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bleeding ulcers?

FunBrain
on 7/14/12 9:38 pm
 My friend had RNY in 2007.  Her surgeon did not stress the importance of protein, vitamins, & labs. Due to the fact her surgeon was 10 hours away, she has not seen him since 2008 (her one year appt.) So the other day she was rushed to the ER & woke up in ICU being told she had bleeding ulcers. Ofcourse this caused her iron & b12 to be very low as well.  I told her to ask if the ulcers are in her new pouch or old stomach.  Is there anything else she should be asking/concerned about?  Might add she has gained more than half her weight back.  Just wondering if anyone else had these issues....  Thanks OH.
Lady Lithia
on 7/14/12 9:44 pm
She might also have been taking NSAIDS and/or been a smoker, both of which promote the formation of ulcers.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

FunBrain
on 7/14/12 9:48 pm
 Thanks Lady for the reply.  I know she has never been a smoker, however being that she doesnt know all the "rules" she sure may have been taking NSAIDS.  Will have to ask/inform her.  Thanks!

Lady Lithia
on 7/14/12 10:12 pm
I'm daily astounded by the individuals who don't know about the ulcer thing. I've had to change it to "can't take NSAIDS" to "allergic to NSAIDS" so the hospital won't give it to me in the ER (happened to me!) 

I wish her luck.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

Cherokeesage
on 7/14/12 11:31 pm
RNY on 02/24/12 with
Good idea to say "allergic to NSAIDs".  I'm going to start doing that.

Banded  Oct 2008:  290       
RNY Feb 2012:        245    
Dr's set goal:            170 reached Oct 11, 2012
My goal:                     160  reached Dec 1, 2012
Today :                       145-150

I am half the person I was in 2008.

Lady Lithia
on 7/15/12 8:08 am
I believe it is VERY important to say it that way. I've had a number of procedures and they want clarification on what it does to me, and when I explain what I know about the action of NSAIDS on the lining ofthe stomach, they always agree with me. I've actually had some interesting conversations with my PCP and spine surgeon and neurologist about this, and we've discussed the merits of various NSAID treatments for my pain issues, and I've used some NSAIDS but only with a clear discussion before hand. Several times I've had doctors give me copies of studies related to the use of certain topical NSAIDS and the research that shows how much (or how little) of the NSAIDS get into the blood stream. I think that understanding the issues with NSAIDS is an important part of my conversations with my doctors. It's DANGEROUS to not say "allergic to NSAIDS" in a situation when you can't stand up for yourself as was the case with me when they thought I was fixin to die and had -- they thought -- swine flu.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

Kim H.
on 7/15/12 3:15 am - VA
RNY on 07/11/11 with
I really disagree with the idea of saying we have an allergy when we don't. We CAN have NSAIDS in an injection- into muscle or a vein. We just don't want it sitting in our bellies. In some cases, like if we're having a heart attack, we need to have aspirin because studies show it reduces morbidity and mortality but if you flatly say, "I'm allergic" the med won't be given. It takes less than ten seconds to say, "My doctor prohibits use of oral NSAIDS due to my gastric bypass." I see people all the time who say they have an allergy when they don't and it limits how we can help them unnecessarily. Just a thought from nurse Kim...
        
I am my own hero...I save myself one day, one meal, one bite, one choice, one challenge, one step at a time...
Lady Lithia
on 7/15/12 8:04 am
In truth, this is WRONG. I almost ended up with a bleeding ulcers because when I was hospitalized, I told them I couldn't take NSAIDS and they gave it to me intravenously. They didn't tell me and I was in ICU because I was horrendously sick. I almost ended up back in the ER after being released because I had massive inflammation and ulcers due to the intravenous NSAIDS. If something is going to make me sick, perhaps sick enough to die, I think it shoudl be categorized as an allergy.

I used topical NSAIDS after my tailbone was removed and was fine so long as I only used it 8 hours out of every 24 and avoided being stressed out by anything. But when I used the topical NSAID while hubby was in hospital with heart problems, I got an Ulcer AGAIN

NSAIDS thin the lining of your pouch and your remnant stomach. It is NOT UNCOMMON to get an ulcer in the remnant blind stomach that never touches the NSAID because of the thinning of the lining. So your understanding of NSAIDS is wrong.

I told the hospital folks I couldn't take NSAIDS because of Gastric Bypass. They ignored it. I got sick and spent six months on medicines to fix it. NOW I say allergy because of this. When they ask why, I tell them clearly and concisely and they give me the allergy band.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

poet_kelly
on 7/15/12 9:59 am - OH
yes, we can take NSAIDS as an injection.  We can take them any way we want to.  However, taking them by injection poses the same risk of ulcers as taking them orally.

Ulcers aren't caused by a pill sitting in our bellies.  They are caused because when the NSAID enters our bloodstream, it causes the lining of the stoma*****luding the remnant stomach (and pills never sit in there) to thin, which can cause ulcers.

many health care professionals don't seem to understand how NSAIDS works, which is why some people have chosen to just say they are allergic to NSAIDS instead of saying they can't take them due to RNY.  Those professionals will still prescribe and/or administer NSAIDS because they think it's OK if they are given by injection.

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.

 

Citizen (USA & Brit)
Kim

on 7/15/12 1:59 pm - Castle Rock, CO
I agree 100% with Kim - if its a choice between surviving a heart attack or maybe/possibly getting an ulcer - I'll take the ulcer ...

Of course, if you KNOW you will get an ulcer, and you are in an ER for a condition not REQUIRING NSAIDS, you may make another decision but I would certainly NOT recommend that everyone with RNY state that they are allergic - it takes a hot minute to explain why and advise medical staff that they are NOT to give you NSAIDS (unless it's gonna save your life!).

You should insist that they write your wishes in your notes!


10 years post RNY - Success - one day at a time

Proud Feminist, Atheist, LGBT friend, and Socialist Liberal 

Want to join the new R&R 3.0?    PM me for an invite!

Lady Lithia
on 7/15/12 4:35 pm
I tried it that way Kim, but they apparantly "knew better" and gave me some in pill form moments after I told them I couldn't have it (I refused), and later I learned that they gave it to me in intravenous form while I was there (I was too sick to question everything).

I now tell them it's an allergy, THEN explain why. I find it's easier and they are far more focused on me.... here's the old and the new dialogue: 

ER Nurse: Are you allergic to anything.
Me: No, but I'm not supposed to take NSAIDS.
ER Nurse: Why? 
Me: Because I've had gastric bypass.

Result: 3 days on IV NSAIDS and almost readmitted to hospital with severe ulcers up and down my duodenum, remnant stomach, pouch.

NOW what happens: 

Nurse: Are you allergic to anything.
Me: YES. I'm allergic to NSAIDS.
Nurse: What happens when you take them?
Me: I've had gastric bypass, and it's extremely easy for me to get an ulcer.
Nurse: Even if it's not an oral NSAID? 
Me: Yes, even then, and because of the bypass, it's hard to diagnose and can be life-threatening.
Nurse: Hold out your arm for this allergy band.

I learned my lesson the hard way that they LISTEN when I call it an allergy. I won't risk them doing it again.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

Citizen (USA & Brit)
Kim

on 7/15/12 5:27 pm, edited 7/15/12 5:28 am - Castle Rock, CO
I understand that choice - given your medical history. One thing that disturbs me about all of this is that nurses are giving you NSAIDS - unless they are NP's, it is doctors who should be prescribing - they should just be dispensing ...

The most important thing you or your partner can do is to make sure they write it in your notes and you really should insist that they do that in front of you or that you check it is there ...

No one should be giving you ANYTHING without you or your partner's consent (if you are unable) with the exception of something that will save your life in a catastrophic situation and then an ulcer is the least of your worries!

I have seen too many bad things in hospital settings to trust doctors or nurses with this kind of thing, to be honest! Yes, I'm sure they think I'm a royal PITA, but I really don't care ...

10 years post RNY - Success - one day at a time

Proud Feminist, Atheist, LGBT friend, and Socialist Liberal 

Want to join the new R&R 3.0?    PM me for an invite!

Lady Lithia
on 7/15/12 5:34 pm
The one emergency really woke me up to what ccan happen if I am not VERY aware. I just start the dialogue with allergy and go from there. I don't know if at that time the doctor suggested the oral NSAIDS, but I did think to ask when she handed me the pills and I rejected them when she said there were NSAIDS in the handful. She got a "huffy" look on her face as if I was too big for my britches and she knew better. But I had bigger to things to worry about as my blood pressure was bottoming out, and I almost had no white blood cells at all and they pretty much rushed me off to quarantine ICU. I was too sick for several days to even worry about what they were pumping into my veins. It was only after I was checked out that I had pretty much Go-to-ER abdominal pain and ended up needing a CT scan, and while not definitive in the diagnosing of ulcers did show my entire gastrointestinal tract was inflamed. I was on anti-ulcer meds for six months to a year afterwards. Saw they had me on IV NSAIDS later on. That pissed me off big time, because I had been explicit, if not FORCEFUL. (I'm forceful now!)

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket

Larry Wassmann
on 7/15/12 6:22 am - Lacey, WA
RNY on 05/09/12
 I think Barbara was just being tongue in cheek.

 

fb.png   Visit my Blog at  http://www.lwassmann.blogspot.com/                                

Cicerogirl, The PhD
Version

on 7/15/12 12:33 pm - OH
Hmmm.. I thought she was being 100% serious.  Shows how the lack of tone on the Internet can muddle even the simplest communications....

Lora

 7 years out and maintaining 190 pounds lost!  

“You don't drown by falling in the water.  You drown by staying there.”

 

Cherokeesage
on 7/15/12 2:04 pm
RNY on 02/24/12 with
I was serious but after reading through the post realize that the Drs need to know that gastric bypass patients can't use NSAIDs.  I have this discussion with my PCM, pain mgmnt specialist, orthopedic and dentist at each appt. 

Banded  Oct 2008:  290       
RNY Feb 2012:        245    
Dr's set goal:            170 reached Oct 11, 2012
My goal:                     160  reached Dec 1, 2012
Today :                       145-150

I am half the person I was in 2008.

Lady Lithia
on 7/15/12 5:04 pm
I've found that the impact of NSAIDS on gastric bypass patients and the systemic interaction even when it isn't oral varies widely from doctor to doctor. My current orthopedic specialist truly awed me with her knowlege of how NSAIDS work on the system, and we discussed a variety of topical NSAIDS that can be used, and how some of them are very localized with very little that gets into the blood stream compared with a ffew other types. I feel like I can trust a doctor who shows a strong understanding about NSAIDS more than I can trust a doc who doesn't get the way they work in the system.

~Lady Lithia~ 200 lbs lost! 
March 9, 2011 - Coccygectomy!
I chased my dreams, and my dreams, they caught me!
giraffesmiley.gif picture by hardyharhar_bucket