VSG and NSAIDs

I posted this on my local forum, but as of yet, no answers. I thought maybe I'd try you folks seeing as you all have gone the VSG route... 

I am going to have VSG in February 3 and I'm trying to lay out some sort of plan now for medications later. But I'm stumped with this one.

I take NSAIDs regularly for psoriatic arthritis. This type of arthritis will usually not get better with weight loss and my rheumatologist has me on the maximum dose to control my symptoms. We tried other medications prior to trying NSAIDs, but they did not work. NSAIDs are the only thing that can control my pain. Without them, I was walking in a cast because of the severe pain in my right heel and foot. I am crippled without them, and obviously that was a detriment to my regular exercise routine.

I know that with VSG, I will be able, at some point,  to take these NSAIDs again (in pill form), but for pre- and post-surgery I need to find an alternative. I cannot crush my pills because they have a protective coating on them to protect the stomach lining. So I have to find something else. Can anyone give me any tips or advice? If you are took NSAIDs regularly before surgery, what did you do to prepare for surgery and/or what did you do post-surgery for pain relief? Thanks for any help you can give!

I now take ibuprofen, it was not allowed for 3 months but your surgeon may allow it 

I have read that there are drugs that the doctor can prescribe that protects your stomach from the problems nsaids course

probably not the friday night answer you were looking for, but perhaps you can call your surgeon/bariatric centre?  this is an important question for you to ask and confirm so you can plan accordingly. 

i am 1 mth post op and i was told no nsaids.  maybe your rheumatologist may have a suggestion as well?  i would think they would be working closely with your bariatric centre to sort of medication issues.

talk it over with your doctor.  i was able to take most pills immediately (well 3-4 days after) after surgery ... it took forever per pill but doctor said was fine.  There was one really large one that was uncomfortable going down, but i was able to find it in a liquid form for a week post op.  It tasted horrible, but it was for my autoimmune disorder and i did not want to have a flare up for not taking it.

as for just pure pain relief, all the morphine family of pills are really tiny and not a problem to take.  also easy on stomach.

I'm having surgery in January, and my surgeon allows NSAIDS, which is good because I have arthritis, and while I expect losing weight to help, I will obviously not lose all the weight overnight. I will have to take them with a PPI, and once I can I will also need to take them with a full liquid or food.  Are you sure your surgeon won't allow you to take NSAIDS right after surgery?

Also, not all NSAIDs are created equal.  They all reduce COX enzymes, but there are two types, COX1 and COX2.  The 1 are related to the production of the lining of the stomach, the 2 are more related to inflammation.  OTC NSAIDS like advil and aleve impact both enzymes equally, meaning they are more likely to cause stomach upset.  There are prescription NSAIDS, like meloxicam, which I take, that impact the production of COX2 a bit more than COX1, so they are somewhat easier on the stomach. There is a third category, of which celebrex is the only one currently for sale in the US, which impact COX2 significantly more than COX1, and these are the least likely to cause stomach problems--although it is still a possibility. If you're not already on one of the NSAIDS in the second or third category, can your rheumatologist switch you?

Hi Jiliana, I had VSG on Nov. 6, 2013 and had taken NSAIDs for years for arthritis.  I had to discontinue them prior to surgery.  My knees and back hurt after surgery and at my 2 week post-op appointment my WLS prescribed Celebrex for me.  I have only needed to take it once and the effects have lasted for several days.  I hope this helps.

Kecia

I take Cymbalta daily for severe osteo-arthritis. It has worked well enough for me to postpone shoulder joint replacement for nearly 2 years.  I was able to take the capsules starting the day after surgery. Not sure if this would help you, but it's worth asking your doctor. 

After surgery I was not allowed back on meloxicam.  I have chronic back pain and my surgeon said that any type of aspirin related meds could cause stomach ulcers.  My husband just had sleeve surgery and was taking a high dose of naproxen ( prescription strength) and he was able to take until 2 days before his surgery.  He just finished his two week appt and at he asked the doc if he could start taking  his naproxen again, he said no, ice for inflammation and he put him temporarily on a arthritis medicine for the pain.  I would really go into detail with your doctor about the effects of not taking it cause you.  If your pain is unrelated to weight loss, it seems maybe he could try harder to weigh the risks vs the benefits. I would hate to see you get ulcers which entail their own set of problems.  It would be worth it to see if there is another set of medications out there that would work for you. I know there is a debate about ibuprofen being bad vs good, I am not thrilled with having the pain that could be solved by just taking them ( and it sounds like your pain is extremely more severe), but to me it wasn't worth taking something that could potentially cause bleeding ulcers.  I'm not sure I believe that some people can take the ibuprofen in large doses everyday and never get a ulcer.  I think it's not a matter of if, but a matter of when.  I don't know if this helped at all, but I do hope you can find some sort of resolution that will benefit you.  This surgery is sooo challenging for so many of us because we have pre existing stuff that complicate things!

wishing you well,

smiles:),

Lisa

I take naproxen for arthritis and gout prevention.  If I go more than two days without it I get an attack of gout.  My Doctor will put me on meds to reduce the uric acid in my body next month and I will see the surgeon in January and try to get approval for surgery.  I will probably have to go on celebrex or something after surgery for the arthritis.  God bless you.

Hi Jiliana,

There are a wide variety of medical opinions about NSAIDS as you have seen by all these comments.

All I can offer is my own experience. I have used prescription strength NSAIDS, mostly naproxen, daily for more than 15 years. I still use it without problems almost 2 years after getting my VSG. The only exception was a few weeks right around surgery. I was asked to stop NSAIDS one week before surgery and given tramadol. After surgery I used liquid tylenol with codeine while I was on liquids, but was relieved when my surgeon gave me the OK to go back to naproxen once I was on purees and soft food. His only caution was that I should always take it with something to coat my stomach. Even now I take it with a spoonful of greek yogurt (not really sure if the yogurt is really necessary any more but why change what has worked so well?). I have been able to reduce the dosage somewhat as I have lost weight.

Good luck

all the best, Katy