In This Issue
* Why Is It Now So Hard?
* PETA Made to be Accountable
* Recipe: Grilled Chicken Fajitas
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).
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
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
But whatever you do, I'm
afraid that it will never be that easy again.
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.
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.
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
Click here for more information on the Obesity Action Coalition.
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.
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
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
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.
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
I want to offer a special thanks to Debra
Ostlund for sharing her story with us.
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
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
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'
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
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