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Suggest A Remedy For Persistent Pain In Left Knee Osteoarthritis
Question: I am a 63 year old female. I had a DVT in July 2014 in my left leg immediately after returning from a trip from Indiana to California. I also had a DVT in my left leg immediately
after a hysterectomy for benign uterine fibroids in 1998. Per recent X-rays. I have osteoarthritis in my left knee. I am limping to one side. This limping and knee pain started only after my 2nd DVT in my left leg. I have been to physical therapy with some success. I went on Nutrisystem and lost 75 pounds since last January 2015 (From 230 to 155. I am 5 foot 4 inches tall). My first question is: Is there any medication I can use to relieve my left knee osteoarthritis pain that will NOT interact with the Warfarin that I have been taking since July 2014 to today's date? My second question is: Since I have had 2 DVT's 16 years apart and both I guess were provoked, will I probably be on Warfarin for the rest of my life?
after a hysterectomy for benign uterine fibroids in 1998. Per recent X-rays. I have osteoarthritis in my left knee. I am limping to one side. This limping and knee pain started only after my 2nd DVT in my left leg. I have been to physical therapy with some success. I went on Nutrisystem and lost 75 pounds since last January 2015 (From 230 to 155. I am 5 foot 4 inches tall). My first question is: Is there any medication I can use to relieve my left knee osteoarthritis pain that will NOT interact with the Warfarin that I have been taking since July 2014 to today's date? My second question is: Since I have had 2 DVT's 16 years apart and both I guess were provoked, will I probably be on Warfarin for the rest of my life?
Brief Answer:
Considerations
Detailed Answer:
hello and thank you for sending the question.
First I will address the need for continued anticoagulation. I agree that both of your deep vein thromboses would be considered provoked. In light of this it may not be necessary to continue anticoagulation indefinitely. I think it would be reasonable for you to visit with eight hematologist for a consultation. The hematologist me request some genetic testing to see if you have an inherited predisposition to developing blood clots.if that work up is negative then you may discuss the possibility of discontinuing it to coagulation with close follow-up. Again this is at the discretion of your physicians and I would not change your current course event to coagulation without consulting with them.
Regarding your knee pain, unfortunately most anti-inflammatory medications are contraindicatedin the setting of warfarin use due to the risk of bleeding. I see from your profile that Tylenol seems to affect your INR. One other possibility would be the use of a medication called tramadol which can be used on an as needed basis to help control pain. I'm not sure if you have visited with an orthopedistbut that may also be a reasonable approach. Sometimes injections into the knee joint can provide durable relief for many months.
Thank you again for sending your question. Again I think it's reasonable for you to consult with a local hematologist for continued management of your anticoagulation and possible discontinuation with a laboratory workup to evaluate for possible inherited predisposition for blood clots.
Sincerely,
Dr. Galamaga
Considerations
Detailed Answer:
hello and thank you for sending the question.
First I will address the need for continued anticoagulation. I agree that both of your deep vein thromboses would be considered provoked. In light of this it may not be necessary to continue anticoagulation indefinitely. I think it would be reasonable for you to visit with eight hematologist for a consultation. The hematologist me request some genetic testing to see if you have an inherited predisposition to developing blood clots.if that work up is negative then you may discuss the possibility of discontinuing it to coagulation with close follow-up. Again this is at the discretion of your physicians and I would not change your current course event to coagulation without consulting with them.
Regarding your knee pain, unfortunately most anti-inflammatory medications are contraindicatedin the setting of warfarin use due to the risk of bleeding. I see from your profile that Tylenol seems to affect your INR. One other possibility would be the use of a medication called tramadol which can be used on an as needed basis to help control pain. I'm not sure if you have visited with an orthopedistbut that may also be a reasonable approach. Sometimes injections into the knee joint can provide durable relief for many months.
Thank you again for sending your question. Again I think it's reasonable for you to consult with a local hematologist for continued management of your anticoagulation and possible discontinuation with a laboratory workup to evaluate for possible inherited predisposition for blood clots.
Sincerely,
Dr. Galamaga
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Above answer was peer-reviewed by :
Dr. Yogesh D
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