Post surgical medication absoption and sleep study questions

Hello folks,
I saw Dr. Glazer yesterday and he expressed concern about how my meds would be absorbed after the surgery. At this point, RNY has been the suggested procedure.
I am currently taking Celexa, Nortriptyline and clonazepam for depression and anxiety. I also have an autommune disorder called Multiorgan Sarcoidosis for which I have received large doese of Prednisone and for which am currently taking Methotrexate. Amongst the many symptoms I expereinces was loss of sight, so when I do encounter changes in my sight, I need to take the Prednisone right away. Both prednisone and methotrexate are very hard on the stomach, although they don't seem to bother me now.
Dr. Glazer asked me to speak with my pharmacist about how the surgery would affect the doses of my medications and he was at a loss to give me an answer.
My questions to you are..... has anyone else here had to contend with issues of medications that they are already taking prior to surgery? How did the surgery affect your absorption and dosage post-op?
Does anyone have expereince with the Gastric Sleeve and medications?
I have a real issue with sweets and confess that this is where much of my overeating comes from. For this reason, I was "looking forward" to having to deal with the threat of dumping to keep me away from sweets.
I am also going for a sleep study tomorrow. Can anyone enlighten me as to what I might expect?
Any advice would be greatly appreciated.

Carol

With the RNY, you will not be able to properly absorb any time-released or long acting medications. Your pharmacist will be able to advise you which of your medications are of this kind and whether there are immediate release alternatives available.

Looking at the VSG or the DS might be a good option for you. Keep in mind that less than half of people with a RNY dump regularly, so you can't rely on that to keep you away from sweets.

Are you aware that Nortriptyline causes weight gain and carbohydrate cravings? If it is at all possible, you may want to look at an alternative med.

Sorry, this sort of made me laugh - so she'll malabsorb with RNY but NOT DS??!! haha

Yes Karen, that's correct, there are differences in absorption of medications between the DS and RNY. As you know, the DS allows for certain meds that the RNY doesn't like NSAIDs. Also, as the DS retains the pyloric valve and has normal gastric emptying, there is opportunity for a drug to break down normally in the stomach which doesn't exist after the RNY, so DSers actually have fewer, not more, problems with many meds compared to RNY.

I didn't know pharmacology was so entertaining!

Oh my go****'s completely entertaining.

Well, not really.  But to suggest that medications are "better absorbed with a DS" doesn't make sense to me.  I do understand what you're saying about the gastric emptying - but that begs the question, so why then do DS patients feel they have to take more vitamins and a more specialized regimen than a RNY patient?

See my dilemma?

DSers need more fat soluble vitamins because of the dramatically lower absorption of fats compared to RNY. Other recommendations are pretty similar to RNY when you compare the ASMBS RNY to DS recommendations or the Vitalady RNY to DS recommendations. Where I think the difference comes in is that most RNY patients follow a regimen that is less even than the ASMBS guidelines whereas DSers tend to follow something greater than the ASMBS guidelines, closer to what Vitalady recommends.

Absorption would vary a bit though depending on where a particular thing is absorbed. If it is primarily in the stomach or the duodenum, you would expect a DSer to have better absorption than a RNYer, if it is in the rest of the small intestine, you would expect a RNYer to have better absorption than a DSer.

DSers do not need higher doses of any medications, though some do find problems with extended release drugs while others don't, just like with RNY - but my understanding of this with RNY is that at least part of the problem is that the drug doesn't have the opportunity to sit in the stomach and have stomach acid begin the process of eroding the coating, capsule or whatever is protecting the drug, therefore it doesn't release and get absorbed throughout the digestive tract. This problem would not be an issue with DSers, but again, I would think it would be somewhat dependent on where the drug needs to be absorbed to be effective.

Hi Carol,

I had a sleep study in 2006.  I had been requested to come to the hospital before 9 p.m.  They showed me to my sleep room and had me change into my pjs.  I normally sleep in a nightie, but didn`t want to give a real SHOW while I tried to sleep so I had pjs instead!

Once you have changed and put your slippers on, I was brought into a room where they started to hook about 30 wires to different parts of my body and on my head (some yucky stuff held it onto my hair).  Then they took me back to my room - last trip to the bathroom.  Then I climbed into bed.  They then took the wires and hooked them into something on the nightstand.  They check that everything was working.

Then they let me read my book a bit and came back and turned out the light.  Then it was sleeping time.  I remember waking up in the night and used the call button as I need to use the washroom.  They came and unhooked me.  They came back and hooked me back up.  I slept for another 2 hours ****il 5:30 a.m.).  Then when I woke up again, they came and unhooked me and then also took the wires off of my body and scalp.  They gave me the option of showering there or heading home.  I chose to go home.  Yes my hair was wild with the crappy stuff in it. 

Good luck,

Judy

Carol, Judy is right on with the sleep study stuff, I took my own pillow. It helped. good luck

 I wasn't allowed to take my own pillow. I think it's the bedbug scare. 

I went to my regular pharmacist to ask questions about where in the digestive system the drugs I was taking absorb. I thought I said something to that effect... I'm postive I did ...  but by the look he gave me you'd think I'd have just propositioned him cause he was so shocked and taken aback  by my question.

I finally went to the pharmacist owner of the store (at any pharmacy one of the pharmacists is the owner) and to a friend's wife who is a pharmacist. It took a lot of very pointed asking to get good answers. One of them actually ended up calling the drug manufacturer etc..

All I can suggest is to go back and ask more questions and ask they research the drugs. You could also contact the manufacturer and ask.

Wish I could help more but I wasn't on any of the drugs you listed when I had my surgery.