Pain.

On March 9, 2010, in Uncategorized, by Andrea

Yuck in a bottle.

I’m no stranger to pain.

No, really.

I’ve had two kids — and any woman will tell you — this is no walk in the park.  The guys that might be reading this?  Count your lucky stars that you’ve never had to deal with the concept of pushing a watermelon out of a lemon-sized hole once, much less twice.  Consider yourselves even luckier that there was a repeat performance of the act that got the watermelon there in the first place.  On top of this, there’s the monthly fun, and the yearly indignity that isn’t exactly comfort.  Trust me — these are things that bring up the idea of “ow” pretty quickly for most women.  So there’s that.

On top of this, I suffer from daily chronic headache (yes, that’s daily — not frequent but daily) and frequent migraine.  I also have had a cluster headache a spinal headache if those weren’t enough for my headache portfolio.  If you’ve never had a spinal headache over a weekend?  My suggestion is to just not.  Cause, well, no.

This wasn’t a discussion just to say “nah nah nah nah boo boo” on how much my life blows.  Cause while it can, and does at times, I try not to discuss it much of the time.  I could — but really, what’s the freaking point?  I have enough on my plate to deal with without adding this kind of crap to my day.  Talking about it only depresses me more, and I’d rather not do that anymore than I have to — thanks, but no thanks.

No, this was just to highlight the fact that when I say I woke up in severe gut-wrenching, tear-inducing “Call the ER because I have a knife in my stomach, GIVE ME THE FUCKING CARAFATE!” pain — well, I mean it.

I was having a dream — of what, I’m not really sure to be honest.  I know that I was dreaming.  And all of a sudden, I was dreaming that my stomach hurt.  Badly.  And then, well, I was awake.  And my stomach hurt.  So I get up to get some of the Carafate that I have on hand — which I have on hand because my pouch had been bothering me of late — but nothing THIS horrible.  More of a “acidish” type deal.  And I take a dose of it.  And I go back to bed.

5-minutes later?  It hits.

Now, I want to make a few things clear.

1) I see a bariatric gastroenterologist.  He specializes in RNY patients.  I saw him not 2 weeks ago when I told him I was getting a bit tender, but not anything horrible.  He wrote the script for carafate and script-strength prilosec to self-treat as needed and made an appointment for 6 months.  We didn’t think anything was bad.
2) He has no problem with me drinking coffee (of which I had not been drinking coffee of late, actually..)
3) I had not been a bad girl with my food or drink — no alcohol, no “no-no” things — nothing really to put me in the #BBGC except for being off the Christmas Card list for a certain group.

So with this said, this was out of the blue.  Yesterday’s food choices?  Protein latte (32g, baybee!), Campbell’s soup for lunch (how horrible!), some Dreamfield’s pasta w/ marinara and parmesan cheese for dinner, and then an Isopure Smoothie for “dessert” (liquid peach-flavored chalk!  Another 32g!)  And not a single narcotic for my headaches to sit in my pouch all day.  Certainly nothing to piss off my pouch.

So at 4am I’m on my kitchen floor, rocking to and fro, with tears running down my face.  The husband, who is now panicked beyond belief is trying his best to figure out what to do.  “ER?  Walk?  Sit up?  Lay down?  Go to the couch?  Off the hard floor?  Drink something?  Pain killer?”  So we try a pain killer.

And for the record — pain killers are good — EXCEPT when you have an apparent gaping hole in your pouch.  Because when it hit?  OMGIWANNADIEPLEASEKILLMENOWPLEASEOMGPLEASEOMGWHERESTHEKNIFETHATISSTABBINGME?!?!  I thought I was about to faint when it hit — and there was NO mistaking when it hit.  Cause I saw stars.  And I was inside.

So another dose of Carafate.  And 10 Tums.  Glass of milk.  A discussion of protein and why it’s so vital to me and the healing process?

Why I couldn’t go to the local ER (they have a love affair with Toradol — the last time this happened?  They pushed a dose on me despite being told NO adamantly several times.)

And by 6am I could get out of my fetal ball on the kitchen floor and walk around — just in time to see our daughter up.

Yay!

So now I have a call in to my Bari-GI to see him this afternoon.  Not that I really have the time.  And I already know what the answer will be — an endoscopy to see what’s going on.  Not that I have the time for that, either.  But he’s super protective of us RNYers of his — and there are worse things in life, I suppose.

Now why am I sharing all of this with you?  It isn’t as if I enjoy baring my entire life for all to scrutinize..

Ulcers are a way of life for RNY patients.  My first 3 (all at once, FTW!) were not my doing.  I got them, most likely, after unknowingly getting a shot of Toradol during my labor with having my son.  At the time, I didn’t know they gave NSAIDs for labor — and I didn’t know to ask.  I never had taken a single aspirin or advil — but still got ulcers.

And there are many post-ops that get ulcers that follow the rules — these are a way of life after RNY.  The intestine is not meant to be attached directly to the gut.  There is supposed to be a valve to keep acid from getting to the intestine.  We don’t have that anymore.  Carafate and prilosec, and nexium, and such are quite common.  I see posts from newbies asking how long people are on their PPIs after surgery — and I’m thinking “this time” cause inevitably they will be on them again in a few years.  And it seems like I’ll be on them for life because when I go off them I get ulcers — again.

So I share this just so you can prepare — just in case.

Now if you’ll excuse me?  I need to go drink my breakfast.  Cause there will be no food…

Puzzlement.

On December 31, 2009, in Uncategorized, by Andrea

I don’t write many “opinion” only pieces.  I generally like to keep my thoughts on here to facts only.  Not really sure why — I guess because I’m just a little ‘ole person who blogs.  I don’t have an edumacasion that’s worth anything, so my opinion isn’t really worth a whole lot.  Or so I think.  Maybe, I don’t know.

But today, today I’m puzzled.

Yesterday, I reported that the link between proton pump inhibitors (PPIs) and osteoporosis — something that was thought to be an iron-clad link as reported in JAMA in December of ’06 — was completely obliterated.  I was surprised and shocked that I found it first — and I knew that I had by perusing the Osteoporosis page over at Alltop.

The reaction was lukewarm at best.  Which was … shocking.  This is a medicine that tons of WLSers take on a daily basis to avoid ulcers, and in a community that is already plagued with calcium and bone density problems, the hint that a drug that we need to avoid ulcers might hinder our calcium absorption is scary.  Well, it was to me.  Avoid ulcers or have broken bones?  What a choice!  I mean, both options really suck, especially coming from someone who has lived with both.  So seeing the link between the two broken was a welcome relief and I expected the community to be just as excited as I was.

To see that they weren’t — well, surprising isn’t the word I’d use.  I’m not sure disappointing is the word I’d use because I can’t be disappointed at the lack of reaction from others.. but more than surprised.  Perhaps shocked.

And still not a peep from the osteoporosis community, either.

The mind boggles at what people find intriguing and what they find boring.

Do PPIs Increase the Risk of Bone Fracture?

On December 30, 2009, in Minerals, by Andrea

In December, 2006, JAMA published a study linking a popular post-WLS drug — the proton pump inhibitor or PPI — and increased hip fracture.  It was hypothesized that the PPIs interfered with calcium absorption through achlorhydria or through inhibition of osteoclastic vacuolar proton pumps.

Long-term Proton Pump Inhibitor Therapy and Risk of Hip Fracture

Yu-Xiao Yang, MD, MSCE; James D. Lewis, MD, MSCE; Solomon Epstein, MD; David C. Metz, MD

JAMA. 2006;296:2947-2953.

Context Proton pump inhibitors (PPIs) may interfere with calcium absorption through induction of hypochlorhydria but they also may reduce bone resorption through inhibition of osteoclastic vacuolar proton pumps.

Objective To determine the association between PPI therapy and risk of hip fracture.

Design, Setting, and Patients A nested case-control study was conducted using the General Practice Research Database (1987-2003), which contains information on patients in the United Kingdom. The study cohort consisted of users of PPI therapy and nonusers of acid suppression drugs who were older than 50 years. Cases included all patients with an incident hip fracture. Controls were selected using incidence density sampling, matched for sex, index date, year of birth, and both calendar period and duration of up-to-standard follow-up before the index date. For comparison purposes, a similar nested case-control analysis for histamine 2 receptor antagonists was performed.

Main Outcome Measure The risk of hip fractures associated with PPI use.

Results There were 13 556 hip fracture cases and 135 386 controls. The adjusted odds ratio (AOR) for hip fracture associated with more than 1 year of PPI therapy was 1.44 (95% confidence interval [CI], 1.30-1.59). The risk of hip fracture was significantly increased among patients prescribed long-term high-dose PPIs (AOR, 2.65; 95% CI, 1.80-3.90; P<.001). The strength of the association increased with increasing duration of PPI therapy (AOR for 1 year, 1.22 [95% CI, 1.15-1.30]; 2 years, 1.41 [95% CI, 1.28-1.56]; 3 years, 1.54 [95% CI, 1.37-1.73]; and 4 years, 1.59 [95% CI, 1.39-1.80]; P<.001 for all comparisons).

Conclusion Long-term PPI therapy, particularly at high doses, is associated with an increased risk of hip fracture.
Author Affiliations: Division of Gastroenterology (Drs Yang, Lewis, and Metz), Center for Clinical Epidemiology and Biostatistics (Drs Yang and Lewis), Department of Biostatistics and Epidemiology (Drs Yang and Lewis), and Division of Endocrinology (Dr Epstein), University of Pennsylvania School of Medicine, Philadelphia; and Department of Medicine, Doylestown Hospital Research Center, Doylestown, Pa (Dr Epstein).

Well.  Fast forward to today.

I’m on Medscape and see this post:  Do PPIs Increase the Risk of Bone Fracture? and I think to myself.. “Well, duh.  This was answered awhile back.”  I go in, and find a video by prof citing a study that’s coming out from Manitoba Canada where, aparantely the government really likes to track PPI usage as well as fractures and there’s no significant correllation.

Wait.  What?

But.  Wait.  Say that again?

I thought that the osteoclasts, which are, in essence little proton pumps in their own little rights, were also being shut down by the PPIs and so bone resorption was a problem and the hopes and dreams was a osteoclast specific PPI to help prevent osteoporosis down the road and then the world would be glitter and rainbows and sunshine once again?  No?

Oh.

Here’s the video.  Go watch it.  It’s worth the 6 minutes, 40 something seconds of your life it will take.

I’m looking forward to reading the full article when it comes out.  But for now, if you’ll excuse me, it’s time for my Prilosec.