Question: Ulcers and Pouch

Hi All, I'm wondering if anyone here on the board got an ulcer in their pouch after surgery? I'm in a situation where I have two partially torn tendons in my right foot which cause a lot of pain if inflamed. (For four weeks I thought it was arthritis so I've only known they were torn tendons for 2 weeks.) Essentially, I am worthless while I am healing if I don't have some sort of inflammatory. I know all the risks of aspirin, ibuprofen, etc. and quite frankly, they don't work anyway for me other than reducing the pain (everything still swells so the pain comes back in a few hours without more - and that's not something I want to do) and I retain water which slows the weight loss. What does work, and works wonderfully is the steroid dose pak Prednisone. When I have been on these, I feel great, swelling goes away, workouts (swimming) are better and enjoyable, I can run my business with little interruption, help around the house - essentially I have a life while I heal. I have had no problems with the Prednisone and I usually flush the pouch with 3-4 oz of liquid when I take one of the pills so it doesn't stay in the pouch. I started taking the round of dose paks at 1 month after surgery, and am now 3 months post-op. I've been through 3 paks so far (2 when I was not in the restrictive boot and now 1 since I started the boot process). I've had the cortisone shots, and they work for about 3-4 days but then deteriorate from there (you are limited to 3 shots per year in the joint because the shots weaken the joint over time - I've had two in two months so they can give me a shot somewhere else but it won't be as effective). All of this to find out that as I talked to my surgeon yesterday he said the Prednisone may be as bad Ibuprofen on the pouch. So I'm at a loss right now. I've had no problems with the pouch and Prednisone to date, feel great when I'm on it (willing to deal with the other risks that come with that until this heals in the next 3-4 weeks), just worried now about the pouch and ulcers there....I'm trying to avoid the surgery on the tendons - I'm tired of surgeries and so is my wallet, but realize the ulcer would probably cause another surgery too. Anyone deal with this one out there? PS. On the bright side, I'm down 82lbs total as of today including pre-surgery loss. Thanks guys, Greg

Greg, I'm not a doctor and I don't play one on TV but I would say either consult your WLS surgeon and see what he recommends. If that becomes a no go, what I would do is keep taking the prednisone, but back it with a chaser of like Pepcid Complete or something like that which keeps the stomach, or in our case, pouch, coated. Doing this is a lot less likely from keeping and ulcer from forming, and if ones does happen to form, it should keep it relatively quiet. Just a guess, hope it helps some. Best wishes. Keep us all posted on your progress. Troy

The Duke WLS process has me taking Prilosec OTC daily for the first year to reduce the risk of ulcers while everything is healing and readjusting. Tim

Hi Tim, believe it or not my surgeon told me that the Prilosec or Prevacid is actually for the old stomach, not the pouch. That was surprising to me.

Thanks Troy. It was the WLS that told me this might be a problem, even though I haven't had any problems.

Hey Greg... you have hit on a contriversial subject...My WLS, prescribed me Kids liquid motrin, on day 2 post WLS for pain,instead of the morphibe pump...that is what I have taked faithfully ever since, for 2 hernias, 1 gallbladder, and big PS...all with the generic ibprophen...excuse the typing...my eyes are still crossed.... There was another WLS who came to answer questions at our support group,,,so we nailed him hard on NSAIDS.... He said...note quotation marks..."if you had no trouble with NSAIDS before surgery, you will not have problems after surgery....if you had problems with bleeding before surgery, that will continue, and you will not be able to take Ibuprophen".... That really shut a lot of the chick what spout the urban legends up... But every doc is different...for me the liquid works vuundebar.... the tabs or capsuls just so so... but that is me.. ok on the Dose Paks, they are the miracal drug...they work great...they even clear up your sinuses that you didn;t even know that were stuff....but they are hell on the rest of your body....they make your blood sugar spike to 400, stress on the heart, all kinds of micoscopic **** that we don;t even know how to talk about...that is why the doc is so stingy...on top of that they make you retain water, and your face blows up, and that plays with you blood pressure...if you start getting off of them too soon....you can have a heart attack....theyare serious stuff.... revisit the liqud ibuprophen with the doc.... that is my 2 cents worth... Russ

Thanks Russ, I know of the downside of the steroids. Fortunately I am not seeing as much of a spike on the blood sugar or the blood pressure. Fortunately the weight loss is helping that dramatically. My last fasting blood sugar was down to 102, but the HB1C went up to 7.2. (I was at 9.5 at my previous PCP visit in July) So the results are not ideal but not seeing those bad side effects on the first 3 paks to a really bad level as of yet. I don't want to be on these things forever, hopefully just for the next 3-4 weeks. Thanks for your insight. Greg

Hi Greg For what it's worth about ulcers in the pouch. About a month after my WLS I had a some chest pains that the doctors never found out why I had them for sure, they put me on several med's including low dose aspirin. Not thinking I took them without question. A few weeks later I had a follow up appointment with my WL Dr. and I told him about my new med's. He told me to stop taking the aspirin right away because it could do damage to my pouch. Well about a month later I developed an ulcer, and it started bleeding big time. By the time I got to the ER. my blood pressure was 0 over 0. So I spent the next 6 days in ICU getting over 10 pints of blood, and over 15 pints of plasma. They put that scope down my throat and looked at my pouch and you could see where the ulcer was in my pouch and a big nasty blood clot hanging from it half the size of my pouch. Just wanted to let you know that a ulcer in the pouch can be bad news. Hope this helps some. Good luck Alan.

Thanks Alan, good input - sorry you had to go through that. How are you doing now?

I am doing well now thanks. After all that blood, Plasma and iv's I regained almost 20 pounds back. I just now lost that and a little more.