medication absorbtion/ rny patient

Question
hello i had rny gastric bypass surgery in feb 2003 i have maintained my weight up until 10/08 i have gained 40 of the 100 lbs back, i injured my back in 10/08 and am on several medications, percocet, flexeril,and tramadol, i have to crush the medications in food ie yougurt, to get any relief, i was told prior to surgery that there is a problem with malabsorbtion of meds, my question is if i can absorb calories and put on weight , why am i not getting the full effect of the medicine i am taking. my family dr has referred me to a pain management dr who wants to give me steriod injections in my spine, can you shed any light on this ?

Answer
Hi Shawn:

I don't think there have been any studies done to see how malabsorption of medication may change over time--even though we know that the body does get more efficient in absorbing many nutrients as one becomes further post-op from a gastric bypass.

In general, the absorption of meds after a gastric bypass has to do with two factors...
1) The reduced acidity of the stomach
2) The shorter intestinal tract and smaller stomach area/pouch(less time to absorb a medication...especially an extended release formula)

Crushing your meds allows them to be absorbed more quickly...and thus you are not waiting on the stomach acid and stomach churning to help them break up to be absorbed.  That's why it may be helping. You can ask your doctor for liquid meds to see if that helps.  The gastric bypass may be why they are considering injections as well...that too, bypasses the stomach/intestinal issues with regards to drug delivery.  

I think it's a good idea that you're seeing a pain management specialist.  S/he should be familiar with bariatric patients and may be able to recommend some other solutions that you are comfortable with, and that will help manage your pain.  You're on some very powerful drugs, two of which can be addictive (percocet and tramadol).  Also, percocet contains acetaminophen (same ingredient as Tylenol) so be careful is you take it along with any OTC Tylenol... you could inadvertently damage your liver.  I hope your back gets better.  Hopefully with the help of your physician, a chiropractor or osteopathic physician, a physical therapist and perhaps massage therapist, you'll be feeling much better soon.

You know, even though it's been six years since your surgery, your bariatric surgery would probably willing to help your family practice doc figure out drugs which would work with your bpass.  Don't be afraid to give him/her a call...or have your PCP do so.  (Don't be afraid to contact him/her because of the weight gain either. :) )

Hope this helps,
Karla

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