Steroids and RNY (or VSG)??

Hi all,

In my continuing quest to understand "all this", do you know if steroids can be taken after WLS?

Specifically, I am referring to steroidal asthma meds. One of my main reasons for wanting WLS is asthma improvement, but realistically I have had to have more than 40 days of prednisone in the last 5 months, plus all the other meds I am currently taking to try to get my asthma back under control after an attack in the fall.

As always, your knowledge and input is really appreciated!

From the ASMBS:

Corticosteroids (such as prednisone) can also cause ulcers and poor healing but may be necessary in some situations.

NSAIDs get more press, but steroids also affect the prostaglandins in the body and can elevate the risk of ulcers. The risk increases with length of use.

The reason it's so much more dangerous with a RNY is the residual stomach that is left in the body. You can still develop ulcers in the residual stomach, but because it's not part of the food tract anymore the symptoms can be masked/hidden while the ulcer becomes life threatening.

With the VSG, any ulcer that develops is in a functioning digestive tract and the symptoms are most likely going to be noticed so the ulcer can be treated before it reaches such an advanced state.

The risk of ulcers with these meds is there regardless of the type of surgery. It can be mitigated somewhat with the use of PPIs. The potential "where" of the ulcers is the main difference between types of surgery.

This is definitely something you and your medical team have to discuss and come to a concensus on, regarding which surgery is best for you, and what your treatment plans for your conditions need to look like after WLS. For me, not only was my surgeon involved in these discussions, but my rheumatologist and PCP weighed in as well, and we had to all be on the same page before moving forward. For me, it was the VSG, and we took a bit of a risk with my history of GERD, and it paid off (so far, anyway). Your team may come to a different conclusion, but it's always a risk vs. benefit calculation and you need the doc's input on this.

The issue with the residual blind stomach is only part of the problem. The bigger concern is with the anastomosis where the stomach pouch is joined with the small intestine - that structure is basically an ulcer waiting to happen. If there was a concern with a particular patient about leaving the blind stomach and its compatibility with some ongoing or future course of treatment, it can be removed when the RNY is performed, which is a common configuration for the treatment of other GI maladies. Of course, that also removes the theoretical ability to reverse the RNY or revise it to a DS, so that would all be under consideration in deciding which way to go. If I were to change to an RNY, it would be without the blind stomach due to my cir****tances, but the same medication limitations would still apply because of that anastomosis vulnerability. The sleeve based procedures don't have that anastomosis problem so they remain somewhat more tolerant of these medications, and this is where the surgeons' experience comes into play in weighing the various options (ideally multiple surgical opinions when one has a complicated case).

Good points. The residual stomach was the primary concern explained to me by my surgeon as the reason the contraindication on NSAIDs and steroids was an absolute for RNY and a relative one for VSG. She probably didn't see a need to elaborate further since that was enough for me. :)

Essentially, the two surgeries are anatomically different enough that the NSAID and steroid restrictions can be different based on the surgery you get. Ideally, you don't take NSAIDs/steroids again after either surgery, but with the VSG there can be situations where the benefits outweigh the risks, and that's unlikely with the RNY since the risks are so much higher.

Your provider should weigh the risks and benefits and proceed accordingly. most people stay on their pre surgery meds for a while. I am 6 months post WLS. I was off narcotic pain meds that I'd been on for 12 years in 2 weeks, off blood sugar meds in 6 weeks and have been off of all medications for almost a month. Asthma should improve dramatically with a 10-15% weight loss.

@oneatatime - I'm 8 months post VSG. I have asthma (severe enough that it is controlled with Xolair injections). My regimen includes Breo inhaled daily, and Singulair daily. Since surgery, I have been on prednisone twice. The most recent time (last week ) was a five day "burst" of 20 mg. 2x daily. Added to that was nebulizer Xopenex 4x daily. I felt like my heart was going to jump out of my chest, but I was fine.

One of the other times, I was on for about 15 days during the midst of cold-flu season when everyone in my house had a nasty upper respiratory infection. I started with a 5 day burst then a 10 day taper. My asthma doc knows about my VSG and my surgeon knows about my asthma. We discussed this prior to surgery about how to deal with it.

What I can tell you is that my pulmonary function is way better now. I've been able to stretch to every 3 weeks with the Xolair from every two weeks. And other than when I've been sick the two times, I haven't used my rescue inhaler at all.

Do discuss with your team. I can tell you that this surgery was one of the best decisions I have ever made (other than marrying my great hubby and deciding to have kids with him.)

Best of luck.

Thanks for all the great info. I will certainly discuss all this with my team.

Did you consider RNY or rule it out due to your medical needs?

Im on daily Breo, Singulair and Spririva and take daily allergy meds as well plus a migraine prevention med, and Pulmicort nasally for sinuses. Lol. Oh, and now a PPI since I started the Breo because it gives me heartburn. Ugh.

My medicine cabinet looks like that of an old lady!! Im really hoping to regain health.

I've been on Protonix since just before surgery. I was concerned about RNY due to malabsorption and dumping issues but we discussed both. He felt that VSG was the better choice for me. My asthma is only part of the problem. I also use Qnasl for allergies and OTC Zyrtec as needed. I have severe osteo arthritis in my knees - bone on bone in both knees. Prior to surgery, I took a prescription NSAID for pain control (I use narcotics for breath through pain when necessary). I was switched to a Cox2 Inhibitor (celebrex type) for surgery and have been taking that since surgery.

I left the decision to my surgeon, although we discussed it thoroughly prior to the surgery because he's the expert. I had done my reading and was leaning toward VSG.

I'm down about 86 pounds and I'm still going to need to have my knees replaced. But I can run a 5k if I have to, I do fencing 2x weekly and workout at the gym. This is going to change your life. Talk with all your docs about what is best for you with your medicines.

I hope you find better and better health as time goes on. Thanks for all the info and recommendations. :)