Misc Info

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DRUGS THAT CAN DAMAGE THE POUCH***

 ALL "NSAIDS" (*see below for the Cox 2 Inhibitors)

DRUGS THAT ARE CONSIDERED SAFE..........
 

Bextra is the newest, next generation of NSAIDS. It is simply an anti-inflammatory with no compound to aid in the protection of our GI systems.
 

I want to help everyone understand the reason NSAIDS are dangerous for  us. Contrary to popular belief, it is not just that they are "pouch  burners" as the industry wants us to believe. It goes much deeper than  that. According to an article published in the June 1999 New England  Journal of Medicine, NSAIDS, once absorbed into the blood stream cause a  chain of chemical reactions that affect the prostaglandins and this in  turn reduces the production of mucus in the GI system. The mucus is what lines our GI system and protects our pouch and intestines from damage.

If the mucus production is reduced, this would allow ANYTHING, including  eating something with too sharp of an edge or foods that are extremely  spicy, to inadvertently begin a marginal ulcer. The best answer is to  avoid NSAIDS at all cost. Taking an H2 receptor drug such as Prilosec,  Prevacid or Nexium is only a band-aid and no guarantee that it will  protect you.

If you are desperate to try an NSAID, my recommendation would be  Arthrotec. It is an NSAID with a prostaglandin compound in it that tries  to prevent the chemical chain of events I was speaking of in the above  paragraph. There are still no guarantees. You are at risk for marginal  ulcers any time you take an anti-inflammatory medication.

Ultram is a mild narcotic and can be habit forming, so I would not recommend more than a six week course of it at any one time.

Michele (with one L)
Van Hook-Troesch, RN

* copied with permission:
 

DISTAL VS. PROXIMAL
Let's assume that we all start with 300" of (small) intestine.  We don't,  but we need to have a figure, so that's it.  From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y.  The "junction" of the sides is the determiner if a procedure is proximal or distal.

The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach.  This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas.  There is no food here.  This is the LEFT side of the Y.  This is the portion that is bypassed.

The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb.  This is the RIGHT side of the Y.

The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur.  This is the part that is still in use and is also referred to as the common channel.

If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal.  If the junction occurs as a far distance from the stomach, it is said to be distal.  That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.

Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses.  We are all missing the stomach and its normal digestive function.

Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time.  Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight.

My doctor measures what is in use, not what is not.  So, in my case, I have a 40" common channel, then 60" was used to reach the pouch.  The bypassed portion is then ABOUT 200".

Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".
 

* the basic 8

These need to be supplemented in specific ways to help absorption.  We also malabsorb SOME fats/oils and complex carbs. We never, ever malabsorb sugar.
Some will have to supplement potassium or magnesium, but not everyone.

I have had them many times.  Marginal ulcer.  OK, you know the stoma? The OUTLET from the pouch where the intestine attaches TO the pouch?  You with me?  OK, make puckered up lips.  Look in the mirror. Now, make the opening about as big as a nickel.  Still got it? HOLD that position.  Now, put your finger in the opening.  Wherever your finger is touching, THAT is the "margin" of where the intestine has been attached to the pouch.  The stoma or anastamosis.  We will call it a stoma. 

OK, so now we know WHERE it is.  WHY did they not see it pre-op? It wasn't there yet.  You didn't have a stoma.  WHY did it appear so quickly? In a distal like mine, they can appear within 24 hours.  Usually do within 7 days. Gina's probably did, as she had the symptoms right from the start.  Nausea and/or vomiting, everything tastes metallic, water feels like sandpaper, might be pain that feels like you've been kicked, might have back pain------- with me, just nausea & finally, the kicked pain.

So, now we know WHERE it is and WHY it is there. Or how it got there. AS to why you? Some do, some don't. The hunk of intestine that is now the stoma WAS further down the food chain and accustomed to receiving processed foods, all nice 'n wrapped in saliva & gastric juices.  Now, it has been cut and sent to the front of the  line where it is receiving unprocessed anything. YOW! Freak out!  Irritation! Turn everything bright right! Reject! Reject! And so it swells.  And so the opening is now no longer nickel sized.  Now you have to stick your pinky finger in, then a pencil, then a pencil lead as the ulcer swells & eats up that once nickel sized hole.

FURTHER, while we had your lips puckered & fully functional, in order to move the food from the pouch, your stoma (lips) make like fish-lips and open/close (peristalsis), which pulls the food down into the intestine and moves it on down the line, conveyor belt fashion.  That is how it SHOULD work?

Ever had a canker sore?  Well, NOW, your nickel is pencil sized, and what opening is left has now surrounded by a canker sore. White, rigid, it refuses to perform the peristalsis action. 

So, now you know why the food just sits there & does not want to go down.

If you don't clear shortly, be sure to remind your doc that you are malabsorbing and might need a larger dose of the Nexium.  We take TRIPLE the Prilosec to get any result at all.  They also give us Carrafate (gen Sucralfate) for use at night only, which does not enter the blood stream, but pours a cooling blanket of healing on that wounded tissue.

Yes, left unattended, they can perforate and then what a mess.  However, caught on time, they are manageable.  I think I've had 8 or so.  But then, I was an ulcer factory pre-op, too.  So, not a big surprise in my case.
Michelle
Vitalady, Inc. T
www.vitalady.com