PAIN KILLERS AND AF

[Desanthony]

Hello again,

starting to take apixaban has meant that I can no longer take my painkillers so my chronic back and neck pain is back with a vengeance. I also have arthritis in my knee which was being kept in check from the pain killers and exercise which I am no longer able to do so now I have a trio of chronic pain! Are ther any long term painkillers that I can take with AF please? Would it make a difference if I could take the painkiller in a different way ie suppository. I ask because I was found to be slightly anaemic and have undergone a gastroscopy and sigmoidoscopy and yesterday a CT Colonography and although at present there is no sign of bleeding I do have a small stomach ulcer and a benign polyp - which they say they are going to remove but after the effect on my body from the colon preparation. As it is benign I think I am going to pass on that one. I have had to stop taking iron tablets for the endoscopies and colonography a week before - one was cancelled so I have been off the iron tablets for 3 weeks and in the middle of that a blood test found that I was no longer anaemic. So, all in all i have only taken a months's worth of iron tablets so don't think the anaemia was that bad to be honest. For the last month since the evening after the endoscopy and sigmoidoscopy I have not been able to eat a meal without having a bowel movement and explosive wind and flatus all the time and as a consequence lost 2 stone in weight. Getting an appointment to see my GP is a huge challenge. I have had more emergency appointments than ever and really I am not an emergency but to make a routine appoitment a month from today I have to ring the surgery at 2.30 sharp on a Friday only - if you leave it until 2.40 all the routine appointments are gone and you have to wait until the following Friday to go through the same thing again. To make the phone call you are in a queue at least 8 people long and if the wait is over a certain time you get cut off and go back to the beginning so again quite often by the time you get there the appointments are taken. to take an emergency appointment you get to see practically every GP and locum - of which there are many in the practice and quite often they have not read your history and give you advice and information that contradicts everything you have been told before. I have two lots of tablets which I collected from the pharmacy and when I read the patient information leaflet I found it was either contraindicated with other medicines or conditions I have or was absolutely the wrong thing - for example I was prescribed a laxative when I was complaining about having diarrhea. I keep thinking they are trying to kill me. I know I can change GPs but I will be doing that within the next month anyway as I am moving house but I really would like help here and now. There are no walk in centres here and A&E so far have not helped as everyone I have seen there when going in about 5 times since April with AF episodes have also given contradictory advice! I really am at my wits end with this. Obviously because of the effect apixaban has on stomach ulcers I am also off apixaban now - although the endoscopy unit said I didn't need to come off them and the anticoagulant nurses said it was up to me my GP has decided to take me off them. Really I just feel like taking absolutely nothing and crashing my car into a wall to put an end to this bloomin merry go round at times.

[Bagrat]

Have you been referred to an EP or cardiologist? Hope when you move you are in the care of anotherGP practice.

All meds are a balance of what is best for you in your particular circumstances. It sounds tough as even off Apixaban your ulcer may mean some pain meds are risky. Have I got that right that you've stopped Apixaban now?

That is a lot of weight to lose. How long ago did the weight loss start. Sorry for so many questions. Am wondeting if your GP practice does telephone appts?

[Desanthony in reply to Bagrat]

Yes, I have stopped apixaban but am not really happy about that to be honest. I have seen an EP privately. He wants to see me again after all the endoscopes have been carried out. Don't know who I am now seeing on the NHS it just says referred to cardiology department with the date of the appointment will have to look the guy up - he is a locum anyway so probably only there for a year so may only see him once. The weight loss started after the gastroscopy and sigmoidoscopy I was ill from the evening after them. I have found on another forum that others have had this same thing and it seems to be aggravation caused by the laxatives and/enemas used to clear the colon. One person on the forum had been ill like this for 9 months. I think this is under reported because most people having these investigations are having it for stomach problems and don't notice much change and any change noticed is put down to whatever they are already suffering from. I was undergoing the investigations because some form of internal bleeding was thought to be the cause of my low blood count. I had no symptoms from the little ulcer that was found so everyone thought at first that it was those symptoms but weird if the first symptoms come on the evening e endoscopy. Anyway, trying to up my "friendly gut bacteria" by taking pro biotic - as suggested by GP. Hoping that helps but have already had 4 BMs this morning so between 07.30 and 10.00. I am going to have to live in a lavatory next door to a GP surgery just around the corner from a good hospital - something that we never considered in our house search. 😂😂😂😂

[Desanthony in reply to Desanthony]

Sorry boulder have said the weight loss started on the evening of June 14th this year.

[Bagrat]

I feel for you. AF is awkward but worse still when other ailments intervene. Thats a big weight loss in a month. Wonder if some of it is dehdration because of loose bowel movements. Hope you are managing to drink plenty. Wonder if GP would think it aporopriate to give meds to slow bowel down a bit too. I realise you don't have much faith in the practice though.

[Desanthony]

Yes am drinking lots and occasionally taking rehydration salts - dioralyte. GP told me some time ago that these were useless!

[eleanor--1941]

Hello Desanthony,

I am not allowed Anti Inflamatories as I am on Rivaroxaban.I refuse to take Painkillers which make me "Not With It"but I do take 8 Co-Codomol 30/500 capsule form, daily,advised to take this amount by GP,otherwise does not have effect it should have, which helps my Arthritis,Spondolothesis etc this is a great help and does not interfere with Anticoagulants,but no Alcohol alliwed,which doen't bother me,as I do not use it,

Have a word with your GP about this.Good luck and keep well.

Eleanor.x

[Desanthony in reply to eleanor--1941]

Thanks been told I can't take anything with codeine - the co part of co-dydramol or co-codamol because of the little ulcer that has been found - in fact it may even have caused the ulcer I suppose even though I was on omeprazole to try and stop this happening. Seems I can only take paracetamol these days but they do absolutely nothing really. They may take the edge off the pain but not much and not for long. 20 years ago I was on diclofenac suppositories and these were wonderful - course they are NSAIDS so no way I can take them now. Taken off them because of the fact they may cause strokes. Then put on Co-proxamol. These were not quite so good but taken off them because apparently according to a letter received from my GP it cost £500 a month tohaveme on them. I had special permission to have them as I think they were taken off prescription some time before for similar reasons to the diclofenac. Put on co-dydramol but this stopped again because of the apixaban and now this darned ulcer. This is never ending! Just hope that the lansoprazole and peptac liquid help get rid of the ulcer so that I can get back on apixaban. Would like to be able to treat one chronic condition properly. Thing is until the AF I was doing rigorous exercise which helped a lot with the pain but now I am unable to do anything but walk which only seems to work as a distraction. Do a lot of walking - spend most of my day out on the level paths can't manage hills very well and I am really slow now- luckily we have some beautiful country side around here so I can take some time to admire it.

[Tojo2020]

The risk of a significant bleed on apixaban alone is around two pre cent in the first year. See, Real-world comparison of major bleeding risk among non-valvular atrial fibrillation patients initiated on apixaban, dabigatran, rivaroxaban, or warfarin

G. Y. H. Lip et.al. The risk of a major bleed while taking both apixaban and an NSAID is around 6.5

per 100 patient years. The risk of a clinically significant bleed while on both abixaban and an NSAID is around 37.5 per 100 patient years. See, Bruce L. Davidson, et.al.

JAMA Intern Med. 2014;174(6):947-953. doi:10.1001/jamainternmed.2014.946.

I can only say that as one taking apixaban for Afib, the risk/benefit tradeoff favors apixaban. The above risk for a clinically significant bleed would be too high for me. But, if a major bleed was my only concern, I would be tempted to use the NSAID for joint pain along with apixaban. Another (analgesic), option is acetaminophen instead of an NSAID. In your case there may be other complicating factors.

I sincerely hope you get solid answers and a resolution of your very valid concerns.

[Desanthony in reply to Tojo2020]

Thanks I will look up your references.

[Desanthony in reply to Desanthony]

Acetaminophen I believe is another name for paracetmol? This is what i am on at the moment which really does nothing to the pain. At the moment I think my biggest problem is dealing with the fact that everyone is giving me contradictory advice and lack of sleep. I have sleeping tablets which don't work that well but do give me some sleep but I have been told not to take them infrequently and I take them about once every three days tonight should be a better night as I shall take one.