Path to RNY changing to Sleeve

I'm also not allowed NSAIDS. I have a bulging disc in my back and have had a few epidural steroid injections to help. I'm also on neurontin for the nerve pain. I'm hoping once i lose more weight the pain will be less. Before,  ibuprofen was the only thing that helped a little. Luckily the neurontin has been a lifesaver and made it much more tolerable,  coupled with the injections. 

Do your research, and consult your own surgical team, etc.

I am allergic to the entire world.. Well... Ok... Corn, Walnuts, Tylenol, Gravol, Codeine, Latex... etc. K so you get the hint right?

Part of why I was sleeved is to allow me to be able to take some kind of pain medication should I require it. NSAIDS are one of my only safe medication families and that was taken into account.

Is it ideal? No. Do they want high dose, long term? Not really but it is an option as long as I also take something to reduce any stomach acid. Protocol here is H2 Inhibitors for the first 6 months post op. I am actually on it for life because m stomach acid levels are too high.

 The problem of NSAIDs and the RNY center around the suture line between the pouch/stoma and the small intestine. Unlike the duodenum - the part of the small intestine immediately downstream of the normal stomach - the intestine that is joined to the pouch in the RNY is not resistant to stomach acid. The upshot of this is that this suture line is continually irritated by stomach acid and never completely heals making it vulnerable to stomach irritating drugs. This is not a problem with the VSG (or the related DS which uses the VSG as its basis,) as the normal relationship between the stomach and duodenum is maintained; other incisions within the stomach heal normally as no outside tissues are brought into the picture. The prospect of ulcerations in the blind remnant stomach left behind after the RNY is a real but lesser concern as it is no more vulnerable than a normal stomach - just more difficult to scope and diagnose.

Most surgeons who are experienced with the RNY tend to transfer that experience and advice to the sleeve when they start doing them and will do so until their own experience convinces them that the two patient groups can be treated differently. Surgeons with long experience with the sleeve - primarily docs who adopted the DS as part of their skillset some years ago and followed the natural progression to offering the VSG as a stand-alone procedure - generally recommend the use of NSAIDs for their sleeve/DS patients as that is what their experience indicates. Indeed, NSAID use is one of the major selling points of the VSG/DS over the RNY and has been successfully used in overturning insurance decisions favoring the RNY over the DS or VSG.

Amazing answer. Thank you for that detail. I understand a bit more now. 

My surgeon doesn't have a problem with NSAID use. I had to wait 6 weeks, but after that I was cleared to take them as needed. Luckily after losing 50lbs I no longer needed them. I like knowing that if I do need them it will be okay to take them though.

I am 7 years out with an RNY. I have never taken NSAIDS. With extreme pain in my back after throwing out my shoulder and 2 of the vertebra in my neck, we found a non-NSAID muscle relaxer that helped tremendously. All of my back issues resolved themselves when I took off 164 pounds. With the weight off, my spine was very happy. If your medical doctor is savvy, he can give you meds to help that are not NSAIDS. The RNY was the best deal for me. I wanted the band but had too much weight to  lose to be successful. The sleeve had just been done on my surgery nurse, and she was the first I believe to have had it done. It wasn't an option at the time. I am still happy with my RNY. I know it was right for me. I think your doctor's advice on which is best based on your habits and history is the way to go. I trusted Dr. Walton with my life, and he gave it back to me with this surgery (and Dr. B who assisted).

I was like you set on the RNY, 3 years ago. I backed out and came back to my surgeon in 2013, he suggested the Sleeve, but I had GERD. Two weeks before my surgery date I told him I was going to switch and have the Sleeve. So happy I did! No problems with reflux so far and  I am almost a year out. I used NSAIDS before also but was told no NSAIDS unless I absolutely needed them. But since I have lost weight my knees and feet are good haven't needed even tylenol, I just needed to lose weight. Wish you the best on your decision!

Hi desertdancer,

As you have seen there is a great variety of medical advice on this topic. All I can offer is my own experience. I have taken prescription NSAIDS for arthritis daily for more than 15 years, including the 2 years since I got sleeved. The only exception was for a few weeks right around surgery.

My surgeon recommended I stop taking Naproxen about a week before surgery. I was given some Tramadol as a substitute. When I came home from the hospital after surgery I used liquid Tylenol with codeine (It was prescribed for post-op pain though I had more discomfort from arthritis than from surgery after the first 2 days.) but that was not a long-term solution. Once I moved from the full liquid stage to pureed foods I asked my surgeon if I could go back to Naproxen. He said OK as long as I always took it with food so that my new stomach would be coated and protected. Two years later I have had no problems. I almost always take my meds with a few spoonfuls of plain greek yogurt. I really do not know if the yogurt is necessary but it has worked for me.

All the best, Katy  

I have taken occasional NSAIDs since surgery with no issues. I just make sure to take an acid reducer daily but I need to anyway because I developed mild acid reflux after my surgery. The doctors pushing no NSAIDs are using RNY protocol and are just being super careful to protect their own butts in my opinion. However, there may be some really rare medical issue that NSAIDs would not be safe and in that case listen to your doctor. But if you have always taken NSAIDs safely-you should be able to after surgery. I go to a local support group sometimes and all the post op sleevers have taken NSAIDs successfully with no issues--some being 5 years post op now. I honestly really think it's irresponsible for doctors/nurses to tell sleevers they can't take NSAID's after surgery unless there is some major medical issue as long as they take NSAIDs as directed and with food or acid reducers. Many of them have the RNY mindset because they've been doing that surgery for so long.