Help! Post-op pain control

[Annieof2 0]

I am wanting to have the Mini Gastric Bypass. The problem is pain control. Through my research I see most surgeons in Mexico only prescribe Toradol AKA Supradol. This medication is classified as a NSAID. I have allergies to NSAIDs and develop Steven Johnsons Syndrome; imagine your oral mucus membranes and your "lady parts" turning into big ulcerations. This is EXTREMELY painful. Fortunately, this does not happen with Toradol but because of my decreased kidney function I have been advised by my urologist to only take Toradol for kidney stones and only if absolutely necessary. I have reached out to Bariatric Pal and other Medical Tourism planners and cannot get them to respond. I assume they think I am a narcotic junkie. What I am searching for is a surgeon that is willing to prescribe a narcotic that is metabolized in the liver to prevent more kidney damage. If anyone has had a surgeon that prescribed something other than an anti-inflammatory can you please post or send a private message? Thank you in advance and for taking time to read my post.

[summerset 5,261]

Paracetamol, Novalgin. If the pain is bad, opioids.

You'll not be allowed to take NSAIDS anyway after MGB.

[@RealScoobyDoo 94]

I think it sounds extremely twisted for anyone to think that someone would go through major abdominal surgery just to get opioids. Seems a lot easier to feign back pain!

But seriously, Stephens Johnson is no joke. You would have better luck talking to an actual surgeon. Unlike in the US, the representatives very often have zero medical background. Problem is that they want to see if you are a good candidate and make you fill out a questionnaire. My advice is to find a surgeon in Mexico with excellent English, fill out the health questionnaire and arrange a Skype interview where you can discuss your concerns. Won't cost you a cent.

I used Dr. Fernando Garcia, and I hear that his English is very good (I only spoke to him in Spanish), and I'm using Dr Illan for my revision, and he and his partner Dr Ponce de leon also have excellent spoken English.

Good Luck!

[Annieof2 0]

@RealScoobyDoo THANK You for your response!

It is nice how well the conversation goes with the representatives until we reach the topic of post-op pain control. I am sure due to all of the media exposure on opioid abuse and misuse their mental “red flags” go up. Most disappointing of all, Dr. Illian was my “first choice.” I reached out directly to Bill Yanez with Bariatric Pal over a week ago with questions on post-op pain control and have not had any response; not even “I am sorry but we cannot help you.”

Summerset’s response was well intentioned, I hope. I doubt that she realizes their actual chemical compounds. Paracetamol is acetaminophen a.k.a. Tylenol. In addition, she stated MGB patients are “not allowed” NSAIDs post-op yet her suggested Novalgin is in fact a very powerful NSAID. After researching Novalgin, it contraindicated for me because of my history of Bronchial Asthma.

I have had multiple abdominal surgeries for endometriosis and lysis of adhesions. Because of all of my scar tissue, my surgery will be more complicated and has a risk of being an “open” surgery. In either case, it is my hope to have a post-op pain control plan in place BEFORE it is needed. My original post was created in hopes of receiving recommendations of surgeons that are willing to offer several post-op plans. If my only post-op options are “Tylenol” or NSAID’s that could potentially kill me…..then I will just stay fluffy.

Again, thank you @RealScoobyDoo for taking time to respond to my post.

[summerset 5,261]

Novalgin is in fact a very powerful NSAID.

Interestingly enough it is still recommended as an alternativ to NSAIDS after GB. You seem to know your stuff. Why is that?

[Annieof2 0]

I have MULTIPLE medication allergies. Unfortunately I learned the hard way that "we/patients" must educate ourselves on all prescribed medications. I have had anaphylactic reactions because healthcare providers did not bother to read my list of medical allergies. So after 2 anaphylactic reactions and 2 Stephen's Johnson Syndrome reactions I do not take anything without first researching the medication.

[Hammer_Down 631]

My surgeon in Mexico sent us home with keterolac (powerful NSAID).

We were taken to a pharmacy where the pharmacist could prescribe just about any medications we wanted to purchase from there.

We bought some Tramadol (an opioid, not an opiate). Unfortunately I didn't do my homework, and because the USA recently (2014) reclassified Tramadol as a narcotic (again, not an opiate but an opioid) I couldn't take it. As a commercial driver, I am medically excluded from driving while taking narcotics.

There was a variety of pain medecines available and I wish I had looked it up before buying Tramadol specifically.

[Djmohr 6,965]

@@Annieof2

I too have multiple medicine allergies and now that I have had bypass, nsaids are completely out of the question. I also have stage 3 kidney disease in addition so surgeons are careful with me when it comes to medications of any kind. I used to give myself shots of torridol as a rescue drug for Migraine and I can no longer use that either.

I don't think it is unreasonable given your allergies that you know the plan ahead of time. In fact, I would insist on it.

If it helps any, for me the bypass was not what I would call painful. There was discomfort. For the two days i was in hospital, they gave me liquid vicodin because I am allergy to percocet and NSAIDS were immediately off the table. I can take vicodin or even dilaudid if the pain is really severe but I honestly did not need it for this surgery. The only time they gave me that was in the recovery room when i woke up and my chest was hurting but once that was under control, that pain never came back.

I took liquid vicodin 3 times per day, then went home. I took it one more day and by day 4 i was on liquid Tylenol. That stuff is horrible to drink after having stomach surgery because I think it has alcohol in it. I found that simply avoiding all of it made me feel better. Any kind of pain reliever was actually more of a problem than what it was worth.

I used a heating pad and chewable gas x which helped with the gas pains when your bowels start working again. I walked the gas off that they use for surgery, honestly the pain medications did not help that discomfort anyway.

I do have a high tolerance for pain but I have seen many many many posters like me that just did not have a great amount of pain. The gas is the worst part and meds really dont help with that. Lots of Water, walking, heat and gas x is the only thing that helps.

Let me know if you have questions. I would be happy to help.

[Donna Smithy 0]

After my sleeve in Mexico, I thought my pain was really well controlled except for break through pain the second night. They bring pain meds on a schedule and have an order for extra Torodol, but that didn't help. They called the doc on call who ordered some morphine, but it took almost 3 hours to get it from the pharmacy. Not sure why that was.

My surgery wasn't done until 7pm, and I walked most of the 1st post op day. Must have just overdone it. But overall, I thought they did great with controlling my pain.

Don't assume that they think you are an opiate junky. Culturally I've found that in Mexico they don't ever like to give you a negative answer and would rather just ignore the question.