NSAIDS

Nadinemel
on 1/17/12 10:26 pm - St Paul, MN
Why can't we take NSAIDS after RNY?  My doc never said why no, just don't do it. 
paranoidmother21
on 1/17/12 11:05 pm - Lake Zurich, IL
I have been told it's because they can irritate to the point of ulcers any of your suture lines, even when healed - and, since you have a much higher ratio of suture line to stomach lining after RNY, sleeve, or DS, they want you to avoid them on general principles. This applies even to IV NSAIDS, as it has to do with how they work, not just where they land physically in your pouch.

It is possible that they won't cause a problem, but given the pain and meds involved in treating ulcers, I'm not going to go there.
Rebecca
Circumferential LBL, anchor TT, BL/BR, brachioplasty 12-16-10 Drs. Howard and Gutowski

Thigh lift 3-24-11, Drs. Howard and Gutowski again!
Height 5' 5".  Start point 254.  DH's goal: 154.  My guess: 144.  Insurance goal: 134.  Currently bouncing around 130-135.
      
Nadinemel
on 1/17/12 11:14 pm - St Paul, MN
Thanks Rebecca, I got an ulcer 6 months after surgery and it is a bummer trying to manage it.  I don't want to irritate that!
wvugal89
on 1/17/12 11:15 pm - MD

Found this when I was doing research, hope it helps.

Teri-Lynn
POI



NSAIDs are more than just pain relievers. They also help reduce inflammation and lower fevers. They prevent blood from clotting, which is good in some cases but not so beneficial in others. For example, because they reduce clotting action, some NSAIDS, especially aspirin, may have a protective effect against heart disease. However, you may bruise more easily. NSAIDs can increase the risk of developing nausea, an upset stomach or an ulcer. They also may interfere with kidney function. 


 

NSAIDs work by preventing an enzyme (a protein that triggers changes in the body) from doing its job. The enzyme is called cyclooxygenase, or COX, and it has two forms. COX-1 protects the stomach lining from harsh acids and digestive chemicals; it also helps maintain kidney function. COX-2 is produced when joints are injured or inflamed. 

Traditional NSAIDs block the actions of both COX-1 and COX-2, which is why they can cause stomach upset and bleeding as well as ease pain and inflammation. 


 

Contrary to popular belief, it is not just that they are ?pouch  burners? as the industry wants us to believe. It goes much deeper than that. According to an article published in the June 1999 New England  Journal of Medicine, NSAIDS, once absorbed into the blood stream cause a  chain of chemical reactions that affect the prostaglandins and this in  turn reduces the production of mucus in the GI system. The mucus is what lines our GI system and protects our pouch and intestines from damage.


 

If the mucus production is reduced, this would allow ANYTHING, including eating something with too sharp of an edge or foods that are extremely spicy, to inadvertently begin a marginal ulcer.

     
poet_kelly
on 1/17/12 11:55 pm - OH

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 seem to 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 weigh 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.


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.

 

jvan71
on 1/18/12 1:47 am - TN
Back when my mom had RNY 22 yrs ago, they didn't know any better about NSAIDS so she'd been taking them off and on for years.  Last year (or maybe the year before that) she had some really high liver enzyme readings.  She went to a specialist who told her that the ibuprofen she was taking was the likely culprit.  She stopped taking them and just a couple weeks later her liver enzymes were back to normal.

I'm not sure if this is only for ibuprofen or all NSAIDS or if it is only for bariatric patients or everyone, but since then, she hasn't taken ibuprofen at all.

I have definitely heard the problems with potential ulcers (also the reason I'm not going back to drinking caffeine)...but I also wanted to add that it can apparently cause liver problems as well.

Jen
HW: 330   SW 314   CW 262   GW 130      
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