Post Date: 6/9/09 1:54 pm
Last Edit: 6/9/09 1:54 pm
if i understand correctly, NSAIDS actually suppress production of a biochemical that regulates the production of acid.  because of the reconfiguration of our intestines with the bypass, we are more vulnerable to problems, and then if you start overproducing acid, it's a set-up for ulcers.  Plus, there is a whole section of our stomach that is no longer accessible by endoscopy, so it's difficult to check if ulcers are suspected (requires surgery).  So it's better to play it safe.  Whether or not you can ever, ever, ever take 1 nsaid is subject to some debate e.g. some folks take them and just take prilosec or nexium to try to compensate.  i can see myself maybe taking one once in a while, but if you depend on NSAIDS to control, say, arthritis, you will need to either change your meds or come up with some other plan with your doctor (or do a different surgery).

if i got any of this wrong i'm sure someone will be along to set us both straight!

Post Date: 6/9/09 1:59 pm
Last Edit: 6/9/09 1:59 pm

How NSAIDs Work

The mechanism of action of NSAIDs is the inhibition of the enzyme cyclooxygenase, which catalyzes arachidonic acid to prostaglandins and leukotrienes. Arachidonic acid is released from membrane phospholipids as a response to inflammatory stimuli. Prostaglandins establish the inflammatory response. NSAIDs interfere with prostaglandin production by inhibiting cyclooxygenase.

Prostaglandins, which are inhibited by NSAIDs, function in the body to protect the stomach lining, promote clotting of the blood, regulate salt and fluid balance, and maintain blood flow to the kidneys when kidney function is reduced. By decreasing prostaglandins, NSAIDs can cause stomach irritation, bleeding, fluid retention, and decreased kidney function.

We have staple lines that already put us at greater risk for ulceration of the pouch, stomach, etc. The taking of NSAIDs and the resulting reduction in production of prostaglandins increases this risk.

Post Date: 6/9/09 2:54 pm
They can be made of either non-magnetic stainless steel or titanium, and as such will not be a problem with an MRI.

Post Date: 6/9/09 9:10 pm
Last Edit: 6/9/09 9:12 pm
{EDIT} never mind, she beat me to it, and had better information to boot.

Post Date: 6/9/09 2:33 pm
Non Steroidal Anti Inflammatory Drugs---like Advil, Ibuprofen, Motrin, Aleve, Naprosyn, Daypro, etc

Post Date: 6/9/09 4:07 pm
NSAIDs do any number of things -- but one of the worst things they do is thin the mucosal lining of the pouch and stomach.

The stomach is VERY tender meat -- think of it as soft as a filet mignon.  The body requires a fair amount of stomach acid to begin the breakdown of food in our gut.  The mucosal lining keeps the harsh stomach acid from actually touching that very smooth and soft meat.

NSAIDs thin this mucous lining, making it possible for the acid to touch the stomach wall, and thus cause ulcers.  If left untreated for too long, they can perforate and internal bleeding can occur.

Why this is particularly troubling for RNY patients is that NSAIDs are systemic -- meaning they work throughout the body and not just where the pill touches.  So the remnant stomach that still produces acid will still be affected by the NSAID, thinning the lining as it does with the pouch.  However, we cannot see the blind stomach without a surgery as it's not connected to the esophogus for an endoscopy.


Will 1 NSAID kill you?  Probably not.  However, you need to be aware that everyone's mucosal linings are individual.  Some have particularly thin linings and yes, one NSAID could thin it enough to cause an ulcer.  Some of us have iron tummies and have thicker linings, so thinning it a bit won't cause issues in the short-run.  Unfortunately, there is no way to know which stomach you have and that 1 COULD be enough to start an ulcer.

Just a note -- NSAID patches and shots are JUST as bad and evil as pills.  Since they are systemic, they will affect your stomach just as if you swallowed an advil or two.

Post Date: 6/9/09 4:24 pm
Yup.

Aspirin, advil, aleeve, alka-seltzer, pepto bismol...

Post Date: 6/10/09 4:27 am
Pepto is an analogue to aspirin.  It's made from the same compound that makes aspirin, and thus is not a good thing to have.

Mylana and maylox are perfectly fine.

Post Date: 6/10/09 7:14 am
Thanks.  Love your avie by the way !

I wonder if my surgeon OKs something like Celebrex, is he uninformed or why would he OK the use of that if it's dangerous?