
2		Michael	Emma
3		Joshua	Madison
4		Matthew	Abigail
5		Ethan	Olivia
6		Andrew	Isabella
7		Daniel	Hannah
8		Anthony	Samantha
9		Christopher	Ava
10		Joseph	Ashley
11		William	Sophia
12		Alexander	Elizabeth
13		Ryan	Alexis
14		David	Grace
15		Nicholas	Sarah
16		Tyler	Alyssa
17		James	Mia
18		John	Natalie
19		Jonathan	Chloe
20		Nathan	Brianna
21		Samuel	Lauren
22		Christian	Ella
23		Noah	Anna
24		Dylan	Taylor
25		Benjamin	Kayla
26		Logan	Hailey
27		Brandon	Jessica
28		Gabriel	Victoria
29		Zachary	Jasmine
30		Jose	Sydney
31		Elijah	Julia
32		Angel	Destiny
33		Kevin	Morgan
34		Jack	Kaitlyn
35		Caleb	Savannah
36		Justin	Katherine
37		Austin	Alexandra
38		Evan	Rachel
39		Robert	Lily
40		Thomas	Megan
41		Luke	Kaylee
42		Mason	Jennifer
43		Aidan	Angelina
44		Jackson	Makayla
45		Isaiah	Allison
46		Jordan	Brooke
47		Gavin	Maria
48		Connor	Trinity
49		Aiden	Lillian
50		Isaac	Mackenzie
51		Jason	Faith
52		Cameron	Sofia
53		Hunter	Riley
54		Jayden	Haley
55		Juan	Gabrielle
56		Charles	Nicole
57		Aaron	Kylie
58		Lucas	Katelyn
59		Luis	Zoe
60		Owen	Paige
61		Landon	Gabriella
62		Diego	Jenna
63		Brian	Kimberly
64		Adam	Stephanie
65		Adrian	Alexa
66		Kyle	Avery
67		Eric	Andrea
68		Ian	Leah
69		Nathaniel	Madeline
70		Carlos	Nevaeh
71		Alex	Evelyn
72		Bryan	Maya
73		Jesus	Mary
74		Julian	Michelle
75		Sean	Jada
76		Carter	Sara
77		Hayden	Audrey
78		Jeremiah	Brooklyn
79		Cole	Vanessa
80		Brayden	Amanda
81		Wyatt	Ariana
82		Chase	Rebecca
83		Steven	Caroline
84		Timothy	Amelia
85		Dominic	Mariah
86		Sebastian	Jordan
87		Xavier	Jocelyn
88		Jaden	Arianna
89		Jesse	Isabel
90		Devin	Marissa
91		Seth	Autumn
92		Antonio	Melanie
93		Richard	Aaliyah
94		Miguel	Gracie
95		Colin	Claire
96		Cody	Isabelle
97		Alejandro	Molly
98		Caden	Mya
99		Blake	Diana
100		Carson	Katie

So, whaddya think?  We don't know gender - so boy/girl/unisex suggestions are welcome. 

• I prefer to not use anything popular "right now." 
• I loathe intentional mispelling of names.
• I am drawn to unisex names.
• I don't want anything "biblical."
• I like me some metrosexual boy names.  ;-)
• I don't mind historical or traditional names.  I dig the list of names from the 1900's from the SSA.
• I like surnames as first names
• The kids' last name is two syllables, and it's harsh.  The childs' name must flow.
• I don't like cutesy nicknames - I prefer if we can't actually shorten the names.  (Even though I do.)

I'm picky, too. 

It's a....

Head.

Today's update. I went to my bloodwork appointment, blood pressure was high, hemoglobin count was slightly better than last time, and I got my weekly B-12 injection. Then, off to the OB/GYN office for a prenatal. When I went in, they shuffled me into ultrasound, where the tech immediately stated that she didn't know why I was there, because it is "too early" to see everything, etc. I was put off instantly, and the test was quick and uneventful. She measured the head, femur and abdomen, all of which measured normal, and look fine, I assume. I didn't even ask if she could peek at the gender, because she kept saying that she wouldn't be able to see everything, which I took as "don't ask." Went in the office to wait for the doctor, and in came a midwife. I have nothing against the midwives, but this was specifically supposed to be a OB consult. Frustrated, again. I started asking her questions, and she brought in a more senior MW, who then asked me what my question actually *was, because she didn't understand why I was thinking I'd see a doctor today, I guess. I explained to her that I wanted to deal with the anemia and I need a referral to a perinatalogist to get the treatment. She did say that they consult with the same PN that the blood doc consults with, so he'd be the guy to see.

She also said after I voiced my concern about feeling like crap still, that it's totally normal to feel faint, pass out, etc. while pregnant. I didn't really have any urge to argue with her, that it's completely and utterly not normal for ME as a person who has been pregnant a million times to feel that way. She suggested I tell my manager that it's normal for me to feel like I might pass out now and then, and that I'm fine. Now of course I feel like she thinks I am making this up, and I'm done talking about it with her.

When we got home, we called to get an appointment with the perinatologist, but it's by doctor referral only. Of course, I haven't seen a doctor, and was again frustrated. As the scheduling secretary was taking my information down for a message, she said, "Oh, a referral has come across for you." So, the MW's supervising doctor must have gone ahead and done so, and I've yet to meet this person. A week from Monday, I'll see the perinatologist, and hopefully he can make the decision as to whether we fix my blood or not.

Suh-weet.

I'm weird, I love the rain. We just had a quick "severe weather" moment that shut down the satellite TV. We got some take-out delivered, sat down to eat, and when I looked out the window to see if the rain had really stopped, I saw the rainbow. Then, I saw, two rainbows. Anyways, that's really it for now. I'm going to watch a movie with Bob, and there's new pictures at the Flickr. Have a lovely evening.

Something I can snort.

A up-the-nose B-12 supplement, what fun! Apparently not something I can take blindly, but everything seems to have this notation:

But, for you, my peers:

Nascobal® (Cyanocobalamin, USP) is a synthetic form of vitamin B₁₂ in a nasal spray.

Nascobal avoids the gastrointestinal tract by delivering vitamin B₁₂ directly to the bloodstream through blood vessels in the nose. This product is ideally suited for patients with such conditions as Crohn's disease, HIV/AIDS, multiple sclerosis, or pernicious anemia where absorption of B₁₂ from foods and oral supplements is either poor or does not occur at all.

This product is not indicated for patients with sensitivity to cobalt and/or vitamin B₁₂ or any component of this medication.

Reasons for prescribing Nascobal:

• Convenient - replaces the need for monthly injections
  
• Consistent - provides smooth and consistent serum B₁₂ levels demonstrated in a crossover study compared to IM injections (please see prescribing information)
  
• Easy-to-use - self-administered; One dose, One nostril, Once per week
  
• Indication - for the maintenance of B₁₂ levels in patients with such deficiencies resulting from Crohn's disease, HIV/AIDS, multiple sclerosis, ileal resections, gastric surgeries, and pernicious anemia

Nascobal Nasal Spray is indicated for the maintenance of normal hematologic status in pernicious anemia patients who are in remission following intramuscular vitamin B₁₂ therapy and who have no nervous system involvement. Nascobal Nasal Spray is also indicated as a supplement for other vitamin B₁₂ deficiencies, including:

I. Dietary deficiency of vitamin B₁₂ occurring in strict vegetarians (Isolated vitamin B₁₂ deficiency is very rare).

II. Malabsorption of vitamin B₁₂ resulting from structural or functional damage to the stomach, where intrinsic factor is secreted, or to the ileum, where intrinsic factor facilitates vitamin B₁₂ absorption. These conditions include HIV infection, AIDS, Crohn’s disease, tropical sprue, and nontropical sprue (idiopathic steatorrhea, gluten-induced enteropathy). Folate deficiency in these patients is usually more severe than vitamin B₁₂ deficiency.

III. Inadequate secretion of intrinsic factor, resulting from lesions that destroy the gastric mucosa (ingestion of corrosives, extensive neoplasia), and a number of conditions associated with a variable degree of gastric atrophy (such as multiple sclerosis, HIV infection, AIDS, certain endocrine disorders, iron deficiency, and subtotal gastrectomy). Total gastrectomy always produces vitamin B₁₂ deficiency. Structural lesions leading to vitamin B₁₂ deficiency include regional ileitis, ileal resections, malignancies, etc.

IV. Competition for vitamin B₁₂ by intestinal parasites or bacteria. The fish tapeworm (Diphyllobothrium latum) absorbs huge quantities of vitamin B₁₂ and infested patients often have associated gastric atrophy. The blind loop syndrome may produce deficiency of vitamin B₁₂ or folate.

V. Inadequate utilization of vitamin B₁₂. This may occur if antimetabolites for the vitamin are employed in the treatment of neoplasia.

• Pregnancy Category C: Animal reproduction studies have not been conducted with vitamin B₁₂. It is also not known whether vitamin B₁₂ can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Adequate and well-controlled studies have not been done in pregnant women. However, vitamin B₁₂ is an essential vitamin and requirements are increased during pregnancy. Amounts of vitamin B₁₂ that are recommended by the Food and Nutrition Board, National Academy of Science - National Research Council for pregnant women should be consumed during pregnancy.

B-12

Katie asked if I am getting the B-12 shots, and yes, I am - but my B-12 isn't very low.  I thought for sure that I'd need it before this, but I was never low in previous bloodwork pre-preggo.  The doc said I'd recieve shots daily if the levels were lower, but right now I'm okay to have one a week for a few weeks and then monthly potentially forever, just as a precaution.  I was nervous thinking I had symptoms of a B-12 deficiency, because they're neurologically involved and sometimes irreversible.  Here I am thinking that I'd have brain damage, so you can understand my concern.  Luckily they're not low enough to cause those problems at this point.

The iron deficiency anemia is what seems to be the problem now.  I just need my iron levels to go up.  I am not producing full-grown red blood cells, they're small and immature.  Hopefully this will get better as I get some advice at the next appointment. 

Slightly better.

Bob called this morning to get me a new appointment for the OB.  The receptionist left him on hold, presumably to ask someone what she should do regarding my appointment, and she came back to the phone, and said I need to come in on Tuesday, and have an ultrasound and doctor visit right after.  This works out well, since I'm already off for the blood testing and B-12 injection that morning at the blood clinic.  This way the doc will see my blood count levels from that very day as well, since I can just bring them with me.  The ultrasound is a bonus, since I wasn't going to have one until late June.

Argh.

My appointment with the OB was cancelled.  "Doctor has a conflict."  This is highly frustrating.  I had to ask for time off for that appointment.  (I know, that really isn't important, but...I'm treading a thin line at this job already because of this situation.)  Bob called while I was working today to try to get some answers, and was promised that a doctor would call me back by tonight to discuss what to do next.   I basically want to know if I can bypass the OB and just go see a high-risk OB, since now I have to re-schedule that initial OB appointment (you following this?)  From what I've read, it takes 2 months to raise iron levels?  By the time we get through this, I'll be bleeding to death on the birthing table and they'll be giving me emergency transfusions, right?  So now, I've got to call and make another initial appointment with an OB I've never met, and then ask if I need a referral to a high-risk OB, and then make an appointment with he/she, THEN to just confirm that I do indeed need some sort of supplemental iron put into my body.  This could take weeks.  I will pass out and hit the floor before then.  What then?

We're Fatter Than We Knew!

According to new research in the "Journal of the Royal Society of Medicine," Americans have grossly underestimated their girth -- by more than half in most states.  Hey, on a positive note, my home state has one of the lowest rates of female obesity.  Go figure.

"In the Journal of the Royal Society of Medicine, researchers note that national obesity statistics typically rely on self-reported weight and height, which are often wrong.

Those inaccuracies often make people sound lighter or taller than they actually are, write Majid Ezzati, PhD, and colleagues. Ezzati works at the Harvard School of Public Health.

Self-reported weight and height don't always match reality, so U.S. obesity statistics are too low, Ezzati's team argues.

The researchers recalculated America's obesity statistics, adjusting for those errors. The result: The nation's obesity estimates went up.

Corrected Obesity Statistics

Obesity is defined as a body mass index (BMI)body mass index (BMI) over 30, according to the CDC.

In 2002, 28.7% of men and 34.5% of women in the U.S. were obese, Ezzati and colleagues estimate.

The uncorrected estimate for that year indicated that 16% of men and 21.5% of women were obese.

Ezzati's team based their corrections on data from two large, national surveys of U.S. adults:

• Behavioral Risk Factor Surveillance System (BRFSS): Given by telephone
• National Health and Nutrition  Nutrition Examination Survey (NHANES): given in person, with some participants measured and weighed afterwards

Ezzati and colleagues compared BRFSS and NHANES data for similar years. They found that people tended to report their height and weight more accurately in person than over the phone, but that all self-reports generally missed the mark.

Weight, Height, and Reality

Women tended to underreport their weight, the study shows. Men didn't do that, but men aged 20-44 tended to overestimate their height more than women, especially in telephone interviews.

After age 44, men and women overestimated height to a similar extent. Height often dips with age. Middle-aged or older adults who haven't measured their height lately may mistakenly think they're still as tall as in their youth, the researchers note.

Such errors stack the deck in favor of a lighter BMI (body mass index). BMI is calculated based on height and weight. A BMI of more than 25 but less than 30 is considered overweight, while a BMI of 30 or higher is considered obese.

There are other ways to calculate size and shape, such as comparing waist size to hip size. But researchers often use BMI to track obesity.

If height and weight aren't right, neither are BMI and obesity statistics. It's like looking in a circus mirror that makes us look taller and leaner than we really are.

Where Obesity Lives

Ezzati and colleagues identified the states (and Washington, D.C.) where obesity was most common in 2000, based on the new calculations. Here are those findings, along with the percentage of obese men or women in those areas.

Highest prevalence of obese men:

• Texas (31%)
• Mississippi (30%)

Highest prevalence of obese women:

• Alabama (37%)
• Washington, D.C. (37%)
• Louisiana (37%)
• Mississippi (37%)
• Texas (37%)
• South Carolina (36%)

Lowest prevalence of obese men:

• Colorado (18%)
• Washington, D.C. (21%)
• Montana (21%)

Lowest prevalence of obese women:

• Montana (16%)
• Colorado (24%)
• Massachusetts (27%)"

http://www.webmd.com/content/article/121/114381.htm

Joseph's Lavash Square Flax Seed Low Carb

Since I've been eating "real food" - I've re-discovered roll-up sandwiches on lavash bread.  Oh These Are Good, Joseph's Lavash Flax Seed is SO good, and good nutrition.  Definitely pouch-worthy, and they don't make me feel any discomfort, at all.   I found these at my local grocery store, and they're actually local to Massachusetts, so I don't know how far they ship, but you must try them.  From the Peapod description:  "Square breads. Excellent source of ALA omega-3! Super soft! Great taste. May help protect your heart while loosing weight. Reduced carb. No cholesterol. High protein. Contains flax. Joseph's provides you with a healthy, reduced carb, high protein Lavash bread, now containing flax! These Lavash have no cholesterol and contain three healthy ingredients, flax, oat bran and whole wheat which may help protect your heart, while losing weight.   Used in a roll-up sandwich or as a sliced party snack, this bread will not fall apart. Simply spread the dressing across 1/2 of the Lavash, layer with your favorite deli meats and lettuce, and roll. Secure with a toothpick if desired. "

Nutrition Facts
Serving Size 0.5
Servings Per Container 8
Amount Per Serving
Calories 50		Calories from Fat 15
		% Daily Value*
Total Fat 2g		3%
Saturated Fat 0g		0%
Cholesterol 0mg		0%
Sodium 260mg		11%
Potassium 0		0%
Total Carbohydrate 7g		2%
Dietary Fiber 3g		14
Sugars 0g
Other Carbohydrate 0%
Protein 5g
Vitamin A 0%		Vitamin C 0%
Calcium 0%		Iron 4%
Percent daily value reflects "as packaged" food.
Product is marked with a Kosher symbol.
* Percent daily values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:
	Calories:	2,000	2,500
Total Fat	Less than	65g	80g
Sat Fat	Less than	20g	25g
Cholesterol	Less than	300mg	300mg
Sodium	Less than	2,400mg	2,400mg
Total Carbohydrate		300g	375g
Dietary Fiber		25g	30g
Calories per gram:
Fat 9	Carbohydrate 4		Protein 4

INGREDIENTS:  Water, Wheat Gluten Corn Starch, Flax Oat Fiber, Whole Wheat Flour, Oat Bran, Isolated Soy Protein, Soy Flour, Soy Oil, Sesame Flour, Salt, Sodium Acid Pyrophosphate, Dextrose, Sodium Bicarbonate, Calcium Propionate (a Preservative), Fumaric Acid, Potassium Sorbate, Monodiglycerides, Sucralose, Sodium Metabisulfite.

Manufacturer:   Joseph's Middle East Bakery, Inc.
Address:   30 International Way Lawrence, MA 01843

WEIGHT LOSS SURGERY: A MAGIC BULLET?

This is an older article from a psychotherapist who dealt with folks with disordered eating.

WEIGHT LOSS SURGERY: A MAGIC BULLET?
A REALISTIC LOOK AT THE MEDICAL AND PSYCHOLOGICAL RISKS

Sharon K. Farber, PhD

"As a psychotherapist who specializes in treating people with eating problems, I have known for a long time that binge eating and compulsive eating are the most common eating disorders around and play a major part in the development of obesity. I do individual and group therapy for people with these problems and find often that what they really want is some kind of magic. Of course, no one will say so openly, or if they do, it is in the form of a joke. But underlying the hope and expectation they bring to meeting with me is the very human and understandable wish for magic, even in the most intelligent and sophisticated people. Sometimes I wish I had a magic wand that I could wave to alleviate their pain. But of course, I don’t have that kind of power and neither does anyone else. And now that I have am doing pre-surgical consultations for people considering bariatric or weight loss surgery, I am still hearing the expectation of magic. There isn’t any magic. What I have and what the bariatric surgeons have are tools for helping people who eat far too much to modulate their eating. These tools are not magic. The weight loss industry has always profited from people’s desperation to lose weight. When Weight Loss Surgery is presented as the only viable solution for obesity, as is so often the case, this preys upon the sense of desperation that so many obese people have. As bariatric surgery, the highest paying general surgical procedure there is, has become part of that industry and surges in popularity, with even obese teenagers having the surgery, the Journal of the American Medical association (JAMA April 2003) has raised very serious and scientific questions about the effectiveness of weight loss surgery, about the safety of the procedures, and has raised ethical questions about the way the surgery is promoted in the media. With such aggressive promoting of these surgeries, it is easy for someone who is feeling desperate to remain in the dark regarding the serious medical and psychological risks to these surgeries.

What are the medical risks? Of those who have gastric bypass surgery, over one-third develop gallstones and ten to twenty percent will require a second surgery to repair a complication, most commonly a hernia. Other complications are the staples pulling loose, so there is no longer a pouch or the opening from the pouch to the stomach becoming stretched. It is also possible for a leak to occur from the stomach into the abdominal cavity, which will result in peritonitis, a serious infection. It is also possible for the plastic band to begin to wear through the stomach wall. Some may have persistent problems with vomiting, especially if trying to eat more than the pouch can hold. This can also cause the pouch to stretch, thus eliminating any benefit from the surgery. European research notes that complications of laparoscopic stomach stapling include abscess, leaks, fistulas, and pulmonary complications. There is a small risk of death from the surgery. The European research found that the complications of laparoscopic gastric banding include an inability to eat (food intolerance), wound infections, band slippage, and pouch enlargement. Second operations may be necessary in 13 out of 100 operations. About 1 in 200 (0.5%) people die from the surgery.

The AMA advised surgeons to tell patients that weight loss surgery is 'investigational' and that it is not known whether these procedures will help the patient. The JAMA article acknowledged that the short term results of weight loss surgery were impressive, showing large weight losses as well as improvement of disorders like diabetes type II. But it also stated that the long term consequences remain uncertain, such as whether weight loss is maintained and what the long-term effects of altering nutrient absorption are. The available data indicate that the outcome of bariatric surgery, although usually good in the short term, is variable and weight regain sometimes occurs at 2 years after surgery. A 1998 literature review found that on average, most patients lose 60% of excess weight after gastric bypass and 40% after vertical banded gastroplasty, but that weight regain occurs at 18 months to 2 years after surgery in about 30% of patients.

What are the psychological risks? Binge eaters or compulsive overeaters eat in an addictive-like way for emotional reasons, to distract themselves from anxiety, to push angry feelings down, or to anesthetize themselves to depression. Just as many compulsive eaters can defeat diets, the nature of their eating disorder can defeat the purpose of the surgery. Binge eating serves a powerful psychological function for those who do it, and the need for it will not disappear once surgery is performed. How many people do you know who can lose a good deal of weight, but cannot maintain their weight loss? That is because they become quite anxious or depressed when they cannot use their overeating or binge eating to keep those feelings at bay. It is much like the way alcohol functions for the alcoholic, and drugs for the addict. Even if they regain the weight they have lost, or “blow out” ” their staples or stretch out their bands, this is the price they will pay in order not to experience those disturbing feelings. Weight Loss Surgery makes it more difficult to eat large quantities in this way, but it does not make it impossible and it does not make the compulsion to eat disappear. This is why many will regain much of the weight they may have lost initially. A study of psychosocial adjustment to the initial weight loss found it to be generally encouraging over the short term, but there are reports of poor adjustment after weight loss, including alcohol abuse and even suicide. For some compulsive eaters, bariatric surgery does feel like magic. It is a tool that helps them to eat less, feel satisfied with less, and lose weight and maintain the loss. When put to the test, they discover that they have more ability to withstand the impulse to binge than they ever thought, and this itself boosts their self-esteem, improves their health, and empowers them. They are the fortunate ones. The key question here is how can you know in advance how you will respond psychologically to bariatric surgery? Unfortunately, with presurgical psychological screening, we can have a general sense of who is more likely to do better and who might do poorly, but we cannot predict this with any certainty. Certainly someone with a history of severe depression, anxiety, or psychosis, or addiction to alcohol or drugs is an especially poor candidate. The best you can do is to make yourself as knowledgeable as possible and not allow yourself to rely on magical thinking. This website and www.Obesityhelp.com are good sources of information to start with. Ask the surgeon to connect you with patients who are willing to share their experience, both positive and negative, and look for such accounts on the Internet. I think that all patients considering bariatric surgery should seek an independent (not affiliated with the surgeon or hospital) pre-surgical consultation with an experienced psychiatrist, clinical psychologist, or clinical social worker who is a good diagnostician and has had extensive clinical experience in evaluating and treating patients with binge eating or compulsive eating disorder. Patients should be apprised of the psychological risks involved. Traditional psychotherapy has not had a good track record with compulsive eaters, but I have found that an approach that combines helping them to develop a tolerance for feeling difficult emotions with the use of certain behavioral tools can be enormously effective, and a safer alternative to bariatric surgery. Some patients who choose the surgery may do well with the weekly or monthly post-operative support groups offered at some medical centers, but many will need psychotherapy to help them deal with the psychological consequences of their surgery."

Ugh.

I went this morning for a B-12 shot and also picked up my bloodwork results.  While I am trying to decipher them, here's the stats, if you're knowledgeable of these things:

• Ferritin <5 (verrrrry low)
• Vitamin B-12 191 (slightly low)
• BUN/Creatinine Ratio 30 (high)
• Iron Binding Capacity 543 (high)
• Reticulocyte Count 2.2 (high)

I brought the paperwork to the midwives office, and I asked to chat with the MW on duty.  She concurred that I should see a perinatologist next, and they've got one that oversees the practice.  I have an appointment with a regular OB/GYN that also works with the midwives next week, so I don't know when I'll see a perinatologist?  Perhaps if this OB thinks I need to?  I did tell her that I don't want to have too many proverbial "hands in the pot," because I'd like to know what's going on with me, and just see one set of doctors if possible.  The MW said that any care I get from this point will be centralized out of their offices, but I will remain a patient of the MW's and my files remain with them, even if I recieve more medical intervention.  This is frustrating.  I just wonder if this can effect the fetus - or - if I'm going to get sick - or is it not a big deal at all?  Anyone out there go through this - what was your treatment, was there any?  Did you just, uhh, ignore it and hope you didn't pass out?!

In other news, I think I'm getting strep.  I've got swollen glands, and a nasty throat-ache. I can't miss work for something as simple as strep.  I need to save it for getting me some blood products later on, if need be.   

No wonder I'm a sleepy girl.

The hematologist called with my blood testing results today.  My iron levels have dropped, and are now quite low,  now less than 5.

Anemia

The Hct in women who are not pregnant is normally 38 to 45%, but in pregnant women, normal values can be much lower (eg, 34% in a single and 30% in a multiple pregnancy), even when stores of iron, folic acid, and vitamin B₁₂ are adequate. This lower range represents the physiologic hydremia of pregnancy and does not indicate a decrease in O₂-carrying capacity or true anemia. Normally, a pregnant patient has erythroid hyperplasia of the marrow and a measurable increase in red cell mass; a disproportionate rise in plasma volume results in hydremia. Unless excessive blood loss occurs at delivery, the Hct generally rises in the immediate postpartum period. Absence of the dilutional effect in late pregnancy suggests inadequate blood volume expansion, which has been associated with growth retardation, pregnancy-induced hypertension, and fetal death.

Anemia during pregnancy is defined as an Hb level of < 10 g/dL. However, any patient with an Hb level < 11 to 11.5 g/dL at onset of pregnancy must be treated as anemic, because the hemodilution that occurs during pregnancy reduces the Hb level to the anemic range. Anemia occurs in as many as 80% of some gravid populations.

Iron deficiency is responsible for 95% of cases of anemia during pregnancy. The deficiency is usually due to inadequate dietary intake (especially in teenage girls), to a previous pregnancy, or to the normal loss of iron in blood with menses (which approximates the amount normally ingested each month, so that iron stores are never built up).

Whether routine supplemental iron therapy is necessary during pregnancy is controversial. Nonetheless, supplemental iron (ferrous sulfate 325 to 650 mg/day) is usually recommended for most pregnant women, even if the Hb level is normal at the beginning of the pregnancy. This prophylactic measure prevents depletion of iron stores and the anemia that may result from abnormal bleeding or a subsequent pregnancy. Unless normal dietary intake is supplemented during pregnancy, pregnant women at term have deficits in iron stores.

Diagnostic indexes for iron-deficiency anemia include an Hct of <= 33%, an MCV of < 79 µm³ (fL), or a serum iron level of < 60 µg/dL (< 11 µmol/L). Characteristic hypochromic microcytic RBCs are found in the peripheral blood smear. The diagnosis can be confirmed by RBC indices and by serum iron and iron-binding-capacity measurements.

Pregnant patients with iron deficiency can be successfully treated with one 325-mg ferrous sulfate tablet taken at midmorning and a multivitamin (pregnancy formula with folic acid) taken with citrus juice at bedtime. Higher, more frequent doses increase GI adverse effects, especially constipation, and one dose blocks absorption of the next dose, thereby reducing total intake. About 20% of pregnant women do not ingest or absorb adequate iron; rarely, parenteral therapy is required. In these cases, iron dextran is given IM in divided doses every other day for a total of >= 1000 mg over 3 wk. Prompt response, indicated by an elevation in the reticulocyte count, is usually apparent. If the anemia does not respond to therapy for iron deficiency, folic acid deficiency should be suspected.

Because iron is preferentially transported across the placenta, the neonatal Hct is generally normal despite maternal anemia, but total iron stores in these newborns are usually reduced, indicating a need for early dietary iron supplementation.

Folate deficiency with severe anemia, megaloblastic marrow changes, and glossitis is relatively uncommon, but laboratory evidence of folic acid deficiency is found in 0.5 to 1.5% of pregnant women. The earliest evidence of it is the presence of macrocytes in peripheral blood. The diagnosis is confirmed by low serum or erythrocyte folate levels. Folic acid deficiency has been implicated in the fetal alcohol syndrome and in the fetal hydantoin syndrome, which is associated with phenytoin-based anticonvulsant therapy. Folate deficiency increases the risk of spina bifida. Daily prophylaxis with folic acid 0.8 mg is recommended for all pregnant women. Patients who have had a fetus with spina bifida should take 4.0 mg/day, starting before conception.

For megaloblastic anemia due to folic acid deficiency, treatment is folic acid 1 mg bid. Severe megaloblastic anemia may require hospitalization for bone marrow examination and further treatment. Anemias can be severe enough (Hb <= 6 g/dL) to require transfusion.

Refractory iron-deficiency anemia or megaloblastic anemia warrants consultation with a hematologist for definitive treatment. "Shotgun" vitamin therapy (with multiple vitamins) or administration of iron by injection is occasionally needed.

She's chatted with a high-risk OB to discuss the iron IV infusions, and the risks thereof to see if it's something I do need.  It's classified as a Class-C medication in pregnancy.

"Pregnancy Category C: Iron dextran has been shown to be teratogenic and embryocidal in mice, rats, rabbits, dogs, and monkeys when given in doses of about 3 times the maximum human dose.

No consistent adverse fetal effects were observed in mice, rats, rabbits, dogs and monkeys at doses of 50 mg iron/kg or less. Fetal and maternal toxicity has been reported in monkeys at a total intravenous dose of 90 mg iron/kg over a 14 day period. Similar effects were observed in mice and rats on administration of a single dose of 125 mg iron/kg. Fetal abnormalities in rats and dogs were observed at doses of 250 mg iron/kg and higher. The animals used in these tests were not iron deficient. There are no adequate and well-controlled studies in pregnant women. INFeD should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus."

Lovely.

Injectable iron dextran...Adverse reactions may occur with the used of injectable iron dextran. Immediate reactions include headache, dyspnea, flushing, nausea and vomiting, fever, hypotension, seizures, urticaria, anaphylaxis and chest, abdominal or back pain. A small test dose (0.5 mL) should be given to the patient first to determine whether an anaphylactic reaction will occur. If the patient tolerates the test dose, the full-dosage infusion may then be given at a rate of 50 mg per minute, up to a total daily dosage of 100 mg.

Oh, what fun we're in for now.

 

My B-12 levels are slightly low, just enough to get me a ticket to a weekly shot of B-12, which can only help. 

4 Months Preggo

Sixteen weeks today.   I don't have an ultrasound scheduled until June, so we won't be finding out the gender of the bean yet.  The little one has been poking my belly and calling it "Baby Sophia."  Oh boy, I mean, oh girl.  Maybe she's messing with me, she can do that, even at four years old.  She does have nice taste in names, though, Sophia is a sweet name, even if it is on the Top 100 list of baby names that I try to avoid.

Some info about this stage:

Mom:

You may begin to feel the baby move around this point. This is more likely to happen now if you are a multipara (someone who has had a previous child) or if you are very thin. Generally you will feel the baby move about one month earlier than you did in a previous pregnancy, mainly because you know what you are feeling. It is not uncommon for first time mothers to not recognize fetal movements until 22-24 weeks. These first movements are called "quickening." They can also be used in helping to determine your due date.

Baby:

Your baby's nails are well formed, and some babies are even in need of having their nails trimmed at birth. The ears have also moved from the neck to the head.  Your baby is emptying his or her bladder every 40-45 minutes. The limb movements are becoming more coordinated. Your baby is about 3 ounces (85 grams) and 6.3 inches (16 cms). The gender may be detectable by ultrasound.

Post-Op Product: Cuisinart DLC-1 21-Ounce Mini-Prep Food Processor

What is a necessity after weight-loss surgery?  A chopper.  While I haven't had to use one to chop up my food in a long time, someone just newly post op could really benefit from one of these devices.  This stainless steel version is the one I have, and it is perfectly small and powerful. 

"The Mini-Prep Processor, is the perfect kitchen helper for your small food preparation tasks. This compact processor occupies minimum counter space yet offers major advantages: more power than other choppers, 2-speed operation, large 21-ounce capacity and several colors to choose from. It includes a powerful chopper/grinder, a 21-oz. work bowl, 2 speeds for precision processing, a patented reversible blade, stainless steel blade with sharp and blunt edges, a spatula and an instruction/recipe book. To clean, the machine has removable dishwasher-safe parts and is backed by a limited 18-month warranty. "

Secrets discovered for fart free beans!

Two strains of bacteria are the key to making beans flatulence-free, Venezuelan researchers reported on Tuesday. They identified two bacteria, Lactobacillus casei and Lactobacillus plantarum, which can be added to beans so they cause minimal distress to those who eat them, and to those around the bean-lovers, Marisela Granito of Simon Bolivar University in Caracas, Venezuela and colleagues reported.

Flatulence is gas released by bacteria that live in the large intestine when they break down food. Fermenting makes food more digestible earlier on. Writing in the Journal of the Science of Food and Agriculture, Granito and colleagues found that adding these two gut bacteria to beans before cooking them made them even less likely to cause flatulence. They tested black beans, known scientifically as Phaseolus vulgaris. Legumes, and particularly Phaseolus vulgaris, are an important source of nutrients, especially in developing countries," Granito's team wrote in the report.

"In spite of being part of the staple diets of these populations, their consumption is limited by the flatulence they produce."  Smart cooks know they can ferment beans, and make them less gas-inducing, by cooking them in the liquor from a previous batch. But Granito's team wanted to find out just which bacteria were responsible for this. When the researchers fermented black beans with the two bacteria, they found it decreased the soluble fiber content by more than 60 percent and lowered levels of raffinose, a compound known to cause gas, by 88 percent.

They fed the beans to rats and then analyzed the rats' droppings to ensure that the beans were digested and kept their nutritional value.

When pre-soaked in the L. casei, the beans stayed nutritious and produced few gas-causing compounds, they reported.

"Therefore, the lactic acid bacteria involved in the bean fermentation, which include L. casei as a probiotic, could be used as functional starter cultures in the food industry," the researchers wrote.  "Likewise, the cooking applied after induced fermentation produced an additional diminution of the compounds related to flatulence."

http://www.cnn.com/2006/HEALTH/04/25/health.beans.reut/index.html

Oh, and I'm never eating again.

Last night I made a mistake. I ate White Cheddar Cheez-Its. These little squares of death will not pass my lips, ever again. Why I didn't feel a touch of fullness or uncomfortable while I ate them, I don't know, but a short time after I finished, I thought I might explode. I felt like there was something in my throat, I described it like, "an apple, stuck." It must have been pure overload, because it hurt, for a long time. I tried to go to bed, nope, that wasn't happening. I tried to stand up, let gravity work the pouch, nope. Tried to go the bathroom, nope. Figured maybe I could throw up - and it would pass - nope. It was stuck. Damn crackers, stuck. Like glue. I was miserable for at least two hours from Cheez-Its. OF course while this happened, I remembered that even before WLS, Cheez-Its gave me issues, like reflux and indigestion. This actually hurt enough that I've sworn off of solids, at least for now. I'm going to have liquids for a while, and lay off of any carbohydrates for a bit, like I would normally. I've been eating poorly, which translates to anything I want (hence, Cheez-Its) and it's not working, and I can't gain any more weight beyond actual physical fetus weight at this point, I am not looking forward to having to re-lose any more than I already have to. So, the plan (since I gave myself until 12 weeks to just chill, in case I lost the bean) is (and of course this is limited, too - due to anything medical, phew.) Today, liquids, because I hurt. 

• Breakfast:  Carb Freedom Yogurt Smoothie  140 calories
• AM:  Hot coffee/2 oz low carb "milk"

I'll update this later, got to get a few kids off to school...prenatal app't.....and go to work.

I Vant Your (Type A) Blood.

I had an appointment with a hematologist yesterday.  While the blood work hasn't returned from the lab yet, for the more detailed results, the doctor says I am still anemic.  My red blood cells are "too small" and a bit too low in number.  She initally suggested iron infusion therapy, and then took it back, stating that she hadn't really given it to pregnant patients, and that it did definitively cause birth defects in lab animals.  I know that other folks have had that therapy while pregnant, and some have had bad reactions and anaphalaxis also, so I don't mind forgoing it myself.  She suggested that we control the anemia with blood transfusions as necessary, and we'll know more when the bloodwork is finished.  We chatted about B-12 deficiency, just in case I am already lacking.  The nurse gave me a B-12 injection, just as a precaution, and if my B-12 is low, I'll go back for 4-6 more shots daily, and then weekly.  While checking symptoms, I definitely have many of the "symptoms" of anemia, and a few of low B-12, but it hasn't been very low before, so we'll see. 

Today, I have a prenatal visit with the midwives, and since their office is right near the hematology clinic, I was able to drop off the preliminary bloodwork yesterday for the nurses to peek at before I go in.