Question re NSAIDs for the bilats

[SteveT]

Hi everyone,

Is this a situation people are familiar with?  Both hips have to get resurfaced at some point.  One is a little further along but both hurt.  I've been advised (by one of Dr. Su's PA's) that I'm still pretty early on and that I should use NSAIDs for as long as they control symptoms. For now they help a lot.  But surgeons recommend discontinuing them for several weeks before and at least 6 weeks after surgery (and some, it seems, recommend far longer).  What have you bilats done in that interval in between, just trudge along for several months enduring pain that you had previously been holding off?

Steve

[Pat Walter]

NSAIDS can cause bleeding and also used long term can destroy cartilage in joints.  There are many other pain relievers.  Usually they will give you narcotic type pain relief like trimodal, vicodin or percoset. They have some different ones overseas.   Tramadol is used a lot and is much more gentle than vicodin and percoset. The NSAIDS include asprin, advil, ibuprophene, meloxicam, Celebrex, Motrin, etc.  I did take advil after I left the hospital because the meds they used in Belgium made me sick.  So a lot depends on the surgeon's protocol. 

Please understand that the hospital and doctor will keep you out of pain both during the hospital stay, often with morphine and/or percoset, and then give you something to take home like tramodol or vicodin.  A lot depends on your pain levels. They don't just hang you out to dry without pain meds if you need them.

I hope that helps.  If you are worried, talk it all over with your surgeon and see what he recommends. Also many of us had cortisone shots into our hip capsules.  That will buy you more time and pain relief if the NASIDS aren't working.  They can work for a few weeks to 6 months or more.  Generally you can only get one or two of those.  So you still have several options before surgery if you hip is not too deteriorated.

Pat

[SteveT]

Hi Pat,

Sorry, let me clarify.  But first, what you said about the dangers of NSAIDs are what I had heard generally, so I was confused at the Su's PA's nonchalance about them.  I asked him about extensive use of the them at the appt and he sort of disagreed.  I found this all confusing and wonder if others might chime in on that issue.

But regarding pain relief post-op, I didn't mean the immediate need for relief from the assault of the operation; I meant, what do you do medium term, after the immediate pain has receded, about the other hip, the one that used to benefit from the verboten NSAIDs.  I guess your reference to tramadol gets at that.  I've never taken those but aren't they all narcotics?  They can't be great long-term either.

[Pat Walter]

There are a lot of pros and cons about NSAIDS.  The problem is that as we get older and have osteoarthritis, back, knee, hip and other joint problems - we need something.  I take celebrex almost everyday because my hands, back, knees etc need it, but I am 67.  What do you do, stay in pain and try to preserve your joints or get on with life and be active.

Also Tramadol is used a lot.  I was on that for a long time since I can't take NSAIDS other than Celebrex because I am on coumadin due to my new heart valve and a-fib.  I know people with heart problems that can only use narcotic type pain meds since you can't take NSAIDS on blood thinners.  Many of the pain doctors use Tramadol.  I even have it for my dogs.  It is one pain reliever that can be used on animals.  NSAIDS can't be used.

Tramadol is not a very heavy duty narcotic like Vicodin, Percoset, Morphine.  That's why it is used so much.

So you will have some pain meds if you need it as long as you need it. When you are older like I am, that could be for a long time!  LOL   A lot depends on your surgeon or family doctor as to what to prescribe.  Also depends on what other meds you are on. Some will prescribe Celebrex or NSAID while others use the light narcotic type meds.  They use a lot of different types overseas that are not available here.

You will find a solution for your pain and I hope you will still be taking it when you are 100!  :D

Pat

[John C]

Hi Steve,

My doctor said that it was okay to use Celebrex to ease my other hip, but I have read enough about it, that I only use it for a day or two on rare occasions. Mr McMinn is very much against it, because he feels that it can deteriorate the head of the femur enough that it could make resurfacing more difficult.
For myself, I use Tylenol (acetaminophen) for more regular pain control on my un-operated hip. It is not an NSAID, so it avoids some of those concerns, though of course it does have its own issues regarding the liver and kidneys with long term use.

[ScubaDuck]

I think Pritchett recommends not using NSAIDs after surgery.  Like John said I use acetaminophen occasionally for pain.  I much prefer to ice if I can instead of using anything.  It also seems that if I keep moving it helps with the pain also.

Dan

[Anniee]

Actually, I don't think Celebrex is considered an NSAID.  I currently use it, plus Tylenol to control the pain.  It does not work as well for me to control the pain as Meloxicam, but I'm getting close enough to my second surgery that I'm not allowed to take NSAID's at this point.

[Anniee]

I guess I was wrong about Celebrex not being a NSAID.  For some reason, I'm allowed to take it until I have surgery, but not other NSAID's.  I wonder why?

[Luanna]

Interesting about Celebrex. The multi-model drug cocktail that they gave me about an hour before wheeling my into surgery consisted of Celebrex, Tylenol, Oxycontin, and Gabapentin/Neurontin. It worked GREAT!

Luanna

[obxpelican]

Celebrex is a very powerful NSAID, it's in the same family as vioxx which was taken off the market about 7 or 8 years ago.  I'm told vioxx worked really well although celebrex helped me a lot, including all my other joints that are shot.  Made me feel like a 18 year old again.

What scares me are the warnings that they have for celebrex, have any of you actually read the warnings?

I do not know why but I could swear Dr. Gross and Lee said advil is ok.  I guess all doctors are different.  I still take it for my other joints not everyday, probably twice a week, especially if I am going golfing.

Most important thing is listen to your doctor.


Chuck

[Pat Walter]

Celebrez is a NSAID

Here is a quote from their website:

"What is CELEBREX?
CELEBREX is FDA approved to treat the signs and symptoms of osteoarthritis (OA) and rheumatoid arthritis (RA), and for the management of acute pain in adults.
It is a type of NSAID â€" a prescription-strength NonSteroidal Anti-Inflammatory Drug. Prescription CELEBREX has been the option for millions of patients for over 10 straight years.
CELEBREX is not a narcotic. "

Most people are told to stop taking any kind of NSAIDS including asprin and most drugs a couple weeks before their surgery.  Having NSAIDS in your body can cause additional bleeding. 

Just wanted to make sure you understood what Celebrex was.  The reason is it used so much is because it is a COX-2 inhibitor which means you don't get as much a chance of bleeding in your stomach or intestines. 

"Older NSAIDs (for example, aspirin, ibuprofen, naproxen, etc.) all act by blocking the action of both the COX-1 and COX-2 enzymes. COX-2 inhibitors selectively block the COX-2 enzyme and therefore have a lower risk of causing ulcers of the stomach or intestine."

Do a little searching on the internet and you can learn a lot of pain medicines.

Pat

[John C]

On the topic of Celebrex, another reason that Dr. Gross and others prescribe it during and right after surgery, is as a way of preventing heterotrophic bone formation (small bits of bone growing where it should not be in the soft tissue after surgery). I have a friend who is an orthopedic surgeon, who said that I should not be taking Celebrex right after the surgery, because it would inhibit bone ingrowth, however it turned out that he was not taking into account the intention regarding heterotrophic bone.

[Tin Soldier]

I just dealt with the pain between surgeries, but my right hip (no. 2) wasn't as bad as the first.  For me it was more a matter of simply reducing physical activity.  Kinda sucked, but then it was pretty obvious when I began overdoing it.  My body/hip would let me know it was going to be a few days of pain if I didn't stop now. 

Like Dan and John, acetaminophen worked great for me.   

[FlbrkMike]

I know it seems somehow politically incorrect, but I had no problem with using the narcotic pain relievers. 

My doctor gave me some oxycodone after my first surgery.  They worked better for relieving pain than any NSAIDs or acetaminophen.  By the time a couple of weeks had gone by I had reduced them to 1 or 2 at night to help me sleep.  Same thing after my second operation.  They definitely did not inhibit my recovery in any way, and they don't promote bleeding at all so there's no problem using them between surgeries.  I was back in the office in 10 days or less after both operations.  Though obviously not fully recovered, I was strong enough within three weeks of my first (LBHR) surgery to know that I would have no problems relying on my left leg to be my "good" one after the second procedure. 

I felt a little uncomfortable for a day or so after stopping them completely, but that was definitely worth the amount of relief I had gotten for about 7 weeks.  I did have to use some stool softeners, and continued my daily dose of Metamucil, but again it was well worth the inconvenience.

[jack]

For several years I took Celebrex for the pain/inflammation and it worked wonders. The trouble with prescription nsaids, is that they can have side effects that have proven to not be worth the relief that they offer for some people. Celebrex tore my insides up. I could go into some graphic details, but I will leave it at that and only say that it was pretty severe.

I know a guy in his 60's that was taking Celebrex. He went into surgery on his knee and they found him bleeding internally. They ended up removing his entire stomach and the condition was blamed on Celebrex. Wow, after this I started looking for an alternative even though it worked so well on me for pain relief.

If you are taking prescription nsaids, I urge you to keep a close eye on things and use strictly as directed. They can be nasty!

Here's a good link to some info on Sam-e
http://www.biopsychiatry.com/sameart.html

One week prior to my resurfacing surgery I was required to stop the Celebrex and that was one of the best things that could have happened to me. After surgery they gave me Indocin, another nsaid, and I continued it at home for a short time but that gave me side effects too and I had to stop it at about 8 days. From there on I had no nsaid and paid the price in pain and stiffness.

After lots of research on the internet, I bought the Sam-e and it really has helped. I feel  as good now as when I was taking Celebrex and Sam-e has no serious side effects for healthy individuals. It not only acts as an nsaid but also has mood enhancement qualities at higher doses but I have not seen any trace of that with my dosage. I am taking 400mg of Sam-e once a day now and this works for me after more than 1 1/2 years.

During my Celebrex taking I stopped it once to see if I really needed it. After 3 days I started it again. The inflamation and associated pain came right back, and again went away when I resumed the Celebrex. After taking Sam-e for 5-6 months, I performed the same test and the results were exactly the same as the Celebrex. After a couple days the pain came back and I knew without question it was working the same.

As a point of interest â€" Sam-e has been a prescription drug in the UK since 1976 according to what I have read. It is not FDA approved here in the states so it can only be sold as a supplement. There are many studies and it has a proven track record though. Do your research and use at your own risk! It’s a good idea to talk to your doctor first too.

I am sure there must be lots of people here that could benefit from this. It is a bit expensive if you have drug coverage since you will not get coverage, but for me it’s worth it at twice the price! It costs me less than $20/month, Maybe I sound like a salesman, but I’m not. I have no affiliation with anyone in the medical field, just a user, and  I wanted to share this wonderful find in hopes someone else will benefit.

I try to get Nature Made brand if I can as its touted to have one of the best quality control in manufacturing but if I cannot find a deal I get it from here-
http://www.drugstore.com/products/prod.asp?pid=227028&catid=137633&aid=337953&aparam=doctor_s_best_double_str&CAWELAID=418507870
They work equally well for me. Best of luck with whatever you choose.

[Anniee]

What I find interesting is that Celebrex, which I think is a newer drug, does not help me with my joint pain anywhere near as much as Mobic (Meloxicam), which I am not allowed to take at this point because it is so close to my next surgery.  So right now, I cannot even walk normally, especially after sitting for a while.  I hobble and feel about 200 years old.

Mike, the narcotics did help me a lot with the pain, but I do not like the side effects.  They mess with my appetite, and all I want to eat while I'm on them is unhealthy carbs like potato chips!   Also, they make me sleepy, so there is no way I could take them and still work.  However, I will take them after surgery while I really need them, because I don't like being in pain either!

[SteveT]

Thanks to all who responded.  Clearly there are options.

Steve