Dx with gastritis--can I still take NSAIDs occasionally?

Hi, @nancyjt. That is a good question about the NSAIDs, especially if you are getting to the point of needing a knee replacement and are likely experiencing pain.

Here are a couple of publications related to this topic that may be useful:

- Non-steroidal anti-inflammatory drugs and the gastrointestinal tract https://www.sciencedirect.com/science/article/pii/S1470211824033244?via%3Dihub

- Gastritis https://www.mayoclinic.org/diseases-conditions/gastritis/symptoms-causes/syc-20355807

Please note this part in particular in the Mayo Clinic article, found under the "Risk factors" subheading: Regular use of pain relievers. Pain relievers known as nonsteroidal anti-inflammatory drugs, also called NSAIDs, can cause both acute gastritis and chronic gastritis. NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, Anaprox DS). Using these pain relievers regularly or taking too much of these medicines may damage the stomach lining.

However, I'm wondering what your gastrointestinal specialist or your primary care physician suggest regarding the use of NSAIDs for you, given your particular medical situation?

@lisalucier Thanks so much for the reply. The Science Direct article was interesting.

I haven't talked to my doctors specifically about occasional use of naproxen, and I would apparently have to restart as a new patient with the GI doc in order to talk to him. Maybe the ortho PA, whom I'm seeing next week, will have some advice, as I imagine it's not an uncommon situation for arthritis patients.

Thanks again!
Nancy

@nancyjt, I have 2 cents worth.

I am working through figuring out this same thing. My primary care doc is helping me navigate starting with history he is aware of, that I should be taking aspirin. Maybe your primary care has records from your previous GI doc. They also should be able to help with possible solutions.

I also take Tylenol Arthritis 650s and fortunately have been able to cut down to 4 a day. Any other type that wasn’t an extended release didn’t work as well for me.

Do you remember is your erosions were totally healed at the time they were found? Do you have a primary doctor that could help you?

Thank you, Janell. Hmm, I wonder if the Tylenol Arthritis 650 would be better for me? I've been taking two of the 500-mg rapid release capsules three times a day (the max). Thanks for the idea--I should try the extended release!

No, the erosions weren't healed when found; I had already started cutting back the naproxen after getting the abnormal FIT results, being pretty sure I had finally done damage to my stomach. Then it was another 3 months until the EGD/colonoscopy, and the doc saw the erosions.

I think you're right, I should consult with my PCP (I finally have one again--took a year for the clinic to get a new family-medicine doc after my old one retired) about whether it's OK to take naproxen occasionally. Also maybe the ortho PA that I see next week will be familiar with patients in this situation.

Were you taking NSAIDs for a long time? Do you have erosions/symptoms? I did not have any symptoms of gastritis and was cruising along feeling smug at having taken Advil and Aleve daily for 25 years without a problem!! Would not have known otherwise if not for that FIT test. (Which I had also been doing yearly for a long time, with never an abnormal result until last year.)

I find that when I'm not on my feet too much, the knee pain is more or less tolerable (with just Tylenol). But shopping, babysitting grandkids, and yardwork--ouch!!

Nancy

You are welcome, @nancyjt. I accidentally figured out the Tylenol difference. I hope trying extended release works for you if you try it. Let me know! Maybe your ortho PA will have thoughts about this next week as well.

I take Tylenol because my body hurts, and a baby aspirin every day since 2017 related to cardiovascular disease. I’ve had digestive problems and not necessarily sure what to attribute my symptoms to. A scope this past June found erosions. Since, my PCP helped me pin down based on what we know I need to continue the aspirin. He recommended adding either PPI or Famotidine to protect my stomach from the aspirin. It is a process we’re working through and what we’re doing thus far is helping.

I’m sorry your knees hurt. Shopping is important, yard work will get away from you if you don’t do it, and well…..grandkids go without saying!

Is anything going on with your knees, or maybe your feet that would benefit from some TLC?

@jlharsh Thanks, Janell--great idea to see what the ortho PA says about the Tylenol 650 as opposed to the rapid-release.

I should ask my PCP about aspirin, too--I've been taking a baby aspirin ever since my neurologist suggested it 25 years ago (on the theory that my sudden hearing loss in one ear might have been caused by a stroke in the ear). I don't have any KNOWN CV issues except I am a migraineur (luckily no headaches), which itself is a risk for stroke. But a good idea to revisit the aspirin with my PCP.

Oh yes, my knees are both bone-on-bone, and I can get a knee replacement (for the worst one) anytime I want (I'm 68). But it's a long and very painful recovery, and I just don't feel ready yet, which is why I hope to postpone it while being able to use Aleve occasionally when I really hurt.

I also have all-over aching from presumably fibromyalgia, which is why I started taking the painkillers to be begin with, 25-30 years ago, but the Tylenol usually takes care of that OK. But my daily life was so much better with Aleve!! Better sleep, better energy, clearer head. I miss it.

Thanks for your thoughts and sharing your experience!

Nancy

@jlharsh Do you have fibromyalgia, or what causes your pain?

@nancyjt, excellent question. The short answer is yes. Long answer….I am not sure what is happening. I was diagnosed with fibromyalgia 11-12 years ago at Mayo Clinic. They are the ones that have consistently told me 4,000 Tylenol daily is fine, stay away from NSAIDs.

I had originally gone to Mayo MN because my life-long cholesterol had shot up without any known trigger and I had some pain that went along with it. One step we took was discontinuing statins thinking they were the root cause, but pain continued. We waited and tried each new drug as they came out and once I was out of options I was referred closer to home for an every-other-week diaslysis-like process (LDL apheresis) to clean LDL cholesterol out of my blood.

I hit a circulation crisis a few years ago and ended up back at Mayo Clinic. They told me they knew what was happening but were not sure what to do about it. They told me I did not currently fit the criteria for fibro. Their approach would be to protect my heart, then address one symptom at a time. That is what we’ve done. They tell me what to do, I do it and improve. I eventually was able to get off the blood treatments and my cholesterol is better controlled than ever. I have been taking 4 drugs to treat my cholesterol, a couple I had said, “never again” yet here I am taking them.

I have a new PCP that is going back to basics so to speak. In addition to addressing the aspirin discussed above, he also recommended Cymbalta for muscle pain. It is helping. We are back to talking about fibromyalgia in the mix. So….I am not really sure. 🤔

I checked out your profile and found a comment you made about trigeminal neuralgia. This caught my attention because I had an ER visit earlier this year with mouth and face pain.

I wish I didn’t know what trigeminal neuralgia is. What is your experience with it, and is it resolved?

Hi Janell--wow, you have had quite a journey--LDL apheresis does not sound fun! My cholesterol shot up at menopause, which my internist at the time said was common, but thankfully it got back to normal with one pill, a statin, which I continue taking 20 years later. However, my sister-in-law had (or still has?) extremely high cholesterol and I don't think they know why (genetics?). I'm glad you have got better control of it. Scary!!

Glad the Cymbalta is helping you. My mother had a terrible case of fibro, suffered most of her life, had to take oxycodone in the end, but then--mirabile dictu!--they put her on Effexor and she did not have to take the heavy-duty pain pills anymore. Those neurotransmitter modulators (or whatever they're called) can be really helpful for certain types of pain.

I don't actually have a fibro diagnosis, though a rheumatologist I once saw vaguely mentioned "central sensitization," which is basically what fibro is, as I understand it. I believe mine was triggered not by trauma (which I've never had) but by years of irregular sleep patterns when I was doing freelance copyediting and was ALWAYS behind, so staying up late, getting up early, etc. That's when I remember I started having the Tylenol bottle by my desk for weeks at a time (in the early 1990s), then it would get better, then worse...and by the early 2000s I was taking Advil as well, though not max doses of anything til later. Arthritis + fibro--you need 'em for one or the other or both!

It sounds like your new PCP is taking things seriously; I hope you will feel better soon.

What did they say at the ER (or elsewhere) about your mouth and face pain? I was never actually diagnosed with TN, but I know that's what it was. In late spring of 1999 I was sitting at the computer minding my own business when I began getting excruciating lightning-bolt shocks under my ears, but they went away after a few weeks of randomly appearing now and then, so I didn't see a doctor at that time. The rest of that year I had one thing after another--lost the hearing in one ear when I sneezed, got dizzier (compared to my longtime low-level unexplained dizziness, which I later realized was vestibular migraine), and then in September of that year started having little tingly shocks above and below my left eye which soon went all the way around the outside of my eye, then into the side of my nose and upper lip, plus shocks on the right side too. The first time I saw a diagram of the trigeminal nerve, months later, I recognized it immediately--"that's my shocks!!" A year later a neurologist specializing in dizziness and hearing loss essentially told me I had MS, but I never got a diagnosis. But I know that's what I have--luckily a very mild case, still functional except I can't walk or stand for any length of time anymore. Since I did not have MS lesions seen on my brain (last MRI in 2011) and they could not get spinal fluid out of me, and my neuro exam is mostly normal, they say I don't have it--but I do. My lack of muscle stamina worries me with respect to how I'll recover from a knee replacement, which I will probably have to have since I can't ruin my stomach by continuing to take NSAIDs.... too many interlocking complications! But I still feel lucky, because I know a LOT of people are MUCH worse off with all these things.

Re the face shocks, I still get them occasionally, but it was only that first batch that were painful, and occasional painful ones after that for a few months, but then they became simply electrical shocks with somehow no pain (thank goodness). Grateful for that. Same with my Lhermitte's (buzzing or vibrating sensations in my legs when I bend my head down)--it's not painful, just electrical in nature, or vibrating. Very weird. Another MS symptom, no other explanation for it has ever been offered.

I did have a highly abnormal ABR (auditory brainstem response) test in 2000, so the neurologist put "cranial neuropathy" in his notes (did not say it to my face). So I have multiple cranial-nerve symptoms--the 8th nerve (hearing/balance), 5th nerve (facial sensation--TN), and I believe I also have some 7th-nerve issues with episodes of left ear-clicking with strong pain behind the ear, and thumping in my right ear when, say, pulling a weed with my left hand, left-side BPPV with right-side ear-thumping, etc. VERY weird stuff and no explanation. I think it's due to MS, though no one will even acknowledge these symptoms, much less try to explain them. I gave up!! Sorry for the long rant.

So what was your face pain like, and is it continuing? Did they give you anything for it?

Also, do you find your muscle aching is better when you get sufficient good sleep? That's definitely the case for me--another reason I think it's fibro.

Balancing the pros and cons of knee replacement sounds tricky. I just listened to a podcast about maintaining healthy joints that you may find helpful. A transcript version is also available to either listen to or read online.
- Aging Forward podcast episode: https://podcasts.apple.com/us/podcast/mayo-clinic-aging-forward/id1742273984?i=1000727343930
- Episode transcript online: https://mcpress.mayoclinic.org/healthy-aging/maintaining-healthy-joints-and-feet-from-the-ground-up/

I hope you find this information helpful, @nancyjt. I am interested to know what you think after listening.

Bone-on-bone knees sounds difficult. I understand why you want to be intentional to gain as much strength as you can and get your pain under control before considering replacing. Would you have both knees done at the same time?