Physically, I'm half the woman I used to be, but as a result of my journey with gastric bypass surgery I've gained a lot. I'm Julia, and this blog is about the miles I've traveled in transforming my body, soul, and spirit while shedding more than 160 of the 300-plus pounds I carried before surgery. 

I'll share my personal experiences of restoring my health and changing my lifestyle, and I'll offer spiritual encouragement, social and emotional tools, nutritious recipes, health information, and more.

I've had a few challenges along the way, but through all the struggles I've grown stronger and regained my health and my life. I had my surgery on Easter Monday, 2006, which I call my personal resurrection day. Because of my transformation, I now look forward to many more "miles to go", and I invite you to travel with me on the road to a happier, healthier lifestyle....yes you can...I just did!

overcoming loss

Every time I close the door on reality 

 it comes in through the windows.  

 Jennifer Yane

Believe it or not, after weight loss surgery, we lose more than just weight, we also face feelings of loss over food, security, and the familiar. Emotionally we go through a process of grief.

We need to be aware that these feeling are normal and we need to be prepared and equipped to face them and to work through these emotions to bring closure and healing into our new life.

There are five stages loss or grief that are just a normal part of the process that leads us towards healing.

denial,

anger,

bargaining,

depression,

and acceptance.

The first four (4) follow no prescribed order or length of duration and can be experienced over and over again as we adjust to our new reality.

Then there is the fifth (5). Acceptance. Although all of these feeling are extremely important, to let ourself feel and expereince as the work through the emotions. Acceptance is the most important one on the list in the sense that this final step brings us closure in the healing process. Reality may not always be easy to accept but it is the only key that unlocks the cycle —working through all the emotions and accepting what is true, present, and real. 

Don't be afraid to grieve. It is important to allow yourself time to move through these stages. It is important to take time to grieve, to feel. to experience, to process. But we don't want to live and dwell in these stages long-term. It's important to move forward. Accepting reality. Putting the past behind and embrace the new.

It's when we find ourselves not moving forward or not experiencing and embracing our present, that we need to seek professional counsel to help us move forward.

Yes, you can. You have many more miles to go!

a trick or treat?

Making a habit of eating sugary treats can plays tricks on you.

They can set you up for sugar addition.

You could easily end up with the same food cravings that got you into the weight battle in the first place.

The longer you go without sugar, the less you will crave it. Eating processed sugar makes you crave more. I have found that fighting this battle with natural, unprocessed sugars can lower the risk of addiction and satisfy your sweet tooth. One of my favorite substitutes for milk chocolate is high cocoa dark chocolate, 70% or higher.* Foods such as apples, prunes, pears, and even raw honey. Eaten after a meal or with cheese or proteins such as ham, pork or cold cuts offer a perfect afternoon snack. 

This month I challenge you to find healthy alternatives to processed or sugary treats with foods that are naturally sweet and good to eat. 

My seasonal recipe treat is sweet figs wrapped in bacon - from Kraft.

You need:

  • 2 tablespoons goat cheese
  • 6 ripe figs cut lengthwise in half
  • bacon cut in half

Directions

  • Pre-heat broiler 
  • Spread cheese onto cut sides of figs; wrap with bacon, overlapping ends of bacon under figs. Place figs, cut sides up, in shallow pan.
  • Broil, 6 inches from heat, 8 to 10 min. or until bacon is crisp.
  • Drain on paper towel.

Serves 6

Remember, low sugar, the right "natural" ingredients and small portions are among of the "tricks" to success!

*(please read food labels, less than 10 grams of sugar per portion size - note that a portion is different than a serving. A serving is the standard serving amount noted on the label, but a portion is the amount you choose to eat, and should be determined by the amounts within the limits for bariatric patients to prevent dumping.)  

its a pill

Do you ever wonder if you have taken your vitamins or prescription medication for the day? Remembering to take pills, can be "a pill" —meaning it can be annoying, unpleasant or just simply hard to remember.  

Missing a medication once in a while may not seem like a big deal, but the accumulation of missed dosages adds up over time. No matter how organized we are, we can still forget to take them on occasion. So with that said, the more organized we can become with establishing a habit of "pill taking" especially of important medications and vitamins, the more likely we are not to forget them.

I'm an organizer by nature, but there are still times that I get distracted from my routine. I find that having a pill organizer is the best solution for me. I have 4 to 6 pill containers, which I fill all at once on a monthly bases. Filling several cases at a time, is a lot more convenient that having to do it every week. The convenience of having this done ahead, helps ensure that I don't get lazy or procrastinate and skip doses.

Place the pill organizer in a place that you will see it often. Maybe on your night stand, beside the bathroom sink, or in a kitchen cabinet where you keep your morning coffee cup.

Pill organizers come in all shapes and sizes, so it's easy to find one that fits your needs. These organizers are available at most big box stores, pharmacies, and you can also search for a huge selection online.

I place all my "pills" for the day together in one organizer section marked for that day. Each morning I remove the pills and after taking my morning dosages, I place the night time ones back in the box where I will remember to take them at bedtime. The other ones, I place in a separate, small, round pill container, which is more portable for traveling during the day. When I'm at home, I can place them in a place where I will see them often throughout the day.

I prefer to take the rest a few at a time throughout the day because if I take too many at one time, my tummy doesn't feel so good. Sometimes when taking pills with just a bite of a cracker or an apple slice will soften the blow to a empty stomach.

For pills that have to be taken with food or certain times of the day, setting an alert or reminder on your phone might be a good idea.

Even if you have to be creative, taking your medication or vitamins is more than just a good idea, its an important thing to remember for our overall health, especially after weight loss surgery, which limits the absorption of certain vitamins.

Once you establish a habit of taking pills at the same time everyday, and making the process as organized and convenient as possible, it's not such a "pill" after all.

Yes, we can. We have many more miles to go!   

For more ideas on taking pills, do a search in the Miles to Go sidebar on the left.

october local support group meeting

Miles Support Group Meeting

Tuesday, October2, 2018

2018

6:30 pm

NHRMC Orthopedic Hospital

(formerly Cape Fear Hospital)

3rdFloor Education Room North

Topic / Guest Speaker: Jamie Swanson, with Pampered Chef, will share recipes and products that can assist you in preparing proteins/meats, and even your own natural frozen treats!

Posted on Monday, October 1, 2018 at 10:00AM by Registered CommenterJulia Holloman in , | Comments Off

crucial information for hypoglycemia after gastric bypass

Three years after gastric bypass surgery, things were going well for me. I was maintaining my 160 pound weight loss and training for a half marathon. But then it all came to a screeching halt when my blood sugar started plummeting without warning. 

The next several years were a nightmare. Trying to find a solution sent me to four doctors and several nutritionist seeking answers to an seemingly incurable problem. No matter how "on track" my diet was, there was no rhyme or reason to my low insulin levels.

According to articles written in Haelio, (written by Dawn Belt Davis, MD, PhD) Postprandial hypoglycemia is one of the long-term risk of RNY gastric bypass surgery. The prevalence still remains unknown, however, Haelio endocrinology reports that as more and more people have RNY for obesity, endocrinologist will undoubtedly be seeing more patients with hypoglycemia. They report that:

"Hypoglycemia typically does not present until 2 to 3 years after gastric bypass surgery. These hypoglycemic episodes are characterized by low blood sugars that occur 2 to 3 hours after a meal. Fasting hypoglycemia is typically not seen. The etiology seems to be excessive insulin secretion in response to the meal. It is well documented that patients are more insulin sensitive after gastric bypass surgery, but the pathophysiology of these specific patients who develop hypoglycemia remains unclear. It is hypothesized that it may be related to elevations in the incretin hormones glucagon-like peptide 1 and gastric inhibitory polypeptide, and their ability to stimulate additional insulin secretion. It has also been debated whether increased beta-cell mass may lead to excessive insulin secretion." 

The effect on the lives of patients can be devastating and severe. Without information and education about hypoglyemia, patients can become trapped in a vicious cycle of high and low insulin levels. Symptoms can develop rapidly and seemingly without cause or warning. Some patients can have loss of consciousness and experience seizures, which may result in motor vehicle accidents. Many patients go undiagnosed for extended periods of time, as there is limited awareness of this disorder in the medical community and the initial episodes are often mild with subtle symptoms. 

This is exactly what happened to me. For six years I fought the battle of hypoglycemia with no control over my blood sugar levels. Until I was properly diagnosed, doctors who inquired about my insulin levels said I was just fine. 

But I wasn't fine. I was very, very sick.

Finally, I was referred to an endocrinology who diagnosed me with severe case of Reactive hypoglycemia (also known as post-surgical or postprandial hypoglycemia). 

First I discovered that even though my thyroid numbers were almost normal, I had suspected for years that I had a thyroid issue. I found that going on thyroid medication help improve my hypoglycemia. Afterwards I was placed on a prescription medication, Arcobose, to help with carbohydrate absorption. I found some relief, but I was still very sick. My life was ruled by unpredictable rises and falls in blood sugar levels. I was unable to exercise or control my weight. 

In June of 2014, I made an appointment to see Dr. Walter Pories. Dr. Pories is a re-nowned surgeon in the field of bariatrics and is currently doing research and trials on the cause and cure of post-surgical hypoglycemia. After listening to my story, he explained the "medical and scientific" reasons behind my problem and offered a solution.

He suggested that I replace my vitamin routine with 2 Silver Centrum for Women. That's all. Just 2 multi-vitamins (with iron) everyday. No supplemental calcium or vitamin B12. I was shocked that this solution could be that simple. We are told that calcium and B12 are a must after RNY. I'm not suggesting you go off calcium and vitamins without checking with your doctor, but if you are having low blood sugar issues, and under a doctors care, you might want to try it. It seemed like such a "crazy" thing to do, it took me a few weeks to stop taking my calcium.

He suggested that it might take up to a year to see any results. However, I began to see result in just a few weeks. After seven months my blood sugar was significantly stabilized and was able to eat a healthy and normal diet and discontinue my Acarbose. My leg cramps dissipated greatly. I was able to add Vitamin D back into my routine several months later for joint pain. It did take a year to see significant results, and several years to find better control of my blood sugar levels. But I did it!

If you are suffering from post surgical hypoglycemia, there is a solution.

First-line treatment is education. I suggest that you should document your daily diet routine and discover what things set off your hypoglycemic episodes. Keep detail records of what you eat, amounts, and what times you eat. Also record amounts of food intake and avoid high-glycemic-index carbohydrates and limited portions of any slowly digested carbohydrates.

Along with making sure that I eat protein first and low carbohydrate meals, I have eliminated most wheat products from my diet altogether. I have also eliminated refined sugars and added raw honey to my diet. In small amount, honey is digested slower than refined sugars and can help eliminate drops in blood sugar levels and give you a safe energy supplement. (a teaspoon or less).

I eat several small meals a day. If I am active, I don't go longer than 3 hours without eating a protein snack. Always eat any carbohydrate food with protein. I also totally avoid foods that leave the stomach faster than normal—soft foods such as yogurt, protein shakes and other predigested or liquid calories, including ice cream, milk, jello, or high calorie drinks, or fruit juices etc.) Remember if you are suffering from postprandial hypoglycemia you are probably 2 to 3 years out from surgery - past the weight loss phase and should no longer be eating these foods anyway.) Any sugar that leaves your stomach is undigested and dumped straight into your intestines—which will cause hypoglycemia and dumping. 

I also avoid strenuous exercise or lifting, such activities such as mopping floors and lifting heavy groceries can induce an episode. I can walk and do low-impact palates. 

Blood sugar levels are also affected by emotional stress or getting to hot, such as weather or even a shower, spa, or sauna. Extreme hot or cold affects the way your body uses insulin. 

Acarbose (Precose, Bayer Pharmaceuticals) is often successful in patients with relatively mild disease to reduce carbohydrate absorption. However, even though it helped me for awhile, the side effects were unpleasant and affected my social life. I am thankful that I could eliminate it after a few years.

In severe patients who do not respond to these initial therapies, the addition of medications to antagonize insulin activity or minimize insulin secretion can be helpful. Calcium-channel blockers, octreotide or diazoxide are other options that can be tried. In the most severe patients, partial pancreatectomy has been performed; unfortunately, it has not been successful at reversing the hypoglycemic episode and it is unknown if reversal of the gastric bypass is a successful strategy.

Having personally experienced postprandial hypoglycemia, I recommend that you see your endocrinologist (preferably one who has experience in working with gastric bypass patients or at the very least proactive in helping you find a solution that works for you. 

I highly recommended that you get regular follow-ups including blood work, as well as consult with your primary care doctor or surgeon before changing your vitamin routine, or before discontinuing any prescription medication, vitamins or calcium supplements. I also have my bone density monitored. It is crucial to continue monitoring your overall health and be proactive in finding a solution that works for you. There is hope if you are willing to find it. 

Yes, you can. You have many more miles to go!

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