Help needed

 I had my gastric bypass in February of 2007.  Within the first year I'd almost reached my goal weight of 160 lbs (starting weight of 333 lbs) (I actually went down to 130 lbs, but was very sickly looking) While this sounds great, it wasn't the greatest year.  I had pain develop in my upper left abdominal area, and was never able to eat properly.  I pretty much lived on a liquid diet the entire time, as everytime I attempted solid food I'd throw up.  I know my protein intake was very low, as the protein powder did the same thing.

After a year of dealing with the pain on my own, and with my mother pushing me to get to the doctor (we only have GP's in this town) to get something other than Tylenol 1's to help control the pain and allow me to start to actually try to live... I went.  I could finally get some solids in by this point, but usually stuck to soup for meals.  After 3 more years of seeing multiple doctors & specialists, having tests, pain meds and no real relief, I had a rupture in my stomach at the site of the pouch attaching to the intestine (March 28, 2011).  I was flown out for emergency surgery, then put on a feeding tube for 2 months.  I was actually OFF all pain meds the day after surgery.  The surgeon had ordered a pile of pain meds, but I told him the pain wasn't that bad at all and I didn't need them.  I came home from the hospital for about 2 weeks, and ended up back in due to some complications for another 2 weeks, but still no pain meds.  After another 2 weeks of pure BLISS... no pain , no meds, I woke up one morning having a slight "ache" in my upper left abdomen.  I told myself, "it's nothing, you just slept wrong..."  I told myself this for the next 3 weeks.  The pain got worse daily.  I finally couldn't stand sitting in the bathroom crying my eyes out so my kids wouldn't have to see me in pain and went to the local Dr. 

It's now been 7 months, I'm still waiting on the revision surgery that the Surgeon that did the emergency surgery said I'd need, and I'm back on the same pain meds I was on before.  The doctor has me on 6 mg of Hydromorph Contin 2 times a day and also Dilaudid 2mg as needed (usually use up to 8 / day, although that only dulls the pain, it doesn't erase it)

Before the rupture I was on 20 mg of the Hydromorph 2 times a day and using Endocet for the breakthrough pain (used 8 - 12 / day, depending on how bad the pain was)

Now, I've been doing some reading tonight, trying to figure out why it is that the 40 mg hydromorph contin seems to do as little as the 6mg.  I found a bunch of articles talking about the extended release medicines not being useful after Bariatric surgery.  Is this so?  Why would I be put on this medication to control pain, and after so long of it obviously not working to its full potential, what other medication could be an option?  While I don't relish the idea of living on pain medication, especially narcotics, I just want a day when I can actually walk downstairs, throw a load of wash in, and when I come back upstairs have to concentrate on not screaming.

Another...side effect... if that's what I can call it.  I've finally been able to eat in the last 4 months.  I can actually eat meat, and eggs, and all that stuff I missed so badly.  I've had a few days that food doesn't sit well, and I either throw up or have very bad nausea for a few hours after eating.  The worst part is, I've started gaining weight, so now I'm not only in pain, but I'm depressed too.  I don't want to ever go back to where I was, but I'm creeping back up to 190 lbs.  

Does anyone have any ideas on the pain med issue or what I can do to control the constant hunger I seem to have now.

Oh and the advice to "see another doctor" isn't really an option.  I'm in a very small northern ontario town.  We have TWO ... count em.... TWO doctors.  And one isn't taking any new patients.  The closest place I could go would be a 5 hour drive, and to actually get in to see one would take months unless it's an emergency.

 I am SO sorry that you have had such a hard time since your WLS.    I was told from the beginning that time released meds would NOT work properly on us.    That is a shame that you only have a few docs nearby.    Where was the doctor who did the operation on you that took the pain away and told you that you would need a revision?   I personally would go to him ( provided he is a bariatric surgeon ).    If you are getting a revision from your RNY I wouldn't worry about the regain.....you will lose that weight with the revision from your RNY.    Hang in there since you are seeking a revision to your original surgery.....I am sure that it will eventually be OK for you.  I think if I were you I would call a doctor and explain your situation.....hopefully someone will take you in sooner and give you some relief from your pain.       Good luck and I will keep you in my thoughts and prayers.

Hugs and blessings ~~~ Vivian

Extended release is not practical for RNY or DS patients. Ask your doctor about pain med patches. That may be a better option. At least you have a doctor that attempts to give you the level of pain medication you need. My pain management doctor insists on giving me short-acting pain pills for my chronic back pain (I got injured 6 years ago, and am not improving. Actually getting worse, but no patch for me~sigh~).

Anyway, see if the patch route is an option. Good luck!

It's horrible that you should be so unattended and in such pain. 

You can use Lortab, which is a liquid.  I was prescribed this immediately post-op, but only used it once or twice.  It's liquid tylenol and codeine. 

Best wishes for a painfree life.

 The surgeon that did the original surgery in March isn't a bariactric surgeon, this is why I have to have the revision, he did a quick patch job, that's all he knew what to do on someone that had had a gastric bypass.  And Lortab...ahhh yes, I remember that too from after my surgery.  I had mine done in Deluth, Minnesota.  However, I live in Ontario, Canada, and Lortab isn't available to us.  They can give us 2 different meds mixed together, that is "something like" Lortab, but isn't nearly as effective.  This was one of the first meds they tried me on.

Owwww!  Well, kid, I'm not sure what else to suggest, unless you can get the pain meds patches.  Unfortunately, I understand that the patch is such strong medicine that it's only used for cancer pain
relief, etc.

Good luck.

 Well I went back to my GP today.  I ran out of my wimpy lil 1mg dilaudid tablets to handle the breakthrough pain from the slow release morphine capsules.  A one month supply, lasted a full 2 weeks lol (and I was being very stingy with them too)

The Dr has me on a 25 mcg/h ratio-Fentanyl patch now.  Change it every 3 days.  It's been 4 hours now since I put it on, and I've noticed the pain has moved to becoming background noise.  Whether or not it will actually mask it totally or not is yet to be seen.  Never even thought about it at the time, but I guess I should have insisted on something for breakthrough pain as well, even though I doubt this doctor would have given me anything.  He told me I couldn't take my morphine while on this patch as I would overdose.

After looking at a site where you convert the amounts of other narcotics that you're on to what the equivilant would be with fentanyl, the patch he has me on is actually only 1/2 the strength it should be. 

Oh well, yet another test of wills lol

Hopefully this will work.