Dances with DS

There are many very positive reasons to consider a Duodenal Switch surgery  and I have spoken at length about them before. So in this blog I am going to focus purely on the weight loss aspect of choosing a DS.   It’s not the B and end all of choosing a surgery, but imo it is a very important player.

I’ve often heard patients with other surgery types say to me that they only wished they’d known about the DS as they’d have definitely opted for it. When I ask them why they’d have chosen it,  it is interesting that I’ve never heard anyone say ‘ because it would have helped me be healthier’. The answer without exception, is that they feel they’d have lost more weight with it.

I’ve given the same answer at times when I have been asked why I chose my DS.

People generally understand it much better than ‘I wanted to preserve my pylorus, keep my digestive system vagally intact and capitalise on the metabolic factors it offers ‘, for example.

At the end of the day weight loss matters… it’s just as simple as that.

It’s at last becoming more common knowledge that the BPD/DS has the best percentage of excess weight loss of all surgery types.  What data we have consistently shows this over the past years.

The link below also looks at some quite recent research that shows it has an excellent percentage of body fat loss over the other surgeries too (and that’s what we want to lose, not muscle!):

http://www.weightlosstriumph.com/weight-loss-surgery-comparison-gastric-bybass-duodenal-switch-gastric-band-sleeve-gastrectomy.html

The duodenal switch has traditionally been thought of  as the optimal surgery for those who have higher BMI’s.  It’s something that I have read of over the years - the DS is for those with BMI’s that are greater than 45.  And I agree.

But I don’t agree that it might not also be an excellent  surgery for those in the 35 with co-morbs - 40 BMI range. I was over BMI 45 and nonetheless regarded as a DS lighterweight - but had I been BMI 35 with co-morbs I would still have fought tooth & nail to get my DS.

Why would I say this when it is clearly a major surgery?

• Because I have observed over the years that for lighterweights there seems to be a  much better chance of losing beyond the frequently quoted excess weight loss percentages.

• Co-morbs such as high blood cholesterol and diabetes have the best track record of resolve with the DS .

Those that are involved with WLS might sometimes see super morbidly obese people as being in a worse off situation than those of us who are morbidly obese. This appears to sometimes justify reserving the DS for higher BMI’s only.

However - being at any stage of obesity is a very subjective thing and we do appear to have different ways of coping with wherever we are at on the scale.  I don’t think we can quantify mental and emotional suffering. Even trying to quantify physical suffering is extremely difficult.  I have friends who remain very large - much larger than I was. And they elect NOT to have surgery at all.  When I look at them  they appear to be coping and in much better health than I was, even though my obesity was not as developed as theirs. It’s very personal and very individual.

When it comes to deciding if someone is viable for a DS  I don’t think it is right to just throw a generalized BMI blanket over it.  To my mind this is very linear thinking. It still happens, although it seems to be getting marginally better in the UK.  Some surgeons appear to refuse to give those below 40BMI even with co-morbs any consideration. Even getting it at 40BMI can be quite difficult for those who are determined and who, on the face of it, do seem to be very good candidates for a DS.

That said I do think we need to draw a rational line under it and my feeling is that  the cut off point of 35BMI with co-morbs is sensible.

It’s vital to take into account what co-morbs someone may have and if the DS could have an effective impact on them over and above other surgery types,  how they are coping emotionally, mentally and socially, whether they have a mature sense of realism about the surgery, whether they have a strong knowledge about the DS upfront, whether they personally feel they will cope with it’s nutritional demands,  and  how they intend to do this.

This is the truly important stuff.

To any Dser considering the surgery, lighterweight or not - I suggest strongly that you research and understand as much as you can about it. Search your own soul about it too, be honest about the possible hurdles you as an individual might face due to your own personal issues. This way you’ll give yourself more ability to change whatever it might be that needs changing for the future.

Another reason very frequently  given to lighterweights struggling to get a DS,  is that they risk ‘overshooting’ and ending up losing too much weight.

Perhaps giving people with BMI 35 with co-morbs to 40 BMI longer common channels might help prevent overshooting. There is also the possibility of  leaving the stomach a little larger,  but these are discussions for one’s surgeon.

As a pre-op I thought long and hard about the fact that I might overshoot into anorexic thinness and struggle to maintain a healthy weight.  It seemed very unlikely to me. I felt I had much more chance of being left overweight as my obesity felt deeply entrenched and almost immoveable to me.  Just prior to my surgery I had lived through a last ditch attempt to diet. I tried the Atkins diet which was harsh, and during which I lost almost nothing. It was as if my system had finally packed up and turned to stone. I saw a brilliant endo at the time who said it was likely my syndrome X was part of the reason the diet had not worked.  I mentioned WLS and to my surprise he told me in my shoes he would consider it. I still consider him an evolved soul, way ahead of his time!

In those days coming in just above 45 BMI was probably the equivalent of trying to get the DS at BMI 39 today. Surgeons seemed happier doing it at 50BMI plus.   Of course I hoped my body would just slot into a good healthy weight and be done with it but I also had to play out possible scenario’s in my mind.

Given a choice of the two possibilities:

To potentially struggle with still being overweight?  ( Rebound weight gain is not uncommon - even with the DS.)

Or - to potentially struggle with being underweight? … which could I live with better?

Call me fickle - but if I was not going to hit a perfect BMI - I’d plump for the underweight option everytime.  I’d had a lifetime struggle of ‘overweight’. I was fed up with it.

I thought in the event I lost more rapidly I would control it by adding more carbs and sugars to my diet. That did not look like too much of a hardship to me at the time!  As an obese person used to depriving diets, it had quite a luxurious ring to it - imagine being able to eat all the carbs I liked!

Oh little did I know!

However before I came to the fine line of potentially slipping into excessive skinny-ness, I did have a little taster of what it feels like to have a rebound gain in weight. A few years into my DS,  I had some weight gain. It was not a lot in the greater picture, but I panicked awfully. Each time I weighed myself I had an awful feeling in the pit of my stomach. I lived with anxiety and at times it depressed me.  Luckily for me my regain stabilised and in the following year I began to lose weight again. Just the teeniest amount - here and there. This continued for several years adding up to a pretty substantial overall loss.

I still can’t quite work out why. It might have been that by then I had slotted into an eating pattern that was simple. I had got over my need for a daily small chocolate and lost interest in having it. I ate a diverse range of protein foods and healthy fats, lots of complex carbs and little else. But  it might also just have been that my DS decided it was time to be on the metabolic move again!

The day did come when my weight kept threatening to slip into being overly thin.  And eating carbs was quite a chore - I moaned about it a lot, to my own surprise!   They unsettled my tummy and just tasted so awfully bland.

I’m afraid my carb eating approach did not last long. It was not the pleasurable activity I once imagined it would be.  I became aware that it was going to be BIG effort time again. And effort - is effort. Whether one is working not to gain weight or not to lose weight!

Instead of flour based carbs I turned to simple sugars. I took to sucking boiled sweets throughout the day with my surgeons blessings. 

However after a while I stopped doing it because I felt the sweeties could become very hard to stop at some stage.  I was enjoying them way toooo much, justifiable or not, and my use of them was rapidly accelerating in quite an unconscious way. I had also begun to drink a lot of sugar in my tea -  and I felt it was that or the sweets. Not both.

I think my sugar intake helps me not lose further weight - but I also worry about it from a health point of view.    I have recently been  a bit conflicted about it. I’ve been worrying that I might be playing a potentially dangerous game with my blood sugars. However I had my blood sugars tested last week and was very pleased to hear today that they are entirely normal, so at this point my body is coping with them.

I’m currently 8 stone 7.

Were it not that my DS check ups require getting on the scales, I’d be happy to never see one of those darned things ever again!  Even at my current weight they make me momentarily and involuntarily anxious!

I’ve lost over 100% of my excess weight.

The thing is - I don’t have to be in a constant worry about weight gain.  It has huge psychological implications for those of us who know the full impact of being uncontrollably obese. I have been there both before and after my DS - and I don’t like being there.

I was spot on about things pre-op.  Even though I discovered that trying not to lose weight is as much an effort as trying to lose it and neither are ideal or easy - I definitely prefer to do battle with potentially being underweight than overweight.

I’d love more solid data about just how many DS lighterweights actually do overshoot, but there seems to be almost no data about it. Is it a danger that is over considered perhaps?  I asked a doc who is very informed, what the percentage of the DSers overshooting in her care was.  She said that they very loosely put all the surgery types together and say roughly 10%  will regain, roughly 10% will overshoot. In the series of Hess, standalone DS figures were 3.8% - for both regain and too much weight loss. Again the figures remain lumped together and I’ve not been able to find any definitive figures for DS overshooting alone. Which makes me wonder if it is an insignificant enough figure(unless of course you are personally struggling with it) that it simply doesn’t form much of a priority in research?

Most of the data I have read on the DS  speaks of losing iro 75 % EWL. I have also read data saying EWL is 40%…and various figures in-between.  It doesn’t seem to hold a huge risk for overshooting based on these figures.

I have a hunch we might see more overshooting earlier in the DS - but longerterm?  Do we find we can hold firm in a healthy BMI range?  Do some of the initial overshooters find that with further adaptation of the gut they begin to have some gain in weight?  As you can see, unfortunately as usual I have more questions than answers.

Over the years I have read a few horror stories about uncontrollable overshooting. There have been people who have been through hell with it and have had to resort to revisions to stop the loss.

So, if one is a lighter BMI opting for a DS must be thought through very carefully and discussed with one’s surgeon in the smallest detail. Overshooting  can be quite alarming and I personally have at times found it quite difficult to be teetering on the brink…although I think,( hope) I am stable now.  On the other hand some DSers I know who have overshot say they enjoy the complete freedom to eat loads of food and pretty much what they please, as they work to stabilise their weight loss.

All in all,  I don’t think we should just dismiss out of hand that the DS for lighterweights could be an incredibly optimal surgery.  For the right lighterweight candidates, it could bring not only the health benefits of weight loss but also the chance to lose an optimal and substantial amount of weight.

I think there is something to be said for that.

So at the risk of sticking out my neck - I am saying it!

http://www.ajcn.org/cgi/content/abstract/90/5/1236

http://www.nutraingredients.com/Research/Prebiotic-fibres-may-boost-weight-loss-Study

http://mayoclinproc.highwire.org/content/83/4/460.full

Diving straight in here!

A prebiotic is soluble fibre. It’s the substrata or food for increasing probiotic colonies in the gut.

A probiotic is a  ‘good gut bacteria’ such as acidophillus

As I wrote in my previous blog I made the huge mistake of jumping into the prebiotic arena no holds barred and I suffered a bloat to outdo anything I had experienced before.  I very nearly wrote off the entire idea. In those days inulin was much more available than oligofructose so this was my intro into prebiotic world. Oligofructose is a much more recent addition in my life and something I started with only this year.

With both inulin & oligofructose I very slowly built up my tolerance levels…after my initial bloat episode I stopped taking the inulin for several weeks then slowly began again - this time sprinkling small doses of it on food.

For most people pre & probiotics seem to be beneficial.  For weight loss surgery patients they also appear to provide many benefits, some that are pretty interesting…weight loss, better bowel function, increased absorption of minerals.

A minor drawback, that does not feel so minor when one is farting away,  is  that both prebiotics and probiotics can cause initial bloating and wind.

I have never had this with probiotics but our mileage as always, varies.

Most of the bloating passes relatively quickly as the gut adjusts, but consider lowering the amount you are taking if you have too much discomfort or are not seeing any improvement.  There’s no harm in taking acidophilus for a day, then resting the next day.  Bloating as a side effect can be dose related.  Increase natural food sources of pre & probiotics first perhaps - using things like artichokes, banana’s, yogurt, chicory based drinks (taken cold or warm but not hot) .  There is no rush and my experience has been that taking things easy has still added up to good longerterm effects.

When I first read that prebiotics might increase weight loss, of course my ears perked up! (In the bariatric link below.) However in my case at this point weight loss is not as much a concern as keeping my weight relatively stable. I’m hoping prebiotics are playing a role in this for me.  The greater reason I take them is because they appear to increase calcium absorption. (Albeit in big doses that I don’t do.) Oligofructose has been shown to be helpful in reducing constipation too - and recently I lean more towards this form of prebiotic than the inulin to beat my constipation. ( I currently take it in a higher % than the inulin…a rough ratio of 2:1)  It does seem to be helping me quite significantly in this department which I am very happy about. It does not cause me diahorrea at all - rather in my case it has generally given me back my original DS Mr Whippy texture which I prefer over any other stool consistency. For me this is a ‘normal’  DS stool.

Constipation is not a good thing.  WLS patients should get medical help if it is an ongoing problem despite trying things like increasing fluids and prunes etc. There are some indications that constipation might play a role in diverticulosis - a condition that frankly I fear having nearly lost my mum to the more severe form of it. And let me not even start on how it wrecks the anal tissues!

If you lean more towards diarrhea, you’ll need to think on using prebiotics carefully - perhaps bounce it off your health professional.  With the low dose I take I don’t get diarrhea. Even when I initially took high doses I only experienced bloating - no diarrhea.  Some people report inulin as causing them diarrhea. Whether this stops over longerterm use I don’t know. Or whether it is because megadoses of the stuff is to blame in some way for their discomfort, who knows?  There are many studies strongly suggesting prebiotics might prevent help to prevent diarrhea, IBS and such.  I read an abstract that had people taking 15gm’s of oligofructose with no side effects being reported.

However if I had diarrhea I would first be looking at getting resolve under my GP’s guidance. I’d want to rule out  bacterial overgrowth and correct it using antibiotics followed by  probiotics.  If I was trying prebiotics with a history of diarrhea unrelated to bowel overgrowth, I would only use trace amounts until I was certain it was giving me no side effects.

As it is, I’m very conservative with my use of prebiotics. I have some difficulty with the idea of huge doses of it based on nothing scientific..but rather on my own bodies responses to it.  My body seems comfy with the dose I take currently, although this might change at some time.  When it comes to the use of prebiotics & probiotics my feeling is that we each need to explore and find our own optimal balances.

I also feel through natural sources we’d not get a concentrated dollop of refined inulin-oligofructose consistently. As it is more and more being added to various foods we probably get some in from these sources as well as natural dietary sources.   My max dose is 5 gms and more often it’s below 2.5gms…many would consider this a very minimal amount, but I still feel it benefits me. I very very seldom need flagyl, or acidophilus for that matter, although I sometimes take the odd probiotic boost. I find where the prebiotics soften my stool — probiotics tend to firm it up…but this is just my personal observation about the effects these have on me.

Both oligofructose & inulin look like fine white powders. Inulin is less sweet to my taste. Both add a nice ‘mouthfeel’ to whatever I add them to…just a bit of extra creaminess factor.  Inulin should not be taken hot or very cold as temperatures might affect it’s performance. Oligofructose on the other hand is stable in temperature extremes and is quite often used in commercial baked products where it may replace some fats and sugars. I like the fact that I can add it to my cooking if I please.

Avoid synthetic forms of prebiotics - these cause gastro intestinal discomfort.

When buying acidophilus buy the best you can afford. Look for one with multiple strains of good bugs. I’m not a fan of the ones that sit outside the fridge on supermarket shelves…I don’t think they do the job.

I use Kudo’s acidophilus and I also keep a bottle of Udo’s 5 chewables in my fridge which  I use mostly when my tongue looks gungy  or when I have a sore throat. It’s designed for oral as well as gut health.  It has a bacteria in it called Lactobacillus Salivarius which I don’t want to know more about!!  But it works very well for me on these issues and also has plenty of gut beneficial bacteria.
 POTENTIAL SIDE EFFECTS:

Aside from the relatively common occurrence of temporary bloating there may be rare side effects with prebiotics & probiotics.  I wrote this into my previous post but again: don’t take acidophilius if you are immunocompromised in any way. It may not be safe and could cause serious problems according to some websites I have looked at. As you know the internet can be brilliant at times but it can also contain plenty of conflicting theories. I looked for more solid medical data about the possible dangers and found very little, but that doesn’t mean much in the grand scheme of things. 

This one did say it could be a risk for those on corticosteroids as these suppress immune function:  http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFulltext&ProduktNr=223838&Ausgabe=231832&ArtikelNr=94041

I don’t know if prebiotics could cause problems as well. I did read that someone had a serious allergic response to inulin but it’s probably a rare occurrence. Much more often they have been shown to benefit those with allergies:

 http://jn.nutrition.org/cgi/content/abstract/138/6/1091

I think anyone with an immunocompromised system, an illness of any kind or who is taking medical drugs, is better off getting medical advice about anything they take, be it prebiotic or probiotic or for that matter any alternative type of therapy.

Here is a very interesting comprehensive article that explains possible benefits for bariatric patients way better than I can:

http://bariatrictimes.com/2009/11/17/probiotics-prebiotics-gut-microbiota-and-obesity/

More about Prebiotics:

Explanation & some listed food sources:

http://en.wikipedia.org/wiki/Prebiotic_%28nutrition%29

Increases mineral absorption:

http://www.ajcn.org/cgi/content/abstract/73/2/459S

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On another note - here’s my food intake today:

Breakfast:

8 tablespoons of spinach (leftover from yesterday)

1 tablespoon bacon bits

1 small chopped onion

cooked with 2 fried eggs

and 3 tablespoons cheddar cheese

Lunch:

Cherry compote yogurt

2 slices of leftover roast lamb

handful of mixed nuts

Dinner:

1 tablespoon macaroni cheese

1 and half chicken fillets baked in cheese/bacon sauce

Spinach again - creamed! - half of a ready meal sized punnet. ( My son bought it not realising I had eaten a mound of it this morning!)

a small banana

I’m hoping before 10 pm to drink a big glass of milk - and then it’ll just be water until sometime tomorrow!

Today I decided we could all do with more fish oil in our diets. Pete & myself because I’m thinking we need the anti-inflammatory effects of it to perhaps help us get past this evil flu that seems to linger on for an age.

My dogs get it frequently but the capsules are such a performance - I thought I would buy some in liquid form. Ruby especially needs it right now to help her fully recover from her ordeal and to give her a little more energy. She is steadily improving now and all day long Pete and I take extra special delight in her antics and express our gratitude and relief that we never lost her.

So we went to boots and I bought some Equazen ‘eye q liquid’.   It comes in vanilla and orange flavour…something that does not impress me - wot’s wrong with plain old fish oil as is?   The idea of vanilla fish is enough to turn my stomach so I plumped for the orange.  I took a dose just now and actually it’s not bad at all. No dreaded fishy taste & the orange flavour was a bit like orange peel & not sickly sweet - it leaves a not unpleasant aftertaste that does’nt linger tooo long. Think I can live with this. I find it much easier to take than those great big capsules that have been my usual choice. I don’t like that they don’t explain how they access the fish oils - distillation or not?   I do like that they include evening primrose oil & Vit E  in the mix & no artifical flavours.   It cost £9.99 at Boots.

However - it’s definately imo not suitable for dogs - so I bought some plain cold pressed fish oil off the internet for them which will hopefully arrive before I run out of the last capsules.

Here’s a site about the benefits plus possible side effects and interactions with drugs of Fish oil:

http://www.webmd.com/vitamins-supplements/ingredientmono-993-FISH+OIL.aspx?activeIngredientId=993&activeIngredientName=FISH+OIL

I also decided to monitor my food intake again over the next few days. I’m eating well at the moment.

Breakfast:

M&S pot of readymade oats porridge, added oligofructose, marvel milkpowder plus cinnamon
2 scrambled eggs plus:
bacon bits, mushroom & onion (around 3/4 tablespoons)
grated cheese (around 4 tablespoons)

Snack:
Starbucks hazelnut hot choc (small size)
1 and a half starbucks gingersnaps

Lunch:
Small Bowl of chicken curry and about 2 tablespoons of yellow rice

Snack:
Cherry tomatoes, sliced cucumber, olives, edam cheese

Dinner:
3 medium slices roast lamb
2 roast baby potatoes-skin on
4 tablespoons spinach
3 tablespoons butternut squash
gravy

and one totally stuffed me!

You might notice ‘oligofructose’ in the oats porridge and be wondering what the heck that is and why I eat it? It’s a prebiotic much like inulin which is chicory derived.  Prebiotics are ’soluble fiber’.   I have taken prebiotics for years with my DS…I think I recall writing at times about the importance of soluble fiber in our diets.  I take both oligofructose & inulin because they work in different sites of the colon.  I find them very beneficial for my bowel health - basically in very laymans terms they provide a good environment for the good gut bacteria to flourish.  A paper was  written about them that seemed to indicate they helped people lose weight. I don’t need the loss, but I like to explore all avenues of maintaining my weightloss - and if this helps it’s a further plus. Another benefit is apparently better mineral absorption, calcium among them - this is can only be of benefit to us WLS patients.

If you are thinking it sounds good and you’d like to give it a try, a small word of caution - don’t just jump in and take the recommended dose!  Bloating can be swift and hideously uncomfortable. I have worn that T-shirt!

I think I might have had a ‘die off’ of bad bugs that never helped either so I would never ever in a million years repeat my mistake! If only I had been a bit wiser but in those days I was an intrepid adventurer and my own experiment.   If I could un-live that experience I’d first take acidophilus for a few days & get my bowels in some good nick.  This is not the stuff to park into a bowel overgrowth straight off imo.  If  bowel health is very poor medical attention is needed as step one (and  flagyl or augmentin first perhaps)…followed by plenty of yogurt, more yogurt… and then quality acidophilus…and then a slow intro of prebiotics.  If your bowel health is reasonable, begin with trace amounts. Feel it out. There’s no rush.

Although I now have a good tolerance level,  I still don’t take the full recommended doses because I feel that in nature we’d not get huge concentrated amounts  of the stuff in our food sources. It’s just my opinion but I feel through natural sources it would be trace amounts here and there. I take between 2.5ml -5ml of an oligofructose-inulin mix…but it took me several years to do this.   I felt I saw benefits in the years I took trace amounts (of inulin only)…so I’m personally not convinced that we need the 8-10gms some manufacturers recommend.  I know I have gone on a bit - don’t be put off by what I have written though - it is well worth making a plan to move towards good bowel health with prebiotics and the benefits are worth the initial setup.  I seldom even think about my intake nowadays - it’s taken much how I might take marvel, with little thought. Next time I blog I’ll try to explain it all in better detail.

Just another word of warning - don’t take acidophilius if you are immunocompromised in any way. It may not be safe and could cause serious problems. I don’t know if prebiotics could cause problems as well - but I think anyone with an immunocompromised system is better off getting medical advice about anything they take. 

Back to the above food intake - I’ve not counted up my tea - neither the milk or sugar in it but it’s probably a fair whack of sugar..I seem to keep cycling through this issue lately and I’m getting a bit fed up with myself!  I’ve run out of palm sugar and not replaced it yet so to add injury it’s brown sugar which I know is not kind to my GI responses. Some weeks I control it much better and other weeks it’s not good.  It’s not been a particularly good week on this front…but there have been worse. Still, in my heart I know there must be a point where I really move to reduce this intake whether it is palm or brown sugar.

I reckon I really could have done without the gingersnaps at Starbucks - why I feel moved to buy & eat things when I have a Starbucks I don’t know! :roll:  I’m trying to get more of a grip of late about what is essential in my eating life - and what is just unnecessary extra.

I’m quite pleased with my veggie and protein intakes on the plus side.  Though I think I could aim for less food if required,  as I know I go through phases of ‘plenty’ and then  phases of ‘just enough’ …and tomorrow I might well not eat as much as I did today, I’m not going to change anything at the mo. 

So I relook my previous post on bugs in chicken with new eyes now!

Was it a weird type of premonition of some kind perhaps?  Not quite the same as what was to transpire - but  still in some ways connected.

Yesterday I took my virus laden body ( I am still quite ill with this flu) into the garden as I thought flu or not I could not waste the beautiful sunshine apon us. I had a plant that needed relocating. I noticed that Ruby my bullterrier had already dug me a nice big hole in the flowerbed - alas not in the perfect place.  Then I noticed her chomping on something disgusting.  I pulled a mouldy goodness knows what out of her reluctant mouth. I thought then that it looked like the stuff food poisoning was made of.  I wondered if she had buried it at some time and had dug it out of the hole. A few moments later I retrieved an old white bone from Zenni as well.

I thought nothing further of it.  Later in the afternoon I was again outside with my dogs when I noticed Ruwbs get very excited. She hunts small flying bugs like no other dog I have had - makes me laugh as she always does this with a soft toy in her mouth, as if for security against the flying invaders. A little later I glanced   her way again. I noticed her leg tremoring. I thought her obsession was now getting over the top. I called her over to me and realised something was badly wrong. Her eyes were erratic - they moved from side  to side with no co ordination. Her tremors were increasing by the minute.

No one else was at home. Pete was in Holland. My son Luke at work and my youngest had just gone to the shops. I phoned the vet said I had an emergency and was on my way. I grabbed Ruby and a blanket and rushed to my car. To my distress the battery was absolutely flat. Can you believe it!  I spiralled into an all time panic.  I ran to my lovely neighbours and they got ready to take us to the vet. Just then my youngest arrived and he held Ruby in the back of the car.  By then she was frothing at her mouth and vomiting profusely.

It seemed an age of negotiating traffic and I was beside myself really. I thought it might have been the mank thing she had dug up, but several years ago I lost my beautiful pup, Petal to A Vasorum. It looked similar. Not the same - but it was clearly neurological whatever it was. I thought it impossible that Vasorum could come back to haunt us. We are fastidious about deworming our dogs with the correct drug - every month. We NEVER miss it. It is logged in and we also give the dogs panacur as an additional precaution every 3 months in the vasorum season. As it was spring & the slugs and frogs are coming out - we had in fact just given Ruwbs panacur two weeks ago. I could not believe it. Again for the hundreth time I saw my Petal in her final awful hours only this time I also saw my beautiful Ruby slipping further and further into a catastrophic physical mayhem.

Our vet began work on her immediately. He said he thought it was not likely vasorum - more likely connected to the dug up debris. Her situation was very serious. They began her on a drip & charcoal also valium to try to stop the ever increasing tremors and hyperactive brain activity.  By this time I am afraid I had lost the plot and I was in tears. I rushed outside and threw up.   My nose began to bleed quite profusely into the miserable bargain.  I think I must have looked an awful sight.  My son was concerned but also slightly embarressed by his emotional mother,  but the staff were so kind and understanding.

I left my sweet little bullie in the vets for the night but I could not sleep for thinking about her.  We gave Zenni charcoal just in case but thankfully he seemed fine. Through the long long night I read paper on paper on mycotoxins through the night and only scared myself even more.

Although most dogs do survive many don’t. Some are left with permanent tremors and neuro effects. I thought - even if my bright spark came back to me with brain damage I could face that. I would work with it. I just wanted her alive. It was a terrible night.

This morning the vet called. Good news!  Ruby had been extremely ill through the night but they had seen slow improvement starting around 4 am. She was still ill but out of the woods. She was shaking but the vet felt this was just her usual anxious behaviour - she does this on any visit to the vets.    He felt because of this it would be best to fetch her at midday & settle her into her own routine at home.

I can’t tell you how relieved I was!  

We collected her at midday. She was so excited that I got afraid she might relapse.  She is still not well - very weak. Her back leg still has a worrying kind of semi-paralysis to it. I have been rubbing it gently today to try to bring feeling back into it.  The good thing is that she has no neuro-symptoms and is ravenously hungry. I feed her small bits of bland food every hour or so. We sit on the sofa a lot, her little nose in the crook of my neck. Resting together.  I am breathing her into my very body with relief.

I am soooo exhausted. My rat lab efforts for the DS & WLS  research started today to top it all, and of course yesterday in the crisis I lost all my will to eat anything!  I had to really force myself to kind of resemble a normal eating day for me - it was not easy as I felt very nauseous too. I just am totally crap at dealing with high stress situations.  Still - I am determined to go through with it - flu, doggie crisis - whatever else hits me!  I really want to find out what makes this DS tick.  I am interested in the metabolic possibilities - I have always felt with my DS that it goes further than just the malabsorption.  I duly collected my samples in the am!  Today I have done my best to slot myself back into my usual eating patterns in the interests of science. Although I ate cold chicken for breakfast, something not usual for me!  Then later I had a yogurt. Lunch was a tin of tuna and bean salad. Dinner - chicken curry, beans and a little rice. Not really enough - looking at it now. Later I will eat a banana and some nuts and drink a big milky drink.

Still - let me say despite the exhaustion, I had a wonderful day today. To have my Ruby back in her own home has been fantastic. What is so sweet is that her tail has not stopped wagging.  Pete arrived in the morning quite grey with fear I think, poor man. I had contacted him last night and he too had a dreadful night. It was great to be able to tell him that our girlie had made it!

Never in my wildest dreams would I have thought that a piece of mouldy food could be so incredibly dangerous. I think the fact that it had been dug up might have made it more so than usual as mycotoxins are also found in compost and at the begining of winter I duly composted all the flowerbeds.

I hope with all my heart that this is the last of dog crises in my life FOREVER!

My world could get paranoid - A Vasorum everywhere, even the sight of a slug gives me the heebeejeebs..then thinking about all those yuccky bugs in supermarket chicken & now mycotoxins…

I was in marks & sparks just now & caught myself deliberating about buying a huge bottle of germ killing hand sanitiser, but then I thought a cherry compote yogurt might be a much nicer idea ….here’s to the good bacteria in life!

I almost can’t write about bugs/viruses etc today. I am infested. I have the most ghastly flu. I have been in bed all day - too weak to do very much at all. It’s very frustrating as I have so much I need to do. I have no appetite at all but managed a few protein shooters and glasses of fortified milk.  Anyway I am having a pity party - but it will pass - and soon I hope.

When I can eat which is more often than not  - I love chicken - roast with crispy rosemary potato’s on the side, cut into cubes and stewed till tender in wine & mushroom sauce, stir fried with ginger & lemongrass, chicken in tomato & onion sauce, chicken curries…it’s something I never get tired of eating or cooking.

Then I go and read this….

http://www.telegraph.co.uk/foodanddrink/foodanddrinknews/6265152/Deadly-food-bug-in-65pc-of-chicken-FSA-study-says.html

Usually I’m up to the neck with food scaremongering - everything seems dangerous these days. If we could be breatherians we’d be okay but somehow I don’t think that is possible for me in this life yet.  Seriously though - this article did shock me somewhat.

Organic meat/chicken/diary has never been a big thing on my list - ever since a friend of mine who is a microbiologist told me that bugs love organic food best.   It made sense to me.  So I had a heads up on that one…many years ago.

But I am a big on the free range concept. I’m a guilty carnivore.

I like the idea of the little chicklets having a brilliant time scratching in real soil, gazing up at blue skys above and tussling worms out of the earth. I like to think at the end of a happy hen day they are fluffily bedded down in sweet hay filled barns to sleep, perchance to even dream - before they meet their awful end.

So I head for free range off my supermarket shelf and pay my extra money for the extra portion of bad bug potential…

All I can say is those of us with surgeries like the DS that mean we eat lot’s of meat & chicken must be aware that a bug in our rerouted guts is no joke. I contracted such a bug on a trip in Hong Kong and compared with the odd bug I got in my olden days of a normal bowel - well, it is not comparable. I’ll save you the gruesome details but my discomfort was extreme. I was very ill indeed though mercifully never ended up in hospital.

I doubt I will stop eating chicken.  It’ll probably still be free range because weighed up against an antibioticed battery hen living an unbearable life…welll…I just don’t know.  I think I will be looking into it a little more and deciding which way I will be buying my hen in the future.   Meantime I plan to cook my chicken & meat VERY well.  I’ll definately be giving it that extra 10 mins cooking time to be on the safe side in the future.

And so we never did get to eat our belated birthday meal at the Inn on the Hill today. There will be another time. Sometimes better things come up - my daughter moved out of home a couple of weeks ago.  I have missed her sooo much - it’s silly really. It is right that she should be independent & find her own life, but gawd I have felt at the strangest loss these past few weeks.

She called last week to ask if she & her boyfriend could come over for the weekend.   I cooked a huge dinner for us. Whenever I am happy I cook huge dinners. I think it is a family thing - in my family coming together is always celebrated by a sudden cooking curve. My grandma did it, my mum does it & I am no different!   The food is not always fancy - mostly it is just humble stuff but in a BIG volume!  We had chicken thighs and legs topped with a mix of mango chutney, chilli sauce & fromage frais. This sounds odd but it is delish - try it sometime, you just add equal fromage to equal chutney and chilli sauce to your taste - mix it together and spoon over the chicken.   I served it up with stir fry brown rice with almonds, mixed veggies, buttered glazed carrots and even had dessert - chocolate mousse which I was looking forward to, but then did not want to eat it after such a big meal! Always makes me smile as never ever in the pre op days would this have happened.

They needed things for their apartment desperately - they have been semi camping in their new home and she has not had a chance to even buy basics like pot’s & pans. So this morning we walked around the local car booty in search of things for her place. Or that was the idea.

It was such a warm & beautiful day & lovely to see some of the seller regulars after the winter. Of course I was not going to buy anything as my house is full of beautiful but sad antiques still in need of restoring - but then I fell apart at the table of one of my favourite sellers.  We share an interest in Chinese & Japanese antiques and he knows just how to pepper his talk when it comes to me! He had an old woven little Chinese rug. What I love about it is it has a  Tibetan feel to it so perhaps it comes from a region close to Tibet. It’s a really great little piece -  simple but charming,  with dragons & phoenix on it and veg dyed.  The dealer gave me a price only a fool would refuse so out the proverbial window went all my self control. I ended up lugging it home along with a beautifully turned stool full of the best Victorian workmanship but with a tattered seat ( well …call it project 1001-to-be!), bright trays of pink summer geraniums and a massive bunch of frilled parrot tulips.

Then we went to good old Costco.  While my daughter stocked up on pot’s pans and other household paraphenalia,  I bought the usual delish salmon which I have just enjoyed for dinner with new potato’s, cream cheese ( I have a pash for Boursin garlic at the moment!) and a mixed salad.  A huge pack of bulk mince will make several dishes this week if I think creatively enough. Probably I will make several packs of meatballs in sauce (to freeze), a large aubergine mince stew and there will still be enough over for what I don’t yet know.  I find it much more economical to buy bulk meat wherever I can, although it can turn into a cooking marathon.

I also bought a humungous pack of medjool dates because I think I love these more than chocolate nowadays. They  provide many phytonutrients which is always a bonus. I mash them with chopped walnuts or sometimes brazil nuts and roll little balls of them in ground almonds for easy, quick to make yummy little sweetmeats. One or two of these  knock back my sweet tooth very effectively on days it is being the devil on my shoulder.

http://www.weight-loss-advisor.com/weightlossarticles/date-nutrition.htm

I also bought a big bottle of Wellesse Calcium Citrate 1000mg  & VitD3 800iu. Can’t remember the exact price but it was under £8.00.  2 tablespoons is a serving - which means I need 5 tablespoons to hit 2500mg’s  & then it will last me under 15 days.  Not the cheapest option by far. The blurb on the label say’s  ‘Great tasting’ on it and in a moment of extreme weakness this lured me.  Oh - for a calcium that is great tasting!   As we were rushing I impulsively bought it without doing my usual check of ingredients, I’m ashamed to say.  My CalmagD is a powder & quite gritty - but at least it is pure with no crappola attached…and I’m used to it.

I think I am getting a bit of buyers remorse now as I read it the label properly. Not so impressive are countless fillers - xanthan gum, artificial flavours, glycerin, preservatives, splenda, acacia gum, corn starch

…holy cow maybe it is not such a great buy.  I really hate it when vitamins are plumped out by fillers.  Half of them I wonder about possible longerterm effects so i avoid this where ever I can.  The only plus I see besides it being calcium, vit d & apparently ‘great tasting’, is that it has oligosaccaride - a soluble fibre & even then it is not listed as from a natural source. Synthetic ones can cause a fair bit of bloating to say the least.Natural one’s may do initially, but I take them regularly as I believe in inulin power and given time my system totally adjusted to my initial bad experience which is the tale of another blog - perhaps next time…

So I shall proceed with caution and do a half dose tonight supplemented with my regular Calmag D.  And having just had a huge slug of it - eeeeeUUUUCHHHH!  Great tasting! 

I don’t think so.  It tastes artifically orangey & medicinal at best. I still get a slight rolling grit in my mouth. This is one I won’t buy again. It’s not for me, although I will polish it off this month regardless.

It was a busy but lovely day - however I think I am getting flu - again!!!  I’m so miffed , as for years I seldom got it & now twice in a pretty short span of time it twacks me. Pete had it - a Euro strain he brought back with him from his trip to Holland last week. Maybe it is Vit D resistant or something. My throat is on fire tonight, my nose is snuffly and my muscles are achy.  I’m ticked as I wanted to make a flu rubbing balm last week & never got around to it.  I sorely need it now.  Think I am going to get an early night (for me!) and hopefully tomorrow I will be okay and still plant up my pretty summer geraniums…but that might be wishful thinking on my part.

Today is my Birthday!  It’s nearly over now so before the clock strikes 12 - I thought I would just do a quick Birthday Blog! Think I will miss the 12pm cut off for 12th of April though and this will go in on 13th of April  - but still gonna post it!

I have had a lovely day.  Many warm and kind birthday wishes from my family in South Africa & great news that my mum will be visiting me in June. Best prezzie ever - even if I must wait for her to get here.

Friends spoiled me with a cake and cards that made me laugh.

I am not happy that I am getting older in the least but I am so happy I am here on the planet in a body that WORKS…that it outweighs the aging thing mostly (well in the better moments anyway!).

And on the forum today I was delighted to know that two of our DS Clan had their surgeries several years ago on my Birthday. I don’t know why but it moved me.  Who’d have thought it that somewhere right now - on one’s birthday someone in the world is getting WLS and the possibility of an improved life.  It made me smile to read their posts.  I only wish I could share some of my cake with them in celebration of how well they have both done, but then we would all be windy which could pose a potential threat to the ozone layer.

Pete wanted to take me out to dinner but because last week I totally forgot I was turning into an older person today 

…   I had neatly booked Zenni in for his vet check up at 7pm.  As I would have felt a stoopid ninny trying to weasel out of it by saying it was my Birthday & I really did forget it - and as I am really bad at lying at the best of times and could not think of a way to get out of it without a fib - I thought it best to just keep it.

So off we went. I felt the vet gave me a gift without even knowing it when she looked at my foo-boy and said he had plenty left in him yet and she was pleased with his overall health despite his problems.

Pete & I have a late birthday date to go out this Sunday to the Inn on the Hill for the BEST roast that I know of in the UK. Lamb & Beef & fresh crackly pork rinds and roast potatoes and cauli cheese  - I haven’t even eaten it yet but I am already happy just at the thought!  I really am a die hard foodie.

I also love the drive out there - it is so beautiful - the hills and woods.  Spring is bursting into life here  in the UK and there may be new wee lambs in the fields even! I’m looking forward to  Sunday and am hoping it doesn’t bucket down with rain.

Apart from the above, I spent some time today in snippets,  trying to get more insight into the interactions of Vitamin A - of all things. I’m toying with trying to do a series of blogs sometime about Vits & minerals - sort of a quick reference thingie if I can just move myself to get more verbally concise! I can’t say what I read filled me with excitement, but it was very interesting. I confirmed for myself a few hunches I have been nursing for a while now.

Guess I am just always a bit awed about how little I truly do know, not least because info & knowledge about vitamins and how we absorb them  is an evolving field of research in itself.  What we accept as fact today might change. But my lawd how I wish sometimes we could set these things in cast rock and say we KNOW. EXACTLY.  Now that would be a very fine day indeed.

Which reminds me - I have volunteered to be a lab rat for some research that is being done at Kings Hospital. Looks interesting… I will blog a bit more about it sometime soon.  I am trying to get past the idea of handing over my precious DS poop for analysis - I can only think,  those poor people who must endure processing such data! Bless them all!   I am thinking I should include a small vial of my best loo spray with the samples as a courtesy and that perhaps the lunchly baked beans should go for that time.  Good fibre and protein they might be but it just seems kind of cruel to subject others to the erm, well… impact on their olfactory nerve .  ;-)   I’m also having a little anxiety over whether the tupperware for the deposit is actually big enough … just praying there is no terrible overflow or something

… but enough now & my apols - my lavatory humour is seriously juvenile. I blame it all on my DS.

Anyhoo what I was trying to say before I went into juvenile mode - is that seriously,  we need all the research into WLS of all types we can get…so if you are willing to  be a lab rat, let your care providers know that if they are ever doing any research you’d participate. I’m sure they’d appreciate it.

I have to be honest and say that I’m not big on exercise. I walk my dogs daily and that’s about it.  But then - I always thought it was about general fitness & of course, weight loss.

I learned something new about it from the article below, that it can actually help control diabetes. As type two diabetes is not uncommon among pre-op patients I thought I would publish this.  Thanks Su, for your informative article.

Little Known Ways to Prevent Diabetes with Fitness.
What effect does exercise have on glucose levels?
It is quite easy to manage diabetes when you incorporate a program for exercise in your daily routine. Such exercises have been shown to have positive effects for people who are suffering from diabetes, especially those who have low glucose levels. One example is exercise being able to channel muscle energy, convert it into glucose and then using that glucose as fuel. At the start of it, the body will just use the glucose that has been converted into glycogen from one’s muscles. Glucose is also found in your bloodstream. If you maintain a long term exercise program, it is highly likely that the levels of your blood glucose will not dip. Also, glucagon and other hormones found in your body will also be released. These hormones and glucagon work together and break down all of the liver’s stored fat and then converting such stored fat into more glucose. It is best that you engage in exercise frequently, because your body will improve. It will develop a sensitivity to insulin, as well as help you gain better control of the body’s glycemic index.
Why is the effect of exercise on glucose levels important to those with type 2 diabetes?
Exercise, as mentioned before, has an effect on the levels of glucose. This is important for people who have type 2 diabetes. Many studies show that diabetes patients have better control of their glycemic when they exercise regularly. Those who do not have a regular exercise regimen are not better off. With exercise, your insulin sensitivity improves. This translates to having to use fewer medicines in order to have control over one’s blood sugar levels. Sometimes, people who have type 2 diabetes are somewhat at risk of hypoglycemia, which is exercise-induced. This is during and also after exercise. Then again, there are also some patients who have poor control of their diabetes and are also high risk for hyperglycemia.
Should patients with type 2 diabetes exercise more often or differently than otherwise healthy people?
There are, of course, people who become at risk for hypoglycemia due to the combined effects of their diabetes and engaging in high stress exercise. This happens during exercise and after it, too. If you think about it though, people can also be at risk for hyperglycemia simply for having poor control over their diabetes. Therefore, the leaders in this field recommend engaging in moderate exercise for a minimum of 2 hours and 30 minutes, or 90 minutes if they want to do vigorous exercise.
What type of exercise is best for type 2 diabetes patients?
In light of this, the frequency of the routine is more important that the kinds of exercise one engages in. There are many researches wherein an abundance of benefits result from both weight training as well as aerobic activity.
When should patients be discouraged from exercising?
There are times when you one shouldn’t exercise, especially if you are at risk for cardiac conditions .It is best to start slowly and tentatively just to be safe.

_____________ * _____________

About the Author:

Su Rollins writes for http://www.hypoglycemicdiet.org , her personal hobby blog focused on tips to prevent and cure hypoglycemia using the right diet and nutrition.

I wrote to Su after reading her article and asked a few more questions about hypoglycemia in particular:

Jane:  One thing I am wondering about - is it possible

 to prevent episodes of hypoglycemia before, after or

 during exercising?

Su:  Exercise may help get those episodes more short….but it’s not the
“cure”…meaning that it helps get you more resistant to those episodes
but when they happen. The only way to resolve an hypoglycemic episode is
eating.

 Jane: Are there any types of drinks or snacks that are best

 for keeping the  blood sugars stable after exercise?

 For example are pure carbs better  or would it be of more

benefit to include some fat or protein?

Su: There are a lot of diabetes snacks on the market:

http://www.rd.com/living-healthy/15-diabeticfriendly-snacks-tips/article98255.html 

A snippet more info about foods you can eat to avoid hypoglycemia when exercising:

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=6531

I posted most of this up at WLSinfo  this evening & thought I would copy it here.

I went for my regular check up today and got my vitamin lab results & they are a piece of perfection all in all. I’m so happy about this.

I have seen a few spot on labs in my DS life before, but usually it’s my zinc or iron that is low. In fact I was getting a bit tired of almost expecting to see this on my labs over recent years. Because I was getting slightly resigned to it all I felt I needed to stop plugging myself into the negative energy of resignation.

So, last year I set myself a challenge. I wanted to prove to myself that I really could be master of my vitamin destiny and show the low zinc who was boss.

I also wanted to prove to myself that it is possible for a longerterm DSer to do very well in this regard and that deficiencies and malabsorption don’t need to be inevitable side effects of this surgery.

There are times that Dsers might be conscientious about their supps and still have difficulties with deficiencies.

Most of the time however, we are in the drivers seat with the DS. A solid ‘base’ of good quality vitamins everyday as top priority will almost always correct any problems.

So take them - every day!!!! Even if you can’t take the lot and are having problems - take something, anything to start with - it will go some way to getting you in good health. No good quality vitamin is ever wasted on a DSer!

Very interesting to me is my cholesterol levels look good. I asked whether we could test these specifically last time as I always wondered if being a such a lipophile ,with fats being the major source of cals in my diet, would have an impact on me longerterm. I’d read before DSers don’t generally seem to be affected on this score in terms of getting bad cholesterol levels, but I wanted to know this in my own context. I’ve eaten high fats since my DS with an increase in my 2-3rd year & it looks fine.

We discussed some probs I am having with what I thought was the pile from hell, it seems it might well be a polyp so I will get that dealt with soon. Made me realise it’s never clever to not get these things checked out professionally. What we think something is - may turn out not to be the case at all. I’m not too thrilled about it to say the least, but if it is a polyp it’s very likely completely unrelated to my DS. I had three on my tum pre-op and those were removed which is why I had a very small DS tum to start with. Sooo, I seem to just have a disposition for these unfortunately.

Anyway - I have decided to just enjoy the weekend and bask in the good news on my lab front and feel positive about this. I’m using it to reassure myself that if I need a surgery to remove the polyp, at least I know my labs are in fine fettle. I will deal with the polyp from hell in the near future.

——————–*——————–*——————–*——————–*——————–*———-

A further thought I am having is that I am very very lucky  to receive such excellent care from Mr Patel & his fantastic team. I’m so grateful to them for always being there for me. Everytime I go to see them I think back on the days I pretty much slogged it out alone with  mostly,  pretty disinterested GP’s  when I had challenges.  My surgeon in Germany to his credit, was always there for me and responded to my e-mails every time. He also used to regularly contact me to remind me to send him any lab results I had managed to procure, but distance can be a real hassle when one is trying to put over the finer details. Nothing beats a face to face consultation.

It was tough and sometimes I felt soooo despondant.  It got to the point that I realised I needed to get savvy about my own meds etc.   I can see in the bigger pic that it must have been part of my bigger universal plan to slog it out , because it forced me to start to try to understand the DS and it’s challenges better.    Survival is a big motivator on the road to self empowerment sometimes - so it was not all bad stuff.

But and it is a BIG BUT…nothing beats a team committed to WLS. I suppose one has to sometimes experience both ends of a stick to know what is good and what is abysmal.

My advice is if you are going to get a WLS check out the aftercare offered.  If you had surgery abroad do try to find a good team to help you through the more trying times. It makes a big difference to one’s feelings of being able to live with the changes & challenges of one’s surgery.