Why NSAIDS hurts us & why we can't talke just any pill

I'm a day or two late to this conversation, but wanted to chime in. I've been told repeatedly since surgery not to take NSAIDs and haven't taken a single one. I take acetaminophen regularly because I'm missing two disks at the L-4/L-5 region of my back and have another bulging disk. A month or so ago, I was rushed to the emergency room with some pretty horrific stomach pain. After an MRI, x-rays, a sonogram and blood work, the doctor diagnosed pancreatitis and an enlarged liver. I then got a stern lecture about drinking alcohol and was advised to seek rehab. There was not a drop of alcohol in my system and I assured the doctor that I'm not a drinker. I explained the RNY surgery again and told her that I was advised by my wls not to drink and I took it to heart. The doctor then told me that the Pancreatitis was probably caused by a fatty diet and advised me to cut back on fats. I don't eat a large amount of fats and haven't for three years. The nurse then came in and gave me the same talk about not drinking and told me how much damage I'm doing to my pancreas and liver. I came home and started doing some research. All the symptoms I had and Pancreatitis are normally caused by consuming large amounts of alcohol over an extended period of time. This wasn't adding up to me. Then I thought aout the acetaminophen. I don't take it everyday, but I do take it a couple of times a week. I know that it causes liver and kidney damage in large doses. Could it be toxic over an extended period of time for someone who has no duodenum and a shortened small intestine? I called my brother who is a biochemist in Baltimore. He's preached the evils of Tylenol for a long time and won't touch it. His opinion was that it probably is the Tylenol and did some further research. While there are no definitive studies about wls patients and Tylenol, he says that it probably is the Tylenol tht is causing the damage to my liver and pancreas and then went into a long diatribe about the chemical ractions, yada, yada, yada. I tune him out when he gets to the molecular level. He's not an MD, but he is a Phd and teaches medical students so I tend to believe him about these things. So I explain all of this to my pain management doctor who admonished me to stop taking Tylenol immediately and told me to take the Vicodin that he prescribed instead. Vicodin has some acetaminophen, but not as much as Tylenol. I've had prescriptions for years, but I don't take it beacuse of the addictive properties. The PM doc felt that I'd be better off kicking an addiction than killing my liver or pancreas. I was pretty shocked at that advice, but he also assured me that he felt comfortable with that advice because he's treated me for years and can't get me to stay on any type of pain management drug because of my fear of addictions. I'm already a food addict. Isn't that enough? Right now I'm not taking anything and haven't since the night I went to the ER. It's been rough with the rainy weather, but I want to give it a few months and go back to my pcp for follow-up tests. My diet has stayed the same and I still don't drink. I want to see if cutting out the acetaminophen brings my liver and pancreas back to normal. I think that this is an area of the wls world where not enough is known. Connie

What they probably found was Non-alcoholic fatty liver disease (NAFLD) also called non-alcoholic steatohepatitis or hepatic steatosis (NASH) if you wanted to do some research on it. I don't know why they wouldn't have told you that instead of accused you of drinking, that's rude! NAFLD/NASH is related to diabetes & insulin resistance as well as other metabolic disorders. It can also be worsened by a lot of medications including NSAID, corticosteroids, arthritis meds, antibiotics, cardiac meds, anti-cancer meds & Lipitor. Talk to your physician if you think any of your medications might be tough on your liver, maybe they can give it a break, don't do it on your own, let them make that decision. Weight loss helps, diet control, and they are leaning more & more towards Glucophage (Metformin) as a medication to help this. Please keep an eye on it by having your liver enzymes checked about every 6 - 8 weeks.

I just re-read what I posted this morning about your fatty liver findings, I can't edit on here so I need to post again ... Here is what I should have said, It is possible that they found ... Non-alcoholic fatty liver ... and i it does turn out to be NAFLD/NASH ... Metformin as a medication to help this. Without knowing anything else or seeing test results I couldn't possibly say what they actually found! What was I typing?? LOL, sorry. I still think it's rude and disrespectful of them to accuse you of drinking just because you had a fatty liver, that's just uncalled for!

Webbie, I think it was the Pancreatitis in combination with the enlarged liver that caused them to jump to conclusions and decide I'm a lush. lol Doesn't matter at this point, but it does drive home how little is known about wls by the medical profession at large. I'm really fortunate to have a pcp who took great time and care to research wls and is concious of my rearranged innards when he prescribes. I'll be following up with him in a week or two when I go in for all my regular lab work. He stays on top of my blood work and calls me to come in if I forget to schedule an appointment. I'm not on any other meds other than my Gummie Bear vitamins and sub-lingual B-12 so we'll see how the tests go. I'm curious about whether or not there is a change after no Tylenol for 6 or 8 weeks. Another factor may or may not be my kidney disease. I have Medullary-Sponge Kidney and not even my nephrologist is very well versed on it. There's so little known about the disease that I'm not sure whether or not it could be contributing to the liver and pancreas issue. I don't take calcium supplements because of it, but we do a bone density scan twice a year and so far so good. If the absence of Tylenol doesn't have an impact, I'll ask if the MSK could be contributing. Thanks for the advice on the Metformin. I'll be sure and ask about it if my liver is still impersonating the liver of a wino. Connie

Connie, Very valuable information! Thank you so much for sharing! I have been counseled by my pcp since my Rny to go easy on the Tylenol and so have limited myself to a half dose of Tylenol PM on restless nights. I'm so sorry you've had so much pain to endure but we are indeed needing to be mindful of our special plumbing and adhere strictly to the lists that are o.k. .... I know that Tylenol is basically o.k. for most post-op Rny's to use (within reason) but I suppose that they would have incrased issues if they are drinkers, take it excessively or are on cholesterol blockers. ......they say the sun will be out today and maybe all of us "poor weather" sufferrers can have a break from our aches and pains! Take care sweetie pie! Hope to see you on the 17th!!! Joyce

Joyce, If you are taking the Tylenol PM for a restless sleep, why don't you just take a small dose of Benedryl (Diphenhydramine) and pass on the Tylenol all together? The PM part of Tylenol PM is Diphenhydramine. It now comes in tongue strips so no chewing tablets to take.

Ah Ha! Just when I thought I knew it all; along comes some GREAT information! LOL! I'm swinging by Walgreens today to look up the STRIPS!!!! Thanks Miss Web Medic.........Who is that masked person anyway???? Do tell us more about yourself ! *winks* Hugggzz to you! Joyce

Thanks, Joyce. I plan to be at lunch on the 17th and will see you then! Connie

Connie. Your concern is about becoming addicted to pain medications is understandable. I had the same concerns as I have a totally addictive personality. There are however some misconceptions about becoming addicted to pain pills. As long as you are only taking it when you are in pain you will not become addicted. You can become dependent which is different then addicted. When you take pain pills and you are in pain it goes to a particular part of the brain. If you are taking the pills to "Feel good" and you are not in pain they will go to another part of your brain which causes the addiction. You should talk to you doctor or brother about it. My doctor advised me even if I became dependent we would simply wean off them slowly. He was not concerned with it at all. That is not uncommon with many medications, to have to ween off them. I've had to do that with many medications I have taken and they were not pain pills. You shouldn't continue to be in pain. If you need the pain pills take them. Your doctor wasn't blowing smoke when he told you that it was easy to deal with the addiction. He can see you are concerned and told you what he thought you needed to hear. But he isn't wrong. As long as you are taking them as prescribed and for pain you will not be addicted. And the dependency you might get can be dealt with by weening you off them slowly. Talk to your brother about your addiction concerns it seems he knows a lot about it. He should be able to ease your mind. You should continue your research. There are more things that can cause liver damage. There are rare diseases that doctors don't commonly consider. I just found out a distant relative has a rare disease that caused her liver damage. We had never even heard of such a disease. Something about higher levels of .. i think it was iron in her body. I don't remember exactly. But keep looking for the answer. It may be Tylenol. I have never trusted Tylenol anyways. They even admit in their own advertising that it causes problems. However it may be something else all together that the doctors are over looking. Remember this. They are practicing physicians and they are practicing on you! It's up to you many times to find out what is wrong with you and what can be done about it.

Melissa, Thanks for your advice and concern. I'm going to keep digging into the cause of this and my brother is researching also. I'm really not in unbearable pain right now so haven't felt like I have to take anything. I have a hot tub that I use and I've been in for a couple of massages so I'm holding my own. Actually, this has made me more diligent about doing stretches and stregthening so so maybe it's a good thing that I've kicked the Tylenol habit. I understand your point about the difference between dependency and habit and the bro agrees. I'm just not a pill taker (well, except for the Tylenol). Growing up with an alcoholic father made me a little substance shy. Heck, I don't even get a flu shot! Connie