Why we are advised not to take NSAIDS

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.

Wow thanks Kelly! This is very educational, and very informative to us pre opters that are getting ready to have RNY! I suffer from bad menstrual cramps, and heavy bleeding, but I don't think that women should have to live our lives suffering, and being at the mercy of motrin and other NSAIDS just to feel normal. I report regulary to my GYN doc for pap smears, and I complain, but the only thing offered was b/c pills to help with my cycle. So I chose to have RNY, so the next thing is to get ole mother nature together, and find out why my menstrual  cycle is so bad! I will not live at the mercy of NSAIDS!

Of course  you should not live your life suffering.  Even if you feel comfortable taking NSAIDS once in a while after surgery, though, you don't want to rely on them monthly.  So yeah, seeing your doc to discuss other options is important.  And it would be a good idea to try to figure out why you have so much pain with your cycle.  Lots of people have cramps but if you're really suffering, it could mean something is not right.  Sometimes we have to really be assertive with our docs to get them to investigate the cause of our pain, though.  Do pursue it.

Thanks Kelly will do!

 I have also wondered about the NSAID restriction. Are they out in all cir****tances for the rest of our lives? For example, my dentist will not give pain meds after working on my teeth - and directs only the use of Motrin for a few days following. What if I were to have an accident ( break a leg, sprain and ankle)? NSAIDS are usually required in the short term to deal with swelling. Does short term, specific use such as this still pose a risk to us?

Yes,
NSAIDS are possible and so are oral steroids.  Most internists will tell you that ulcers from steroids actually form because of the weakening of the stomach lining from the systemic steroids (so even IV steroids will cause them).  To help prevent ulcers, doctors in the "know" prescribe carafate suspension.  You drink a couple tablespoons several times a day and it actually sticks to the lining to protect it.  This is also the treatment for ulcers.  The thing about NSAIDS is this.  Yes, if the NSAID were to stay in your stomach, it could cause problems.  However, if you were to take NSAIDS with a protein drink, and wash them down, they will travel right past your pouch.  Yes, there is also another seam on the intestine below but if you don't take them regularly, you should be fine.  Listen to YOUR surgeon.  And tell other doctors about your surgery and suggest carafate suspension as a prophylactic.

Washing NSAIDs down with a protein shake (or anything else) will NOT matter.  The problem is not caused by the physical contact of the NSAID and your pouch lining, it is a systemic reaction that thins the lining of your pouch (AND your remnant stomach) once the drugs get into your body.  So it doesn't matter what you take them with or what form you take them in (pill, IV, injection, patch), any time you take them you are putting yoruself at risk. 

It is probably reasonably safe to take them very occasionally, but there HAVE been cases where people have ended up with ulcers after either a single dose of Toradol in the hospital or by a very short course of OTC NSAIDs.

Lora

NSAIDS are systemic drugs.  They do NOT cause a problem if they sit in our pouch.  They DO cause a problem when they enter our bloodstream.  Since taking them with a protein shake does not prevent them from entering the bloodstream, it does NOT prevent them from causing ulcers.

Taking them with something like Carafate helps prevent ulcers due to NSAIDS, though.

Short term use still poses a risk, yes.  The risk is greater if we use them often, however.  What I do is decide if the pain of my cramps or whatever is greater than the pain of an ulcer would be.  If I decided the pain I'm in now was worse than an ulcer would probably hurt, I'd take the risk of an ulcer and take NSAIDS.  You'll have to decide for yourself if/when it's worth the risk.

If you explain to your dentist why you cannot have NSAIDS, he should be willing to prescribe pain meds.  If not, i would find another dentist.  I see no reason to risk an ulcer when there are effective pain meds available for dental work.

It's good that you're asking this question while still a PRE-op. Have you considered the Sleeve or the DS? Both of those surgeries still allow for the use of NSAIDs.