Current Pictures

F I N A L L Y !!!

It seems like one moment I have been waiting for, this whole journey, is to see the 220s on the scale again. I remember graduating from high school weighing around 218 and then I graduated from college in the 230s. I don't remember ever seeing the 220s! I just kind of flew right through them while I was away at school.

This morning I saw 229.0. PRAISE THE LORD!

My running is finally paying off.

Holy Mackerel

Holy Mackerel everyone- I set off for a mile run and decided to push myself to see how much further I could go. I ended up going 2.5 miles! 2.5 miles WITHOUT stopping!!! 2.5 miles up and down hills. 2.5 miles!!!

Did I happen to mention I ran 2.5 miles?

:Happy Dance:

A Mile in My Shoes

I am officially 60 down with 60 more to lose. HALF WAY THERE BABY!!!

I have been running every evening, and it feels dang awesome I must say! After running in the evening for the past few weeks, I decided to finally "clock" the distance using my car. I was hoping to build up to running a mile- it's been a while!

To my amazement, I found out that I have been running 1 to 2 miles and didn't even realize it! I am so stoked about that. It feels so good to turn on the old mp3 player and go running with my new puppy. The best part is the fact that my belly and badunkadunk don't hold me back anymore. I don't seem to suffer from the bounce back effect anymore which is nice.

My family and I just got back from a trip to PA to visit with a sick relative. While I was there, all of my husband's family kept expressing their shock over my change. The last time they saw me I was close to 300 pounds. My sister-in-law later apologized for saying something. Apparently I turned red when she said something and assumed she upset me. HOWEVER, in Kate's words, the truth of the matter is that I need to learn to take a compliment and I still feel like I have so much further to go. SOOOOO, it's hard for me to just smile and take the credit.

Maybe I can make that my next NSV- hearing I look good without turning bright red.

THIS IS WAR !!!

Dear Scale,

Due to your abundantly clear decision to continue to punish me on a daily basis, I have decided that I have no other choice but to wage a full out war on you.

I have exercised every day for the past two and a half weeks, without fail, for 30-45 minutes a day. What more do you want from me!?

I will no longer wrestle with, attempt peace treaties with, strategize against or hope to tame you.

You have gone too far in your attempts to derail me.

I am a warrior.

This is war.

Sincerely,
Lynn

Carousel

We went to the mall today, and like always, my boys wanted to ride the carousel. I bought our tickets and placed my purse in the stationary seat - where I ALWAYS sit - and helped my boys get on their horses.

I haven't ridden a carousel in YEARS. My oldest turned four back in January and I have never ridden with him. Besides the stares I was always avoiding, I was afraid the darn horse wouldn't be able to go up and down, resulting in a major mechanical blowout with tons of black smoke which would cause everyone to head for the exits screaming with mass panic thinking that a terrorist was present. That and my big'ole behind wouldn't fit in the molded saddle.

But today was different. After strapping my boys in place, I looked at the horse suspended between them and without hesitating, hopped right on! Yippee! My boys were so excited and let me tell you, I had an absolute blast!

I am looking forward to going again soon. Oh, and my behind fit just fine. A small child could have fit behind me!

Poo-Poo Guy

My husband has a friend who weighs about 320 lbs. or so. We've always gotten a chuckle out of the fact that my son has often times referred to him as a "tough guy". And of course by "tough" he means large.

I guess he thinks that overweight people are "strong" and "tough". He has NEVER used the words big or fat- because I haven't taught those to him- so he has defaulted to the only way he knows how to describe what he sees.

Today at the mall a very overweight woman walked by and my son hollered, "Look at that lady Mommy! She's super tough!". I hope that she didn't hear him, oh how I hope.

Now, my son has also referred to me in the past as being "tough". After he pointed out the passerby, I asked him, "Is Mommy a tough lady?" and he said "No". Hallelujah! My four year old no longer things I'm large compared to the "normal" world.

I have always been worried about being an embarrassment to my boys when they were old enough to understand. Thank GOD I am traveling down a different path.

What's up with the title of this post you ask? Well, last night while my two year old enjoyed swinging at the playground, he screamed out "Hi poo-poo guy!". Who had he screamed at? No other than an African-American boy playing on the other side of the playground. I WAS MORTIFIED. It was the perfect time to make sure he is aware of the fact that there are differences between all people. *SIGH*

Kids say the darnedest things.

Skinny B*tch

First of all, it has finally happened. And actually, it happened twice! I have had TWO people tell me in the past week that I look S K I N N Y!!! One of those people was my mother-in-law.

Now, I am by no means skinny, but the fact that my neighbor called me a "skinny b*tch" kind of made my day, you know!? Moving along...

My best friend Kate was here for a visit a few weeks ago and we thoroughly enjoyed our time together. What was so wonderful about this particular visit was the fact that it was the first time - that I can remember - that we didn't eat from the second we were together until the second we parted. She has been my binging buddy for over 20 years now, and instead of eating junk we actually exercised!!! We both LOST weight while she was visiting. There is a first for everything. Praise the LORD.

And speaking of firsts, my parents just left after a four day visit and I got to experience something entirely new to me. My mother has always been the, "Do you really need that?" "Put that back Honey, you've had enough" type, but I was amazed to hear her constantly telling me, "You need to eat something Honey" "Here, please eat this...". Wow, what a 180.

AND- I have TONS of NSVs lately- my husband took a picture of my two sisters and me and I DON'T look MORBIDLY OBESE! I am so excited about that picture. I no longer stick out like a sore thumb.

I have been exercising like crazy, having a new puppy helps keep me motivated. I have to walk her, sometimes twice a day, in order for all of us to keep our sanity! I have also been busting my butt on the elliptical machine.

Now for my favorite NSV EVER (so far!)- my husband told me last night, while we celebrated our 7th wedding anniversary, that making "boom, boom" has been wonderful lately. He said that I was looking great.

Have I mentioned that I love my band?

I will post some pictures later today.

I'm Here, I'm Here!

Sorry to be missing in action lately. Things have been pretty busy around here! Everything is going well, and I plan on writing a post later this evening to fill you all in.

Hope everyone is happy and healthy!!!! :)

North. West. East. South. NW, NE, SE, SW or Any Combination

I never thought the day would come when I have to make sure my nipples are pointing in the SAME directions (respectively of course).

They have shrunken quite a bit and I have been left with some loosey-gooseys unfortunately.

Lilo. Or Hanna. Or Mollie. We just don't know yet.

My husband caved. He loves me. :)

Cinco de Mayo Birthday Celebration

Today is my birthday. My birthday AND my husband's birthday! But, he will ALWAYS be two years older than me! ;)

We went out for dinner and enjoyed a hibatchi meal- the kind cooked right in front of you. I ate about two scallops, two spoonfuls of rice, one piece of zucchini, 2 small shrimp and called it quits! I couldn't help but reminisce about that last time that my husband and I had eaten at this Japanese restaurant... I watched as the chef served everyone at the table making sure that I didn't get any less than everyone else there... it had to be fair. However, tonight I watched as he served me hoping that he wouldn't give me anymore! Big difference.

It's nice to go to bed on my birthday knowing that I didn't pack away a 5,000 calorie meal just because I could.

Puppy Love

I want a dog.

Badly.

My husband does not.

We had a dog before our boys were even born, but through a series of circumstances, we ended up re-homing him. We re-homed him, not because he wasn't wanted, but because he wasn't getting what he needed any longer since I had an infant attached to my boobies 24/7! I would take him back in a heartbeat- I miss him like crazy.

I have started thinking about adopting another dog since my boys are now at an age where I feel I actually have the capacity to love another living thing. My boys both want a dog, I want a dog, but my husband is totally against the idea. All he thinks about is hair, stink, vet. bills, and just another expense. When I think of a dog, I think of love, loyalty, fun...etc. We are on totally different sides of the coin here, and I just don't know what to do! I don't know how to convince my husband of how badly I want another dog.

This is Nani- she needs a new forever home and I want her!

Oh yeah, I have eaten WAY too much today and feel like a total failure. It's amazing what stress can do.

UPDATE: NANI WAS AN ABSOLUTE NIGHTMARE ONCE WE MET HER! THE PEOPLE I SPOKE WITH ON THE PHONE MADE HER SOUND PERFECT FOR OUR FAMILY, BUT SHE WAS HORRIBLE!!! She mauled my boys- it was bad.

What on Earth!?

Yesterday I went into Belks to try to find a new pair of pants because I have ONE pair of size 18 jeans that I wear.... every.... single.... day. I wash them in between wearings of course, but still, the situation was just sad.

I hopped on the escalator and started my venture to the "Women's" section hidden in the back right corner. I couldn't find any size 18 jeans or capris and was totally bummed out. THEN it hit me. Size 18? Hmmmmm, I bet they have size 18s downstairs. Happy as a clam I marched my hiney down to the "Normal Ladies" department to purchase a pair of pants NOT in the plus section for the very first time since I was in high school. My current size 18s are getting loose so I grabbed a pair of 16s JUST IN CASE.

Bad idea. Not only did the 16s not fit- not even close- but the 18s were T I G H T. But...but....they are an 18?!?!? What on earth is going on!?!? Ahhhhh, yes. Then I remembered that size 18s are not all created equal. A size 18 from the Ladies' department was not the same as a size 18 from the Women's department. I refused to be defeated and squeezed my size 18W butt into the regular size 18 and bought those suckers. AND, just for good measure, I threw in an XL polo shirt from Izod. I am looking forward to being firmly planted in the Ladies department.

Now for your viewing pleasure, just to support the fact that I will never learn, all my take-out boxes from the past week. I keep ordering as if I can actually eat! (There are four boxes there just in case you can't tell.)

Taco Bell Run

Well, around 9:00 tonight, my husband made a request for Taco Bell. Mmmmmm....junk. I hadn't eaten dinner yet and fell prey right along with him. I ordered 3 soft tacos and a large diet pepsi. Diet because it makes such a big difference after eating 3 tacos right!?

I couldn't even eat half of one taco. THANK YOU BAND. (Bless her heart, she still doesn't have a name.)

I LOVE MY BAND.

When will I learn!!!!????

Current Picture vs. Before Surgery

Picture taken today- April 10, 2010 (236)

One month before surgery- July 2009 (290)

14 Pounds in 20 Days

The title of this post sounds like a cheesy infomercial that you might hear at 2:00am in the morning, something you might see highlighted and large on the front cover of STAR magazine, something you might expect printed/promised on a bottle of the latest diet pill.

But...

I have actually lost 14 pounds in the past 20 days. I guess when my doctor told me that I would lose quickly after I got some restriction back, he was telling me the truth! I must say though, I am only able to consume 400-800 calories a day, so this is definitely going to catch up to me and bite me in my big'ole behind eventually. The reason I am consuming so few calories is because I am literally NOT hungry. Quite the contrary. I usually feel full all day long so I make an effort to drink plenty of water and squeeze a few protein shakes in. Now, I don't think I am too tight, because I can eat and it normally stays down just fine. I've just been extremely busy, and food is far from my thoughts for once in my life!

In addition to the scale moving, I have noticed a few new NSVs that I am going to mention for documentation purposes. I have noticed that in addition to collar and hip bones, I now have ribs. When I lay flat on my back, my belly sinks in and my ribs pop out. AWESOME. My husband laughed at me the other night when I shouted out, "I have ribs!". Another big one is my two year old can now wrap his legs around me when I hold him without me feeling like I am inducing a forced split! Poor guy, he is probably one of the most flexible little boys around. Another one is the fact that I can not only sit at ANY booth comfortably, but I can now cross my legs under the table! :) Oh, and I can't forget the fact that I am continually surprised by my own reflection when I catch a glimpse of my body in a glass door.

When I started this journey seven months ago, it was so hard for me to imagine wearing an XL top and a size 18 jeans again, but here I am. I am LOVING my band.

Vita- yum, yum, yum

Unlike my past candy bar post, this post is about a seemingly healthy, super-yummo snack/meal. Have you heard about VitaTops and VitaMuffins yet? They are SO good. One of my close friends buys the vitamix and makes her own muffins, it's much cheaper that way. BUT, my grocery store didn't carry the mix, only the VitaTops, which can be found in the frozen section.

Each muffin top contains 100 calories, 1.5g fat, 6g fiber & 3g protein. Not too shabby, huh?

You have to store them in the freezer, as they are preservative free. This is a good thing, because you can thaw only one at a time, thus reducing the urge to overindulge. I actually had one for lunch- two hours ago- and I still feel super content.

Well Hot Dog- 50 lbs. Down

FINALLY 50 pounds down. I have been waiting for this milestone for quite a while. The lap-band journey has been an interesting, motivating, inspiring but sometimes difficult journey. I am looking forward to what my future has in store, which is refreshing.

Geesh, Who Doesn' Know!?

Well, a few things on my front. You may or may not remember the fact that I was worried about not telling one of my best friends about me sporting a lap-band. I didn't want to tell her at first because I didn't want to apply any extra pressure to myself. I felt the more people who knew, the more I would freak myself out.

So...

My friend and I went out for dinner the other night, and she was acting really weird. She kept telling me she was worried about me because I wasn't eating anything. Skip to about four hours later, and after she told me she was afraid that my bulimia had started up again- I felt it was time to tell her. So I did. Spilling the beans to her was super anti-climatic. She was very understanding and was happy that I had made a decision to better my health. Really? That's it? That's it. Why didn't I tell her a long time ago? I felt a little stupid.

THEN-

While going out to the movies with my neighbor (who had promised to keep my secret exactly that- I shared with her because she too had WLS) and her sister the other night, I realized that people knowing isn't entirely in my control. I found out she told her sister when she nonchalantly started talking about my band. WHAT? Then, when the SAME neighbor introduced me to her daughter who was visiting, she introduced me as, "This is Lynn, she has the lap-band". Seriously. She did that. I don't think it gets much more rude. To top it all off, when I kindly asked her to stop sharing my information, this was her response, "Oh, I would never tell anyone, that's your business, not mine." Did this lady fall and hit her head on a rock? Or do I just no longer understand the English language?

Writer's Block

I've been experiencing a case of writer's block lately. I have so much going on, yet nothing really inspiring or blog worthy. Does that make sense?

Sometimes I blog about the most boring and ridiculous stuff, but when my life is full of craziness- I don't feel like blogging. It's just weird.

So, because this blog is supposed to be a documentation of my journey, I am going to list a few things going on with me right now. Okay? Okay. So, here it goes:

• My husband and I had to fire one of his employees yesterday. It sucked. Bad.
• I had a fill of 4 ccs two Fridays ago to prime my band once again and to end my insane eating.
• I gained 5 pounds in two weeks before my fills returned.
  
• I had a fill of 2 ccs last Friday and have lost 7 pounds since Saturday. Hopefully there will be no plateau for me anytime soon.
  
• We bought a wooden playset for my boys- I am so excited! Now, if we could just decide on who gets to put it together for us.
• My boys have had the privilege to attend a wonderful private preschool over the past two weeks. But, their last day is Friday and I feel just awful that we can't afford to allow them to keep attending.
  
• I am going to cry on the boys' last day of school. They love it there, and I LOVE their teachers! But more so, I LOVE what going to school has done for my boys. It's been a wonderful experience all around.
• My husband is addicted to a "retarded" game on the computer called World of Warcraft. Embarrassing, but that's something going on.
• My husband neglects the boys and me a bit to fulfill his WOW fix. It's irritating.
• I run away from life by eating- he runs away by playing his game.
  
• I AM WEARING A SIZE 18 AGAIN!!!! This is a good one, let me tell 'ya.
• I bought myself some new undies yesterday.
• Oh, oh! Yeah, I almost forgot- I got some new Spring/Summer tops and they were a size XL! Not 3x, or 2x or 1x, but just plain 'ole XL.

So, there you have it. My last few weeks in a nutshell. I hope I didn't bore you!

Followers

Is it just me or do you take it personally when someone de-follows you? I hate it when that happens!!!

There are no words...

I just found out that a fellow blogger, and friend, has passed away. She passed away last night after suffering a heart attack. Bethany was a 33 year old wife and mother. Please pray for her family during this horrific time.

She's Baaaaaa-aaaaack

My band has returned. I met with the FNP today at my surgeon's office and she helped mediate a compromise for the two of us. My band decided to return to her post with a whopping 4 ccs- 2.5 for the prime and 1.5 for restriction. I am so relieved!

I felt a difference immediately and hope to be back on track by next week's fill. I learned a few things this past week and a half:

• I appear incapable of restraining myself (without the band) when it comes to food.
• My stomach actually shrunk- a lot. I could barely eat "normal" portions. I was so excited to once again eat pizza and placed two whole slices on my plate settling in for a major chow down. Surprise! I could only eat half a slice.
  
• I gained BACK 8 pounds in 1.5 weeks! 8 pounds. My body must have been starving for those extra calories.
• My insomnia returned along with my fierce temper, hot flashes and irritability. It's amazing what eating yucky foods (ie. foods that are NOT band friendly) can do to your overall health and state of well-being.
  
• It is so important to take better care of myself- see bullet above.
• I don't ever want to be without the band again and plan on treating her with extreme caution and with a great degree of care.
• It only takes 1.5 weeks to go from a size 18 back up to a 20. (Don't try this at home.)
• All the foods that I have been "missing" over the past six months were SO not worth eating again. NOTHING came close to tasting as good as losing weight feels. As a matter of fact, I am totally grossed out by how disgusting all of my past favorite foods now taste. I need to make sure I remember this one.
• The past six months has actually changed my mentality quite a bit. Instead of constantly dreaming about my next meal, I found myself forgetting to eat and not worrying about food. It was great.
  

Reading over all of your blogs has reminded me of how successful I can be if I truly put my heart into making this journey work. THANK YOU ALL for being here for me. I would be so lost without all of you.

FYI- "Remember Me" with Rob Pattinson is an excellent movie. It's a definite must see.

Guest post by Matthew Constantin, PhD (biochemist)

The Importance of Multivitamin Supplementation Following Bariatric Surgery

In a peer-reviewed article entitled “Nutritional Deficiencies following Bariatric Surgery: What have we learned?”, Richard Bloomberg, MD of the Mount Sinai School of Medicine, and his team study the importance of nutritional supplements following bariatric surgery. Research shows that following bariatric surgical procedures, vitamin and nutrient deficiencies are common. A close examination of these deficiencies after weight loss surgery shows that supplements should be a standard post-operative element so that potential nutritional complications will be minimized [1].

Roux-en-Y gastric bypass (RYGBP), biliopancreatic diversion with duodenal switch (BPD-DS), and biliopancreatic diversion without duodenal switch (BPD) are three commonly performed bariatric surgeries. These surgical interventions work by reducing the size of the stomach (restriction) and preventing the absorption of food in the gastrointestinal tract (malabsorption).

While bariatric surgery results in significant weight loss, the malabsroptive nature of the operation can severely compromise the ability of the body to absorb vital nutrients, such as protein and iron, causing nutritional deficiencies. Restrictive techniques, such as gastric banding or sleeve gastrectomy, are less likely to cause nutritional deficiencies comparing to malabsorptive techniques. This is because restrictive procedures do not directly affect food absorption in the small intestine. If a deficiency occurs after a restrictive procedure, this is usually the result of food intolerance or the tendency of the patient to avoid certain nutrient-rich foods postoperatively. This article focuses on the effect of malabsorptive procedures (RYGBP, BPD-DS and BPD) on the absortion of protein, iron, vitamin B12, folate, calcium, vitamin D, thiamine and fat-soluble vitamins.

Nutrients Deficiencies

Protein

Protein deficiency after bariatric surgery has been well documented. This is most likely the result of bypassing of the small intestine where protein is absorbed in the body. Protein deficiency occurs usually in BPD and BPD-DS surgeries. A study done by Marceau et al [2] found that there was a high incidence of protein deficiency after BPD and BPD-DS surgeries with 11% of patients having serum albumin levels lower than 3.5 g/dL. The normal serum albumin levels for adults are 3.5-5.0g/dL. In another study, 3.7% of patients who underwent BPD needed to be re-hospitalized because of the severe protein deficiency they presented. Dietetic counseling and increased protein intake aided in preventing further recurrences of the deficiency.

Iron

Iron deficiency can occur in both restrictive and malabsorptive operations. In the case of malabsorptive procedures, iron deficiency results from the fact that the duodenum and proximal jejunum (the part of the small intestine right after the stomach) is bypassed. Iron deficiency has been shown to increase in RYGBP patients during the first 5 years postoperatively [3]. Other studies however, such as the one by Rabkin, who studied BPD-DS patients, have found that iron levels were normal over a period of 3 years [4].

Vitamin B12 and Folate Deficiency

Bariatric surgery usually affects the absorption of vitamin B12 and folate. B12 is absorbed in the terminal ileum, the portion of the small intestine the stomach is connected to in the BPD procedure. Almost one third of all patients studied by Halverson and colleagues were deficient in B12 and two thirds were deficient in folate, one year after gastric bypass [5]. It is noteworthy that patients can present deficiency in these two nutrients even if their vitamin levels are normal preoperatively. Studies have shown that regular supplementation with B12 and folate after the surgery can prevent deficiency of these two vitamins.

Vitamin D And Calcium Deficiency

Vitamin D is absorbed in the jejunum and ileum, while calcium is absorbed in the duodenum and proximal jejunum. Since bariatric operations result in bypassing of these segments of the small intestine, vitamin D and calcium deficiencies are a common phenomenon in weight loss surgery patients. Calcium deficiency can lead to potential bone loss and increase the long-term risk of osteoporosis. In fact, some retrospective studies have shown evidence of postoperative metabolic bone disease. Calcium and vitamin D deficiency rates can be as high as 50% [6], and while many morbidly obese patients already suffer a lack of these nutrients pre-operatively, the deficiency is exacerbated after the surgery. Often, supplementation may not be enough to correct low calcium and abnormal vitamin D levels. A study of BPD patients by Slater et al showed significant deficiencies in calcium and vitamin D, despite supplementation [7].

Thiamine (Vitamin B1) Deficiency

The deficiency of this vitamin is relatively rare. Studies have shown that thiamine deficiency occurs in only 1 every 5800 bariatric patients [8]. Treatment with thiamine (intravenously or intravascularly) resolves the deficiency as quickly as one day and no more than four months after the surgery.

Other Fat-Soluble Vitamin Deficiencies

Vitamin A

Levels of Vitamin A were found to be low in 61% of patients undergoing BPD with or without duodenal switch, despite the fact that 4 out of 5 patients were compliant with vitamin supplementation.

Vitamin E

Vitamin E deficiency is uncommon and occurs after malabsorptive operations, usually BPD. Patients who receive multivitamin supplementation can effectively sustain normal levels of vitamin E after the surgery. A study by Slater showed that 96% of BPD patients who were taking vitamin supplements had normal levels of vitamin E even 4 years postoperatively.

Vitamin K – Magnesium – Zinc

There has been no substantial evidence to suggest deficiency of vitamin K after surgery.

Magnesium levels do not seem to be significantly affected by bariatric surgery. One study found that magnesium concentration remained normal 4 and 10 years after BPD surgery, while another one found that only 5% of patients had low magnesium levels 2 years after surgery.

Zinc deficiencies have been found in as many as 50% of BPD-DS patients and in only 10.8% of BPD patients. Interestingly, 80% of these patients where taking multivitamins.

Conclusions

Clearly, there is a great deal of clinical research that indicates that vitamin and nutrient deficiencies do occur after bariatric procedures. It is because of this that the use of supplements may be more commonly recommended after the surgeries. Additionally, it seems that more research should be done to investigate the impact of such supplements on the deficiencies and the resolution rates.

References

1. Bloomberg, RD, Fleishman, A, Nalle, JE, Herron, DM, Kini, S. Nutritional Deficiencies following Bariatric Surgery: What Have We Learned? 2005. Mount Sinai School of Medicine. Obesity Surgery 15: 145-154.

2. Marceau S, Biron S, Lagace M et al. Biliopancreatic diversion, with distal gastrectomy, 250 cm and 50 cm limbs: long-term results. Obes Surg 1995; 5: 302-7.

3. Skroubis G, Sakellaropoulos G, Pouggouras K et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg 2002; 12: 551-8.

4. Rabkin RA, Rabkin JM, Metcalf B et al. Nutritional markers following duodenal switch for morbid obesity. Obes Surg 2004; 14: 84-90.

5. Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 1986; 52: 594-8.

6. Brolin RE, LaMarca LB, Kenler HA et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6: 195-203; discussion 4-5.

7. Slater GH, Ren CJ, Siegel N et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55; discussion 4-5.

8. Chang CG, Adams-Huet B, Provost DA. Acute postgastric reduction surgery (APGARS) neuropathy. Obes Surg 2004; 14: 182-9.

About the Author

Matt Papa, PhD, has dedicated a great deal of his research time to better understand the elements of bariatric surgery as well as the benefits and complications. He is excited he was given the opportunity to share some scientific facts with the BlubberyBlogger community. In his website he presents research findings  and posts practical information on the topic of weight loss surgery, and offers a coupon for Medifast and a coupon code for Nutrisystem.

 

Yeah, so leave us alone darn it!

Farewell Band, Please Hurry Home

As I type this entry, my band is somewhere over the Atlantic Ocean- far, far, far away from me. Our distance deeply saddens me and fills me with a horrific anxiety. Why did she leave me you ask? I don't know. All she said right before she walked out the front door with my 7 ccs of saline was this, "I need a holiday". Because we have only been apart now for ten hours, her words still haunt me; still so fresh in my mind. When will this hurt, this wound heal? I have been told to expect her to be gone for at least two weeks.

She has served me hard and served me bravely over the past six months. She was tired and she was too full. She tried as hard as she could to firmly grasp my stomach, but she was just too tired of trying to hold on while my stomach continued to swell resulting in my inability to keep anything down over the past four days. The ulcerated and painful environment that she was working in was just too much for her to bear. Her gallant efforts resulted in a ten pound weight loss in the past four days, but even for her that was too much.

I am hoping that in two weeks time she will be willing to re-access our situation and once again join me in this battle of the bulge. Maybe this "Band Holiday" is just what the doctor ordered. But until then, to ensure that her working conditions are as satisfactory and as comfortable for her as possible, I will be taking a daily regimen of ibuprofen, steroids and a proton pump inhibitor.

How will I deal with this sudden separation of such a crucial "person" in my life? I am hoping to deal with my pain through exercise and focusing on my health rather than indulging in copious amounts of food to drown my sorrows.

I do hope that she hurries home. I am so scared to be apart from her. So scared.

FINALLY Some Movement

I've been at a plateau for so long now, I just have to post this number. I am hoping to post a #50 soon!

Rules, Schmools

Okay, so as any bandster knows, being a bandster comes with a set of "Golden Rules". I was laying in bad last night annoyed that I couldn't get any water down. I am very swollen from my fill on Thursday AND from trying to eat mushies yesterday when I was only supposed to have liquids.

So, here I am laying in bed worried about not being able to rinse out my pouch with a full 8 oz of water, when all day yesterday I repeatedly "broke" rules!!! It seems with me that some rules hold more clout than others. I usually drink with meals...I usually eat after a fill...I don't do 24 hours of liquids if I've thrown up...etc. But for some reason, I was so upset about not being able to drink my water last night! Go figure. My THS is in full effect once again. Rules exist for a reason.

So- here is my question for all of you: What one Golden Rule do you ALWAYS try to follow?

NSV #731

As my journey continues, I have been racking up the NSVs (non-scale victory). Unfortunately, as soon as I realize them- they seem to slip my mind. One that has not left me is that fact that I no longer have to move the weight to the 250+ mark on the scale. While at my midwives' office the other day, I had to start off with the weight on 200!!!

Little steps, little steps.

Think Poopy Thoughts Everyone

Here is a visual to aid in your meditation:

I LOVE My Band

After struggling ALL day to preserve any bit of control I could muster- I decided to blow it. When my husband got home from work tonight, he teased about wanting McD's. I was ALL over it. Keys in hand I took orders and flew out the door.

I decided on the way there I was going to go all out and splurge big time all the while promising myself tomorrow would be better. It took me about ten minutes to get there and I spent most of that time writing this post- writing a post about how I blew it, how I disgraced myself, how much I ate....etc.

I ordered TWO Mac Wraps for myself and looked forward to sharing my husband's fries. Once I got home I opened the white paper bag of disgusting-ness and dug in. Weeeeeeee-ell, my plans were foiled. After only two or three bites of my wrap I was full. FULL. Two or three bites! FULL.

Reality check- smack in the face. Get a grip Lynn!

I LOVE MY BAND.

It's Not Just the "Fluffies"

It's not just us "fluffies" or former "fluffies" who have/had a problem with self-constraint. SURPRISE!!! I was watching the Wednesday night comedy line-up recently and couldn't help but notice a theme to two of the shows.

The Middle is a hilarious show about a stressed out mother of three struggling to make her job and household work. During the last episode she vowed to never scream at her children again. So, when she got horribly worked up and wanted to scream, she thought, "That's okay, I can handle this. I know just what to do". She proceeded to march straight into the kitchen, opened up the pantry and started squeezing frosting directly into her mouth from the tube. Frosting always made things all better.

After The Middle, I watched The Modern Family (another hilarious show). During that show the mother is upset by her family embarrassing the snot out of her while she was trying to impress a former co-worker. What did she do? She screamed at her family, marched out the door and went straight to a burger joint where she enjoyed a burger and fries. Coincidence? I think not.

We all want to self-medicate from time to time. Like me lately- I have been medicating with candy bars because of our recent money woes. I just wish I could get it through my THS that eating doesn't help with anything expect stretching out my new smaller undies!

Quick, Call the Food Police...

...Because what I just ate ought to be a crime. Someone Pah-Leeze call all the grocery and drug stores in the state of North Carolina and ask that they no longer carry these. They must be stopped!!!

I just discovered this new little trick that Satan has up his sleeve. Stay away everybody, don't get sucked in! I won't sit here and tell you how wonderfully sinful every-single, delicious, to-die-for bite was. No, no. I wouldn't do that.

Instead, this is a public service announcement: When you see these at the check-out, run and run fast. If you find yourself being lured into a purchase, by the sumptuous whispers of the platinum sparkle of the wrapper, call for help.

Pictures: 5 Months Post-Op

I used to have to lay down and pray just to get those jean capris on! Now, they just fall off. Awesome. I am trying to make myself realize that I have made positive progress on this journey, but it's hard not to get caught up in how much further I have to go.

Thanks again for all of you- my followers. Road trips are no fun without passengers!!!

Wanted: Tyrannosaurus Rex

Does anyone happen to have a dinosaur
I can borrow?

My Family

A few of you have asked about this "husband" I talk about. I haven't posted a picture of him before, because I would like for my family to maintain some amount of anonymity. But for all of you curious out there, here is our Family's Christmas picture. I have a husband and two sons! :)

40 Down

I am officially down 40 pounds this morning! I have been waiting for this for a while. I weighed 250 back when my husband was interning for Chiropractic school. He had to use me to get some x-ray credits, and along with the x-ray came a full physical. I was so embarrassed that he was going to find out what I weighed.

When the moment came for me to step on the scale, my husband's "assistant" (another student) and his professor all gathered around. Why? I guess they were all dying to see how big I was. When the number popped up, my husband looked at me and asked, "How is that possible?". I must have turned every shade of red. I thought I would die from embarrassment.

I didn't die. Instead, I managed to pack on another 40 pounds over the course of our marriage. Those 40 pounds are gone now, and I couldn't be more relieved. Oh wait, yes I could. I could be at goal weight. But, that's for another day. But the day WILL come! I am so excited.

Thanks so much for ALL OF YOUR SUPPORT during my journey. This journey would be so much rockier without all of you.

Jiggle, Jiggle

I am ashamed. I ought to be shot. Tonight I did something that I will forever regret.

My husband has been putting on some weight over the past few months- I'm losing it and he's finding it. He is growing increasingly aware of the situation and is becoming uncomfortable with his pant size. My husband has always been a solid size 34 and has held steady at around 175-180 pounds for as long as I have known him. But, lately his 36s are starting to feel tight and his tummy is starting to dun-lap over. I'll get to the point, I promise.

Because he is uncomfortable, he has delegated me to be the one to "remind" him of his little bulge problem, especially when he requests fast food or ice cream late at night. I have been sure to keep the freezer stocked with Weight Watcher's ice cream bars for him. Soooooooo....this evening he ended up getting a milkshake from a certain "chicken chain".

After a while, I looked over at him and said, "Okay Honey, are you still hungry? Do you really want to finish that? Put it down". THEN....oh, my gosh....THEN I proceeded to reach over to his side of the car and I....I....I jiggled his belly with my hand. (Head being thrown into my hands in disgust)

Oh the horror. Of all the monstrosities I could inflict on my poor husband whom I love to death. I seriously did that. For that moment, for that one little moment in time, I was totally that "person" who jiggles you to show you how fat your are!!!

I have stooped to a new low.

He said he didn't care, but I VOWED TO NEVER DO THAT AGAIN to ANYONE!!! I told him I felt SO bad that I was going to go straight home and eat. ;) At least that provided a laugh to break the tension.

Recent Diagnosis

Dear Fellow Bloggers,

I hate to make you aware of this, but I must be honest. I have recently diagnosed myself with a severe case of "Thick Head Syndrome", also known as THS or Dumb Blonde.

My prognosis depends on my ability to get something through my thick skull.

Apparently, I have been in denial regarding my recent weight loss surgery. After struggling with weight loss for at LEAST the last 20 years, it hasn't sunken in that I am actually going to lose weight. Me. I am. Lynn is not going to be "fluffy" forever.

Whenever my husband makes simple comments, such as "When you are down to 170 pounds, you are going to love shopping!", there is a small part of me that wants to smack him! How dare he just assume that it will be so easy to lose all this weight on my own. But then, I realize that I am not doing it alone. Not only do I have all of you, but I have my band!!! Dur.

My husband has faith in my journey, but I keep forgetting what path I am on. I am so used to going down the wrong road, that my THS keeps kicking in.

When is it going to sink in that I AM going to be successful? That I don't have to be this way forever? That I have been equipped with a wonderful tool to help me?

Do any of you suffer from THS?

Bed, Bath & Beyond

Hello all of my fellow bloggers!

I will post a poopy update later today :).

But for now, do any of you have a coupon for BB&B? I would LOVE to find one that was good for 20% off an ENTIRE purchase.

Let me know.

THANKS!

The Truth About Poop

The truth about poop you ask?
The truth is that sometimes you find yourself thinking
about poop much more than you ever have before. Especially
when it's been eleven days since you were forced to think about it.
LORD help me.

The Blubber Blues

This blubbery blogger is feeling.....well.....blubbery. I hate to admit it, but I am in one heck of a crappy place right now. I can't stop eating left over Christmas cookies, even though I should just put them in the trash instead of treating my body as the trash can.

I just sucked down a LARGE milkshake from Chick-Fil-A, something I NEVER do, and I am feeling pretty darn blue.

Crap. Crap. Crap.

Here wagon, wagon, wagon.

Travelling Clothes

A fellow blogger, JEN, was so kind to send me some of the clothes that she has shrunk out of! I am like a small child on Christmas morning.....so excited.

Here I am in a gorgeous Ralph Lauren sweater that I very well may never take off.

THANK YOU JEN!!! and to ALL of you who have offered to send some new duds my way!!!

Rant'in And A Rave'in

Today's Rant:

Why must department stores put the "Today's Woman" department in a "special" place that cannot be found without having to ask for help? Seriously, as if we didn't already feel alienated enough, they make us shop upstairs and in the back corner.

Gross.

Need Help. Fashion Emergency.

Okay ladies (and gents!), I am down 35 pounds as of this morning, and my clothes are starting to suffer because of it. I was looking at myself in the mirror last night and my jeans are starting to look like parachute pants!

There are two pairs of pants, one pair of jeans and a pair of dressier pants, and a small handful of shirts that I can wear. I am getting tired of wearing the same thing every other day, but I don't want to spend money on new clothes right now! What do I do? What have you done?

How have you transitioned smoothly from one size to another without breaking the bank!?

Added December 28th- I need size 18/20 (1xl) tops and pants for those of you who have anything to pass along. I promise I will pay it forward!

MERRY CHRISTMAS EVERYBODY!!!

I hope your day is full of peace, health and family. Enjoy this special day.

34 Lost

It's almost 2:00 am and I am up because my three year old has pneumonia. I have given up trying to sleep in between his coughing, um excuse me, hacking spells for the past four nights. I feel so bad for him!

Oh, sleep....where are you....why must you elude me so. Zzzzzzzzzzzzzzzzz.

Funky

I'm officially in a funk today.

I have a UTI (urinary tract infection).

I have gained a few pounds over the past few days. (?)

Everyone is irritating me.

I am down right nasty today.

Blech.

Just Another Non-Scale Victory

Last night before going to bed my husband thanked me for being such a good little "housewife" lately. He was referring to the amount of laundry, bed stripping and overall chores and tasks I have been completing lately. Which leads me to this:

If you are not sitting on the couch for hours a day stuffing your face,
you have a TON more time to list/sell/mail things on Ebay, do laundry
run errands, take naps!, clean.....etc.

Just another non-scale victory.

I have however, come across at least two things that are bad about losing weight. Yeah, I said it. Bad! The first being, as you lose weight, your hips start to disappear. This is not so wonderful if you have a two year old that likes to sit on them and be held all day long. I am having to use muscles I have never used before to keep my little bugger in place! Second, my jewelry. I am a jewelry whore. I have quite a few sterling silver rings that cannot be sized and most are a size 9. When I wear my size 9 rings now, they spin around and usually fall off. So, I hope my husband plans on making a few extra dollars here soon, because I need to increase my size 8 collection!

Oh yeah, see you later pound number 33!

Brrrrrrrr, Chilly Brrrrrrrrrr

I am down 32 pounds this morning, but still find myself in a weird funk. I am terribly grouchy today! Geesh, losing a pound used to be euphoric for me and would last at least two days. Am I getting greedy? Maybe. But I think my head is just in a strange place today because last night I laid in bed thinking about how exciting it would be to see 258.

On another note....

I wrote on the LapBand forum recently about experiencing chills, cold hands and feet, and not being able to become warm enough to fall asleep at night, even with an electric blanket, two comforters and a sheet. When I brought it up with my surgeon he said that was perfectly normal. He said once we start losing weight, our bodies have to learn how to account for the sudden loss of fat. Basically, its as though we have been comfortable under a 30 pound blanket for years, and then all of a sudden we throw it off! So we start to feel cold.

Okay, I promise I am going somewhere with this. Bear with me... I was laying in bed last night talking with my husband, and warming my icy hands under his back, and we started talking about how my metabolism has to learn to warm up. Then an AHH-HA! moment.

Try to follow me here. If we continue to smother our bodies with a fat laden coating, our bodies have to cool down, right? So, it would make sense that our bodies cool down by slowling down our metabolism to produce less heat, right? And of course when our metabolisms slow down, we gain weight easier. Essentially the more weight we pack on, the harder it is to lose it because our metabolism slows down. So maybe, just maybe, as we begin to lose weight, our metabolisms will have to kick in a bit to keep our bodies warm, burning more calories.

This theory of mine makes all the sense in the world to my biology/chemistry major brain late at night.

You might also find this tid-bit interesting; when we lose weight, we actually lose fat around our inner ear, and until our body finds a new equilibrium, it can make us feel dizzy. Pretty interesting, huh?

Starting to See Myself

This journey sure has been an interesting and very enlightening one. During the course of my life I have only gained. And if I had lost any weight, it was going right back on, and quickly.

Last year we got our Christmas picture taken as a family. I was hoping and praying that it would turn out okay, and by okay I mean me not looking like a giant heifer. Once our picture was presented to us I was overjoyed with what I saw! I was SO happy with it. As a matter of fact, I assumed the photographer must have done a little photo-shoppy shop on my face because it looked so much less "swollen" looking. I framed that picture and have it proudly hanging in our house for all to see.

I see that picture, everyday, several times a day in fact. And one thing I have noticed is how "fluffy" my face looks to me in that picture now. It's amazing to me. I have only lost a little over 30 pounds and I am already used to my "new face" in the mirror looking back at me.

In the past, successful weight loss was defined for me as severe, hospital worthy "morning sickness" with my two pregnancies. It's so weird to see myself changing, and I really like what I see. I am starting to notice my waist again, my bras continue to become looser, my jeans are baggy and my chronic foot issues are starting to resolve. I can only daydream about how wonderful these next few months are going to be as I transform into who I have always pictured myself being. The person I have always felt like, the person I have always been on the inside. A happy, confident person.

The 250s !!!!

Yay! It feels so good to see 259 on the scale this morning. It's been a L O N G time since I was firmly planted in the 50s. Now, I am already feeling impatient for the 40s!

My last fill has left me a bit too tight. I haven't been able to eat more than a half of a banana or a cracker here or there. It's even hard to get liquids through, but when the fill was first done, liquids went through just fine, so I am probably swelling quite a bit. I am going to give it through the weekend and see how I feel on Monday before going for an un-fill. I am so excited to finally have restriction, but this might be a smidgen too much. For the first time though, I understand when people say they can only eat 1/4 cup of mushies. I'm there.

Seeing is Believing....Right?

I've made an interesting observation over the past few weeks, and wanted to discuss it with all of you.

Last summer, I was able to lose 30 pounds. On my own. Through good old fashioned hard work and exercise. BUT, I GAINED IT ALL BACK and then some. Welcome to my life. That was the last straw for me. I couldn't imagine living my life always wondering when I would be "fluffy" again IF I had managed to lose weight again. Hence my decision to finally explore WLS after struggling with my weight for 20+ years.

Anywho, last year I had everyone tell me how wonderful I was looking and how my weight loss was very obvious. I couldn't bump into anyone without them noticing. My mother-in-law would carry on and try to touch me in all of the places I was thinning out. It was a great feeling...not being touched by my MIL, but having everyone notice!

BUT, I have noticed that this time is different. I have lost 30 pounds in about 3 months and no one really says anything. It's weird. Do you think that maybe people are scared to carry on like they did before fearing that I will just put it all back on again? I don't know what to think.

Now, I do realize that me feeling better, my clothes fitting better, my relationship with my husband improving....etc. is really all that matters. But I am just left scratching my head about whether or not people can tell. On another note... some farewells are in order for pounds number 29 and 30. Sianara suckers! :)

Another One Bites the Dust

Doot, doot, doot... another one bites the dust! Hit me.
And another one gone, and another one gone,
Another one bites the dust.

Another One Gone!

Sorry if this is obnoxious, but I really have to make a special point to celebrate every pound lost. It is way too easy for me to get down on myself and feel like a failure.

Oh yeah, and I forgot to mention that now I am no longer morbidly obese, just severely.

Only 99 To Go!

I haven't been feeling well lately, so please excuse my absence from Bloggyland. I have been trying to keep up, but have failed miserably.

After suffering with a sore throat virus, that turned into a throat infection and having to take antibiotics, I went straight into a nasty head/chest cold. I am sure you know the one, you are probably suffering from it as well! If so, I hope you feel better VERY soon!

So...because I have been feeling like crap (for lack of a better word) lately, I haven't been able to exercise. I am now down to 264 (I ALWAYS start typing a 1 instead of a 2!), but I am afraid that might be from muscle loss after not really working out for the past four weeks. BUT, I am going to celebrate nonetheless.

With my new low, I officially have less than 100 pounds to lose before hitting my goal. FINALLY. I am out of the triple digits!

Thanksgiving went extremely well and I am going for another fill next Tuesday. Not only am I not losing as fast as I would hope, but I am able to chew normally without really getting stuck. Two days after Thanksgiving, we had not one, but TWO cakes in the house for my little guys 2nd and my Mom's 60th birthdays. Temptation, temptation, temptation.

One major NSV that I am loving, is the fact that my husband and I are flirty and frisky once again. It's been a L O N G time since I remember him getting touchy feely with me. YAY!

100 pounds to Go!

Today is the day folks. The day where we either stuff our faces and die of guilt for weeks to come why we try to burn off our celebration, or the day where we can enjoy small portions, blessings and family.

I plan on the latter.

I woke up to wonderful news this morning....25 pounds down! So, I would love to keep it that way.

AND....drum roll please.......

After finally discussing my little "problem" with my husband last night, we frolicked and voila....AHHHH-CHOOOOOO!!! Yup, I sneezed! Whoo-hoo.

If you are confused by this, read my last post. :)

HAPPY THANKSGIVING EVERYONE!!!

Effects of Effexor

Well, this is going to be one of my first real candid, gone way too far, provided way too much information, make you blush post. So, sit back, open up your mind and let me know if you can relate.

I have been on Effexor now for about four months. However, I recently discovered that I have been taking the generic form, which is fine, but the generic is not a slow release. When I was taking it, it was dumping into my system too quickly and making me feel like I was going to die (headache, dizzy, sweats, nausea)... literally. But, I had gotten used to it. I happened to mention how awful it makes me feel while I was at my doctor for a sore throat last week, and he switched me to the REAL Effexor which is slow release.

Weeeeeee-eeeelll, there has been a not so nice side effect since I started taking the real stuff. Lately, when my hubby and I "frolic", I have been having a problem with the "CHOO" part. As in a sneeze with an aaahhhh, Ahhhhhh, but no AHHHHH CHOO! if you catch my drift. It's so frustrating!

Have any of you experienced a similar side effect? Did it subside?

Hold The Phone....

It's NEW MOON Friday! (Insert high-pitched squeal here.)

At long-last...we meet again my dearest Edward.

Tourettes Syndrome Moment

You know those moments in a movie when you can't believe that the movie just took that kind of turn, only to find out that the actor was imagining a tourette like outburst, but it didn't really happen? Well, I can't help but notice that whenever I am around a person/group of people that I do not wish to know about my surgery, I flirt with the idea of just screaming out "I had Lap-Band surgery!". Then I snap back into reality. Anyone else flirt with disaster?

Anyone? Anyone?

Fill'er Up.....or Not

I went in for my third fill yesterday. But after reviewing my "case", my surgeon's PA decided that I wouldn't be getting a fill. His reason? I had lost too much weight. Ha ha ha ha ha ha. Seriously? Too much!? He wanted to see around 2-6 pounds in a month, but I had lost 10 according to their scales, so no fill for me because he feels I am obviously working the band properly and don't need more restriction.

I do have to say that I seem to be getting stuck a lot and having to run to the bathroom for quite a bit of PB'ing lately. Do any of you notice that your restriction changes from day to day?

Sometimes I can eat anything and other days I can't even think about eating something that isn't the consistency of mashed potatoes. It's just weird.

Back From the Beach

Hey everyone!!! I got back from the beach just a few hours ago, and boy do I need to make a few confessions.

My friend and I ate like food was going out of style. It was pretty bad. Reese's Cups, Butterfingers, Dr. Peppers, cake, Whoppers, doughnuts...and I don't even like sweet foods! Ugh. My body is probably going to be sooooo sore and stiff for the next few days until all the poison is cleansed.

I am going to go and workout and hopefully burn off at least ONE doughnut. I feel like such an idiot! The only good news is that I got overeating out of my system for quite a long time. I never did tell my friend about me being banded, but she did tell me she was worried about me because I wasn't eating us much as I normally do at meals. HA! Funny.

I will update with a post tomorrow to divulge my rebellious weight gain.

101 To Go

After feeling a loss coming today, I searched for the perfect number "23". But, upon stepping on the scale this morning, I was surprised to find out that I should have been looking for a "24"!!!

I can't wait until I have less than 100 to lose. I am afraid that that might be a while, however, since I have a beach trip planned for this weekend. The plan is to stick to eating right, but I probably won't get any exercise in.

On another note, I took my boys to a play space full of bouncy houses the other day. Now, the last time I went, I left my shoes on and watched my boys struggle to surmount the obstacles because there was now way in HE!! that I was going to put my fluffy self onto one of those things and embarrass the snot out of myself in front of all of the skinny Moms. BUT, this time I threw off my shoes and had a blast with the boys. I am tired of waiting to live my life. And I didn't worry for two seconds what anyone thought of me, it was great. Let me tell you, those slides are scary!

Have a GREAT day everyone!!!

Small shout out for poor little pound 23.

Another One Down, 103 To Go

Whoo-hoo! Number 22!

I was afraid that the scale wouldn't be so kind to me this morning after munching on my boys' Halloween goodies, but after my 65 minute workout on the elliptical last night, I was sweetly rewarded.

My resistance muscle is growing stronger and stronger everyday and eating better is getting easier. I was at Starbucks with a few friends late one night, and they were giving away all of their goodies. I had my eye on a slice of lemon pound cake and I wanted it SO bad. So, I hatched a plan. I asked for that and one other piece of pound cake and requested that they cut them into multiple little squares for us. They happily obliged and I was able to enjoy ONE little square and stop there. It was so yummy!

I also had another NSV the other morning. About a month ago, I went out to eat with a friend and wore a pair of 20 jeans that were WAY too tight. After laying down on the floor to button them, I wore them hoping that I wouldn't be able to eat much. When I tried the same jeans on a few days ago- they were too big! Amazing.

After being "fluffy" (thanks Amy for that very politically correct word) for all of my adult life, I am still having a hard time accepting my inner diva starting to emerge. I am hoping that I don't sabotage myself due to some perverse fear of finally being happy.