I was running late when I stopped to listen to the news about Hurricane Irene. This one sounded as if it could be a problem and I have a busy week ahead of me. My condo has an outdoor atrium and by the time I got to the elevator the back of my hair was already getting wet  – yep, it was the kind of day where I shouldn’t have bothered to dry it, forget about smoothing it straight.

I pressed the button and waited and waited… and waited. I live on the ground floor. I watched the number above the closed elevator door change from 2 to 3 and listened to the ding as the door opened, paused, and then closed. The number changed from 3 to 4, I heard the ding as the door opened… paused… … … and then closed. I stood there… sweating… the pattern painfully repeated itself for each floor and it was going to the top!

Damn kids. I loathe when unsupervised children get on an elevator and press all the buttons. Actually, many do it in front of their parents. WTF are parents thinking when they have a kid who punches every button on an elevator panel and they say and do nothing! As I get older, I tend to ahem, mention it… along with having a few words with kids who tap on fish tanks despite the ‘DO NOT TAP ON THE GLASS’ sign. I think I am turning into my mother – queen of the stealth pinch. (I swear that she once tripped an annoying whining child running past her but she said she just moved her foot) The sweat was now running down my back and my eye started to twitch. I stood clutching my coffee mug in one hand and my purse strap and briefcase in the other.

I decided to take the stairs down to the parking garage. As I turned to leave my spot in front of the doors the elevator begin its descent from the top floor so I stopped. Taking our stairs is not a hardship other than that the steel fire door to the stairwell is corroded by salt air and is nearly impossible to open with both hands full. More sweating involved.

Then the elevator stopped at the 6th floor and began its every floor pattern again.

Arrrrgggghhhhhhhh… I thought about what I was going to do when I caught the kids who were obviously still on the elevator. Would I quietly explain to them why it was not a good idea to play on the elevator? Would I yell at them like the crazy neighbor lady? Would I be so happy to have the doors open, that I wouldn’t care?

I was really aggravated and on top if it, I was now soaked with sweat and I could actually hear my hair frizz as the humidity was more than 90% – definitely one of those days that gives Florida its reputation.

The doors opened. I narrowed my eyes to look a the small person who stepped into view.

It was the Otis Elevator Repair Man – testing each floor as last night the elevator had been stuck after a couple of foot ‘drop’ and someone spent the night in there.

It’s all in the perception and things are not always what they seem. If you have faith, you need to trust that every outcome is to your advantage – you just might not know it until later.

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Your Bones By Lara Pizzorno, MA, LMT, and Jonathan V. Wright, MD

In this enlightening excerpt from Your Bones, experts Lara Pizzorno, MA, LMT, and Jonathan V. Wright, MD, shed light on the overlooked dangers to healthy bones posed by surgery.

Gastric Bypass: Free Pass? Not for Your Bones

Gastric bypass (or small-bowel resection) reduces the amount of absorptive surface area in the intestines, and by doing so lessens the body’s ability to absorb not just fat and calories, but also all the nutrients needed to maintain and form healthy bone.

The gastric bypass is the leading surgery to treat morbid obesity performed in the United States. Since this operation causes the primary sites where calcium absorption occurs to be bypassed, patients become deficient in calcium and vitamin D. In response to these deficiencies, the body up-regulates the secretion and activity of parathyroid hormone. Parathyroid hormone has two bone-related effects: it causes an increase in the production of the most active form of vitamin D (1,25-dihydroxyvitamin D), which helps us absorb more calcium from food, but it also causes increased bone resorption (bone breakdown) to liberate more calcium for calcium’s many other uses in the body.1,2

Calcium wears a lot of “hats” in the body, playing vital roles in a number of critical physiological processes not related to its use in bone. These include helping blood to clot, so we don’t bleed to death when cut; helping nerves to send impulses and muscles to contract (in the case of the heart muscle, contraction = heartbeat); and regulating our cell membranes, so our cells can allow entry of what they need and send out what they don’t.

Because these activities are essential to life, the body tightly controls the amount of calcium in the blood to ensure that sufficient calcium is available for them. Our bones, where approximately 99% of the calcium in our bodies is stashed, serve as a calcium “bank” from which withdrawals can be made to maintain normal blood concentrations whenever the need arises—which it surely will after gastric bypass (or if we fail to consume calcium-rich foods and/ or supplemental calcium sufficient to meet our body’s needs).

Gastric banding, another surgical procedure for morbid obesity, is a safer, potentially reversible, and effective alternative to the Roux-enY gastric bypass that has not been shown to produce as much bone loss as the Roux-en-Y procedure. In gastric banding, an inflatable silicone device is placed around the top portion of the stomach to create a small pouch at the top of the stomach that holds about 3.5 to 6.5 ounces of food. When a person eats, the pouch quickly fills with food, and the band slows its passage from the pouch to the lower part of the stomach. As soon as the upper part of the stomach registers as full, the brain is sent a message that the entire stomach is full, which helps the person eat smaller portions, eat less often, and lose weight over time. Within six to eight years, weight loss from gastric banding is comparable to that achieved by gastric bypass; however, many physicians and patients choose gastric bypass because it results in faster weight loss and resolution of diabetes.3 The fact that some of the weight lost comes from the patient’s bones is somehow overlooked.

What Does This Mean for YOU?

Either of these surgeries will lessen your body’s ability to absorb calcium and the other nutrients necessary for bone health. If you have had or are considering either of these surgical interventions for morbid obesity, please discuss the potential adverse effects on your bones with your physician. Medical journal articles alerting physicians to these concerns are just beginning to appear, and many doctors remain unaware of these issues.4

Although increasing calcium or vitamin D intake does not suppress parathyroid hormone or prevent the acceleration in bone resorption caused by gastric bypass, it is possible that highly absorbable supplements may help lessen the damage.5 Anyone who has had either of these surgeries should be using calcium supplements.

What You Need to Know: Osteoporosis Risk

- Many physicians are unaware that gastric bypass threatens bone health and bone density by decreasing the stomach’s calcium-absorptive area.

- Some of patients’ weight loss following gastric banding or gastric bypass represents lost bone mass.

- Additional calcium intake is crucial for individuals who have undergone these procedures.

- Optimal liver and kidney health is crucial for the activation of vitamin D, a mineral that helps the body absorb calcium.

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I just returned home from a business trip to NYC where I had a very bad low blood sugar incident. Many of us have these episodes and either think they are the only ones having them or believe they have done something wrong.

As a ten year post op who has achieved balance between food choices and a healthy life, I know that I must eat three meals a day that contain a source of protein. Any source will do if I am not in a place where I can have a meal – a protein bar or a shake in my blender bottle, a Believe drink, some cheese, ANYTHING with protein – otherwise my blood sugar can dip into the 50 zone which is very dangerous. It doesn’t happen all the time, only once in a while. It can even happen in the early morning if I have gone to bed without a decent evening meal or it can happen if I skip lunch.

IF I do not plan ahead where I am able to make certain that I am able to have protein every 5 hours or so, I begin to fade out and start to get a headache, feel faint, get very fuzzy and sick to my stomach -  if I don’t catch these symptoms quickly, I slide into a zone where I cannot think clearly or even speak up for myself in order to get out of the episode. In short, if I don’t act quickly and eat something, I have to rely on those around me who may or may not realize what is going on.

I had a very important meeting that was scheduled for 10am – at about a 20 minute taxi ride from our midtown hotel. I woke up early when my room service pot of coffee and fruit plate arrived. It is standard for me to order a fruit plate on a business trip as they are usually served with a dish of plain yogurt and I can have coffee and then my yogurt and fruit while getting ready. THIS particular fruit plate did not come with yogurt so I did not have any protein. For some reason I didn’t ship any BELIEVE or INSPIRE to the hotel as my plans were last minute as to when I would arrive. (Bad excuse as I could easily have overnighted a small package!!)

When I got to the meeting I was already a bit wonky, as all I had eaten were a few pieces of melon and blackberries after my usual quart of coffee with milk and Splenda. I was already pushing my luck and headed for an episode right out of the chute! I didnt realize it then, only NOW.

After TWO HOURS in the meeting, the headache hit me like a sledgehammer and things got very fuzzy. I poked Ingrid and quietly told her that I needed to eat. She is not a bariatric patient and probably thought I was merely complaining, as she had the same morning that I did, and she wanted to eat as well. She sort of nodded and ignored me as the meeting was intense.

After another 45 minutes, I could not even hear what they were saying, I grew silent and was looking down into my lap. Ingrid noticed and asked me if I was okay. I said ‘NO’ I was not okay and then everyone became aware that I had a problem – which I avoid at all costs. Suddenly there were apologies that they were going to have food but didn’t know what to get…. bla bla bla. Everyone gathered around and was staring at me, asking me what they could do, was I okay… I hate when this happens. I dont like ANYONE to think I am different because I chose to have surgery!  It also gives bariatric surgery a bad name – and in business I present a strong image.

I assured everyone that I would be fine, but that we needed to wrap it up, so I could get something to eat. Ingrid asked if there was a restaurant close by, and the well meaning folks told us about the vegan places and salad places nearby where they eat. Nope, need PROTEIN, like SALMON… but I am sure there are restaurants all over the place where we can find something.

I honestly don’t remember saying goodbye or leaving the building – there was a bistro on the corner named MARKT and we grabbed a table. Ingrid told the waiter I was sick and needed to eat quickly. I got mad at her and told her that I NEVER tell anyone I have a medical problem as it focuses attention on me when it is easier to quietly maneuver when I am not center of attention. The server brought menus and upon opening it saw the first item was a House Pate – I asked the water to bring it quickly as I needed to eat.

I also believe I yelled at Ingrid to STOP talking to me. Her talking to me was making me feel as if I were going to throw up. People do that when you are sick – they talk to you, A LOT. The room was spinning. I drank TWO glasses of water very quickly. They put bread on the table and I pulled off a crust, smeared some butter from the dish and ate it. As soon as it hit my stomach I felt better.

Pate arrived and I moved a slice to my plate and ate it with the dark bread on the plate. I drank two more glasses of water even though I just ate food as I wanted to push the food into my intestines, so it could get into my system.

The room started to come back and the voices in the room were almost clear again. I noticed the bistro was beautiful and the food was delicious – I could see in color again instead of black and white. The waiter came back to see if I was okay, and Ingrid told him to give us a few minutes.

I looked at her and she told me that my color had come back as I had turned very pale and was scary sick looking. She said that my eyes were sort of rolling around in my head when I told her to STOP TALKING. I asked her to please NEVER let me go more than five minutes past any time when I tell her that I need to eat… as THAT is the sign that I am getting sick. She saw me get like this once before but not this serious a case. She nodded. Then she asked me WHY I didn’t have a protein bar or nuts in my purse. I DID NOT HAVE A GOOD ANSWER FOR THAT.

I looked at the menu and it was a BELGIAN restaurant. Leave it to me to run into a tiny corner bistro to avoid dying of hypoglycemia and have it turn out to be a well known little spot with 100 year old European decor! Markt is known for the authentic Belgian classic dish called Moules Frites – mussels and fries!  Mussels are PURE PROTEIN and easy for me to eat. I ordered mussels in garlic and broth and continued to eat the pate and drink the water while waiting.

As I ate the mussels I felt the clouds lifting and the fog leaving my brain. By the end of the meal, I was fine… with just a bit of the headache left.

I made such a fast recovery I was able to keep my 3pm hair appointment at the Fekkai salon – I had the good fortune to get a signature Fekkai cut in April when I attended the Johnson & Johnson Ethicon Endo-Surgery, OAC syposium and hoped that while in town this time, I could get it cut again. I was happy that I felt good enough, given how sick I was just an hour earlier, to be able to hop into a taxi for the trip to the salon. I looked forward to the head massage during my shampoo to get rid of the rest of the headache!

This is a typical episode of what happens to some of us when we don’t eat, OR when we eat carbs instead of protein. I do my very best to eat five small protein meals a day and do not deviate much. It’s when I don’t speak up and say ‘I NEED TO EAT’ that these episodes happen. I need to SPEAK UP. I am not shy or quiet but I often don’t want to inconvenience anyone. If I feel this way, I know many of you do too. We must speak up if we need to take care of ourselves, as we have a serious medical reason to eat. We are not being pain in the butts or special… we are managing a condition.

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