NSAIDS & Anti-Depressants after Gastric Bypass? Need experiences/opinions pls!

Hi there,

 

I haven't posted on here in a Looong time.  I had lapband surgery several years ago and after a few complications and some other issues which I will expand upon soon (just pressed for time at the moment) it has not worked for me.

Alas, I've nearly put back on all my pre-surgery weight (I was at 380 lbs and am back up to 339lbs) and due to significant joint related health issues (osteoarthritis in both knees and two surgeries in left knee later I can barely walk short distances and only in significant pain and accompanied by horrific stiffness that I didn't have pre-surgery).  I do my PT devoutly but have issues with my patella in my left knee particularly, which makes walking for longer distances (like grocery shopping or just going to the mall) impossible without the aid of a wheelchair and an amazingly supportive husband.

I am only 44 years old yet feel 90.

I have Lapband removal, division of adhesions and a Gastric Bypass scheduled with a surgeon here in Australia (I was in the States but moved to Australia about 2 years ago) scheduled for December 5 but although many questions were answered, today I discovered some issues in relation to post-surgery absorption of medications and it has set off alarm bells so I wanted to see what real post-surgery experiences are, not just text book and internet "semi-facts".  I will also be checking with my doctor but would welcome feedback here please as I am very concerned. Let me explain. :O)

In addition to my knee issues I am also BiPolar II and have OCD and chronic depression, something I was diagnosed with 20 years ago and have been (mostly) successfully treated for since with medication, therapy etc. 

Prior to the two knee surgeries I had this year (March and July respectively), I was taking ibuprofen for the inflammation as nothing else would really help.  I am aware of the issues it can cause the stomach but the pain outweighed that concern, to be honest.  I also have GERD (which I developed once I reached about 250 lbs) so take meds for that to control the symptoms.

Post knee-surgery I HAVE to take ibuprofen (between 400mg - 1200mg per day) and sometimes some Panadol (Tylenol in the US) - without the NSAID relief I'd be off the walls (note: I used to ice the knee directly of course but it only offers brief respite from the pain and no help with the stiffness and is not a practical solution during working hours).

BiPolar etc., meds are : Paxil (Paroxetene) and Valproate Sulfate (aka Depakote, Divaloprex). 30 mg of Paxil, 500mg Valpro per day (need to check if the latter is an ER or not).

 

So... are there folks post Gastric Bypass specifically - who have arthritis and either treat it with NSAIDS or have found other relief that could share?

Likewise, Bipolar or folks on anti-depressants that I have mentioned above - I would really like to hear from you or from folks who could help me make a better informed decision.

I have a short window in which to decide how to proceed but cannot risk not being able to absorb my anti-depressants - this is critical to my health, and cannot imagine coping long term with bone-on-bone arthritis that will definitely require knee replacement in most likely both knees, in ten or so years (if I can get the weight off, otherwise it will be sooner).

Sorry for the length of the post - this ended up longer than anticipated!

 

Many thanks,

PS

Nsaids are really no -no post op gastric bypass.  Specially regular frequent use.  Even with nsaids we are prone to ulcers. Ulcers can also form in the blind stomach, and there will be no way yt? o see them or treat them. Perforated ulcers can be deadly.... 

I had RNY and really miss my pain pills.  Now i only can take tylenol or narcotics. And the narcotics are harder and harder to get. So with my back issue i have to wait until the pain is really bad before i take some. 

Like the previous poster said, you really cannot take those NSAIDS after RNY. Not in any form. It's the drug itself that can cause the issues with the stomach so ingesting it some other way than the pills isn't a way around that fact.

I have had surgery on one knee and at age 47 they are already recommending a full replacement of the other knee because of my osteoarthritis and a kneecap that sits too high and too far toward one side of the joint.. I have decided to try to hold off a few more years but not sure how long I will be able to go.

For pain I have been taking Tramadol. It's just been reclassified here in the US as a narcotic. Not sure what it is in Australia. Once those don't help they will add another narcotic if I don't go ahead with the knee replacement. I also use things like Tiger Balm that help me sleep at night. The Tramadol is working for me now, however. I do sometimes have to add a couple of Tylenol but not often.  Like once a week or so.

I am not bipolar but I have depression that I am still being treated for currently. Time release meds don't work as well after RNY. They tend wear off earlier than they should. So I switched over to the regular version of Effexor. It took a couple of months to get the dosing right but as long as I stick to schedule I am ok. Not sure if any of yours are available in the non time release version. If not, it may just be a matter of taking them more frequently. Talk to your pharmacist about the drugs before you speak to your doctor. The pharmacist is (obvioulsy) really well versed in the meds, their forms and what can be done. They were a tremendous help to me pre-op.

And although it won't make your arthritis better losing all the weight can help with the pain somewhat.

Take care of yourself.

I take Celexa, and have not noticed a difference in use after surgery.  I have very slight arthritis in my knee, but Tylenol, when I need it, since a lot of the weight came off quickly, I don't have as much an issue

Hi all,

Thanks so much for the helpful responses. It's actually Sodium Valproate that I take (not Vaproate Sulfate which apparently is something my tired mind conjured last night when posting), in addition to the Paxil.

I've made an appointment with my gastric surgeon for Monday and have a standing appointment with my ortho surgeon (from my knees) for a check-up on Tuesday which is rather fortuitous timing as I can ask him if he has any RNY patients who've had knee surgeries/replacements and/or severe arthritis and what methods do/don't work for them and what his opinion is.

I will also pop over to my pharmacist this evening for a chat. He is very, very kind, always helpful and so knowlegable - I don't know why I didn't think of that myself. Great tip, thank you.

In regards to Tramadol, unfortunately it's a medication that doesn't work well with many anti-depressants as I discovered when I was prescribed it a few years ago, so that's off the books for me.  In relation to pain management, obviously NSAIDS are not an option then - can anyone explain the medical reason (i.e. what happens) that makes an RNY patient at greater risk for ulcers when taking NSAIDS than say someone with Lap Band? I'm just curious and wonder what causes the increase in issues, since I'd have thought the absorption issue would have had the opposite effect then on NSAIDS (clearly, I'm not a doctor lol).

 

Cheers and many thanks,

 

PS

I'm not sure what kind of negative interaction you had between tramadol and antidepressants, but I know many many people who take both and hage had no problems.

As far as why RNYers should not take NSAIDs, the simple explanation is that NSAIDs cause a systemic reaction (meaning the problem comes from what happens when the drug gets into your bloodstream NOT because of some thing it does when it comes into contact with the pouch/stomach) that causes the lining of the stomach to thin.  When you have a very small pouch (or even a sleeve) instead of your large stomach (which has some protective "juices" that the pouch doesn't have), that thinning can more easily become an ulcer AND with the small surface area of the pouch/sleeve, an ulcer can effect a large percentage of it (and therefore be more probes attic than an ulcer in the large stomach. So many surgeons suggest that anyone with a pouch or sleeve not take them.

RNYers, however, also have a special consideration and danger. Because we still have the remnant stomach, and the effect of the NSAIDs is systemic, the remnant stomach is also at risk for ulcers.  The problem is that the remnant stomach is "blind"... It can only be accessed via surgery.  So if you do develop an ulcer in the stomach , it is very difficult to treat.

As someone who spent six years after my RNY trying to deal with the pain from severe arthritis in my knees without NSAIDs, and eventually had to give in and have both knees replaced because it was acquiring increasing doses of narcotics to do with the pain, I would tell you that if you are that dependent on the anti-inflammatory action of the NSAIDs, Roux-en-Y may not be a very good choice for you.  (If VSG has been an option for me 7 years ago, or if I were making the choice now, I would have opted for sleeve without the worries about medication and vitamin absorption and not as much worry about the NSAIDs.)

Lora