pain meds are malabsorbing

I had my RNY gastric bypass Aug 24th 2011, weighted 307 lbs on my surgery day.. 8 months later BAM!!! 207lb's!!! 100 lb's gone!!!

Bad news!!!  ever since I had my surgery my percocets hardly give me any pain relief! I'm gobbling them like tic tac's and had no idea why they arent working anymore.

I never thought of the malabsorption issues. I take 10mg percocets 4 times a day for severe osteoarthritis in both knees and hips and I have 4 buldging discs in my lumbar spine.

I just called my rhematologist the other day and he was out for 2 weeks and the Dr on call reviewed my problem. The nurse called me and said Dr.. said your already on very strong pain med's and he would refer you to a pain clinic. She told me to try and tough it out until I can refill my meds again then speak with my Dr and see what he says.

I crush or chew my percocets because if I take them whole they bother my stomach, I can feel the effect of the pain med's within 5 min's and it lasts only 1 or 2 hours, but remember there is little to no relief.

I also came up negative for opiates in a urine test!!!! I went to the ER in December and for weakness and some abdominal pain, I didnt ask for any pain meds. They gave me a CT scan of my abdomin, blood work and a urine test.

I asked the Dr if I could look at my lab work because I'm a nurse and said sure... showed them to me and I said you tested me for drugs?? he said we do it for everyone, but I said I take percocets 4 times a day I should show positive for opiates but its NEGATIVE?? he didnt know what to say.

Does anyone have a definate answer on this topic??

It has to be the malabsorption we have and how opiates are metabolised by the body!

  BEFORE AND AFTER LINK BELOW :)


YOUTUBE VIDEO :)
www.youtube.com/watch




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I too have noticed that pain meds don't last for me.

For heniated discs I get an injection in my back that will last 6 to 9 mos.  I take tramadol every six hours for the knees.  If I miss a dose, I'll not sleep that night.  I don't know what percocet is.

I don't know why,but I find that Vicodin (which is hydrocodone) gives me more pain relief than an equivalent dose of Percocet (which is oxycodone), so you might try switching to that.  I have found that pain meds are generally not as effective as before my RNY, but it really surprises me that you tested negative for opiates while taking Percocet.  I can understand some malabsorption, but you are talking about NO absorption which just doesn't make sense.  I take Tramadol 4x/day and then take Vicodin when the Tramadol is not enough (which is fairly frequently) for my knees, one of which needs replaced (but I am too afraid to do).

I would have a repeat drug test to verify the previous result, since NO absorption seems highly unlikely.  I have had a number of different kinds of tests be wrong, so when something seems obviously amiss, I ask them to retest and the second result always comes back differently (which makes me wonder how many of the results that seem ok might be wrong!)

Lora

Wow you too???
I thought it was just me and I haven't discussed it with my doctor because I'm afraid he'll think I'm some sort of junkie.
I am on pain meds because I have a lung nodule that's next to my pleura causing major pain. I feel as if I have to take a lot to get any sort of relief.  I will have surgery on May 22nd but until then I am on pain meds

I was recently on oxy for gall bladder pain and I did have to take them every 3 hours instead of 4 because I could feel them wearing off. I would suggest that you ask for straight oxy while you are figuring this out though because Percoset has acetaminophen and shouldn't be taken in such high doses over a long period of time. Especially when you are less than 1 year post op. Your poor liver is working over time! Also if you get the oxy without the Tylenol you can stagger Tylenol in between doses to get you through and you can't limit the Tylenol to make sure you aren't taking too much.

When I had a urine test, they did show up.  The longer you take them, the more you build a tolerance.  Maybe that's what's going on too.  I agree about the Tylenol comment.  If you're taking something on a regular basis, I'd find something without the Tylenol.  Lastly, if you have a chronic problem, there are other class 2 narcotics that come in patch form.  You will just have to weigh the tolerance issue there too.  Good luck!

 

First off, I find it strange that Percocet would hurt your stomach, there is no asprin in them unless it was percodan rather than percocet???  It is very odd that taking 40grams per day you would test negative but it is possible.

Many years ago, I was taking an antidepressant long before my WLS and it didnt seem to be working and I was taking a decent dose. So, they decided to do a blood test since that particular drug had a test to see if you are at a therapeutic level = well, I came back with nothing in my system.  So, it can happen.  I was switched to a different drug and it worked much better.

As far as the tylenol goes - if you are on the ones that I take - 10mg with 325mg of tylenol, taking 4 per day -only gives you 1300mg of tylenol which isnt anywhere near a toxic level - you can take up to 3000mg per day.  Are you taking anything else with tylenol in it?  You arent taking anymore than 2 regular strenth tylenols twice per day.  If yours have 500mg each, most doctors dont order those for that exact reason, too much tylenol - you would still be okay with 2000mg for the 4 pills bu****ch anything else you take to see if they have any tylenol in them It adds up fast.  They usually like the oxycodone with the tylenol saying it works better than without the tylenol.


I can recommend one thing that I take that is amazing and should work great for you.  It is intended for people with malabsorbtion and people with severe pain.  It is the duragesic patch - you will have to go to a pain clinic to get it.  It is made of fentanyl = stronger than percocet and you wear the patch for 72 hours and you get continual pain relief into your bloodstream.  then you get a prescription for something usually percoce for breakthrough pain  but you would have to work with your doctor for something that would work for you - maybe like Lora said - maybe Vicodan would help - I know the liquid vicodan helped me when I was post op = didnt know there was liquid percocet.  I am not sure if chewing or disolving pain meds affects the absorbtion but I would think it would get into your system faster and then wear off faster but just a guess.

My other suggestions that might help you even more long term - have you ever considered getting any injections?  I know in the knees you have tons of options - you can get synvisc or hylagen for osteoarthritis - they come in either 3 injections and now they come in a new 1 injections route for the synvisc.  they work great, you just cant be allergic to chicken products - eggs, feathers, etc.  The other options are steroid injections and these can be done in both the knees and hips.  I have had tons of these in all my joints over the 37 years.  They do wonders.    I recently had one near my hip due to bursitis and now need one in the actual hip joint.  I also had an epidural injection into my spine for herniated disc with damage to the nerve at L3-L4 where the pain down my leg has been unbearable.  Back in 2000-2003, I had 3 surgeries to both my knees and a few injections and they all worked.  I was walking so much better after that.

If after you get the injections in your hip and knees, if you are still having terrible pain and swelling - you might consider knee or hip replacement - I am not sure if you are at that place yet.  I wasnt yet.

also, make sure you arent taking any extended release medications like oxycontin -we cant absorb that at all.

I have to say you  look great and have lost a lot of weight in a short amount of time. Now it is time to  control the pain and find a pain doctor that can help you. If you are anywhere near a large teaching hospital - you might get better help there.   Good luck, I hope you can get the help you need.  Feel free to PM me anytime

rbb