Naproxen ok?

Thanks, I'll see if my doc will refer me to someone. Never even thought about it from that angle, I just figured that I had hurt it somehow.

Did they say whether that patient had a bypass, sleeve or other WLS? There are certain quirks with the bypass that preclude the use of NSAIDs that don't apply to the sleeve-based procedures. As sleevers (or DSers) we are much less sensitive to their use.

For the OP, I would certainly check with your surgeon on it - if he comes from the DS side of the business, he will likely have little objection to it; if he is from the RNY side of the business as most are, he will probably have a coronary at the thought, unless he is one who is getting comfortable with the sleeve and its differences from the bypass in which case he will probably be cautiously approving. The prescribed dosage is on the high side and I would be wary of using that much for very long (even for a normal, non-WLS person). I use the OTC strength version occasionally, and even somewhat more-than-occasionally after orthopedic work a couple years ago to no ill effect (much as DS people have been doing for the past 25 years or so.)

Every person, WLS or not, can be affected by NSAID use. If an RNYer gets an ulcer in the blind remnant stomach, it is hard to diagnose and treat. That is the only difference.

Sleevers have exactly the same chance of developing ulcers from NSAID use as a RNYer. Exactly the same. Depending on where you get those ulcers, it can be extremely painful and potentially life threatening. The only way to avoid the issue is to avoid NSAIDs to begin with.

Actually, that is not the case. The reason that the RNY is much more susceptible to ulcers is that it introduces foreign tissue to the acidic environment of the stomach pouch. The part of the small intestine that is brought up and joined with the pouch is not resistant to stomach acid like the duodenum (the part of the small intestine immediately downstream of the stomach) is. This exposes the soft mucosa intestinal lining to stomach acid, and the resultant suture line to the pouch is continually irritated by that environment. The net result is that said suture line never fully heals and becomes an ulcer magnet. This is a situation that does not exist with the sleeved stomach as it maintains the natural relationship between the stomach and duodenum, with the only disruption being where the greater curvature has been removed yielding a scarline between like tissues, no different than with any other gastric resection that gets done for various reasons. DS people have been getting along just fine with near-normal NSAID usage for the past 25+ years (which sticks in the craw of some RNY surgeons who don't like losing business to a procedure that they don't perform.) If one plots NSAID sensitivity on a scale of zero to ten, with zero being the general population and ten being the average bypass patient, a VSG/DS patient falls around a one or two. It's something we have to be cautious about (as does anybody,) but nothing on the order of what a bypass patient needs to be concerned with.

What? I suppose you could be more wrong, but I'm not sure how.

Suture lines never fully heal in RNY? Utter nonsense. Of course it's fully healed.

RNY pouch is more acidic than a sleeved stomach? Ludicrous. RNY cures acid issues. Sleeves make acid worse, and many are on acid reducers for life.

Some people, WLS or not, are susceptible to ulcers. Smokers, drinkers, and those who take NSAIDs will exacerbate the problem and make ulcers appear.

NSAIDS are a systemic drug. They will thin the walls of your digestive tract whether you take them orally, by injections, creams, or any other way.

Sleevers and RNY are at the same exact risk. Diagnosis is the same. They put a scope in, find the ulcer, and treat it either directly or with medication.

The ONLY difference is, RNYers can get an ulcer in the blind remnant stomach. You can't put a scope down your throat and see inside the blind stomach, so it's very hard to diagnose. You can't treat it with conventional drugs because those drugs do not pass through the blind stomach. You GET ulcers in the blind stomache BECAUSE NSAIDs are a systemic drug, and can affect you whether the pill passes through or not.

I had a bleeding ulcer. It had nothing to do with my RNY pouch or suture lines. I've never touched an NSAID, but got ut anyway.

If you want to play Russian Roulette, ignore the ASMBS, go right ahead. But please don't be handing out ridiculous medical advice to someone who might believe you.

I never stated that the RNY pouch as a more acidic environment than the sleeved stomach; rather that it exposes its acidic environment to tissues that are not designed to be exposed to it. Couple that with the bulk of the acid producing capacity of the stomach remaining in the blind remnant no being offset by the food flow, and you end up with an increased sensitivity to ulcers, in both places. It is something that you live with to get the benefits that the bypass can present. Everything in life is a compromise, and the sleeve presents a different set of compromises to be considered - not necessarily better or worse, but different. The biggest negative is that, as most of the protein pump ports tend to be concentrated around the pylorus, there tends to be an excess acid producing capability relative to the remaining volume which coupled with the higher pressures one can see with a small stomach volume and closed pylorus can lead to a greater reflux inclination. But the more natural operation with food flows absorbing the acidity coupled with the lack of foreign tissues in the tract lead to a lower inclination toward ulcerations than the bypassed configuration, closer to that of the natural system digestive. Given the radically different architecture of the two procedures, why would one assume that any particular characteristic be the same? One can argue which is best in a specific case, or in general, but that provides no implication that different aspects of the two procedures should yield the same result. That's why we make tradeoffs.

As to ASMBS recommendations, yes, I will readily ignore them when they are in conflict with those with more experience on a particular issue. Do you follow our government's advice on everything they tell us that we should be doing? Of course not - just as with government, professional organizations have numerous internal and external political influences that color their official positions, ones that may or may not be in our individual, or general public interests. Their primary function is as an advocacy for their members.

There is rarely any single document or policy that represents the overall opinion of an organization (if such can ever be summarized,) but rather a continuum of papers published by parties of varying interests and qualifications under the general sponsorship of the lead organization (ASMBS in this case,) which many take to be a recommendation or endorsement of that organization. That's why we lean on our doctors to provide the guidance that we need, and I will take that from the docs with the most experience with the procedure that I have had over that of those who are extrapolating experience from vastly different procedures. The point of this "medical advice" (which it is not - that's what our docs are for) is to highlight the differing perspectives that come from professionals who do have the experience with these issues that concern us.

Knock on wood, I thank God! Sleeve here and I do not require a PPI.  Less than 2 months on it for healing.  Yes, that was one of my concerns but I so far have dodged that bullet as many other sleevers too.  So we can't be all right all the time.

I don't recall which procedure the person from the story had. There were people in my pre-op class who were scheduled for VSG and some who were scheduled for RYN. I think they pretty much gave both sets the exact same recommendations.

I was also told no NSAIDS  EVER! by my surgeon

Julie, in addition to what others have said.  I have cervical pain and have had great relief with Ultram for pain and using a topical cream Voltaran, which is an NSAID.  It was okayed since I was not taking the oral.  Check with your physician.  It might be considered.  The combination has really provided me with good control on those bad days.

Good luck!  I hope you find relief.