Post-Op Arthritis Meds

I am 4 weeks out of RNY.

I had ankle arthritis both sides for 10 years. One side was due to a 30 year old fracture.

With the weight loss it has improved but is still there. The WLS will improve it but not cure old damage, I am told.

I used to take Prexige, a Cox-2 (like Celebrex), which was great. Of course, this affects the pouch, like all NSAIDs...so my doc has banned it. I have tried paracetamol, without much result. Paracetamol is not very good as a bone pain drug.

Any answers to this riddle? What can I take? I still need something.

P

I guess all doctor's are different.  I was ok to take my arthritis meds...they perscribed them in the hospital.  I had read that they weren't allowed though so I was surprised that I can take them.  Have you tried Tylenol Arthritis?  You should check with your Doctor first though because I've also read of some Doctors who don't allow Acetaminophen.   Fran

I have taken Arthotec and Celebrex. Neither have bothered my pouch, but I have had other ulcer problems. I have been taking Nexium, and sometimes Carafte, to counteract the problems. MY WLS surgeon is ok with me taking them, as long as I take Carafate if I have an ulcer flare-up.

Interesting. What is the name of the drug you take?

I think that some docs ban paracetamol (you use the pharmaceutical name, fine) because of the potential for liver damage if people wolf them down. Apart from the liver thing, it is very safe BUT not a good anti-inflammatory.

I have some slow release, presumably enteric-coated Voltarol, which is an older NSAID. Anyone had this?

P

P, Your doc is out of step with many other Bariatric Surgeons. By all means follow YOUR Doc's advice, But do ask why he/she is dis-allowing all NSAIDs when most Centers of Bariatric Excellence do allow them for many patients, particularly when taken along with a nexium, Zantac, priosec, previcid or such. The "No NSAIDs Ever" myth that some cling to is supported by The ASBS recommendations, in regards to the initial hospital stay- “NSAIDs and corticosteroids: avoided due to hematological and gastric reasons. For example, IV ketorolac is avoided because it can cause gastric irritation and slow the healing process of a fresh gastric staple line. Also, routine use of dexamethasone is avoided to prevent gastritis and problems with healing and avoid confounding factors when evaluating the patient’s laboratory results.” I'm coming up on 5 years post-op and maintaining a normal BMI since one year after surgery. I have been on a perscription of Mobic from my Bariatric Surgeon for the last 6+months with no ill effects. I have a torn rotator cuff that needs surgery that I am putting off for a while. I know and have met about 20+ 4+year Post-ops who also have been cleared to take NSAIDs by thier docs. Check with your doc... (there in Thailand?) Hope you find relief soon.... I would also add an Invitation. It’s great to see other men out here. We make up such a small percentage (12%) Of the people having Weight Loss Surgery, But tend to reach our goal weights quicker and with less Or at least Different hassles than the Gals Due to Male physiology. Drop by the Men’s Message Board And check out what other men like you are going through. It’s a diverse make up of Dads, Singles, Older, younger, etc… Pre-Ops, Post-Ops new and some Old (at Goal) Post-Ops. Lap-Banders, RNY’ers DS, etc… Great bunch of guys with the mutual understanding That WLS for Men can be a totally different Journey. Stop by to add your questions, advice, opinions, and info at- http://www.obesityhelp.com/forums/men/

It’s Great to know we’re not so alone, And that there are others pulling for you. Hope to see you ‘Round the Boards!

Best Wishes- Dx

Duh!!!! I just re-read the start of your post- 4 weeks? Yep! No NSAIDs for You Yet. Ultram maybe? Hang in there for a while. As the weight drops off and your pouch is healed up Much relief is available. My knees used to scream daily for mercy, But at half my weight, they feel better now In my early 50's than they did in my teens. Best Wishes- Dx

I take Arthotec daily.  Prescribed by my surgeon.  I also take l Prilosec OTC when I take the Arthotec.  Have not had any problems and have been doing this for almost 2 years. I understand there is a med called Ultram that is also acceptable.

Do you see a rheumatologist for your arthritis ? - there are many new meds that can be given by injection weekly.

Interesting.



Some points:



I don't want to take Nexium (etc) as a gastric protector if possible. Nexium was good for my GERD (now gone!!) but it costs about 5usd for one tablet here. I am trying to live cleanly without drink, drugs or multi types of tablets.



Ultram is Tramadol. I have had it before, and it has a narcotic effect like codeine. To my knowledge (I was an RN for 30 years), long term bone pain responds better to anti-inflammatories rather than narcs.



Someone mentioned Mobic which I think is meloxicam. This is also supplied as suppositories. I am starting to think that suppositories are the best way of protecting my new pouch. I guess that after 4 years, some of you guys can take stuff..but I don't feel safe yet.



Any other suppositories possible?



P

Osteoarthritis pain seems to respond fairly well to a drug like tramadol.  Low doses may be worth a try, especially in combination with acetaminophen (paracetamol). Omeprazole is no longer covered by patent, and should be available generically, even in Thailand (Nexium is simply esomeprazole, one of the two stereoisomers of omeprazole--40mg of omeprazole contains 20mg of esomeprazole.)  Omeprazole should be substantially less expensive than Nexium, which is still under patent by Astra Zeneca.  Most doctors feel that omeprazole and esomeprazole are completely interchangeable.   There are no studies that show that 40mg of esomeprazole is superior to 40mg of omeprazole (that's because Astra Zenica would never sponsor such a head-to-head study.) Mobic (meloxicam) is just a NSAID with a degree of COX-2 selectivity at its lowest adult dose: 7.5mg/day.  At the higher dose of 15mg/day, more people complained about GI upset. As your surgeon pointed out, even a very selective COX-2 inhibitor like Prexige (lumiracoxib) isn't without risk of causing GI problems, especially immediately post-op.  You might know this already, but Prexige was removed from the market last year in both Australia and the UK, based on worries about its propensity to cause liver toxicity.  Lumiracoxib isn't approved for sale in the US; it was ruled "not approvable" by the US FDA at roughly the same time that it was removed from the OZ and UK markets. NSAIDs supplied in suppository form are not easier on the stomach and duodenum than oral meds, because most GI damage caused by them is not due to local irritation.  NSAIDs, taken by any route, work systemically to stop the production of mucus in the stomach which protects the lining against acid.  If you took NSAID suppositories rather than pills, you'd still need to protect your insides with a PPI like omeprazole, a prostaglandin analogue like Cytotec (misoprostol), or a  drug like Carafate (sucralfate). And I agree with you that being several weeks out is probably not the right time to test your pouch! :-) /Steve