carpal tunnel syndrome and medications to take after RNY

I have had severe pain especially in my left wrist, arm, and shoulder and believe it to be carpal tunnel syndrome. It is worst at night and wakes me up. I plan on getting a wrist splint and made a doctor's appointment. Any suggestions on medications to help since NSAIDS and steriods are meds to avoid. Regular doctors have limited knowledge on medications and gastric bypass surgery so I try to go in as informed as possible.

Only thing I can ever take for pain is Tylenol, sometimes it helps and sometimes it doesn't . A few years ago I hurt my back and like a fool, I took Motrin for 3 days. I had a very bad GI bleed, ended up in ICU for 2 days. What did you take for pain post op?? maybe you can try that?

Best of luck

I recommend calling your surgeon and asking for advice. In theory, they should know what you can/can't take due to your RNY.

Ice or Biofreeze.

I was just reading a study in this month's Reader's Digest where therapy worked better than surgery for carpal tunnel patients.

We can take steroids, same as anyone else. Just not NSAIDS.

I find that interesting, since the major action of NSAIDs that increases the risk of ulcers is the effect on prostaglandin, which steroids also have. I was advised toward the VSG because of my need to take NSAIDs AND steroids due to my auto-immune. Perhaps they don't worry so much about steroids because most people take them for very short periods of time, which reduces the ulcer risk?

The way my surgeon explained it to me was, prostaglandins cover a huge range of bodily functions, from contaction of smooth muscle to fever, clotting, and inflammation.

The only one that really effects us is the production of mucous that protects our digestive tract from acid. The COX-1 inhibitors block that production. COX-2 inhibitors are better, if in conjunction with a PPI. Some surgeons say COX-2 are ok, most don't. The ASMBS says no to all NSAIDS.

Steroids are not supposed to effect the prostaglandins that mess up our protective lining, especially steroid injections, which only effect the local area, and are not systemic. Surgeons pretty universally favor steroids in the right siruation. The ASMBS says try to avoid them, but use them if necessary.

My education doesn't extend to the exact mechanism (which exact element in the prostaglandin chain is targeted), so I'll defer to your sources on that. I am going off of what my team (WLS Surgeon as well as my rheumatologist) told me, as well as the information in the PDR which I look up for every drug I take. Adverse effects of prednisone and prednisolone include increased chance of ulcer and the general mechanism of action includes reducing the precursor for prostaglandins).

I will point out that a steroid injection is typically NOT limited to the local area of the injection. While some injections into joint spaces may work that way (I wasn't trained to administer those, so I'm not sure of the systemic effects), every steroid injections I have given or received have been intra-muscular which is absolutely a systemic route. Otherwise the prednisone injections I've given for respiratory complaints or systemic inflammation (as in auto-immune disorders) would be ineffective.

Every drug treatment decision is a risk/benefit analysis, so it doesn't surprise me that there's a lot of differing opinions out there. I like to understand all the rationale behind any given opinion so I can evaluate it along with my medical team.

I tried acupuncture as a last ditch effort before having wrist surgery. I was so skeptical but desperate. After the 3rd visit, I noticed a huge difference and was so amazed. It was a combination of my neck and wrists. Now I use better posture, stretch and don't sleep on my wrists. I pay attention when my fingertips start to tingle. I haven't had to take medication for it since the acupuncture. I never did have wrist surgery.

One thing I did at night is freeze my wrist braces and wear them to bed. In the morning, I would get them wet and put in the freezer. The didn't freeze solid and weren't too cold to wear. It just felt so good on my tired swollen wrists.

I hope you find something that works well for you.

Neurontin/Gabapentin works specifically on nerve pain.