Issue #172 September 1, 2009

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In This Issue


* Why Is It Now So Hard?
* PETA Made to be Accountable
* Fistulas
* Recipe: Grilled Chicken Fajitas
* Success Story: Debra Ostlund

Why Is It Now So Hard?

The person who sent this email asked that she not be identified.  So, for the sake of clarity, I will refer to her as Jane (not her real name).

Dear Barbara,
I am 5 years post op. I started at 306 pounds (5'10") and my lowest weight was 203 pounds. I had to diet to maintain the weight loss very soon after surgery and then at 4 years post op, the weight piled back surprisingly fast.

I am now back up to 252 pounds.  I have absolutely no reminders of my surgery. If I wanted to, my pouch could accommodate a full 5 course meal if I took an hour to eat it. My blood work is always perfect except for low B12 which I supplement with injections. My blood calcium levels and bone density scans are normal. I feel great and can eat anything.

Jane's Question: Since my pouch and my metabolism don't seem to remember the surgery, am I still in danger of malabsorption of vitamins and nutrients? Since my body seems to absorb calories at its original rate and is completely back to its unaltered state, am I now absorbing 100% of vitamins and calcium again too? I would love to dump all the vitamins and calcium I take, as it seems a waste of time and, to be truthful, is a painful reminder of my failure three times a day.

Barbara's Answer: No you cannot stop taking your vitamins and calcium.  Even though you are absorbing more calories than just after your surgery, because you had an intestinal bypass, you will always need supplements.  Calories are absorbed many places in your intestines, however, calcium and many vitamins are absorbed in the first part of the small intestines that are now bypassed.  This is also the reason why lap-band patients do not have the vitamin and mineral deficiency problems that gastric bypass patients do. The reason your calcium levels are so good is because you have been so diligent about taking your calcium.

Here is a good article on the problem with the lack of absorption of vitamins following gastric bypass surgery.

Jane's Second Question: Is there any hope that I could somehow "reactivate" my intestinal bypass and get the malabsorption syndrome to kick back in? Maybe going on a protein shake only fast for several weeks (like pre-surgery)?   

Barbara's Answer: We are organisms and as any organism, we adapt. That is why the rapid weight loss stops after 10 to 18 months. Our bodies have adapted to the new intestinal configuration. That is also why I tell new patients that they really need to concentrate on losing as much weight as they can during that period. It will never be that easy again.

Going on a protein-shake-only fast for several weeks, is a bad idea.  First of all, it is unhealthy. You will be denying yourself vitamins and nutrients and only getting protein. Any time you deny yourself too much, you are dieting and you will probably regain the weight when you stop, which you inevitably will.  If what you are eating or drinking is too low in calories, your body will go on a plateau because it thinks you are going through a prehistoric famine and will hold onto every calorie by dropping your metabolism.

There are 2 things you can do. The first is to have a ROSE (Restorative Obesity Surgery, Endolumenal) procedure such as a Stomaphyx. This will surgically make your pouch and the entrance to the small intestines smaller so that you get back that feeling of sustained fullness after eating a small amount. I first wrote about the Stomaphyx procedure in my Oct. 1st 2007 newsletter.

Or you can go on a Program like my Back on Track Program which teaches you how to live a healthy lifestyle.

But whatever you do, I'm afraid that it will never be that easy again. 

Jane's Final Comment: Any advice that you or others in the same situation could offer would be appreciated. I am so disillusioned and disgusted with myself, that I have never shared my surgery with anyone outside my immediate family.  I am sending my email with my name but please do not publish my name as I am in the closet for obvious reasons and wish to stay there with the door firmly shut.

Barbara's Answer: I would be remiss if I didnít point out that you have lost 54 pounds and maintained that loss for 5 years. That is something that you should be very proud of.

Back on Track with Barbara

Internet Mentoring Program

Are you:

Suffering from emotional eating and canít stop?
Grazing on carbohydrates and canít control it?
Lacking inspiration to lose the weight you have regained?
Feel you donít know what to do now that you have had surgery?
Dying to be in better shape`?

 Then you are in luck! My Back on Track Internet
Mentoring Program is just what you need!


View a FREE Lesson and Listen to a FREE Telephone Seminar by
clicking here and scrolling down to the bottom of the page.

PETA Made to be Accountable

People for the Ethical Treatment of Animals (PETA), did not show ethical treatment of humans by putting up the above billboard along a Jacksonville, FL highway. The Obesity Action Coalition (OAC) immediately went to work alerting its members and encouraging an email campaign to PETA protesting such cruelty and insensitivity to the obese. Joe Nadglowski, the Executive Director of OAC, appeared opposite Ingrid Newkirk, the President of PETA on the Montel Williams radio program.  Mr. Nadglowski commented that any child in Jacksonville got the message that it is OK to go to the beach and call an obese woman a whale.

As a result of the Obesity Action Coalition and the many people who were outraged by this billboard, PETA removed this hurtful message.

Click here for more information on the Obesity Action Coalition.


Dear Barbara,
I had a very successful laparoscopic gastric bypass over 5 years ago. Last month I was admitted to the hospital and it was discovered that my pouch ulcerated and formed a fistula between my pouch and my stomach.  The food is now going to both areas.  My doctor is doing a revision on Sept. 21.  How dangerous is this and have you heard of this happening before.  He did say that unless I am very careful, I will eventually gain the weight and problems back.  I have kept off about 110 pounds of the 120 I lost, but know that I am uncomfortable and bloated and have gained 10 pounds since the winter.  I just need to be directed to some answers and information.

Barb Woodall

Dear Barb,
Forming a fistula, which is a bit like a tube or connection between your pouch and stomach, is rare, but it does happen.  It happens less and less, because the surgeons who are performing gastric bypasses are now transecting the pouch.  This means that they completely separate the two which makes a fistula between the two much more difficult to happen.

The symptoms are bloating and severe stomach cramps. These are almost always accompanied by weight gain.  Your surgeon is correct, that you will eventually regain all of your weight if surgery isnít performed to correct this.

The surgery is not any more dangerous than your original gastric bypass and is probably safer because you have lost 110 pounds and are in much better physical shape. It is however, a complicated surgery.

If you have had a fistula and have had it corrected, please contact Barb. I know she would like to hear from those who have gone through this. Her email address is

  Grilled Chicken Fajitas
There is nothing quite like the taste of grilled chicken. Combine this with a tangy marinade and an avocado salsa in a fajita wrap and you have a great dish.

Grilled Chicken Fajitas

2 Tbl. lime juice
1 Tbl. mild chili powder
2 tsp. olive oil
Ĺ tsp. salt
ľ tsp pepper
1 lb. skinless boneless chicken breasts
1 pound tomatoes, coarsely chopped
4 Ĺ oz. can chopped mild green chilies, drained
Ĺ cup chopped fresh cilantro (may substitute parsley if desired)
1/3 cup diced avocado
Eight 8-inch flour tortillas
4 cups shredded romaine lettuce

1.  In a sturdy plastic bag, combine 1 Tbl. lime juice, chili powder, oil, ľ tsp. salt and the pepper. Add the chicken, squeeze the air out of the bag, seal and marinate at room temperature for 30 minutes or up to 12 hours in the refrigerator.

2.  In a medium bowl, combine the tomatoes, green chilies, cilantro or parsley, avocado, remaining 1 Tbl. lime juice and remaining ľ teaspoon salt.

3.  Preheat the grill to medium heat. Spray the grill Ė off the rack Ė with cooking spray. Grill the chicken, covered, turning once, for 8 minutes or until the chicken is cooked through. Place the tortillas on the grill for 30 seconds to warm through.

4.  Thinly slice the chicken. Place 2 tortillas on each of 4 plates, spoon the chicken slices onto the tortillas along with the tomato mixture and lettuce, and serve. Top with a dollop of nonfat yogurt, if desired.

Serves 4

Nutritional value for each serving:
438 calories, 35 grams protein, 49 grams carbohydrates

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:
   Debra Ostlund

I want to offer a special thanks to Debra Ostlund for sharing her story with us.  

Dear Barbara,
My weight has always been a struggle. I was always a little chubby even some 20 odd years ago in high school.  My real weight gain started in 1995 while I was pregnant with my first child.  I gained 75 pounds being pregnant with her, and that put me at 236 pounds at the end of my very stressful pregnancy. 

My first pregnancy ended in tragedy with the death of my daughter shortly after her birth.  Three months after her death I found myself pregnant with my second child.  This pregnancy was quite different in that I had no complications and I only gained 15 pounds. 

After the birth of my second child I found myself a single parent, the stress of this situation along with the irregular work schedules that I had, allowed for me to pack on  more pounds. 

In October of 2002, I married my current husband and at that time weighed 280 pounds.  I had read a few things at that time about gastric bypass surgery, but really looked hard at it after a vacation with my son in 2005. 

From 1996 to 2002, it had always just been my son and I. We did everything together.  I worked very hard to bring him up not really emphasizing that he didnít have a father around.  We vacationed quite a bit and I found myself supporting him in sports, mainly hockey, which for a single parent is not easily affordable.  In August of 2005, after the birth of my 3rd child, my son and I got a chance to take a vacation with just him and I.  We traveled by Amtrak Train from Minneapolis to Chicago. For an 8 year old boy, this was a dream come true.  We had a great time in Chicago. We took the Metro everywhere, saw a Cubs game, went to the Sears Tower, and also spent a day at Six Flags Great America.  We had so much fun that day at Six Flags and discovered that my 8 year old had a passion for roller coasters. 

I remember standing in line for 2 hours to get on this really great roller coaster.  As we got in our seats the lap bars came down and mine wouldnít latch.  I remember the ride attendant coming over and actually standing on the lap bar to shove it down and try to get it to latch, but it didnít.  So in front of hundreds of people I had to get off the ride. Because my son didnít have an adult to attend to him, he had to get off too. 

I remember the mix of emotions as I came down the ramp coming off the ride. Iíve wasted time, and my son canít ride because Iím too fat. It was a huge mix of feelings.  I thought that I was silently crying and trying to wipe my tears away, then I felt my sonís little hand slide into mine and he said in a soothing little voice, ďDonít worry mommy, weíll find a ride you can fit on.Ē  I completely broke down right there because I truly knew then that my weight was not just affecting me, it was affecting my kids too.  What had happened to me!? 

When we came back from our trip, I began a program with St. Maryís Hospital in Duluth, MN, I was 297 pounds at that time.  The program was a weight management program designed to help get your life in order and learn proper eating and exercise habits.  Although I didnít lose any weight on this program, I learned a lot about balanced diets & the importance of regular meals & exercise.  I changed my career from working in a restaurant to working in an office setting with an 8-5 daily schedule and not surrounded by food.  This got me well on my way to finally making the decision to actually have my Roux-en-Y gastric bypass surgery, June 5, 2007. 

The day before my surgery my husband told me, ďYou donít need to do this for me you know, because I love you no matter what. I married you because I love you and not because of what size you are.Ē  I told him, ďIím doing this for my health and the health of the kids.Ē  I know that the things I eat and my eating habits were influencing my son especially, and I didnít want him to struggle like me.  I wanted to take an active part in my kids' lives. 

My highest weight was 332 pounds. This was 2 weeks before my surgery and before I started my liquid diet to prepare for my surgery.  The day I had my surgery, my Mom and Mother-in-law went to the hospital with me for support.  I was excited!  I knew that my life was going to change that very day, and boy did it! 

I am 2 years post-op and I weigh 166 pounds.  I love to tell people that I am exactly Ĺ the woman I used to be.  I run almost daily, and my son, now 13, is my running partner with my 6 year old daughter riding bike right next to us as we run.  I play on a co-ed softball league in the summers and cross country ski in the winters.  I have never been healthier or happier with any decision I have made in my life.  My husband and my kids are very proud of what I do and what we are now able to do as a family.  Last summer, 2008, we even had the chance to go to an amusement park and I rode every roller coaster there!  I canít thank Dr. Medlin and the surgical staff at St. Maryís Hospital in Duluth, MN enough for a second chance to be a great Mom and be active with my kids.

Debra Ostlund

Congratulations Debra


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