NSAIDS - education Module re-post from 2008

[Guest guest]

THis has been in the files for years. Originally written for and approved my my

own band surgeons, and used by several other docs.

Sandy r

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Non-steroidal anti-inflammatory drugs, or NSAIDs (pronounced en-

saids), are the most prescribed medications for treating conditions

such as arthritis. Most people are familiar with over-the-counter,

nonprescription NSAIDs, such as aspirin and ibuprofen.

NSAIDs are more than just pain relievers.

They also help reduce inflammation and lower fevers. They prevent

blood from clotting, which is good in some cases but not so

beneficial in others. They should be stopped well before surgery.

For example, because they reduce clotting action, some NSAIDS,

especially aspirin, may have a protective effect against heart

disease. (As of August 2010 this has been disproven. However, other research has

shown that daily low-dosae aspirin protecvts against colo-rectal camcer. This is

important as the obese are high risk for colo-rectal cancer. Dicsuss this issue

with your family docs)

However, you may bruise more easily. NSAIDs can increase the

risk of developing nausea, an upset stomach, or an ulcer. They also

may interfere with kidney function.

For the first few years of banding in the US, NSAIDS were not allowed

for Bandsters. Many docs would not band someone needing heavy NSAIDs

for things like severe arthritis. With time and more experience, this

requirement has softened.

Most surgeons now feel we CAN can take NSAIDS if really needed. Some

allow them with no restriction at all. This was discussed at last

years's 2007 ASMBS meetings (American Society of metabolic and

bariatric surgeons)

We can safely take them in liquid form, or cut up smaller than an

aspirin, with ONE tsp of food, but more will make the NSAID sit in

the pouch longer as the food goes thru- and we want it OUT of there

asap! Follow with a full glass of fluid.

NSAIDs - safe to take or not???

All the NSAIDs are severe gastric irritants, and best avoided by

Bandsters with our even-more-sensitive stomachs. But sometimes, the

anti-inflammatory effects are essential, as no other Class of

medications is as effective.

Most experienced docs, including Dr. Kuri, will allow 2-3 days of

NSAIDS when needed. Sprains, breaks, bad menstrual periods, and

migraines are good indications for NSAIDs.

Some Bandsters have been prescribed a daily low-dose " baby " aspirin

for heart reasons, and this is also ok, if taken correctly with

CAUTION. This daily aspirin must be stopped for 2 weeks before band

surgery, to decrease the extra bleeding it can cause.

NSAIDs are a huge class of drugs including advil, aspirin,

ibuprophen, motrin, aleve, and many others. They can also be in other

meds, like cold meds, so we have to read labels carefully.

Tylenol (acetaminophen) is not an NSAID and has no anti-inflammatory

effects.

The NSAIDs cause potential stomach damage in 2 ways, and it's

important o understand these.

First, coming in contact with the sensitive stomach tissues can cause

local damage to the tissues, including eating a hole in the stomach

called an ulcer. This can be avoided by cutting the tab smaller than

an aspirin, (or using the liquid form - ask the pharmacist for the

adult strength liquid, as it is kept behind the counter so some

stressed young

mom does not grab it for a sick baby ) and then washing the NSAID

carefully thru the pouch with a full glass of fluid.

It can't hurt the stomach this way if it's not IN there.

The other, and more dangerous, way NSAIDS harm the stomach is by

getting into the bloodstream (as almost all meds do) and altering the

protective stomach

mucous. Then, the stomach can easily be damaged by stomach acid, food

toxins, bacteria, viruses, and other gastric irritant meds. This type

of damage from NSAIDS CANNOT be avoided, but is felt not to begin

until NSAIDS are used for 3 days or more - that's why 2-3 days of use

by a Bandster is felt to be ok by most docs.

Longterm NSAID use is felt by some to possibly contribute to band

erosions, which always require band removal, but this is

controversial. We just don't know. However, I have to say I, and

other longterm Bandsters, know of a very devastating erosion in a

lady who had a perfect endoscopy with no sign of any band problems.

She then started heavy daily NSAIDs for severe

knee arthritis, and suffered a life-threatening erosion less than 6

months later. She was 62A good friend who very nearly died. She had

been at goal for years and was eating well and following band rules

very well.

A few people with terrible arthritis, for instance, NEED longterm

NSAIDs like Celebrex to be able to function and LIVE. They usually do

ok with other special precautions, including taking a daily acid-

supressor like The RX nexium or protonix. I like protonix best, and

this seems superior for Bandsters, but it was very expensive. A low-

cost generic form is now available.

The use of NSAIDs is something to discuss carefully with the

prescribing doc AND one's band surgeon. As with all meds, there are

pros and cons to using it. you have to decide , with your doc, if the

pros outweigh the cons.

Here is a list of common NSAIDS:

NSAIDs : non-steroidal anti-inflammatory drugs

Aspirin (Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)

Choline and magnesium salicylates (CMT, Tricosal, Trilisate)

Choline salicylate (Arthropan)

Celecoxib (Celebrex)

Diclofenac potassium (Cataflam)

Diclofenac sodium (Voltaren, Voltaren XR)

Diclofenac sodium with misoprostol (Arthrotec)

Diflunisal (Dolobid)

Etodolac (Lodine, Lodine XL)

Fenoprofen calcium (Nalfon)

Flurbiprofen (Ansaid)

Ibuprofen (Advil, Motrin, Motrin IB, Nuprin)

Indomethacin (Indocin, Indocin SR)

Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)

Magnesium salicylate (Arthritab, Bayer Select, Doan's Pills, Magan,

Mobidin, Mobogesic)

Meclofenamate sodium (Meclomen)

Mefenamic acid (Ponstel)

Meloxicam (Mobic)

Nabumetone (Relafen)

Naproxen (Naprosyn, Naprelan*)

Naproxen sodium (Aleve, Anaprox)

Oxaprozin (Daypro)

Piroxicam (Feldene)

Rofecoxib (Vioxx)

Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic,

Salflex, Salsitab)

Sodium salicylate (various generics)

Sulindac (Clinoril)

Tolmetin sodium (Tolectin)

Valdecoxib (Bextra)

Note: Some products, such as Excedrin, are combination drugs

(Excedrin is acetaminophen, aspirin, and caffeine). Read labels

carefully.

c. Sandy s, BSN, MN

band educator

at healthy BMI goal 5+ yrs