Why we can’t take NSAIDS

poet_kelly
on 6/21/11 7:06 am - OH

Today’s public service announcement.

Most docs tell patients not to take NSAIDS after RNY but they don’t always explain why.

NSAIDS put you at risk for ulcers. They do that to everyone, not just RNY folks.  But ulcers are particularly dangerous to us.  If you get an ulcer in your pouch, even a small one, since your pouch is a lot smaller than a normal stomach, it will cover a much greater percentage of your pouch.  If you get an ulcer in your old stomach, docs can’t even do an endoscopy to see it.  They’d have to do surgery.  Also taking a medication designed to coat the stomach wouldn’t help an ulcer in the old stomach because nothing you take by mouth goes in there.

We really, really don’t want an ulcer.

NSAIDS can cause ulcers because they cause the lining of the stomach (the old stomach and the pouch) to thin out.  This does NOT happen when the medication enters the pouch or touches the pouch.  It happens when the medicine enters your blood stream.  That’s why you can get ulcers in your old stomach.  NSAIDS taken by mouth don’t touch the old stomach but can still cause ulcers there.

Any way you take an NSAID – pill, liquid, shot, IV, patch, gel – it gets into your blood stream.  If it does not get into your blood stream, it will not give you any pain relief or relieve inflammation.  Many docs don’t seem to understand this, though I don’t know why since they have to take pharmacology in medical school. 

Many docs that are not bariatric surgeons also don’t know RNY patients should have not NSAIDS so be very vigilant about what other docs try to give you.  I finally started saying I am allergic to NSAIDS.  They seem to listen to that more.

Some surgeons say it’s OK to take NSAIDS on a very limited basis if you really need them as long as you also take Nexium or something like that to help protect your stomach.  Others say it’s never worth the risk.  A few say it’s OK to take them whenever you want, but I think they are nuts.  But what I really think is that we need to weigh the benefits of taking them against the risks.  Is the pain of your bad back or menstrual cramps or whatever worse than the pain of an ulcer would be?  If so, take the NSAID.  But take it with something to protect your tummy.

Now, how likely it is that taking NSAIDS, especially rarely, will cause an ulcer, no one can say.  I know people that took just one dose and got an ulcer.  I know people that took them many times and had no problem.  So it’s just a matter of whether or not you wanna chance it.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

AuburnChic
on 6/21/11 7:17 am - Arlington, TN
Thank you for this!
    
facethemusic
on 6/21/11 7:25 am
Thank you for posting this.  I acutally got into an argument with a doctor at Urgent Care over this.  He told me he could give me a shot of Toradol and it wouldn't effect my stomach.  I kept telling him no that it would still hit my blood stream and thin the lining of my stomach.  At this point I already had an ulcer so why would you give me NSAIDS at all.  I got accused of drug seeking because of this and told him to go **** himself and left.  I was livid.  I saw my surgeon the next day who promptly called the Urgent Care office and spoke to the doctor telling him that I was in fact correct.  I actually got a written apology for his behavior that day.  

I don't expect all physicians to understand the anatomy of RNY patients, but to not know that even IV or IM NSAIDS still cause thnning of the lining of the stomach is pretty stupid.  I'm not a medical professional and I know that much.  
 HW-240, SW-233, CW-158, GW 135 @ 5'3.5"
RNY April 2011, Reversal August 2011.  
I still have a pouch so I'm a hybrid.

     
 
  
poet_kelly
on 6/21/11 7:27 am - OH
Wow, your surgeon deserves a gold star for calling the Urgent Care doc.

And I agree with you, it is pretty stupid for a doctor not to know that IV NSAIDS thin the lining of the stomach.  It's not a complicated thing.  And it really has nothing to do with the anatomy of RNY patients, it thins anyone's stomach.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

facethemusic
on 6/21/11 8:04 am
My surgeon is amazing.  He may be a pain to get in touch with sometimes, but he will step up for you if he sees you're being mistreated.  One of the nurses in my PCP's office made a snide comment about me having WLS and he and I were talking about the prejiduce against WLS patients even in the medical field.  He called my PCP and explained that his staff needed to be more sensitive to WLS patients.  I don't ask him to stand up for me, but he does and it feels to good to know he is in my corner and wasn't just in it for the money.

I think a lot RNY patients don't realize the implications of not being able to take NSAIDS post-op.  I thought I could get by without them, but now I'm realizing it is going to be difficult.  I was diagnosed with hip bursitis post-op and every time it acts up I think of how nice it would be to take some Motrin.  I don't think I would be successful without malabsorption though.  I wish I had known about the DS prior to having my RNY.  I would of probably tried to go that route instead.  Saying that though I dont' regret my RNY.  I'm only a few months out, but I feel better than I have in a long time.  I can see though that as I get older not being able to take NSAIDS is going to be difficult.  Maybe one day they will make an NSAID that doesn't effect the lining of the stomach.
 HW-240, SW-233, CW-158, GW 135 @ 5'3.5"
RNY April 2011, Reversal August 2011.  
I still have a pouch so I'm a hybrid.

     
 
  
poet_kelly
on 6/21/11 8:10 am - OH
I had terrible arthritis in my knees prior to RNY but hoped losing weight would fix it - and it did.  They have not hurt in, oh, I bet two years.  I think it was unwise for me to count on that, though.  RNY does not fix arthritis for everyone.  I was just lucky in that regard.

However, I developed a back problem after my RNY and the back specialist keeps telling me how I really  need  NSAIDS for it.  After trying a bunch of other stuff, I finally had steroid injections, which worked really well.  However, I was told they would last for a long time and after just a short while, my back was hurting again. 

Vicodin and Flexeril together work pretty well for my back, and luckily my doctor does not think I am drug seeking and will write me prescriptions whenever I need them, but they pretty much knock me out.  Sometimes I want my back to stop hurting AND to be awake.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

scalingback1
on 6/21/11 8:43 am - Mashpee, MA

Your my hero! So glad you and your doctor did something about what happened to you in urgent care and you got an appropriate response!

          
 First goal reached at one year.    
 "What is, is. What will be, is what you make it."  Unknown

   
Carrie W.
on 6/21/11 7:29 am - KY
RNY on 03/30/11 with
Thanks, Kelly!

This is one of the things I didn't understand completely, pre-op. I didn't understand what an impact it would have on my life until my first double-over-in-pain cramps. I'm 32 and been heavy my whole life. I don't think having surgery now is going to keep me from having arthritis when I'm older. Not being able to take NSAIDS could be a huge problem for me later on.
  HW 347/SW 328/CW 176/GW 160                   
 
  
poet_kelly
on 6/21/11 7:32 am - OH
I knew pre-op I wouldn't be able to take them after surgery, but did not realize what a big deal it would be.  Makes me wish I'd had the sleeve - although that wasn't really an option since my insurance wouldn't pay for it. 

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Carrie W.
on 6/21/11 7:59 am - KY
RNY on 03/30/11 with
Me too.  My insurance would only cover RNY.  I don't regret it now but I might when I'm 60!
  HW 347/SW 328/CW 176/GW 160                   
 
  
Beverly D.
on 6/21/11 8:23 am - Lawrenceville, GA
From a pharmacist's perspective, this was a really good post.  Normal people with normal stomachs rarely think about the effects of chronic/long term NSAID therapy.  I am weighing this issue myself.  I have had three back surgeries and have been on NSAIDS for years.  I have been scoped and am ulcer free, but that doesn't mean that I still will be if I get the bypass.  As they say "knowledge is power".  Thanks for the review!
poet_kelly
on 6/21/11 8:28 am - OH
If you currently rely on NSAIDS and are deciding whether or not to have RNY, you know what I think I'd do?  I'd try finding another way to treat the back problem BEFORE having RNY.  Of course, even if you find another way to treat your back, that doesn't mean some other problem won't arise some where down the road that would really respond well to NSAIDS.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

nancybugg
on 6/21/11 8:34 am - Riverview, FL
Thanks Kelly.  In the last two weeks both my OBGYN and Primary Care doctor told me to take NSAIDS.  My primary told me that just a few wouldn't hurt.  Ugh.  I've had a headache for at least the last two weeks.  After telling her that I drink at least 80 ounces but closer to 100 ounces of water per day and that I couldn't take NSAIDS she told me to drink at least 6 cups of water a day and take a few Motrin for the pain.  I couldn't believe it.  Was I just talkng to a wall?  I'm still waiting on my surgeons office to get back to me about what to do with this headache since the tylenol isn't working and my primary care doctor was useless.  Sigh...
kaleidos
on 6/21/11 9:29 am
Thanks for the additional info and just bringing it up!

My PCP has arthritis - and an RNY - so she was incredible at educating me about the NSAID complications (and everything else as well) - and how at 2 1/2 years out she is dealing with it. (If you can get a PCP who has had bariatric surgery and/or with a staff who has had surgery which allows all the staff to see real life examples I cannot recommend it enough. My PCP's office (a small 3 doctor office) has more bariatric surgery patients than the bariatric clinic I go to.

Anyway - super tangential so bear with me.

It was a major part of my surgery consideration. Arthritis runs early in my family - as in I started showing mild (and later quite a bit worse) in scans of my right knee after I injured it multiple times over a few years in high school and college (tennis, cross country running and skiing). Officially diagnosed at 22 and have been feeling it in my right knee (and as I have gotten older in other areas) for quite a long time. I lived on NSAIDS for the last 15 years - along with corticosteroids and other solutions mixed in as well. I knew that losing weight would improve the knees and hips, but for the past few years the pain has been worse in my hands than anything else. Topical was not an option for my knees and hips because of there is no way anything topical could burrow down through all that fat and reach my joints, and trying to work with stinky hand cream, even when covered with gloves which have their own drawbacks

My grandparents (90 and 86) have arthritis as well. My grandma since she was in her twenties as well. Neither of them take any NSAIDS. Not even a baby aspirin. Getting them to take anything - including Tylenol is a huge battle. So watching them deal with their pain and asking them about it over the last few months has been really useful - well essential in my case - when it came to making this decision. Since they have dealt with much worse athritis over a much longer time and live happy and ridiculously healthy lives. (When your 90 year old grandparents can walk circles around you for hours longer than you can it is a real wake-up call. Not to mention knowing there was no way you were going to live to see 90.)

Anyway, I got lots and lots of tips of how they dealt with it and kept pain in check. They do use lots and lots of topicals. Keeping active is essential. My grandfather still drives at 90 and they get out of the house everyday to buy the paper and get the mail. During the summer they take a slow stroll on the beach (hand in hand of course - they are unbearably cute together!) for at least 20 minutes. And in the winter and rainy days they go terrorize the poor folks at Walmart. ;) And would never ever get into one of those drive-around thingees. So their first thing was to stay active - can be slow, can be for a short amount of time, but it has to be each and every day no matter what.

I was concerned about the hands in particular since I keep them plenty active (typing 100+ words per minute helps with that) but it is repetitive. They keep active too - even when sitting on the couch - to keep their hands happier - crossword puzzles, sewing, sorting stuff like nails, coins, and things they find on the beach, And just generally keeping in motion.

I am trying other things myself to see if it helps as these past 18 days (10 days pre-op and now 8 days post op) have been harder without the NSAIDS. *BUT* I have had lots of luck with my hands using a variety of things (compression gloves, Biofreeze, heat and cold, specific exercises from physical therapy, etc.) which makes me have significant hope for the future. Being able to add glucosamine back into my diet will also help.

So for me arthritis was an immediate concern - and I think things will be rough at first as I cannot use topicals, heat, etc. effectively until I lose more weight, but we will use corticosteroid shots if I need them until I can. But I am really hopeful!

What I think is the most important thing for worrying about old age with arthritis and without NSAIDS is that without surgery just how likely were you to live into old age without it anyway? For other pain problems unfortunately that is not as helpful - but hopefully there will be more options out there as medicine gets better and better.
  
Weight loss includes 57.7 pounds before surgery. Not weighing until 2 weeks after surgery.
marioluigi
on 6/21/11 9:47 am
 Thanks so much, Kelly!  I've learned so much from you and others here on these boards.  Much more than my nutrit. or support group!
Heidi L.
on 6/21/11 9:50 am - Fairbanks, AK
I used to pop those all the time when I was a teenager for menstrual cramps, with food. After not taking Motrin for a while I took ONE. Boy did I regret that as soon as I tried to eat/drink. For over a week I couldn't understand why my stomach hurt so bad and I couldn't drink water because the pain was unbearable. Yes, an ulcer near the pyloric sphincter. I lost a whopping 7 pounds that week that I was on bed rest. This was all pre-op. Taking NSAIDs is not worth that agony!

Now that the weight is going and my cycles are back any suggestions as to what to take for horrific menstrual cramping? I'm thinking about a partial hysterectomy, but not sure if that would ease the pain.....?

Pre-op  260.8#.......Surgery 242#........Current 179.5#..........Lowest 166#.........Goal 150#
    

    

    
poet_kelly
on 6/21/11 9:57 am - OH
I don't know if a partial hysterectomy would hel*****t.  Talk to your doc about that.

What about using the Depo Provera shot?  Like for birth control?  Doesn't that generally either really reduce or stop your monthly periods?  I'm sure like anything else it can have its own side effects though, but you might talk to your doc about it also.

There are always narcotics, Vicodin, Percocet, etc.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

PomMomTx
on 6/21/11 11:28 am
Heidi L. and other RNY ladies struggling with severe menstrual cramps, I'll tell y'all what works for me.

I agree with many here that Tylenol by itself does little to nothing in providing pain relief of severe cramps, and when I say severe, I mean doubled-over pain.  Like Heidi mentioned, I too popped nsaids  to get relief as a teen, after a full middle school time frame of missing a day of school nearly every month due to such pain that I couldn't get out of bed, let alone walk upright & attend class.

I have fibroids, diagnosed since my early 20's (46 years of age now).  Fibroids add to the pain.  My GYN & I decided that surgery was a last resort, and so far I have avoided it.  She is very conservative about surgical options, and understands my requirement to avoid aspirin & nsaids due to the RNY.  I'd been struggling with monthly pain & only slight relief ever since surgery. She prescribed a narcotic pain reliever, but I couldn't function on them, so I'd only take them if I had pain at night, which was not usually the case.

What I discovered quite by cir****tance is what I call my 'fixative' for my cramping issue.  While on vacation in Vancouver, BC Canada 4 years ago, I got back pain from a poor sleeping position the night before.  I took the 2 Tylenol that I had in my purse, which was only mildly effective. Following that dose, I needed more so I went into a drug store after more Tylenol.  

On the shelf, right next to the pain relievers, was a back pain product called Robaxin.  I had never heard of it before, so I asked the pharmacist about it and he explained that it was a muscle relaxer.  He also explained that in the US, we need a prescription to get it, but in Canada its an OTC product.  He suggested that I buy the strongest version, so I have the option to snap the pill in half if I needed less and that it was more cost effective to buy it like that.  I bought it and sure enough, I had relief from back pain in under 30 minutes!  What a treat to find true & complete pain relief, especially while on vacation!

About a week later, I got the dreaded monthly menstrual cramps.  Since I was back home from vacation, and had a fresh supply of Robaxin, I took it with a Tylenol and also got full relief within 30 minutes! 

Since then, I have discussed this with my GYN, and she agrees that using a muscle relaxer (since menstrual cramps are muscle-based) pared with Tylenol is a good option for me as an RNY patient.  Since running out of the Robaxin brand I bought in Canada, I now get a prescription for the generic version, Methocarbamol.  I take a 750mg Methocarbomol with 1 extra strength Tylenol gelcap.  I get full relief and can carry on as if I had no cramps at all now, for the first time since I was pre-op using nsaids!

I hope this gives hope to other ladies who suffer!  Talk to your PCP or GYN. 

Open RNY/GB removal/appendectomy4/99; -132lbs; Re-gained 40lbs by '09; Now w/in 20lbs of goal/low wt

  
siberiancat
on 6/21/11 10:34 am - Columbia City, IN
When I was in hospital for plastic surgery (one month ago) I got something IV for pain.  I was taking Vicodan orally every 4 hours.  I had a 4 hour ride home from the hospital and needing something for pain before I left, even though I had a pain pump.  I took Vicodan and the nurse put something in my IV - after she did I asked her what it was and she said Torodol!!

I had ulcers in my small bowel pre and post RNY. 

I'd been home a day or two and started having burning and pain in my pouch.  I had Aciphex at home and started (and continue) to take it twice a day.  The burning and pain stopped within 48 hours after beginning the Aciphex - I'm sure it was from the IV Torodol.

Yesterday I was at appt with plastic surgeon.  I have an open wound from necrosis.  He was cleaning the wound out and talking about the swelling in my belly.  He told me to be more aggressive caring for the open wound and to take some Motrin if I was  uncomfortable.  I told him as a RNY patient I could not use NSAIDS.  He said would a couple hurt?  I said I wasn't going to try because I have a history of ulcers.

I need to keep vigilant.  I feel bad about the Torodol in hospital, but was in so much pain, I guess I wasn't thinking enough to ask what they were going to give me.  I think I "dodged a bullet" there.

We all need to be advocates for ourselves.
 Penny
Highest Weight 255  * Wt loss includes 19 lb lost before surgery

    
Beverly D.
on 6/21/11 12:43 pm - Lawrenceville, GA
It is hard to be your own advocate when you are in pain, so don't be hard on yourself about the Toradol IV.  If you have a spouse or friend who goes with you in the future let them know what you can't have.  Use the "I have an NSAID allergy" line if they give you too much grief.  I am allergic to hydrocodone and I can't tell you how many times doctors (even ones familiar with me) forget and try to give me products containing hydrocodone.  Doctors go with what they feel comfortable with.