Why RNY folks can't take NSAIDS

I posted this on the RNY board but thought I'd post it here, too, for those that don't frequent both boards.

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 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 weight 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.

Thanks for clarifying this, Kelly, it's very helpful.

Thanks Kelly - I learned something new today. I was not aware that you can get an ulcer in your old stomach

Absolutely - and they are really, really bad news.

Thanks, Kelly! On a related subject, I encourage folks to wear a medical ID bracelet that includes NO NSAIDs, NO BLIND NG TUBE, along with the type of surgery and date. I bought a really attractive one on the web.

Amy

I do wear one.  It was not very expensive, either.

So I'vbe just gone round and round with my Drs about this.  A week or so ago, I had a atypical transeint global amneisa.  Dr's do not understand it but want to relate it to TIAs althought all of the many many test they did showed nothing that looked like a TIA.  So they wanted me back on an 81mg asprin a day.  I checked with my surgeon, PCP, everyone I could.  All said, yes, take it.  So I did in the hospital but now am doing 1 everyother day.  I don't want to have a stroke but I also don't want to have an ulcer.  They said any of the other meds that would do the same thing as the asprin are also very irritating to the stomach. 
So what is a person to do?

Well, I don't know about you, but I'd much rather have an ulcer than a stroke.  We just have to weigh the risks and benefits.  Now, I'd rather have a headache than an ulcer, or menstrual cramps, or something like that.  But a stroke?  Nah.  Give me the ulcer any day over that.

Yeah, that is why I am doing it, but every other day, instead of every day.  It's hard to be a rule follower and have them throw you curve balls.

Thanks for hanging this as a separate post.

I've said those words for so long and nobody hears.

Our original instructions said no nsaids, but for me, I already knew, the hard way.

I've seen SO many, same surgeon, same rules, whose (doc of another flavor) told them it was ok with PPI's. And no, that only makes it worse. A PPI (protein pump inhibitor) turns off all the pumps, bad ones AND good ones. Some pump a protective mucous coating and using a PPI stops that, as well.

Some of us get lucky and have pain. Others may have a bleed with a pain warning.

It's very hard to get thru to people that it's not the "touching of the stomach", but the systemic action that makes them so dangerous.