RNY patients and NSAIDS

I've posted this on the RNY board before but I think there are some RNY folks that hang out on the main board but don't come over the the RNY so much so I thought I'd post it here, too.  Note that this is about RNY patients and NSAIDS and doesn't exactly apply to folks with other surgeries.  I've been told that some surgeons are now recommending VSG patients avoid or limit NSAIDS too, though I've also heard of people being advised to have VSG or DS instead of RNY if they have a condition that causes them to rely on NSAIDS. so it seems like the jury is still out on that one.  If you have the band, or VSG or DS, I suggest talking to your doctor about whether or not NSAIDS are safe for you.

Most docs tell patients not to take NSAIDS after RNY but they don’t always explain why.

NSAIDS put you at risk for ulcers. They do that to everyone, not just RNY folks.  But ulcers are particularly dangerous to us.  If you get an ulcer in your pouch, even a small one, since your pouch is a lot smaller than a normal stomach, it will cover a much greater percentage of your pouch.  If you get an ulcer in your old stomach, docs can’t even do an endoscopy to see it.  They’d have to do surgery.  Also taking a medication designed to coat the stomach wouldn’t help an ulcer in the old stomach because nothing you take by mouth goes in there.

We really, really don’t want an ulcer.

NSAIDS can cause ulcers because they cause the lining of the stomach (the old stomach and the pouch) to thin out.  This does NOT happen when the medication enters the pouch or touches the pouch.  It happens when the medicine enters your blood stream.  That’s why you can get ulcers in your old stomach.  NSAIDS taken by mouth don’t touch the old stomach but can still cause ulcers there.

Any way you take an NSAID – pill, liquid, shot, IV, patch, gel – it gets into your blood stream.  If it does not get into your blood stream, it will not give you any pain relief or relieve inflammation.  Many docs don’t seem to understand this, though I don’t know why since they have to take pharmacology in medical school. 

Many docs that are not bariatric surgeons also don’t know RNY patients should have not NSAIDS so be very vigilant about what other docs try to give you.  I finally started saying I am allergic to NSAIDS.  They seem to listen to that more.

Some surgeons say it’s OK to take NSAIDS on a very limited basis if you really need them as long as you also take Nexium or something like that to help protect your stomach.  Others say it’s never worth the risk.  A few say it’s OK to take them whenever you want, but I think they are nuts.  But what I really think is that we need to weigh the benefits of taking them against the risks.  Is the pain of your bad back or menstrual cramps or whatever worse than the pain of an ulcer would be?  If so, take the NSAID.  But take it with something to protect your tummy.

Now, how likely it is that taking NSAIDS, especially rarely, will cause an ulcer, no one can say.  I know people that took just one dose and got an ulcer.  I know people that took them many times and had no problem.  So it’s just a matter of whether or not you wanna chance it.

Thanks for the info Kelly. What are your thoughts on tylenol (Acetaminophen)? I don't remember where I saw it, but someone had liquid tylenol on their post-op list of things to have on hand.

Tylenol should be fine.  I would jus****ch for the amount of sugar in liquid meds.

Well said Miss Kelly!

 Thanks for this Kelly.

Kelly,
What you said is very true. 
This past fall I was in an auto accident and had two broken ribs and also had a fracture in my face.
I was having pain all of the time and I decided it was worth the risk to me to take NSAIDS to try to get more comfortable.  The NSAIDS helped with my discomfort, but it didnt take more than a couple of weeks before I developed an ulcer.

I have stopped the NSAIDS, but I am still taking the famotidine for my stomach.

I dont recommend them to anyone
Susan

 Thanks for the post Kelly. 

Kelly

Would you know what the signs of an ulcer?
Thank you also for the post

Thanks

Jeanne