I am getting the sleeve because of many reasons, but one of them is my cardiologist has me on aspirin... and this really takes the edge off of my other pains... knees, thumbs, feet and hip. I thought about getting the RNY, but the thought of malabsorption, and not being able to take aspirin really was a turnoff for me. I was also low on D3, started taking supplements, and this has helped my knees and thumbs about 50 percent. I hope with the weight loss, I wont have so many problems with the joints. Also helped low grade depression. I will look into dry D3, I'm using gels right now (5000).

I'm taking 3000 mg Tylenol maximum per day, usually closer to 2000 mg max simply because I don't want to kill my liver.

My surgeon has said NO NSAIDs at all, not even 3 years out. I don't take percocet either because I agree that they dull the pain and make one quite slow in reactions. I can't afford to be slow-witted.

Susan

Cecilia,

I have been in both unemployed and depressed and at that time weighing in at 470 lbs, with lymphodema in one leg and two knees that are bone on bone.  I have never been a person who has looked for support but it certainly would have helped, as I now know.

Come to the Pennsylvania board, there is a wide variety of people there who are so supportive.  Also they may be able to answer some of your wish list.  You are not really far from Phillie and many of the people on that board are from the southern suburbs so who knows. 

I don't know if there is a YMCA in your area perhaps you can use their swimming pool and maybe even meet up with a buddie there.

I do know that there are support groups that meet in Chester county and also up in Langhorne PA.  I am going to start attending the meeting in Langhorne in the spring so I can get my head on straight.

As far as depression, you really need to talk to a therapist about that.  If you are unemployed do you qualify for State Aid?  I started therapy in August and after seeing the psychiatrist he changed my medication, and although it is a mild dose it has helped tremedously.

Finally, this time of year is difficult for so many.  I sat last night and cried my eyes out, feeling sorry for myself.  I still have 2 bone on bone knees and can't walk any further than a block without having to rest. 

Just remember take your problems one at a time and try to think as positivily as possible. 

I hope you get all on your wish list.


Happy New Year to you.


Jeanne

Did you have to give documentation to your insurance company that the excess skin was causing your back pain? And if so, how did you get that documentation? I really think a lot of my back pain is due to that, but I don't know how to prove it.

I'm in that enviable pre-surgical stage (my surgery is tomorrow) where I've become increasingly worried about the prospect of not being able to take NSAID's again because I'll be having an RNY. My insurance doesn't cover VGS, and I'm not sure I'd want one either since they're not reversible. That being said, I have arthritis in my knees. Ironically, one of the reasons I'm getting the surgery is so my physical therapy treatment regimen will yield better results, but if my friend's who've had the surgery are any good indicator, then I think that I'll still face the prospect of pain that will resist treatment with relatively weak tylenol/acetaminophen.

I've been researching alternatives, and it would appear that Selective COX-2 (cyclooxygenase-2) Inhibitors (i.e. Celebrex, Mobic, etc), NSAID/PPP combination, and Arthrotec all have the potential to be better at treating inflammation without as much risk of adverse gastrointestinal side effects. I'll discuss each in turn.

Selective COX-2 Inhibitors ("Coxibs")

First, some explanation. Selective COX-2 inhibitors have a different mode of action than traditional NSAID's (Aspirin, Ibuprofen, Naproxyn) because they tend to inhibit both COX-1 (cyclooxygenase-1) and COX-2.  The key here is the production of prostaglandins, an important lipid mediator that can trigger a variety of physiological effects. In a manner of speaking, there are "good" and "bad" types of prostaglandins. The "good" kind are the ones that protect the gastrointestinal tract (without which ulcers can develop), and are produced by COX-1. The "bad" prostaglandins which are produced by COX-2 are more closely associated with pain and inflammation. Therefore, a drug that can target one (COX-2) while sparing the other (COX-1) is of tremendous benefit to patients at high risk for gastrointestinal side effects, i.e. RNY patients.

To me, this seems a perfect solution for RNY patients with chronic pain that doesn't respond to Tylenol (provided they also don't have a history of stroke). As RNY patients are more prone to ulcers from NSAID's for two reasons: the acidity of the NSAID molecules themselves, and more significantly, the indiscriminate inhibition of prostaglandin production which causes increased gastric acid secretion.

I am not a Doctor; I am just a biochemistry nerd with too much time on his hands. However, on first glance, it would seem to me that the combination of COX-2 selectivity and the use of a a powerful acid blocker like a proton pump inhibitor (Prilosec, Prevacid, Nexium, etc) could have a synergistic effect and help prevent the formation of ulcers. 

NSAID/PPP Combo

Now taking the above-mentioned pharmacological discussion of COX-2 inhibitors into consideration, certain NSAID's should also stand to benefit if taken in combination with a proton pump inhibitor. This provides the less selective inhibition of both COX-1 and COX-2, but with an acid blocker to mediate the adverse effects of COX-1 inhibition. This is apparently reflected in the advice given to some RNY patients on this very site, but it's hardly consistent with all RNY surgeons. I am not a Doctor, but I don't see why this couldn't work for RNY patients as well.

Arthrotec (Diclofenac/Misoprostol)

This, to me, seems like the best solution by far for non-narcotic pain management in RNY patients. Arthrotec is a combination of diclofenac (an NSAID) and misoprostol (a sort of synthetic
version of the aforemetioned "good" prostaglandin), meaning that even if the diclofenac inhibits COX-1, the additional misprostol should offset the decreased prostaglandin production. Just thinking aloud (or in print, as it were), I would imagine that there's potential to combine coxibs with misoprostol to offset what little ancillary COX-1 inhibition there is in even those compounds. That being said, and again, I am not a Doctor, Arthrotec seems like a very good solution, but seems rarely encountered or prescribed.

In conclussion, there are very good reasons for doctors to so strongly proscribe the use of traditional NSAID's in the RNY patients, since we're at much higher risk for ulcers. However, that proscription seems completely categorical in most instances and with most doctors, and consideration of other NSAID's that address some of the problems that cause greater susceptibility to ulcers seems rare. Doctor's are bound to operate with an abundance of caution, and neither I nor anyone else should fault them for this. However, there seems to be a converse diminution of the very real, very debilitating chronic pain and inflammation most RNY patients (frankly, most ADULTS) suffer, with patients being relegated to the use of patently ineffective Tylenol or unorthodox and questionable treatments like Biogel.  But in weighting the need for caution with the need for pain relief, I wonder if this categorical imperative against NSAID's should be reconsidered.

I welcome your thoughts on this entirely too long post.