NSAID question

So I got in touch with our friend that is a nurse and used to work on the Bariatric floor to call her wife and talk to her. I understand her not listening to me, but she will listen to her she told her to refuse it immediately, and I forget what she told her to ask for, but she's listening to her.

Thank you All. Hopefully no harm will be done.

There are definitely tons of other options for pain management. Your friend is lucky to have you on her team. I hope things are sorted out quickly!

Thanks. She's a very close friend of mine, and I know her wife has other things to worry about... It was the first thing I thought of when she called me telling me she was in the hospital... What are they giving her??!!

She'll be ok, I think, and hopefully be much better after surgery (looks like hysterectomy due to fallopian tubes, but we dont know quite yet... Surgery this evening).

My knowledge as an RN tells me IV torodol can cause ulcers. Might be okay for very short-term since IV meds bypass the GI system. I would call the surgeon.

Another RN here. ::waves::

Just FYI the danger with NSAIDs is only partially the effects from within the GI system. NSAIDs interfere with prostaglandins in a way that increases the risk of ulcers, and that happens systemically so IV NSAIDs are almost as bad as po. They don't CAUSE uclers so much as interfere with the natural protection against ulcers.

That being said, generally speaking the risks increase with dosage and period of administration, so it's true that a short-term IV run likely doesn't run the same risks as a longer-term oral route run.

You're right, it's always best to call the surgeon. :)

Not to muddy the waters but just had a 3 month follow up with Surgeon at Guelph Ontario and Surgeon stated at 3 months stomach is totally healed and with my surgery VSG NSAIDs are o****il stomach healed though no NSAID.

It's so interesting, and frustrating to me how the doctors all have different rules.

When her wife spoke to the practice today, she was told definitively that NSAIDS are a no-go for her, IV or not.

She's almost a year out from surgery.

It seems more blurred for VSG than for RNY, so I guess I'm glad I just know it's a definite no-no across the board for my surgery.

Haha, nothing is ever completely black and white. My RNY surgeon actually allows me to have "occasional" NSAIDS. When I asked him to define "occasional" he said 1-2 times a week.

I have taken them exactly twice in the 18 months since my RNY. It was two times post-surgery recently for a blocked intestine. The pain when I got home was pretty bad, and he had told me I could take them, but I generally do not. This time I made an exception and took two separate doses.

Just thought I'd chime in to stir the pot a little more ;-)

It's not that my surgeon doesn't see a risk in NSAIDs, but as someone else said, it's about assessing relative trade-off on a patient-by-patient and case-by-case basis. His professional opinion is that if you really need an NSAID occasionally the relatively low risk of an ulcers is less detrimental than living without the NSAID. I, personally, choose to tough out the pain and take the risk down even lower, but I appreciate his perspective.

This is his approach across the board. For instance, he is very anti-grain - even the "good" grains like brown rice and oats. That being said, as I was transitioning into maintenance and actually struggling to stop losing weight and working out quite frequently, he suggested I add steel cut oats and brown rice into my diet. Just bringing that up as it's not just conventional medical wisdom he evaluates on a case-by-case basis, but his own philosophy/beliefs as well.

As a nurse, for me this is the sign of a good doctor. Glad you have one.

I knew when selecting my surgeon that I would NOT be happy with a high-volume clinic that took a cookie-cutter approach. I was VERY glad to be referred to a high quality surgeon who operates a smaller practice, and approaches every patient as unique and alters the treatment plans accordingly.

I will tell you that based on my research, if I'd had an RNY, "occasional" use would be on the order of 2-3 doses a MONTH. As my surgeon explained it, the big "gotcha" with an RNY is that the residual stomach that is left in the body can develop the ulcer, and it can go undetected to the point of rupture because it's not part of the working digestive system. An ulcer that develops in a VSG patient is in almost every situation going to give signs/symptoms early on and allow treatment before rupture.

Agree - I am a huge fan of my surgeon. And you pretty much described his practice. It's a smaller practice with him and one partner, yet he has been doing this for a couple of decades so has a lot of experience. I get to see him directly at every appointment, not his PA (although he has one, and I've met her, but never had an appointment with her). I also really like that my surgeon is my nutritionist. For one, most people do not seem to have a lot of respect for their NUTS, while I have a ton of respect for mine. I also love the fact that he actually follows his own plan. So when he is giving you advice, it's not theoretical. For example, he actually gives you examples of what to eat based on what he eats for lunch everyday at the hospital cafeteria (spoiler alert: he eats a salad that weighs almost one pound)!