Why we can't take NSAIDS

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 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 weight 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.

Kelly

Thank you Kelly for this information.  Many people who have WLS sometimes walk around clueless about their procedures.  It's better to be informed. 

I am a big believer in being well informed.  Then people can decide for themselves what they want to do.  It really bugs me that so many docs don't do a better job of educating patients.  I believe in informed consent.  But you can't really consent to whether or not you want to take NSAIDS if you don't know the risks and benefits.

Kelly:
What is NSAIDS?

Maria

non steroidal anti inflammatory drugs:
Ibuprofren, asprin, alieve (anaprox/naproxin) are among the most common

Oh, duh.  I should have explained that!  Thanks for asking.

Stands for non steroidal anti inflamatory drugs.  Like ibuprofen, including advil, motrin, aleve, excedrin.  Also things like naproxen.midol, mobic, voltaren and toradol.  Some are over the counter, others prescription.  If you aren't sure it something might be an NSAID, ask your pharmacist.

what do you use for pain meds? like if you have a headache or after your surgery?

Tylenol if you want something over the counter.  If that's not enough, narcotics.  I use Vicodin.  Not often for a headache, though.  I also get migraines occasionally and use Imitrex for that.

When I had my tummy tuck i took ibuprofren 800 - every 8 hours.  It was worth the risk for me - but I took prevacid with it.  The vicoden, percoset and other narcotics along with tylenol did not help as much as the ibuprofren!!!

But once I felt I was good without it I stopped because I did not want to prolong the use of NSAIDS.  I took it for 4 days. 

I do think sometimes it's worth the risk.  But whether or not it is worth the risk is something each of us has to decide for ourselves.