?s about nsaids, cortisone, anti-depressants after RNY

Hi there,

I am new to this board. I've been reading on the vsg board a lot.  I won't be able to have surgery until after September, when my insurance changes. So I've had time to start thinking about RNY.  Two of my girlfriends have had it and they are so pleased with their results.

So I have a few questions.

1. Are you NEVER allowed to take nsaids? Do you find that Tylenol is strong enough for things like menstrual cramps, headaches, etc.  I LOVE Excedrin and it knocks my  headache out in no time. I know that it contains acetaminophen and caffeine but there is also aspirin in there so I wouldn't be able to take that after RNY.

2. Are you ever allowed to have steroids? I sometimes have to get a cortisone injection in my heel for plantar fasciitis. Will that not be possible after RNY?

3. Are anti-inflammatories safe via injection/iv?  When I was passing a kidney stone (years ago), the ONLY thing that gave me relief was Toradol, which is an anti-inflammatory.  They gave me morphine at first--but it did nothing! I have had another kidney stone since then so I'm wondering if I tend to be a "stone-former." I just want to be able to get pain relief if that happens again!

4. I take an anti-depressant. I don't think it comes in anything other than extended-release (pristiq).  Will my body absorb that after surgery?

5. And last, but probably not least--are there any future medical conditions that one could develop where one could not get appropriate treatment for because of RNY? (organ transplants, cancer treatment, etc.) I would hate for a doctor to say, "This medication would really help you but we can't give it to you because you've had RNY." I know that sounds silly but I tend to be a worrywart.

Thank you so much for your help!

Sincerely,
Pam

Some doctors will permit short courses of NSAIDs if you also take a PPI to help protect you for  ulcers; others say "no way", never.  My surgeon is one of the former but my PCP is one of the latter.  Tylenol does nothing for me for almost anything, so I end up taking prescription Tramadol and/or Vicodin for my arthritis pain.  I also take the Tramadol for occasional headaches.  It does not matter HOW the anti-inflammatories are given... They are just as dangerous in an IV as in pill form because the action that causes ulcers in from the drug in your bloodstream, not the pill in your pouch.  (The greatest problem with ulcers is if you get an ulcer in your blind, remnant stomach... it is very difficult to treat.)

Cortisone injections are fine. I have had cortisone injections in both knees every 3-4 months for the past 5 years with no problem.

You will definitely NOT want Toradol after surgery since it is an extremely potent NSAID.  If morphine doesn't work, they will have to give you Demerol or Dilaudid or something else.  (I had the same problem... the morpine was not enough, so they gave me Dilaudid the last time I had a stone pass.)

There is no way to guess how well you will or will not absorb the Pristiq.  You can just take your chances and see if the doctor can adjust the dose upward after surgery if necessary or you can switch to a different antidepressant before you have surgery.

Lora

I agree with ****rogirl, it definately depends on the doctor. My surgeon gave me toradol while in the hospital administered IV. I had a morphine pump but never used it. I have taken celebrex for tendinitis along with a ppi. I think the absorbtion depends on the person, my bff doesnt absorb much of anything medicine wise, where as I absorb fine. Her vitamin deficienies are many and mine are usually high. Every body is different. Good luck on your decision making.

I do not think it depends on the doctor.  It depends on the patient.  Some patients might be willing to take Toradol or other NSAIDS by IV but others, including me, would not.  Doesn't matter who my doctor is, I still will not take NSAIDS.  It is the patients' choice about what risk to take, not the doctor's.

1. NSAIDS should be avoided. I would plan a life without them. I have used them from time to time. I had a couple of root canals and found I simply could get no relief from pretty powerful pain meds. Someone suggested that my pain was more from inflammation than anything, and an anti-inflammatory might be a good idea. I took one adn voila, pain relief. But mind you, I took ONE and also took prilosec for a week as a precautionary measure.

2. No issues with steroids. My WLS surgeon had me on steroids a week after surgery (contraindicated directly postop due to inhibition of healing BUT since I was having an allergic reaction to something and my airway was closing, it seemed better to stifle the allergic reaction prior to worrying about healing). I've had several cortisone injections. The big deal about Steroids is that NSAIDS are NON-STEROIDal anti-inflammatories. Steroids are an anti-inflammatory we CAN have. But it might as  side effect result in weight gain (I'm the opposite on steroids, I lose like crazy)

3. The BIG DEAL about anti-inflammatories is that if they are in your bloodstream, they work to thin the lining of your stomach and your pouch. When you've had RNY the majority of your stomach is still inside you, making acid and other digestive juices that help you with your processes inside with digestion, but it's a BLIND stomach. No entrance possible. SO, if you have issues with the remnant stomach, only surgery can be done to see what's going on inside. So if you take NSAIDS, you can get an ulcer in your remnant stomach, and if it becomes a bleeding ulcer that an cause you to become very ill, and in extreme cases can kill you! So any NSAIDS -- orally, intravenously, through a patch or cream will result in NSAIDS in your bloodstream and have the side effect of thinning the lining of your two stomachs, and inviting an ulcer and serious complications. I was hospitalized with a very bad virus when I was 18 months out, and while I told them I couldn't take NSAIDS they didn't treat it as an allergy, and they gave me IV NSAIDS.... by the time I was done in the hospital, my entire digestive system was inflamed and I had to go on proton-pump inhibitors (like prilosec) for six months to cure the resultant ulcers. Last year I had surgery on my tailbone, and I opted for NSAID patches, even knowing it was a risk. I was okay for a while, but then I got stressed at work, and all it took was that to tip me over the edge into another ulcer and another six month course of PPI medicines to allow healing.  

4. As for time release meds, those are often ineffective or less effective than non-time-release. You may find that it doesn't work for you like it did before, and that might lead you to trying a different type of medicine. For the most part I avoid time-release meds, though I do take Oxycontin which is time release. I generally expect to  get about an 8-hour relief from 12 hour meds. For me it works BETTER than non-time-release taken more frequently, so I accept it as being slightly better than regular meds, but not as effective as it is supposed to be.

5. I have degenerative disk disease and arthritis all up and down my spine. The first and primary course of treatment is NSAIDS. (and I might still try an NSAID cream if offered, but I know it's a risk).... so yes, if you get arthritis you'll have issues. A lot of cancer treatments would cause issues... not so much with the treatment but with general nutrition. I can imagine that the effect of chemotherapy on top of an altered gut might make malnutrition a serious issue. But I tend to live my life in a way that is right -- right now... if all I did was live it in a way to be safe...well I wouldn't go to work, cross the street or anything else that might have a bad outcome. Yes, I might get cancer, and yes my RNY might get in the way of any treatments, but I'll cross that bridge when I come to it.

1. you are "allowed" to take NSAIDS if you are willing to accept the high risk of developing an ulcer.  My surgeon recommended never taking them, ever, but some feel it is acceptable for short periods of time.  However, just one dose can cause an ulcer.

2.  Cortizone is not an NSAID.  It's a steroid.  It's fine to take.

3.  NSAIDS are not safe in any form, including injection.

4.  You will not be able to absorb all of the medication in an extended release form after surgery because they dissolve over a period of 12-24 hours and they will not stay in your digestive tract that long since it is shortened by RNY.  You will absorb some of it but will not get the full benefit.

5.  Um... arthritis or something similar that responds best to NSAIDS.

Thank you all so much for your responses. 

This made me think of a couple of more questions.

If I switch to a regular non-time released anti-depressant-is that an issue? Should that one be absorbed okay? Are time-released meds the only ones that have an absorption issue?

And this may be  a dumb question--but why isn't the blind stomach removed? Does the blind stomach still serve a purpose?

Which leads me to another question--is the hunger horomone ghrelin reduced after RNY (as it is after VSG)?

Thank you again! You are all so helpful!

Sincerely,
Pam

Non-time released antidepressants will be fine.  You just have to take them more than once a day.  Like, I used to take my Effexor XR once a day, not I take the regular Effexor four times a day.  Works great, just have to take it more often.

Not a dumb question at all.  The blind stomach still makes some digestive juices that go into the small intestine further on down, where the "Y" part meets up again.  Also, if surgery needed to be reversed for any reason, the parts are all still in there.

Thanks Kelly! That makes sense about the blind stomach. Do you think ghrelin is decreased after RNY?

Is your overall dosage of Effexor higher now than it was pre-surgery to accomodate for some malabsorption?  Is there a way to test the levels of the anti-depressant in your blood (to ensure that you're receiving the proper dosage--which would allow your doctor to increase or decrease it?) 

When you are prescribed any medication-is there always a chance of malabsorption?

Thank you so much for your help!!

I think that as far as ghrelin it depends on the person. I almost never have hunger.

I have some absorption issues with pain meds, they do not last as long as they are supposed to, but I'm not sure it's absorption or tolerance issues (the longer you take it, the less effective)

can't comment on the anti-depressant