NSAID prescribed - Please provide your thoughts...

Thanks for the info. I will call my PCP today and ask for Tramadol 50 mg. since the one I have here expired in November 2011. 

I didn't realize Cymbalta was  time-release. I have read on OH there are some with fibro taking a total of 90 mg. of Cymbalta and twice a day.  Maybe that might help me.

Thanks again and I hope you will be well, too!

Mobic comes in 7.5mg and 15mg tablets. I'm a pharmacist and have never seen anyone take 40mg before. That would be considered a very high dose. Maybe you're thinking of the nexium which comes in 20 and 40mg capsules.

Duhhhh, you're right.  The Nexium is 40mg and the Mobic is 7.5mg.

Thanks for pointing this out.  So, what do you think?  Safe or no if taken in combination?

Again, thanks so much for taking the time you have with me as it's very much appreciated.

DEB

An explanation that is a cut and paste:

 

Most docs tell patients not to take NSAIDS (non-steroidal anti-inflammatory drugs) 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 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.

I also tell my medical team and pharmacist I'm allergic to NSAIDS.  It's easier to do that than explain every time why I don't want to take them.

 

That's a good one to keep in mind!

Most of the time I tell my "regular" patients to take NSAIDS with food to protect the stomach.  Since we are not supposed to drink when we eat, I would suggest taking the mobic right before you eat.  The nexium should be taken 30 minutes prior to the mobic. I too would not recommend taking the mobic unless the benefit outweighs the risks for you.

I am 11 yrs post op and I have taken Nsaids since I was a year out with my surgeon's blessing. He instructs patients to take gel form when available, ALWAYS with food and not if we've been diagnosed with a previous ulcer. I've taken them without any problems for years (as have other post op wls patients I know). Low dose will be fine for you, the Nexium is a great addition to the prescription to help you. Your doctor must know what she's doing to be that thorough. Your low dose daily shouldn't be a problem- many post op patients have chronic pain issues and take Nsaids in one form or another daily. We're fine. Never on an empty stomach is the guideline. You should be fine. sorry about your arthritis pain, hope it's better with the new meds.

Jen 11 yrs post op RNY

I understand why an ulcer in the pouch is bad.  Why is an ulcer in the old stomach bad?

Because the only access to the remnant stomach is via surgery.  It is very difficult to diagnose or treat ulcers in the blind remnant stomach.

 

Lora