Issue #223 August 2012

In This Issue

Smoking Following Weight Loss Surgery

Back on Track with Barbara
Kidney Stones

Weight Loss Inspirational Messages

Recipe: Feta Salmon Salad
Success Story: Kristen Kotik
Obesity Action Coalition Inaugural Convention

Smoking Following Weight Loss Surgery

I recently received this email asking about the dangers of smoking to our gastrointestinal systems

I had my gastric bypass surgery in May 2010.  I had three strictures in six months which I had to have endoscopes to open up.  Shortly thereafter, I was having problems with holding food down; liquids were never a problem.  I lost at least 100 lbs. my first 8 to10 months because of all the problems I had keeping food down.  I was in and out of the ER at least three times my first year because of severe pain where my stoma was.  On one of the visits to the ER, I had an MRI performed and found that I had a very large deep ulcer at the stoma site.

The next winter, I had a revision due to that ulcer.  The surgeon told me that the ulcer attached itself to my liver and when cutting it out he had to take part of my liver.  He explained that was the reason I was having so much discomfort and couldn't eat. 

I am a smoker, although I don't smoke heavily.  Of course, they blamed my smoking as the reason I had the ulcer in the first place. 

I did well for about six months then I started having problems again.  I have been seeing a gastroenterologist since December 2011. My doctor used different medications to heal another large ulcer that had again formed at the stoma site.  Again, smoking was blamed. 

In May 2012, the gastroenterologist did another endoscope and informed me that I had the largest ulcer he has ever seen and he referred me back to my surgeon.

I saw my surgeon at the end of May, and was given an hour long lecture from his nurse about my smoking; even though I had cut my smoking down significantly.  According to him, one cigarette was too much! 

I will see my surgeon again in the middle of July to discuss another revision.  He has given me some recommendations to follow and wants to see if any of those help me. They haven't.  I feel that I will be facing another surgery in the coming month, because I have started to lose more weight, the pain is still there, and I am still pretty much only able to hold down liquids.

I have talked to many people over the course of two years that have had gastric bypass surgery.  Many of them continued to smoke after their surgeries and have not developed any ulcers or problems that I have.  I am not convinced that the smoking is the culprit; especially because I am not a heavy smoker.

I have days when I wish I didn't have surgery, but then realize just how much happier I am since I did.  I only get sick when I eat and liquids continue to be fine although I just want to eat so badly without vomiting.  I have almost become accustomed to that.  I do wish at times that I could eat some of my favorite foods such as Chinese, hamburgers, pasta; but I have pretty much given up on that.

I just would like to know whether you have had any complaints from people that may be in the same situation as me?  I would love to hear from you on this subject because I haven't received any articles from you pertaining to problems with smoking after gastric bypass surgery.


Hi Diane,
Sorry, but I am going to side with your doctors and nurse here.  Smoking is horrible when it comes to healing and in the formation of ulcers. I do address that in my book, "Weight Loss Surgery; Finding the Thin Person Hiding Inside You" .

I believe that you have talked with people who have smoked following weight loss surgery who did not form ulcers, but that's not your experience. Likewise, there are people who can eat horrible diets very high in fat who will not have high cholesterol levels. But with most people, a high fat diet will result in high cholesterol. It is the same with smoking and ulcers. There are people who can smoke after surgery and not suffer any ill effects. Most people can't do that, and you are one of them. You seem to be particularly susceptible to ulcers, and even one cigarette makes your condition worse. You need to believe it!

I know how difficult it is to stop smoking. I was an extremely heavy smoker. This doesn't even seem possible now, but I smoked three packs of cigarettes a day. I loved smoking.

And even though it has been 26 years, 8 months and 16 days (literally) since I stopped smoking, I sometimes still miss it. It was only the arrival of my daughter that got me to stop.

You need a compelling reason to stop smoking and I would think that your body can take only so many ulcers. You need to stop smoking and stop completely now.

Back on Track with Barbara

Internet Mentoring Program

The Back on Track with Barbara Internet Mentoring Program really concentrates on lifestyle changes. Join our group and receive lessons via the internet and the support of others who are struggling just like you are.

Are you suffering from emotional eating and can’t stop?
Are you grazing on carbohydrates and can’t control it?
Are you lacking inspiration to lose the weight you have regained?
Do you feel that you don’t know what to do now that you have had surgery?
Are you dying to be in better shape?

My Back on Track Internet Mentoring Program is just what you
need to start your plan to get your weight under control.

View a FREE Lesson and Listen to a FREE Telephone Seminar by
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Kidney Stones

My question regarding "Weight Loss Surgery - the Worst Thing" prompted people to write to me about some very interesting topics such as the one below.

Dear Barbara,
My two "worst things" about WLS are kidney stones and vitamin D deficiency. 

I never had any problems with kidney stones prior to my weight loss surgery in 2004.  Since 2007, I have had 6 procedures to break up the kidney stones and one in which I had a stint in place for 10 days.   The pain of passing a kidney stone or having one too big to pass is indescribable!  It has been so intense that two Vicodin will not touch the pain, and I've had to go to the emergency room for a shot of morphine. 

My stones are calcium oscillate and a test showed that I am deficient in citrate.  So I take a potassium citrate supplement and have modified my diet accordingly, but I still form stones.  I consider this the absolute worst side effect of weight loss surgery!!

I take 50,000 IU of Vitamin D twice a week in order to maintain a low normal level in my body.  One side effect of taking so much vitamin D is that I have a high para thyroid hormone reading but the para thyroid glands do not have any tumors on them.

A little background - I had my weight loss surgery March 17, 2004. My starting weight was 373 (my all time high was 400+), it took me over a year to lose 125 pounds and I currently weigh around 250.  I still need to lose at least another 60-70 pounds which would put me around 180.  I had regained about 30 pounds, but was able to lose them last summer and have been able to maintain my current weight for 10 months.  

One of my biggest challenges has been my allergy to artificial sweeteners.  My reaction when I accidentally ingest an artificial sweetener is anaphalixis.  Needless to say, I am a very big label reader.  At the beginning, I had many episodes of "dumping" until I found my tolerance level of sugar.  Luckily Stevia is becoming more widely used which has made life much easier and I now have access to zero calorie beverages.  Weight loss though is still very difficult for me, and it always has been. I had to fight for every pound lost.


Hi Vickie,
Unfortunately, kidney stones is a side effect of weight loss surgery, as you will read in the article I cite below. According to the article published in the June 2009 issue of the Journal of Urology,  weight loss surgery patients are almost twice as susceptible to kidney stones as those who have not had surgery.  The study goes on to say that this is not a criticism of weight loss surgery because of all the other benefits of the surgery.

For awhile, it was thought that the kidney stones were from the excess calcium that we have to take, and unfortunately some  patients - even those directed by their doctors, decreased their calcium intake. That was not a good recommendation, and it made the situation worse. Kidney stones are often caused by an excess of a dietary component known as oxalate, which normally binds with calcium and is flushed out of the body. Because we do not absorb calcium properly, we might not have enough calcium for the oxalate to bind to. Therefore it is even more important to take sufficient calcium - especially calcium citrate which gastric bypass patients can absorb. You may also want to increase your water intake. 

I have never experienced kidney stones but I can imagine they are bad enough to want to do anything to avoid them!

Barbara Thompson's

Inspiration to Lose Weight

Weekly Email Messages that Will Keep
You Motivated to Lose Weight and Stay Healthy

Staying in the proper frame of mind to continue losing weight can be hard when life's challenges always lead you astray.  Weekly messages will keep you on a steady track to lose weight.

Start receiving weekly motivational messages today
to stay on track with your weight loss.

Click for more information

Here is a sample inspirational message:

#79  Believe In Yourself

"I've gone through life believing in the strength and competence of others; never in my own. Now, dazzled, I discovered that my capacities were real. It was like finding a fortune in the lining of an old coat."

                                       Joan Mills

Dieting can really wreck havoc with self-esteem.  We lose weight, and then the pounds can creep back on.  We lose our self confidence.  We lose the ability to believe in ourselves and our decisions.  You can be successful. Just remember that you have more strength and resolve than you give yourself credit for. Sometimes you have to just trust in the strength that is in you. 




Feta Salmon Salad

Feta Salmon Salad

This is prime grilling season and here is a dish that is packed with protein and nutrients. It is light and healthy, and your family will love it!


  • 1/4 teaspoon salt

  • 1/4 teaspoon garlic powder

  • 1/4 teaspoon ground ginger

  • 1/4 teaspoon dried parsley flakes

  • 1/4 teaspoon pepper

  • 4 salmon fillets (6 ounces each)

  • 1 package (5 ounces) spring mix salad greens

  • 1 large cucumber, chopped

  • 1 large tomato, chopped

  • 1/2 cup crumbled feta cheese

  • 1/4 cup red wine vinaigrette


  • Combine the seasonings; sprinkle over salmon. Moisten a paper towel with cooking oil; using long-handled tongs, lightly coat the grill rack. Place salmon skin side down on grill rack.

  • Grill, covered, over medium heat or broil 4 in. from the heat for 10-12 minutes or until fish flakes easily with a fork.

  • In a large bowl, combine the salad greens, cucumber, tomato and feta cheese; divide among four plates. Top with salmon; drizzle with vinaigrette. Yield: 4 servings.

Nutritional Information

1 serving equals 416 calories, 25 g fat (6 g saturated fat), 108 mg cholesterol, 636 mg sodium, 7 g carbohydrate, 2 g fiber, 38 g protein.

If you have a recipe that you would like to share in future issues of this newsletter, please send it to me at

Success Story:


Kristen Kotik

I want to offer a special thanks to Kristen Kotik. Here is her story:

Dear Barbara,
Thank you for giving me permission to feel successful, by stating, “You had the courage to have weight loss surgery, so whatever happens, and wherever you are in your journey, you are a success!” in your April newsletter. I am 9.5 years post-op RNY, and enjoy the many individual successes and endure the failures as I go through this WLS journey.

I started at 309, 5’8.5”; with a goal of 180 lbs. Within 11 months I was down to 145 and looked gaunt. The only view of myself that I’ve ever understood, is "fat" and "not good enough." Losing the weight hasn’t changed that for me – it’s magnified my skewed self-image issues.

I’ve always been an over-achiever and God has blessed me with many talents. I have always found myself going over and above for others - using my talents, because that’s what God wants me to do! RIGHT?  Unfortunately, I do this instead of taking care of myself; almost as if it’s a way to make others "like" or "accept" me and not just look at me as a "fat person."

My surgeon, support staff and group members were fantastic in my early years post-op, and educated me well on the necessities after surgery – but knowing and doing are different things.

About six years ago I moved from the Kansas City area where my surgeon and support team was located, to a town of 20,000 in Northeast Nebraska. The nearest bariatric program is an hour and forty-five minutes one-way. I consider myself relatively intelligent, and had convinced myself that I could get my psyche worked out on my own. Humph. I am now a full-blown bulimic and dealing with depression that is more severe than ever before in my life. My negative self-talk and incorrect self-image has won over again. That’s my failure. But, I’m not going to let it be the end of my story (as I cry typing this and still have feelings of doubt).

Ever since I moved to Nebraska, I wanted to start a support group for WLS patients. I have always been in sales and marketing, and last September I began a marketing position with a local compounding pharmacy. I knew it was the right step for my professional life, but I never dreamed what it would do for me personally.

Our pharmacy focuses on healthy lifestyles. What better outlet to begin a WLS support group?! With permission from my owner/pharmacist, I began researching online tools, contacting the area WLS clinic coordinators in the surrounding areas, and reading reading,  reading. All the while, continuing to destroy my body with the bulimia and negative thoughts.

I look the picture of health. My clothing camouflages my post surgery sags, with the help of compression body suits. Most would never guess that my now 155-165 lb. frame was once 309.  As the marketing director, you are the public messenger and the face – adding pressure to “do as I say, not as I do.” The guilt of talking the talk of a healthy lifestyle and then going home to hide so that I could binge and purge was taking its toll; mentally, physically, and professionally. Now add the realization that the date for our first WLS support group meeting is getting closer – and my hypocritical actions broke me.

Nine day ago I hit bottom, knowing that I have to stop this behavior for fear of hernia, tearing & leakage, etc, and all I could think was, “BUT I DON’T WANT TO!” I knew that was ridiculous. I’m a smart girl – why am I doing this? The self-talk has to change. I knew then that I needed help.

One of the WLS coordinators had emailed several patients in my area about the plans for a new support group. One of them had emailed me and told me how excited she is, and how she would love to help. I called her and have been better off ever since. We haven’t even talked yet about our specific struggles, but we have both admitted to having them. That was enough to make me WANT to change. Amazing how contagious the human spirit can be. Am I cured? No, this is not something that can be cured. I am open to getting professional help if I cannot continue to treat myself well and talk to myself in a more positive way. Right now, I am trying to remain "present" at all times, with complete cognizant thought of what I am putting into my mouth, how much and why. This has helped so far, and at the right time, I will share this with those in our new support group.

Barbara, I read your book,  “Weight Loss Surgery; Finding the Thin Person Hiding Inside You” pre-op and I am now reading it again. Thank you for aiding me to realize that my success is not a before and after picture. Nor is WLS success a list of numbers from where you’ve been to where you are now. Today, I learned that, “I had the courage to have weight loss surgery, so whatever happens, and wherever I am in my journey, I am a success”. This will now be the mission statement for our new group. Thank you.

Kristen Kotik

I love good news.  If you have good news, a success story to share, or inspiration, please send it to me at so that I can include it in future issues.

Congratulations Kristen

Obesity Action Coalition "Your Weight


Matters" Inaugural Convention

October 25th to 28th the Obesity Action Coalition is having their "Your Weight Matters" inaugural convention in Dallas, TX. If you haven't yet registered, please go to to find out all about the convention and the incredible program that you don't want to miss.

Something that is easily overlooked is the free advocacy training for all those who are registered. It is Thursday afternoon from noon to 5:00 PM.

If you have ever wanted to know what you can do to help the OAC, then you want to be sure to register for the advocacy training as well. On the online registration, you have to indicate that you want to attend. Don't pass up this free opportunity!

Chew Your Vitamins

The OAC is the ONLY non profit organization whose sole focus is helping those affected by obesity.  The OAC is a great place to turn if you are looking for a way to get involved and give back to the cause of obesity.

There are a variety of ways you can make a difference, but the first step is to become an OAC Member.  The great thing about OAC Membership is that you can be as involved as you would like.  Simply being a member contributes to the cause of obesity.




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