No NSAIDs means .....NO NSAIDs, PERIOD!

I have to begin by apologizing to every guy on this forum.  I should have posted this Dec 12, when I was released from the hospital.  I was really exhausted after my ordeal.  To make a long story short on Dec 9, I woke up early with cramping in my lower abdomen.  I thought I over did it the night before by eating one of my wife's protein bars (too much sugar).  While on the pot I had this sudden gush of liquid.  I looked and there was a lot of dark red blood.  Over the next hour or so I went 3 more times and each time it was a brighter red.  When I left the house for the ER my blood pressure was 75 over 48.  In the ER the blood pressure bottomed out at 53 over 38.  It was over an hour before they got an IV into me with a special medication to help stop the bleeding and start healing the ulcer.  Of course I got a "finger wave" from the doctor to verify the bleeding.  Called in another gastro surgeon to do a endoscopic procedure.  He said the ulcer was near where the bottom of the pouch where it is connected to the small intestines. He said he couldn't' do anything to fix it as he was afraid he would make it worse as it was hard to get at.

I spent 2 days in the ICU and received 3 units of blood and 2 days on a general floor.  I had a blood draw every 6 hours until I was discharged.  Nothing to eat or drink for the first 48 hours and than clear liquids and full liquids the last day.  Between my surgeon and one of the cardiologists from the hospital I was forever more restricted from NSAIDs.  I had been taking an .81 mg coated aspirin everyday, for the past 6 months, as my cardiologist required it as I have 5 stents and my surgeon reluctantly agreed to this.  So now instead of one little aspirin I now have to take Plavix, Nexium, and liquid called Carafate.  The Carafate is to coat my stomach.  I have to take it 1 hour before or 2 to 3 hours after I eat or take medications.  Try fitting that into our crazy schedule of water consumption and water avoidance after we eat.  Right now it's only for 90 days.

I never had anything like an ulcer before.  I didn't realize how dangerous they are.  Luckily I haven't seen any blood since I came home.  What I'm afraid of is what if I have another ulcer forming on my old stomach or some other place.  Only time will tell.  My follow-up appointment with my surgeon was for this Weds but I just got an e-mail changing it to Feb 6.  I guess my situation is not as important to him as it is to me.

I know everyone doesn't get ulcers from NSAIDs.  But after the 4 terrible days I spent in the hospital and than coming home and feeling really tired and weak for another week or so, it just isn't worth taking a chance.  I finally got a release from my cardiologist so that I can resume PT.  Be careful with what medication you take.

 

Jim  

 

       

I'm glad to hear your ok now. Thanks for the reminder.... Sometimes we need them

Hi Jim,

 

Sorry to hear what a difficult medical ordeal you had to deal with it. However, I appreciate you posting to let us know you are doing OK and also as a warning to us all about how our new stomach has to be handled with care!

 

Hope you are better soon my friend!

 

Yours in WLS,

Bill

Thanks Bill.  New year and hopefully all the bad crap is behind me.  Hope you have a good and healthy new year.

Jim

Hey Bill thanks for the post...This is why this forum is so cool, we can relate and throw out ideas.  I'm in the same boat...RNY, heart bypass, 1 stent, aspirin, and Plavix.  So here are my thoughts and what I went through.  After my second heart attack I was put on Plavix (post RNY).  When I started taking it I was doubled over in pain.  I pressed through and keep taking it.  When I bleed from a cut, if it takes over 2 minutes to stop bleeding, I will do a 1/2 of Plavix the next dose or drop the 81mg of aspirin for that day.  This is what I think...Just me.  It could be the Plavix and it could be in your remnant stomach. The problem is they want to control it, if they can, with medication...since it would take doing exploritory surgery to try and find the problem. I take both with no problems...Just me.  I will also take an Advil (one), every time I pull or strain a muscle (NSAID).  When I do I can feel the irritation in my old stomach. Taking the Advil is the only time I can sense my old stomach.  Just saying, Plavix can too cause bleading...Brian

Sorry to hear of your troubles OMJ... Glad to hear you are on the mend! I thought aspirin was OK? I cannot imagine the horror of checking the bowl and seeing blood... I had Diverticulosis which has abated since my RNY, history of Colon Cancer too... Blood out the back door= a very bad thing!

Thanks Brian for your comment.  Yeah the "back door" is more dangerous than the rest of your body.  LOL!

Jim,

Appreciate the post.  I've wondered if the no NSAIDS protocol was just being overly conservative.  I'm fortunate in that I have never had cardiac or arthritis issues.  So many of the meds for these conditions are very hard on the stomach for the "normal" person much less those of us who have had bariatric surgery.  Every healed incision of our pouch and intestine has scar tissue and a weakened point for a potential ulcer.

So glad to hear that you are on the mend.  Your experience reminded me of the #1 caution that my surgeon stressed to me over and over - "If you have blood in your stool OR if you have gastric distress that lasts over 4 hours, go to the ER immediately and have the attending physician contact me [the bariatric surgeon] for a consult!".  The ASMBS supports this in the following documents.

The ASMBS issued the following position statement for the emergency care of bariatric patients:
http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/Pos itionStatement/ASMBS_Position_Statement_on_Emergency_Care_of _Ptients_with_Complications_Related_to_Bariatric_Surgery_Mar _2010.pdf

The ASMBS also created an ER poster:
http://s3.amazonaws.com/publicASMBS/ASMBS_Store/ASMBS_ER_Pos ter9-20-10.pdf

I hope your New Year holds much success and increased health!

- Mike

Mike you are so right about "every healed incision of the pouch and intestines is a weaken point for an ulcer".  That's exactly what the surgeon who found the ulcer said to me.  I guess I was lucky that it took over 6 months to form.  That warning your surgeon gave you is a lot more to the point than I ever heard from the practice I deal with.  Sometimes my surgeon gives me the feeling that I am a pain in his ass.  After he did the two procedures in Sep to find out what was causing my chest pain (did not find anything) he stated on his after surgery report that "He has a very low pain threshold and anxiety problems".  My cardiologist, pulmonary specialist, PCP with extensive x-rays, ultra sound and CatScan have not found the source either.  But they never said I didn't have it or was imagining the pain.  Since I saw the surgeons comment I had decided to make damn sure I have something that is serious and can be diagnosed before I call him or go to the ER.  I guess the bleeding ulcer qualified.

Thanks for the information from ASMBS on emergency care.  

I now know how serious a situation a bleeding ulcer is and I won't hesitate to go to the ER if I ever see blood again.

 

Jim   

Forgive my ignorance, but, what is an NSAID?