Catching Up With Nicole

Bariatric Bad Girls BraceletsMy, my, my. It’s been a busy few weeks. I’ve had so much going on that I’ve hardly had a chance to do anything blog-related. So consider this my catch-up post. I know it’s April Fools Day, but no jokes in this post!

My Trip to Virginia: My friend Robin from BBGC hosted a party in Virginia, and as soon as I knew it was happening…I had to go. Standby flights worked out in my favor, and I got to spend last weekend with some of my favorite ladies in the WLS community. In this pic: Carla, Crystal, Nicole, Suzanne, Robin, and me….all sporting our pink BBGC bracelets.

I’ve spent so much time talking online with these ladies, and only have seen them in person one other time in Atlanta for the Obesity Help event. I feel so much sisterhood with Bad Girls, and I wish I could spend so much more time with them in person. I’m really looking forward to the WLSFA Meet and Greet in May, as well as the Obesity Action Coalition conference in August.

Reactive Hypoglycemia Update: After 2 months of waiting, I finally got in for my endocrinology appointment at the Utah Diabetes Center. The doctor reviewed my symptoms, food and exercise diaries, and agreed the best thing to do for now is to monitor my blood glucose levels. I got my DIABEETUS testing supplies and it’s been nice to have better marker of my blood sugar levels than just symptoms alone.

I have been holding back at hard exercise at his suggestion, so most of my workouts are less than 30 minutes (and usually just walking). I also met with a nutritionist, who suggested that I eat about 300 more calories a day, with more complex carbohydrates and protein. I’ve only had 2 RH episodes in the past two weeks, which I consider a victory. Unfortunately, my 3-month weight plateau continues…

nicole at instacareBronchitis: I’ve been out of commission with bronchitis for a few days, but I’m starting to be on the mend. I had 10 days of minor symptoms that eventually culminated in pure misery and a visit to Instacare. I’m on day 3 of antibiotics, and spent the majority of Easter weekend asleep in bed. I’m hoping to be feeling good enough to travel to California this week for some time with family and the Social Media Managers World Conference in San Diego next weekend.

The 2013 WLS Awards: Today I found out that I was chosen as the “favorite WLS newbie” in DivaTaunia’s Weight Loss Surgery awards. Thank you to all who voted for me…I’m happy that you have been inspired by me (and felt inclined to vote). Check out the podcast to see which other nominees are rocking the bariatric world.

Swimsuit Season: The weather is warming up, and it’s time to find a swimsuit. For the first time in my life, I’ve actually tried on some 2-piece tankinis. I’m still looking for the right suit, but I’m excited to have SO MANY more options than I did in years past.

April is going to be a busy month, but I’ll try to post on my blog as often as I can. I’ve been trying to test out traveling with and without my laptop. It’s a lot easier to ditch the laptop and bring one less bag with me on the plane…but I can’t do everything I want to on my iPad. After I get back from San Diego, I leave for Type-A Advanced in Philadelphia, where I’ll be speaking on one of the expert panels. Then I’ve got WLSFA in Vegas in May, and FitBloggin’ in Portland in June.


Wordless Wednesday: Monitoring Reactive Hypoglycemia

monitoring reactive hypoglycemia

My ER Visit in Vegas

in the ambulance for hypoglycemiaReactive Hypoglycemia. It’s serious stuff. And when it comes on, you have to stop EVERYTHING and take care of yourself.

I experienced my worst RH crash in Las Vegas earlier this month. I was in Las Vegas for New Media Expo, and was taking advantage of every chance I had to network, party, and enjoy my time in Vegas. Before I had my surgery, I didn’t have a lot of stamina to keep going and going at conferences. I would catch a few speakers, then go back to chill in my room. Go wander the expo halls, then chill in my room.

At NMX, I pushed myself to go ALL DAY LONG.

I partied too hard…which is funny for a girl who didn’t touch a drop of alcohol to say. I made the stupid mistake of staying up for 23 hours to play and party, then only slept for 3 hours. Latent insomina has been killer for me since I returned home from my trip to London, and I have a hard time sleeping in past 5:00 am. Once I was awake, I went to the hotel gym for a workout (since I knew it would be the only chance I would have for the day). Nothing too strenuous because I was tired, but I worked out nonetheless.

I went to a networking breakfast after, but apparently I didn’t eat enough. While I was in Guy Kawasaki’s keynote, I started feeling the evil crash of reactive hypoglycemia. Dizziness, double vision, sweating, and they chills. It was time to eat again – NOW.

I gathered my belongings, and walked to the closest place that had anything edible – the hotel convenience store. I got some Nutter Butter mini-cookies and some peanut butter M&Ms, trying to get a little protein in (with not a lot of great options). I took my snacks to the big padded hallway bench and started munching. But the double vision and dizziness got worse, so I laid down on the bench. A concerned conference-goer saw me and grabbed casino security. Security brought the EMTs over, who had me suck down part of a tube of glucose gel. It’s tough with gastric bypass patients…because not enough sugar will keep you crashing, and too much will make you have dumping syndrome.

waiting in the emergency roomTen minutes after the glucose gel, I wasn’t having much improvement in my symptoms. The EMT’s called the paramedics to give me an evaluation (and to bring a blood glucose monitor). By the time they pricked my finger and checked my blood sugar, it was back up to 90. I was getting frustrated and anxious because I usually feel so much better within 30 minutes of eating, but it wasn’t getting better. The paramedics decided to load me up on the gurney, give me some oxygen, and take me to the ER.

I felt sick enough that I couldn’t walk or form very many coherent sentences….but I was able to use my phone. I had the paramedic take my picture while we were on the way to the hospital, and I Instagrammed it with the #NMX hashtag because all these people at the conference saw the commotion with the EMT’s, but couldn’t communicate with me. Social media was the best way for me to keep people updated on my progress. At the hospital, they took a few vials of blood, gave me an exam, and hooked me up to an IV.

Over the next 3 hours, I spent most of it asleep in my curtained off area in the ER. I wasn’t able to eat or drink while they figured out what was happening, but they sure pumped me through of IV fluids. The emergency staff didn’t know much about gastric bypass patient protocol, let alone reactive hypoglycemia. After finishing my 3rd bag of fluids, I was given a diagnosis of fatigue and severe dehydration. My electrolytes were all out of whack, and my body was shutting down. It’s possible it wasn’t RH that made me feel so sick, but I’m pretty sure it was a factor.

nicole in bed recoveringI was discharged from the hospital with a strongly-worded charge to “take it easy.” Someone telling me to “take it easy” is like speaking Mandarin Chinese- completely unintelligible. I was at a fun conference, for heaven’s sake! My sister drove me back to the Rio from the ER, and while I was there, I wanted to talk to a few people to let them know I was okay. So even though I did walk around the expo, I only stayed about 10% as long as I wanted to. I drove my car back over to my hotel, then crashed for a 2 hour nap. I met up with some friends at Mon Ami Gabi at Paris for dinner, then skipped the official conference party. I spent a little time with some friends at the bar, then got so tired so quickly I had to be walked across the street to my room. I slept like a log that night.

The rest of the conference I drank lots of water, ate more often, took breaks often, avoided walking everywhere, and went back to my room to rest a few times. I didn’t go to every session, nor did I go to every party and activity I was invited to. It was tough to limit myself, but it’s what I had to do.

Next time I’m at a conference, I’ll do better about pacing myself…especially if I’m still dealing with daily RH symptoms.

What Is Reactive Hypoglycemia?

reactive hypoglycemia

How RH makes me feel

Over the past two months, I’ve begun experiencing one of the dreaded after-effects of gastric bypass surgery: reactive hypoglycemia. Most people who are familiar with gastric bypass know about dumping syndrome, but reactive hypoglycemia can be just as painful and uncomfortable.

Reactive Hypoglycemia (RH) is a condition indicating recurrent episodes of hypoglycemia in people who do not have diabetes. Scientists and nutritionists think that RH is a consequence of excessive insulin release triggered by intake of carbohydrates, but the insulin release continues past the digestion phase, and and beyond the disposal of the glucose derived from the meal. According to the NIH, a blood glucose level below 70mg/dL at the time of symptoms, followed by relief after eating, confirms a diagnosis for reactive hypoglycemia.

Reactive Hypoglycemia symptoms include:

  • Double vision or blurry vision
  • Unclear thinking
  • Sleeping Trouble
  • heart palpitation or fibrillation
  • fatigue, depression
  • dizziness, lightheadedness, confusion
  • sweating
  • headaches, tremors, flushing
  • nervousness, irritability, panic attack
  • increased appetite, craving sweets
  • numbness/coldness in the extremities

In severe untreated cases, coma can be a result from RH. It’s serious stuff.

How do you treat RH? By eating. The quickest way to feel better is to eat something that will get your blood sugar up quickly, so sugars and carbohydrates seems to work the best. But having protein and fat will help sustain you so you don’t have another RH episode.

Now, I leave a disclaimer that this is NOT to be taken as medical advice, but I’m sharing what I’ve come up with after tracking my RH episodes and talking to my doctor. I will often have peanut butter and crackers, or some popcorn. Fruit juice usually makes me dump, but a sip or two seems to help me get out of an RH episode. I’ll admit, sometimes I’ll eat junk food when I sense the first symptoms of RH, and being timely is much more important than choosing the exact perfect thing to eat.

I had my first experience with RH in November in England. I was meeting up with a friend in Liverpool one morning, and the restaurant we planned to eat at wasn’t open yet. I nibbled on some turkey jerky, then we walked around Albert Dock for a few hours, then I went to the Beatles Story museum. As soon as I got back in the car, I started getting confused, shaky, weak, and had blurred vision. I knew it was because I hadn’t eaten and I actually blacked out for a few seconds. Eating made me feel better very quickly.
The next RH episode was on Thanksgiving. I had a fairly surgery-friendly dinner (turkey, salad, veggies, sf jello) with one exception – I had a little bit of mashed potatoes and gravy. I’ve been having powdered mashed potatoes for a few months, but mashed real potatoes took me over the edge. I went into dumping mode for about 20 minutes. As soon as the dumping subsided, I laid down and fell asleep immediately. When I woke up, I felt disoriented, my arms and legs were completely numb, and had double vision. When I tried to stand up, I collapsed and started shaking uncontrollably. I got on BBGC and left a message with my symptoms, and everyone agreed it was an RH episode.

I started tracking the symptoms through the next 10 or so episodes, and I realized that there were two common items : I had done a rigorous workout within the past 24 hours, and it had been more than 3 hours since I’d eaten anything. To date, I’ve completely passed out 3 times from RH. Every Sunday in the 3rd hour of church, I’d have RH symptoms, so I began packing crackers, granola bars, and other portable items to eat between classes.

I met with my doctor, showed him my log of RH episodes, and he agreed that it was something I needed to take very proactive control over. His main advice to me, which is not what is part of the typical gastric bypass diet, is to eat more carbs. Eat something a little carby with every meal. Eat carbs and protein before and after working out. Stop exercise at the first sign of fatigue. Be intuitive and listen to my body’s signals.

My weight loss has been slow the past 2 months, but my body is shrinking. I’m down a dress size, but only about 5 pounds from the beginning of January. I’m exercising hard, my muscles are getting more lean and toned, and I am enjoying an active lifestyle. My body is no longer in ketosis, but I’m okay with that. I’d rather have energy, exercise, and eat more carbs, than be lethargic with a carb and exercise restriction.

Now, if I can only get this reactive hypoglycemia under control!