Pain relief

With VSG, what OTC pain relief is acceptable? I had a cortisone shot yesterday and wanted to take Advil afterwards but wasn't sure if that was okay. I would like to make sure that I have the right medication in the cabinet. Advil has always been my favorite but if that's not appropriate want to know. My surgeon canceled my appointment as he will be doing surgery that day so can't ask him for a while.

Oh wow! I had a cortisone shot to the hip yesterday, too. Ached so badly last night and now I got to thinking and hoping I didn't mess up having my EGD next week.

Hope you get your answer and that you start feeling better soon! I know a vet will be here soon and will have better/more accurate advice, but I think tylenol is acceptable for VSG? Don't take my word though, I'm just some noobie hoser on the internet!

I looked I your numbers and get inspired!! I bet yu are working hard!! Keep up the good work!!!

Good luck with your decision about surgery!!

Thank you. It's a white knuckle ride of will power and at any time, I'm just one bite away from falling. :( (Also, the 325lbs is my all time high. It's taken quite a few years to get from 325 to about 260lb. Most recent weight loss has been from 287-245.4 this morning...so not quite so inspirational as going from 325, but still has been very hard work!)

Sorry for the threadjack!!!

I heard Tylenol is the way to go too!!! I used it after surgery for pain because I did not want to take the hard stuff after 2 days and it worked fine (liquid tylenol FYI)

Acetaminophen (Tylenol) is the only pain med you should be taking. Ant-inflammatories (ibuprofen), NSAID's, aspirin are not recommended because of how hard they are on our stomachs.

Some people are able to tolerate NSAIDS/ibuprofen/aspirin post-vsg but they should not be attempted until you are at least one year out and better avoided until you talk to your surgeon and get his OK. Stick with Tylenol for now. Same with cold medications - Tylenol/acetaminophen products only.

Ditto. Stick to Tylenol. For something severe and temporary, some use Tramadol. But stay away from NSAIDs.

It's complex. I think there's more leeway with NSAIDs for us, however NSAIDs increase acid production and so they are contraindicated for us....sort of? It really depends on surgeon preference plus patient health/habits. Generally, it's best to avoid if possible.

I had approval from my bariatric team to temporarily take ibuprofen (a high dose) for dental surgery, however it was discontinued after 4 days. We are way less prone than RNY peeps, but we can still have issues, especially if we have GERD already. I can't take any NSAIDs without a PPI at all, and not for extended periods of time.

Even without a sleeve, NSAIDs are super hard on the liver. They can be helpful, don't get me wrong, but probably most people should avoid them when possible.

There are also many compound medications for pain relief, and for nerve pain there are more options still. I need a knee replacement, and I have a compound ointment with various painkillers in it. The bonus to this, is that it does not enter the blood stream in high amounts, and it also does not hurt my stomach.

I'd consult with your surgeon, though, as they all have different NSAID rules. Mine allows them if the doses are very small. The problem is that when acid is an issue, often we can't tell until the damage is done.

Having said that, surgery has done amazing things for my knees and back. While I still have some issues, as I need two knee replacements, my pain is gone for the most part. I don't take any OTC or other painkillers at all on most days.

Just a couple of clarifications.

NSAIDs in addition to increasing acid, alter the substances called prostaglandins. Steroids do as well, but the specifics are a little different. The alteration in prostaglandin greatly increases the risk of ulcers.

NSAIDs affect different organs depending on how they are processed in the body and excreted. Most drugs are metabolized either in the liver or kidneys, so where a drug is toxic/harmul depends completely on which metabolizes it.

Tylenol (acetaminophen - which is not an NSAID but usually gets discussed with the NSAID class) is particularly toxic to the liver, and the difference between therapeutic dosage and toxic dosage is very small. So everyone taking Tylenol needs to be super careful to make sure they don't take too much or take things that have acetaminophen in them in addition to the Tylenol.

Ibuprofen (Advil) is not particularly toxic to the liver, but places a strain on the kidneys and long-term over-usage of ibuprofen can decrease kidney function.

I have a gel called Voltaren (diclofenac) that I use for joint pain in my hands. It's an NSAID in the same class/family as ibuprofen, but because it's applied topically very little of the drug gets into the system. My medical team has approved it since I can often times use it instead of taking ibuprofen orally. Which my team has also approved, but it's a risk/benefit analysis because of my auto-immune disease and the fact that I take a PPI which reduces but does not eliminate the ulcer risk.

You're absolutely right, that everyone needs to consult with their medical team. Each patient is different, and each surgeon has a different set of experiences guiding him/her.

I've actually seen more than one instance of NSAID damage to the liver (particularly ibuprofen). Clinically, I've seen that far more than Tylenol damage. Anecdotal to be sure, however people more frequently seem to overdose on it, at least in the health care systems in which I work. It absolutely does liver damage, especially when drinking. Even without drinking, the compound effect with other medications can be quite significant. Most bariatric patients are less well than many people here by far, and many of my clients are on 30+ meds. I've probably had about 20 clients with liver issues directly attributable to NSAID use, and none with kidney issues, curiously.

Prostaglandin deterioration takes time, at least. The true downside to taking them is not ulcers, but that they appear to retard apoptosis in the gastric tissues, the reversal of which opens one to a host of issues and complications, the ulcers not withstanding.

And yep, most are metabolized in the livers or kidneys, but even between NSAIDs they frequently use different metabolic pathways, depending on the particular pharmacokinetics.