Acid Medicine For...Life? (Another Acid Post)

I have unfortunately been prone to issues with acid as my one side effect with VSG. Recently, I've had to seek follow-up care under my primary doctor because my insurance changed and my surgeon's office no longer takes my plan without a huge deductible.

I started out on 40mg of pantoprazole daily a few months post-op...but after my last endoscopy a few months back, my surgeon's office bumped me to 40mg...twice a day. When I asked my primary doctor for a script for that amount, his reaction was literally "Who has you taking 80mg of pantoprazole a day?!?" I told him my surgeon's office recommended it after my endoscopy and he begrudgingly wrote my my script.

His reaction got me a bit concerned. Is it insane to be taking that much acid medicine? Can I safely take that amount for the long run? Will the acid issues somewhat resolve over time? I have to be honest that I haven't modified my diet at all to try to reduce acid (I loooove my dark roast coffee and sriracha). Is that something I really have to work on?

Any experiences and or advice are appreciated.

Some people express concern over long-term PPI use.  My need still varies.  At one point I was taking up to 80mg omeprazole per day.  Since being back on the high protein, low carb, diet, I am down mostly to 40mg daily, but do take an extra 20 every few days due to coffee use.  It is my very last vice and I am absolutely not willing to give it up. 

If you haven't seen this:  http://www.mayoclinic.org/drugs-supplements/pantoprazole-ora l-route/precautions/drg-20071434

it has less precautions than omeprazole!

I would just recommend discussing it with your surgeon, and weighing the plus' and minus'.

PPIs can screw up absorption of vitamin and minerals, so it's important to keep on top of lab work and also DEXA scans for bone density.  Seeing a GI doc would be wise.  

Prior to having the gallbladder out and super large hiatel hernia I was on that much. Once surgery was done, on it for a while and weaned off of it. Drinking kombucha tea really helps- maybe try that and see if you can taper off some?

Oh, I should add- it was such a problem before surgery I was unable to keep solid food down. If you are at such high levels maybe get checked for a hiatel hernia. They did an endoscopy looking for an ulcer, but that did not pick up the hernia. If my gastro guy had not palpitated my abdomen and found a very tender spot (not in the gallbladder area) might not have found it. He ordered a CT, that found the hernia. Surgeon thought it was a false positive, ordered an upper gi- confirmed. 

OOPs!  Yep, I have a hiatal hernia too!!  duh!

Thank you! I do like kombucha and will have to try it again. 

I will make an appointment with a GI doctor, to check for a hernia. So far no one has found anything regarding it but it can't hurt to make sure. The 40mg was giving me relief so it is working but...

That is nearly three times what my doctor will write a script for. Acid is also my one VSG side effect.  At this point I take only 15 mg daily and use an over the counter generic version called lanzapriole which had the same ingredient as Prevail and is much cheaper. https://www.amazon.com/s/re****c_1?rh=i%3Aaps%2Ck%3Alanzap role&keywords=lanzaprole&ie=UTF8&qid=1487066971

There have increasingly been new revelations about the dangers of long term use obviously, if you can get off the meds, you'd be better off.

Some people can't utilize PPIs no matter what dose they take. There is actually a genetic marker they can test for to see if this is the case. Look for Stacyrg on the RNY menu thread and talk to her about it. She had to revise from VSG to RNY because of acid, and no amount of PPIs were going to help.

Yes.  I was on protonix 2x a day with zero relief.  My PCP had me tested for a gene mutation that affects the rate you metabolize PPIs.  I have it and it means you are an ultra rapid metabolizer of the drug, which means it offers little to no relief.  See if you can try Dexilant.  It utilizes a different channel through the liver which is not impacted by the gene mutation.  It is the only drug that offered me any relief (trust me, I tried them all)  Problem was it was cost prohibitive (for me).  My insurance initially authorized it (after a peer to peer with my surgeon) but then endorsed my policy to specifically exclude the medication.  At 400+ a month (for a 1 pill a day supply) I couldn't swing it.  It's one of the reasons I revised to RNY.  If you have any questions about what I tried and the research I did, feel free to ask me.  I'm pretty much an open book on this topic.