Red light therapy and INR?

[The mail man]

Hello all it’s been a while since I posted here. Coming up on my 11 year anniversary of my aortic valve replacement. So here I am, 62 years old, mechanical aortic valve. INR stays within 2.5-3.5 on 2.5 mg of Coumadin. My problem is osteoarthritis pain, mostly in in my knees. Tylenol doesn’t cut it. A local rheumatologist wouldn’t even see me stating since o was on Coumadin there was nothing he could give me that wouldn’t interfere with it. Really? Since then I’ve looked in to red light therapy and it seems pretty safe but I can’t find any information in regards to if it would affect my INR. I really doubt my primary care doc would have much knowledge of this either. Anyone? I appreciate any and all replies. This arthritis pain gets the best of me at times and I need to keep working.
Thanks

 

[pellicle]

Hi

are you self testing?

because many of the drugs for this "may" interfere with INR and if the only problem is altering INR (and not something else) this can be dealt with by using the readings from your meter and finding out "what the right dose of warfarin is" for "also being on that drug" mostly routine.

My problem is osteoarthritis pain, mostly in in my knees. Tylenol doesn’t cut it. A local rheumatologist wouldn’t even see me stating since o was on Coumadin there was nothing he could give me that wouldn’t interfere with it.

Tell me what in particular (and I'll look it up). That may not ease your rhemuatologist's mind however, but if we find some data online he may respect that.

Since then I’ve looked in to red light therapy and it seems pretty safe but I can’t find any information in regards to if it would affect my INR.

I've tried this on my elbow when I have tennis elbow and I think it made a difference, but that could just be "placebo". I self administered with a red high power LED laser which is about what they use. You can try green, which can give better results but does not penetrate tissue well (because green is absorbed by all the red stuff).

There is no physical interaction between red light and anything related to INR (indeed there is no real clear pathway that shining red LED light (laser or otherwise) on your skin does anything).

HTH

 

[pellicle]

Oh ... and:

2.5-3.5 on 2.5 mg of Coumadin.

this is quite low. This study (while making inane statements) is a good guide

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370303/

Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Stable anticoagulation is defined as the time within >70% of the therapeutic range​

​

The patients were stratified according to the following age groups: ​

• <75 or ≥75 years and
• <80 or ≥80 years.

The mean daily doses of warfarin were similar for patients <75 or ≥75 years (3.34±1.71 versus 3.26±1.27 mg/day, p = 0.794) and <80 or ≥80 years (3.36±1.49 versus 3.15±1.23 mg/day, p = 0.433). In 88 (79%) patients​

​

Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed​

so IF any drug causes your INR to raise you'll be splitting pills with your 2.5mg dose.

 

[oo0My_Valve0oo]

Hello all it’s been a while since I posted here. Coming up on my 11 year anniversary of my aortic valve replacement. So here I am, 62 years old, mechanical aortic valve. INR stays within 2.5-3.5 on 2.5 mg of Coumadin. My problem is osteoarthritis pain, mostly in in my knees. Tylenol doesn’t cut it. A local rheumatologist wouldn’t even see me stating since o was on Coumadin there was nothing he could give me that wouldn’t interfere with it. Really? Since then I’ve looked in to red light therapy and it seems pretty safe but I can’t find any information in regards to if it would affect my INR. I really doubt my primary care doc would have much knowledge of this either. Anyone? I appreciate any and all replies. This arthritis pain gets the best of me at times and I need to keep working.
Thanks

Red light therapy? Many of the massage devices which offer heat have red lights that are skin to eye candy. There is so much BS spread as healthcare gets more expensive like naming some of those "Shiatsu" when they are just randomly roughing you up. If this is a real thing I'd be skeptical of the claims applied to a device which happens to have red lightbulbs.

 

[Chuck C]

Just to share my dad's experience with arthritis. He's 81 years old and started getting arthritis pain at about age 72. He started losing weight about 4 years ago and eventually lost about 30 pounds, going from about 200 to about 170 pounds, which has has more or less maintained. As he lost the weight his arthritis pain gradually went away to the point where he no longer needed medication. My dad's experience appears to be confirmed by studies. According to the Arthritis Foundation, weight loss can greatly improve arthritis symptoms. See link below.

On the other hand, I am aware that not all arthritis is weight related. My mother in law has arthritis and weight loss only helped her a little bit.

"losing one pound of weight resulted in four pounds of pressure being removed from the knees."

https://www.arthritis.org/health-we...eight-loss/weight-loss-benefits-for-arthritis

 

[pellicle]

Hi

Wow, 11 years post-aortic valve replacement, impressive!

personally I set the bar at 20 years before its anything to raise an eyebrow at

10 years is a good basic expectation, 20 years is a good run, and from a mechanical I expect "lifetime" unless something else drives reoperation.

Heck a well educated person here seems to agree with me.

https://www.valvereplacement.org/threads/foldax-continues.887783/post-923880

I suspect that surgeons have been lowering your expected "return on risk" of surgery if you don't follow that. Personally after more than 10 years of participating here I see very high levels of concern and anxiety about thir first surgery, yet somehow that translates into "I'm going to have a 2nd" and maybe make a career out of it. Usually this is to avoid what is perceived (wrongly) as the monster of "warfarin".

The next really important question is: how long do you anticipate living for? If you're 80 probably less than if you're 40.

To return to durability, this is my expectation due to results from a (now quite old) 1979 study on valves which were the "production types" way back then:

https://heart.bmj.com/content/89/7/715.short

Patients: Between 1975 and 1979, patients were randomised to receive either a Bjork-Shiley or a porcine prostheses. The mitral valve was replaced in 261 patients, the aortic in 211, and both valves in 61 patients. Follow up now averages 20 years.​

​

Results: After 20 years there was no difference in survival (Bjork-Shiley v porcine prosthesis (mean (SEM)): 25.0 (2.7)% v 22.6 (2.7)%, log rank test p = 0.39). Reoperation for valve failure was undertaken in 91 patients with porcine prostheses and in 22 with Bjork-Shiley prostheses. An analysis combining death and reoperation as end points confirmed that Bjork-Shiley patients had improved survival with the original prosthesis intact (23.5 (2.6)% v 6.7 (1.6)%, log rank test p < 0.0001); this difference became apparent after 8–10 years in patients undergoing mitral valve replacement, and after 12–14 years in those undergoing aortic valve replacement. Major bleeding was more common in Bjork-Shiley patients (40.7 (5.4)% v 27.9 (8.4)% after 20 years, p = 0.008), but there was no significant difference in major embolism or endocarditis.​

Conclusions: Survival with an intact valve is better among patients with the Bjork-Shiley spherical tilting disc prosthesis than with a porcine prosthesis but there is an attendant increased risk of bleeding.​

so with stuff now (bileaflet not single tilting disc) you'd totally expect

1. lower thrombogenicity
2. greater durability of the valve

Something else to listen to as part of "informing ones self" in the process of "Informed Patient decision"

https://www.medscape.com/viewarticle/838221

Well worth your time when considering the rest of your life.

Best Wishes

 

[The mail man]

Thanks for all the replies everyone. I weigh 180 lbs and am 6’1” . I’ve always been very active. Before my heart surgery I was at my heaviest at 237 lbs. I just physically couldn’t do a whole lot. I used to like to run. Then I started getting a sensation of a side stitch in my chest. That progressed until I got it checked and found out I had a bicuspid aortic valve. After my surgery it’s like I was energized and hadn’t slowed down since until now. Still, I suck it up and keep pushing. Since my health insurance covers 100% of my INR testing I’ve not looked into home testing but I’m up for anything to help me get through this. Maybe I’m grasping at straws with the red light thing. I don’t know. I have a red lazer on my 9mm. Guess I could give that a shot first. Lol. I just want to get back to my old self. Ever since I had that aortic valve replaced I’ve been unstoppable until now. My knees are the worst but I have it in the joints of my hands too. The severity varies and with warmer temps coming up some relief will be on the way.

 

[pellicle]

Hi

Since my health insurance covers 100% of my INR testing I’ve not looked into home testing but I’m up for anything to help me get through this.

so you go to a lab? How often? (its important).

My knees are the worst but I have it in the joints of my hands too.

so ibuprofen comes to mind (but you mentioned Tylenol doesn't cut it) I'm sure there are some other arthritis sufferers here who are also mech valvers, but to be honest your title may not see them reading this and finding what you wrote is actually about "how can I get relief from arthritis pain when I'm on warfarin".

NHS has this and all are possible if you are managing your INR properly as far as I know (and if your going through a lab properly is up for debate):

https://www.nhs.uk/conditions/osteoarthritis/treatment/

Pain relief medicines​

Your doctor will talk to you about medicines to relieve pain from osteoarthritis.​

​

Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control your pain.​

​

The type of painkiller a GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are below.​

​

Paracetamol​

If you have pain caused by osteroarthritis, your GP might suggest you consider taking paracetamol for short-term pain relief. You can buy paracetamol at supermarkets or pharmacies.​

​

However, many people find that it doesn't work very well, and it is only normally tried if you can't take other medicines.​

​

When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.​

​

Find out more about paracetamol.​

​

Non-steroidal anti-inflammatory drugs (NSAIDs)​

A GP may prescribe a non-steroidal anti-inflammatory drug (NSAID). These are painkillers that work by reducing inflammation.​

​

Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.​

​

Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.​

​

NSAID tablets may be needed if topical NSAIDs are not easing the pain. They may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or if you have had a heart attack or stroke. If you're taking low-dose aspirin, ask your GP whether you should use a NSAID.​

note: the above says "certain conditions" and the next part goes on to say "can break down" ... it does not say "will break down" and there are always ways to mitigate it. Your rheumatologist sounds like they are lazy, so you may want to change (depends how you feel about putting up with pain..

If your GP recommends or prescribes an NSAID to be taken by mouth, they'll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.​

​

Opioids​

Opioids, such as codeine, are another type of painkiller that may help relieve severe pain.​

​

GPs will only usually prescribe opioids on a short-term basis because of side effects such as drowsiness, nausea and constipation.​

​

You may be prescribed a laxative to take alongside it to prevent constipation.​

​

Capsaicin cream​

You may be prescribed capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain.​

​

Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective.​

​

Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.​

​

Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it's likely to be very painful for a few hours. However, it will not cause any damage.​

​

You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.​

 

[pellicle]

also @The mail man

as I mentioned above I did some experiments on my elbow with higher power LED laser; I said I'm not sure if it made a difference or not. So you may find this interesting

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9773374/

I'm also playing multiple threads at the same time because I'm also using glycosamine and chondroitin ... also for my knee ... because I need it for my sanity.



Even if it turns out to be placebo, that's still worth something to me

 

[tom in MO]

Hello all it’s been a while since I posted here. Coming up on my 11 year anniversary of my aortic valve replacement. So here I am, 62 years old, mechanical aortic valve. INR stays within 2.5-3.5 on 2.5 mg of Coumadin. My problem is osteoarthritis pain, mostly in in my knees. Tylenol doesn’t cut it. A local rheumatologist wouldn’t even see me stating since o was on Coumadin there was nothing he could give me that wouldn’t interfere with it. Really? Since then I’ve looked in to red light therapy and it seems pretty safe but I can’t find any information in regards to if it would affect my INR. I really doubt my primary care doc would have much knowledge of this either. Anyone? I appreciate any and all replies. This arthritis pain gets the best of me at times and I need to keep working.
Thanks

I've been told the same thing by my internist. My cardio echoed it as well. It's because NSAIDs can cause ulcers and you don't want one when you are on an anticoagulant. My cardio said I could take ibuprofen or naproxen at no more than the over the counter dose for no more than 2-months. He said to take the minimum effective dose so if it's 6/day on the label try 2 or 4/day first and see if it works. When I asked about more than 2 months, he pretty much said he can't recommend it, but it's up to me to decide how bad the pain/mobility is realizing I risk an internal bleed.

 

[Buck83]

I do 25-30 minutes of red light a day. I think it’s more of a placebo than anything. But I have cheaper, knock-off lamps. I know a lot of people that use CBD cream for pain like arthritis. May be worth a try.

 

[Protimenow]

Naproxen and ibuprofen are ALSO NSAIDs and also have an effect on platelets. I don't know if they affect platelets more or less than plain old aspirin.

FWIW - I had a rheumatologist who told me that Ketoprofen does less damage to the platelets than the other NSAIDs. It's expensive stuff, though, and is probably no harder to make than ibuprofen and naproxen. But, because it's only available by prescription, the manufacturers have us over a barrel.

 

[The mail man]

All good info. Thanks for all the replies. I go to the lab to get my INR checked once a month. That’s all I’ve done since the beginning. It’s usually within range and of not my doc will advise to lay off or take extra, whatever is needed to correct it and then I’ll recheck in a week. If I’m having a bad day I’ll take some Tylenol and it does help a little. It’s better than nothing or maybe it’s the placebo effect. If it’s really bad I have Tramadol. I use that sparingly but it does work. The red/near infrared light thing would be ideal if it’d work. The knee/ joints pain and stiffness is something I have to deal with daily so it’d be great to find something I could use long term. Pellicle, is that your SR 500? It sounds good. I’ve ridden for over forty years. I don’t ride much anymore but have an XR650L that I take for a spin once in a while. Also, how’s that glucosamine and chondroitin working out for you?

 

[pellicle]

Pellicle, is that your SR 500? It sounds good.

yep ... and that's fat old me kicking it.

Its going in for a new carby next month, I don't expect it'll change much of the note (going from a 34mm round slide to a 40mm flat slide), but should make the upper revs a little less breathless and remove some flat spots (~3 and then ~5)

Also, how’s that glucosamine and chondroitin working out for you?

Sure isn't hurting me, and perhaps things are getting better?

I'm doing it in conjunction with 20 min per day of cycling (which doesn't hurt the old cardio either).
https://www.sciencedirect.com/science/article/pii/S1063458407001604

Best Wishes

 

[Beach77]

@The mail man I have arthritis everywhere too and I'm a little bit older than you. I agree, Tylenol isn't helpful much. I highly recommend yoga; gentle or even restoration yoga. It's amazing how much it helps me! I'll tell my husband; I can't go to class because I hurt everywhere, but then I say, I HAVE to go because I hurt everywhere. I do one yoga and one gentle yoga practice a week, plus I'll do a small practice at home most days (15 to 30 mins). It helps keep the pain and stiffness in a little control. For my hands, I'll use Voltaaren Arthritis pain gel sometimes and it's pretty good. It does say on the side, not to use if on blood thinners. My GP doctor said it's fine for my hands and it does help. I have used it on my knees a few times too. Yesterday, I was told my jaw has arthritis and I was given stretching (aka yoga) exercise for my jaw. I push through the pain with yoga and that keeps me able to do the hiking and other fun things I want to do!

I'd recommend starting with gentle yoga. Congratulations on 11 years!
Ellen

​

 

[Cris N]

Sort of in line with red light therapy, does anyone have any experience using a vibration platform?

 

[3mm]

does anyone have any experience using a vibration platform?

Chris - We have a vibration platform at my gym, which I used a few years ago. I think the vibrating platform was a good tool for working on the small muscles of the legs and core. It helped develop balance. I routinely train karate, which accomplishes the same goal, so I stopped using the vibrating platform.

 

[Chuck C]

We have a vibration platform at my gym, which I used a few years ago. I think the vibrating platform was a good tool for working on the small muscles of the legs and core

The vibrating platforms do help for balance.

On the other hand, these vibrating machines do nothing. In the mid 70s I would accompany my dad to his gym and they still had one of these.