Aspirin after RNY
Personally, if it's possible, I'd much rather take a daily aspirin than coumadin. Was wondering what others have experienced or what they may know about it. My cardiologist said she would talk to my bariatric surgeon about it, also. I guess I'm a little antsy. While some of my heart functions are better post-surgery (yay), I've suddenly developed another problem.
I would definitely check with YOUR doctor on his views. Given that you have cardiac issues and a blood thinner is necessary, you really need to know what the plan will be for you both pre-op and post-op.
Good luck!
Here's the info...
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Posted by Andrea U
NSAIDs do any number of things -- but one of the worst things they do is thin the mucosal lining of the pouch and stomach.
NSAIDS include -- Aspirin, advil, aleeve, alka-seltzer, pepto bismol…. Etc.
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.
Posted by Amy W
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.
Posted by Foobear (Steve)
The recommendation that patients not self-medicate with OTC NSAIDs comes from surgical experience (after-the-fact epidemiological results, looking at RNYers who present with marginal ulcers and erosions.)
From what I understand, the decision to prescribe NSAIDs, like any other medical decision, isn't binary, either/or, black-and-white; it's a risk/benefit analysis. If someone's quality of life is in the toilet due to pain that can't be treated effectively without using NSAIDs, some surgeons will acquiesce along with other caveats (concomitant use of a PPI like Prilosec OTC to prevent upper GI problems, using them sparingly, and only when needed, etc.) You will find many members here on the Men's Forum and elsewhere on OH whose surgeons aren't quite as reluctant to prescribe NSAIDs when deemed necessary; usually, these people are a year or more post-op (though I'm not sure there are any studies suggesting that the GI risk diminishes the further out a person is from surgery.)
NSAIDs all have a common mechanism of action: they prevent the formation of prostaglandins, a family of endogenous chemicals produced from essential fatty acids, that have a wide variety of biological actions throughout the body. Some prostaglandins are involved with the production of fever, inflammation and the transmission of pain signals. Other prostaglandins promote the production of protective mucus in the stomach and duodenum, protecting them from the corrosive actions of stomach acid. Still others are involved with controlling clotting and bleeding (some promote clotting, others work in the opposite direction).
The enzyme that synthesizes all prostaglandins is called cyclooxygenase, or COX. NSAIDs bind to the active site on the enzyme, temporarily disabling it. This is how they exert their beneficial effects to lower fever, suppress inflammation and relieve pain. Since prostaglandins are needed to produce protective mucus in the GI tract, you can see why NSAIDs, which reduce the production of that mucus, might increase the incidence of stomach upset, GI bleeding and facilitate the development of ulcers.
In the late 1990's, a new isoform of COX was isolated, known as COX-2. It appeared that the original COX, now known as COX-1, was present all the time in tissues such as the lining of the stomach. COX-2 was thought to be produced as needed at areas of inflammation. It turns out that traditional NSAIDs (tNSAIDs) block both COX-1 and COX-2 enzymes. A new family of NSAIDs known as COX-2 inhibitors, or -coxibs was developed that specifically blocked the actions of COX-2 without blocking COX-1. The rationale for these drugs was that they might be able to have same antiinflammatory and analgesic effects of tNSAIDs while avoiding some or all of their other risks such as GI upset. It turns out that this model might be a bit simpistic, though it appears that the -coxibs do tend to produce fewer mild/moderate GI side effects than the tNSAIDs. Some of the COX-2 inhibitors that you might recognize are celecoxib (Celebrex), rofecoxib (Vioxx) and valdecoxib (Bextra).
After about 5 years of these COX-2 inhibitors being on the market, it appeared that their chronic, long-term use might increase the risk of cardiovascular disease such as heart attack. Vioxx was particularly notorious in this regard, and it was ultimately withdrawn from the world-wide market. It is still controversial whether this increased CV risk is a so-called "class effect" of all COX-2 inhibitors, or even of most NSAIDs (whether tNSAIDs or COX-2 inhibitors.) Right now, only Celebrex is still on the US market, which doesn't mean that this question has been definitively answered. Of the NSAIDs studied, only naproxen (Naprosyn, Aleve) and aspirin seem to reduce CV risk, and it's hard to say for sure about naproxen. Other tNSAIDs seem to share in a moderate increase in CV risk, though not all have been studied, and there may yet be significant differences between tNSAIDs. It's kind of a muddle.
Before turning to NSAIDs, it might be worth discussing other analgesics with your orthopedist or PCP. Generally, that means opioids (aka "narcotics"). These don't have any effects on the stomach lining, and don't promote ulcers, AND they certainly don't increase the risk of CV events. Their downsides include sedation, constipation, tolerance, and the potential (albeit rare) for abuse and addiction. Tramadol (Ultram) is a codeine-like opioid that seems to be unique; it rarely causes significant sedation or constipation, and the incidence of drug abuse and addiction is exceedingly rare. It's become rather popular for treating arthritis in the past 5 years, especially given the hubbub around the chronic use of NSAIDs and COX-2 inhibitors.
Posted by JosieB
Read her story of what happened when she was given NSAIDS in the hospital
http://www.obesityhelp.com/forums/rny/3580043/Near-death-exp erience/
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So, as Pam said, if the benefits outweigh the risks, then they MIGHT clear a patient to do it. But that is a call made on a case by case basis.
If you do NSAIDs make sure it's an informed decision and that your team are aware of your lmitations.
I've taken NSAIDS twice after RNY. One aleve on each occasion. Both times I had a root canal and even the strongest of my pain killers left over from RNY surgery did nothing for the pain. Without a decrease in swelling, I was advised, the pain would not go away.
Recently I went to the hospital and ended up being admitted with a very serious illness. While still in the ER the nurse came with a little medicine cup with four pills in it. As sick as I was, I did have the forethought to ask what was in it... two motrin, and two tylenol. I hadn't thought to list NSAIDS when they asked if I had allergies. Several other times while in the hospital I had to tell them NOT to give me NSAIDS, and I think that a few times I was too sick to ask, and they were "successful" in giving me that which I should not have. By the time I left the hospital my gut was inflamed and I had an ulcer in my esophagus.
Next time, and all other times in the future, I plan to list NSAIDS on my allergy list.
~Lady Lithia~ 200 lbs lost!
March 9, 2011 - Coccygectomy!
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