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Stiff and painful knee. Taking lisinopril. Getting dark and stinky urine. Lipid profile test done. Any ideas?

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Pathologist and Microbiologist
Practicing since : 2006
Answered : 6666 Questions
TC = 252
HDL = 103.4
LDL = 137

Good? Bad
Tripped over coffee table. 8-10 days ago. No fracture. No bruising. No swelling. No pain when immobile. Lateral pain only. Walking upstairs painful; walking downstairs minimally painful. Painful on palpitation, but only iin small target areas. Hurts a lot when I wake up in AM when moving it around while still in bed. Stiff for a while. Hurts a lot when I stand on it for more than 1 minute and then move. No instability. Full ROM, but not all the time, and tucking my knee up as usual on my favorite chair takes a bit of time because of pain.

Ligament? OK to wait and see? 'Thought it was becoming less painful; last 2 days, more painful.
After moving from 10mg to 20mg Lisinopril, painful, obstructive urination like cystitis. urine dark and stinky. Went back to 10mg. No more pain. Urine till dark and stinky. Switched to leftover Amlodipin 5mg. No pain. Urine still dark and stinky. Took 10 day course of leftover Cephalexin 500mg x 3/day. Urine 90% lighter and smell is faint, but still faintly malodorous. Bit like it was: light yellow, no anomolous oder I am well-hydrated. ALL 14 assays in urinalysis (for insurance policy) well within normal range. I just want my plain old light odorless urine back.
Went from 10 to 20mg luprinisol. Urine = dark and stinky. Urination = painful and obstructed. Cut back to 10mg and drank cranberry juice. Pain gone. Urine still = dark and stiinky. Switched to 5mg leftover aprinolol. Urine = much lighter and less malodorous. But not normal for me. I am well-hydrated. I just want my old effortless, light yellow, amonia-infused urine back.
Posted Tue, 22 Jan 2013 in Diabetes
Answered by Dr. Shailja Puri 3 hours later
Thanks for posting your query.

The lipid profile suggests that LDL and triglycerides are raised. LDL should be below 100 mg/dl and triglyceride (TG) level should be below 150 mg/dl.

HDL level should be above 60 mg/dl and thus HDL level is normal.

Lifestyle modification can be done to decrease the level of LDL and Triglycerides. These measures are:

1. Reduce saturated fats in diet- red meat, coconut oil, palm oil, etc
2. Taking unsaturated fats in diet in the form of omega 3 fatty acids, fish, safflower oil, sunflower, olive oil.
3. Take regular exercise, try to reduce abdominal obesity if present, try to maintain an ideal body weight according to your height.
4. Include plenty of fluids- water, soups, fresh fruit juices etc.

Consult your doctor for further management. Drugs to reduce the level of LDL and triglycerides may be required.

Secondly pain after a fall indicates a sprain or strain.

Sprain occurs due to injury to the ligament and strain is due to injury to the muscle.
An X-ray of the region is needed.
In case of sprain pain killers and immobilization for 2-3 weeks will help.
In case of strain, muscle relaxants and pain killers will be useful.
Consult your doctor for further investigations and management.

Lisinopril is not known to cause discoloration of urine or obstructed urination or cystitis.
Ensure that you have not taken any other agent which may have caused the discoloration, stinky urine, difficult & obstructive urination.

Since urinalysis is normal, urinary tract infection is ruled out.

You can get renal function tests done after consulting your doctor as lisinopril is known to interfere with renal functions.

If it does not work you need to consult your primary care physician for medication to decrease triglyceride level.

If you have more queries, I will be glad to answer.
Dr Shailja P Wahal

Above answer was peer-reviewed by
Follow-up: Stiff and painful knee. Taking lisinopril. Getting dark and stinky urine. Lipid profile test done. Any ideas? 11 hours later
Dear Dr. Wahal,

Thank you for your reply to all three of my questions. A bit more info/comment, please.

1) Elevated HDL
I am 5'3' Aand weigh 125#.
I do know that my TC should be within 140-230 mg/dL and that my 252 is elevated, but not alarmingly so. I do expect to be put on a statin in the near future, as I have not been successful at staying away from butter - however, I do turn to olive oil and avocados for my fat cravings most of the time.
I also know that my LDL is slightly elevated at 137, since it should be no nigher than 129 mg/dL. Again this does not seem to be alarmingly high to me, but should be lowered, of course.
My Tryglicerides are 54, well within the 0-149 mg/dL range.
My HDL is very high at 103.4, 2h3n it should be between 35-55 mg/dL.

Hence, my questions are really these.
1) If we use the upper range for all four indicators and compare them to my numbers, the pattern seems very skewed to me:
TC 253 vs 230 = 10% increase over normal
HDL 103.4 vs 55 = 88% increase over normal
LDL 137 vs 129 = 6% increase over normal
TG 54 vs 149 = 64% decrease below normal
Chol/HDL ratio = 2.43 (seems average)
LDL/HDL ratio = 1.32 (seems very low)

Do you often seen an HDL reading this high and a TG level this low when the TC is this high? Are these very high and low numbers offering me protection against heart disease? Is my high HDL actually offsetting the other numbers and bringing them into a safe range by way of compensation? Would the high HDL and low TG preclude the need for statins even though my TC and LDL are rather high?

I need help figuring out this pattern. A hugely elevated LDL seems odd, but is it anything to worry about? Or anything to be happy about? Same for very low TG.

My expectation is that even though these readings are numerous and varied, your training and experience can probably establish a meaningful pattern from them that is more detailed that your original one. I didn't find much in it that I did not already know. I am asking about anomalies, not generic advice/information.

I don't have a regular doctor, but am shopping (if you don't mind the term terribly). It is a very hit-or-miss process. I was raised in a family of physicians and am spoiled, I admit. But it has been hard to find anyone willing to have the kind of conversation I am trying to have with you. Do they just not know what I am asking?
What I am really wanting is for these numbers to be treated like a case study and hear what you would say to another colleague, but in layman's terms, of course.
2) Knee
What would I learn from an x-ray?
3) As I mentioned, I have been off the Lisinopril for a while now. I've been taking Amlodipine 5mg. If everything else is normal (URN PH, URN SPEC GRAV, URN CREATININE, URN GLUCOSE, URN TTL PROTEIN, URN PROTEIN?CREATININE, URN RED & WHITE COUNTS, URN HYALINE/GRANULAR CASTS, and URN BLOOD), why would my urine remain darker and more odorous than it was before all this started? I am reminded of this several times a day, of course, and would like to know if this is going to be a permanent situation or not. There must be a reason for it.
Thank you for your help. I'll not ask for more than these answers, but do, please give me more than the generic info that is common knowledge. You are the expert! I'm looking to you to provide me with your discerning medical opinion.

Sincerely yours,

Answered by Dr. Shailja Puri 11 hours later
Hello and thank you for posting your query.

I would like to know a few facts:

1. Have you got the lipid profile for the first time?
2. Were you fasting when you gave the sample for lipid profile?
3. Are you taking any medication for any other problem?

However, within this kind of lipid profile, lifestyle modification is very beneficial.

An X-ray will help the doctor to know the site of injury- soft tissue or bone and thus help to manage the pain.

Lisinopril is not the culprit in causing the symptoms of dark color urine and obstruction while passing urine. Lisinopril can affect the renal functions but a normal creatinine level rule out abnormalities of renal functions.

Medication or some chemical is the most probable cause.

Let me know the answers to my questions, for further discussion.

Dr Shailja P Wahal
Above answer was peer-reviewed by
Follow-up: Stiff and painful knee. Taking lisinopril. Getting dark and stinky urine. Lipid profile test done. Any ideas? 16 hours later
Dear Dr. Wahal,

Thank you very much for your response. Let's consider questions #2 and #3 answered.

As to question #1:
1) This is my first lipid profile in probably 5 years. I believe my TC at that time was really, really high, (in the 300s) but I have lost 35 pounds since then. It's been a while, but I remember taking a statin for a short time after that test - the cheapo approach my former Dr. insisted upon, with 2 tablets instead of just one. I stopped taking it after I fired her. So this insurance-related labwork is the first since then.
2) Yes, I was fasting when I gave the sample.
3) I am taking hydrochlorothiazide (low dose - can't remember exactly how much), Amlodipine 5 mg (both hypertension meds once a day), Wellbutrin SR 200 mg bid, Klonopin .5 mg bid, and Nuvigil 250mg in AM only. OTC = naproxin x 2 every morning and 81 mg prophylactic aspirin 1 x day.

Thanks again,

Answered by Dr. Shailja Puri 7 hours later
Thanks for getting back.

What I learn from your detailed history that you have been able to control your cholesterol levels by weight reduction and medication for a short period of time.

Since, the parameters- cholesterol and LDL are marginally elevated, you can again control them by lifestyle modification.

These life style modifications include a regular exercise (especially brisk walking and aerobics) and cutting down on high fat diets.

If you are successful in controlling these parameters by lifestyle modifications, you will not have to take medications.

After following the lifestyle modification regime for a month, get the lipid profile repeated and observe the changes if any. If there is improvement, you can continue the regime.
In case there is no improvement you will have to refer to your physician for medication.

Secondly, since you are suffering from hypertension, exercise, reduction of fats and salt will help to control your blood pressure too.

You are on psychiatric medication- for depression and for excessive somnolence; exercising will have a great deal of positive impact on your mental health too.

Write to me if you have more queries.
Dr Shailja P Wahal
Above answer was peer-reviewed by
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