Why we can't take NSAIDS

I've posted this before but it's been a while.

NSAIDS are non-steroidal anti-inflammatory drugs, like ibuprofin, advil, motrin, aleve, etc.

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.

Thank you for your post. I've always enjoyed reading your post, as you are a wealth of information. I also want to add Celebrex to the list of NSAIDs. I believe that the inability to take NSAIDs is the only negative I've had, to this surgery.

My surgeon's office is now recommending that VSG patients avoid NSAIDS as well.

So does mine.  With a PPI only for both RNY and VSG patients and only when truly necessary for the anti-inflammatory action (not just for pain relief because there are other things for pain like Tramadol/Ultram).

Lora

Thanks for this insight i very much appreciate it and it is frustrating to me that not only does my primary not understand this link but apparent the nurse for my surgeon does not either - so, does tramadol help w/ cramps?? anyone? they are pretty bad! but, not that big a risk worthy i guess.

Tramadol helped my cramps. I use it in combination with Flexeril.

I'm just gonna start saying I'm allergic to NSAIDs too. That'll keep me safer.

Kelly -- Is the same thing true of Tylenol?  I take a Nexium-equivalent and Tylenol -- according to surgeon's suggestion.  I'm thinking about just stopping it and living with the joint pain.  What's your recommendation? 

Tylenol is fine for us.  The only OTC pain reliever that we CAN take!

Lora

Yep, Tylenol is fine.  It is not an NSAID.  Now, large amounts of Tylenol are bad for your liver, so I would not take it several times a day, every day.  But using it occasionally is just fine.