My knee has some serious inflammation going on...as well as back...from lifting too many bags of manure for the garden and twisting my knee as well...ligamets are swollen and hard to walk. Normally a three day run with an anti-inflammatory corrects the inflammation but being on a NOAC prevents this from being the case and nothing has improved. Doc says take Tylenol (and it is a VERY weak anti-inflammatory) but other than reduce the pain somewhat, does NOTHING for my back or knee. I was thinking of going off the NOAC for a few days, then the anti-inflammatory until my back/knee are healed. I am not in afib and haven't been since one in 2005 and another in 2007, but burden in afibs is not considered when dosing out the blood thinners...I am over 65 now so I get another point on CHADS. This is compromising my QOL as I am active senior citizen and my heart is and has been behaving well (except for one incident of frequent premature atrial complexes earlier this year), my bp is excellent, my lipids are excellent, my heart rate is excellent (never went up with the PACs either) and the only time it did go up is when I had a big rectal bleed from the NOAC a month ago (colonoscopy was clean). So, I am wondering, if nothing else, about a WATCHMAN device or other occlusion device to get off the NOACs or am I considered such low risk they would not consider this option? Anyone here have this device?
Two things: Warfarin VS NOAC and what... - Atrial Fibrillati...
Two things: Warfarin VS NOAC and what do you do when you get an injury and can't take an anti-inflammatory?
From your use of the word tylenol I'm guessing you are in USA and watchman may well be available at a price. Here in UK it is reserved for very rare cases of people unable to take anticoagulants due to bleed risks. Not sure I would want to go that route myself but each to their own. Switching anticoagulants just for pain relief seems a bit drastic as well to me and I really think you need to discuss these matters with your doctor.
I think I will go off my NOAC for a bit, take the ibuprofen, hope it helps my knee issue then go back on after ibuprofen is out of my system. I am not in active afib. The occlusion devices are also in Canada and covered....but, yes, I think they are reserved for people who cannot take the anticoagulants. For pain, my doc says tylenol but that doesn't address the inflammation. Getting a stress test next week and hope my knee is ok by then as I need know what is or isn't going on. My doctor also said he can't tell if I am in afib or not just by listening with his stethoscope....anyone hear that said?
My aunt has similar issues. She can not take Anticoagulants. Instead she takes an aspirin a day. She is not in the best of health. It’s not the best thing but due to her not having a kidney, spinal stenosis, diabetes, etc-she can only take aspirin. She also takes pain medication prescribed by her doctor. Her pain is so bad that she has to have something. She won’t consider marijuana but it is an option I suppose.
For back pain I use a TENS machine with paracetamol and its always worked.
With knee pain is not quite so easy to find the sweet spot to use the TENS.
So I use PainAway and keep trying with the TENS - but not always successful
as its more likely bone on bone thats the irritant.
painaway.com.au/main/pain-a...
must be some US manufacturers that use arnica since its an American herb.
I am on Riveroxyban and last year had a full knee replacement followed a month later by an inguinal and testicular hernia which all burst after surgery so had some pain. I was simply told to take what pain relief I needed, the Riveroxyban was only stopped for a couple of days pre op, not so I could take pain killers
Whatever happened to Ice, Elevation and Rest - until recovered? Arnica gel is at least as good as Anti-inflammatory gels and there is no conflict using gels anyway. Inflammation is there for a reason - to stop you using the knee until healed!
Madness to me - considering a Watchman device just to be able to take anti-inflammatory drugs - which are prescription only drugs in some European countries - with good reason. Many side effects, and I worked for a company that developed these anti-inflammatory drugs - for a very short while!
Unless I completely misunderstood the jist of the post?
When I had my last lone afib 11 years ago, my heart was good enough for an ablation but I preferred to wait for another one before going that route. It never happened. At least yet. As a general rule, I stay on aleve for 3 days and inflammations go away (also included in the elevation, etc which I have been doing to no avail). I tried the Volteran 10% prescription gel...to no avail...and the back of my knee started to swell. I don't think it is a bone problem but more a ligament one. The Watchman device would be for not having to take blood thinners again, not just for taking anti inflammatories which do bother me after about three days use despite the H2 blocker. All of the anti-inflammatories bother me, my stomach that is, and the H2 blocker doesn't prevent the grinding feeling from aspirins, heparin (after afib) nor these blood thinners. Given I have several risk factors for bleeding (and had a significant one with the NOAC and my kidney function took a dive) including diverticulosis, previous h. pylori infection, taking an SSNR, being on tamoxifen, I am nervous...now doctor wants to add a PPI (proton pump inhibitor) which long term use can affect the heart...I am getting prescriptions upon prescriptions and not happy...and also a tricyclic antidepressant, which can have reactions with the SSNR. He didn't even write up a requisition for x-raying my knee! In short, I am between a rock and a hard place, trying to figure out a solution. I cannot fully trust doctors as they nearly killed my sister (she has terminal breast cancer in her spine which they diagnosed as muscle spasms even when I asked them to check for breast cancer since I had it), killed my Dad by not doing a simple operation to take a very curable cancer off his ear and he died from a huge fungating tumour on his face....nothing like talking to your Dad and his ear lobe falls off. Even my own breast cancer wasn't attended to early enough....architectual distortion on mammogram means nothing except what I read in oncology journals, it almost always indicate an occult tumour.....a few years later, guess what....in exact same area, breast cancer. So, it may seem I am "playing doctor" but I do reference good sources. My GP is even back-peddling on his afib diagnosis because the cardiologist who will be doing my stress test noticed that emergency had my heartbeat as PACs. He said, doctors can't tell an afib with a stethoscope. I watch Dr. Sanjay Gupta and he demonstrated how you can figure out your own heartbeat with your pulse and even from that, I knew it was a bigemy PAC......I already know what an Afib feels like....so yes, I keep reading the cardiac journals and heart-related journals to get my information. If I were in active fibbing, I would NOT stop the blood thinner for 4 days. My doctor couldn't even remember why he prescribed a calcium channel blocker...and why I quit that one.....because my pulse went down to 40 and it was NEVER over 100 (88) and then he said he'd never would have prescribed it for an 88 pulse. The only reason it was 88 is because he told me I was in atrial fibrillation. My pulse went up to 121 in emerge from the fear after the bleed, but no atrial fibrillation going on. My surgeon suggested I go to an arrhythmia clinic in Vancouver to get it all sorted out (I live in a small city). I agree, actually. So we will see when I go for my stress test and perhaps figure out a way to get a new GP. I want to be able to walk again (never had any knee problems before this)
Oh what a tale - I do sympathize - and share your frustration regarding script upon script without good reason. I have to say I am moving more and more toward Functional Medicine and returning to using food as medicine - whenever possible. I am currently fighting inflammation of the lung and I was delighted when my GP did NOT offer a drug - but she is also a Functional Medicine Doctor.
I was reading today an article about side effects of Tylenol and not sure I would want to take it, I certainly refused PPI’s which seem to be prescribed for everything? I just don’t understand why some doctors keep prescribing drugs to control side effects - unless in a life threatening situation.
Having read Carneuny’s reply below - I tend to agree - I would focus on the knee if that is the principle ailment and your arrythmias are not currently of primary concern.
The recommendations regarding anti-coagulation seem to vary from country to country, personally, although I hate taking it I am reconciled to taking Apixaban as a reasonable prophylactic against stroke - but I do have quite a few episodes of AF & other arrythmias every month.
Hope you find some answers.
Where did you have a bleed? Did you know tricyclics can cause rapid heartbeat?
The swelling behind the knee suggests a tendon or ligament problem. Have you ever been treated with a fluoroquinolones antibiotic such as Cipro or Levaquin? These can cause delayed tendon and ligament problems permanently weakening them so that it is easier to injure them. They can also cause heart arrythmias.
A TENS machine is a good non drug way to deal with pain. I use a PEMF device for tendonitis which works quite well.
Well my take on your post is do not deliberately, or inadvertently, avoid the fact that your knee issues are most likely to be attributed to osteoarthritis. That being my guess I wonder if you have had any/many x-Rays on your knee, or even an MRI.
Your opening two lines says it all. Osteoarthritis will worsen over time and eventually without surgical intervention your QOL will disappear - that is you won't have any ! Eventually, anti-infammatories will cease to work. In any event, these are only ever a stop gap - they avoid dealing with the real issue ! That is the source of the pain and don't confuse that with the cause of the pain. I know that's splitting hairs 
My view is if your AF is reasonably well controlled then forget it and focus on your knee. You may need to consult an Orthopaedic surgeon and have an assessment of your knee with a view to having a total or partial knee replacement. Once the knee is sorted your will have a significantly better QOL and will be better able to deal with the ravages of AF.
I damaged my right knee in my teenage years during sporting events. I remained clear of problems till in my early 50's when out walking one day I stumbled and tore my right knee cartilage. My surgeon at the time cleaned up the damage but observed he found the early onset of Osteoarthritis.
At 65 I was diagnosed with paroxysmal AF.
At 63 plus some I developed increasing pain in the right knee and the right Sacrilliac Joint, all this worsened despite chiropractic treatment and osteopathic treatment until the age of 70 my right knee was totally stuffed with osteoarthritis and the femur and tibia were bone on bone and out of alignment. I could hardly walk.
I had a partial knee replacement and realignment of the femur and tibia at the age of 71 and haven't looked back. I am now 73 and still working driving buses in the tourist industry and enjoy trips out walking and covering up to 4 miles a day, daily is common.
I am on Warfarin for life (Coumadin if you are in USA) and this was no problem before, during and after knee surgery at all.
So as I say, deal with the knee first, get it sorted and then work on the AF.
May the force be with you.
John
Thank you.
I am no expert but some people in here have said you can use the anti inflammatory gel. Maybe worth checking out.
I'm over 65 now and I have mild osteoarthritis in my knees. An X-ray showed reduction in the knee gap. Rather than go for an operation, I opted for an injection of Ostenil-Plus, which is based on sodium hyaluronate. This is very similar to the natural knee synovial fluid. It increases the gap allowing the knee to move freely without pain.
I had my first injection 18m ago in both knees. Then a second one about 4 months ago. They've worked well for me. I still get a little discomfort but I can walk, run, cycle, sail, etc.
I would stress this is for less severe osteoarthritis where the joint is still quite functional. Also you would need to religiously carry out knee exercises to build up the supporting muscles.
I continued on warfarin without a break.
I am 78 and have AF but no other factors so score only 1 or 2 on the scale you mention
I took warfarin for some years but my doctor found I was only on target 40% or less of time hence change to NOAC Xarello 2.5mg Easier to take but I have not suffered anything worse than 2 minor nosebleeds -treated ok with packing nose with cotton wool for a few hours. I fear suffering a greater cut but nothing yet!
It is possible that warfarin causes hair loss in some people -possibly so in my case but at 78 perhaps a degree (or more!) of hair loss is not surprising
I guess you get the lower dose because of your age? There are two CHADs scores as well....the newer one has more conditions...on the older one, I had 1 for hypertension, but the new one dropped the age to 65 (1 point) and being female (1 point) so now I am a 3. So have about a 3.6% risk of stroke each year. Have a 1% risk of cancer coming back every year too...cumulative....UGH.....
I have been on Warfarin for many years and appear to be one of the lucky ones whose INR is pretty consistently on target. As a 74 year old woodworker I do get pain in my thumbs and wrists from over use. What I have found is that the pain varies from day to day. On really bad days I will take paracetamol and either ibuprofen orally or Voltarol applied locally - never both!!! The pain normally eases after a day or two so that I come off the NSAIDs. I avoid using the stuff day after day because of the danger of internal bleeding. As for your knees sdalen, you may need to consider knee replacements. I have two and, as it happens, a hip as well. One knee and the hip were carried out whilst on Warfarin although I was told to taper the dosage in the run up to the procedures. They have ways of making your blood coagulate after the operation if they need to do so (no pun intended). Keep moving, as you appear to be doing.
My knee only has swollen tendon/ligaments from twisting it. I know exactly where the painful area is, soft tissue injury. I remember breaking my leg a few years ago and my bone snapped cleanly; my sister and cousin broke theirs, all went to splinters so needed a rod. I think my bones are pretty good and I have walked for years! But lifting and throwing 20 pound manure/soil bags off the truck (and there were lots of them) had an effect! Gardening is hard work and harder as one ages!
I found that, unfortunately, tendons and ligaments tend to take a lot longer to heal than bones.
Have you thought of consulting a really good sports therapist? My grandson is an elite athelete and has occasional injuries which seem to heal quite well with treatments such as laser treatment, needling etc.
I had bad pain from spinal problems and had to stop NSAIDS. I have accupuncture once a week for 3 years. Keeps pain down to bearable so I dot need to take anything else.
Hi, My doctor told me that Voltarol gel can be applied externally to inflamed joints, in my case my foot, although I am on Riveraxoban blood thinner. So I presume you could use it for your knee. Another thing which my husband has used successfully on his knee is something called Flexiseq. It is a gel too, but not an anti- inflammatory, so can be used externally. I have found that ice packs help my back when it's bad through gardening, not pleasant but ok if you limit it to 5 minutes at a time. Hope this helps!
Hi sdalen. I am in permanent afib and doing very well. I chose to have an ablation and a pacemaker in 2016 as had many uncomfortable side effects from various drugs. Both these procedures have worked out well for me and in January of this year had a Watchman procedure as I wanted off of coumadin and anticoagulants in general. I will be happy to share any info that will help you. Please feel free to PM me anytime. I have written ad nauseam about my Watchman on this forum and don't want to bore people any more than necessary hence the PM. LOL. I am happy I did it. I'm a retired nurse in the US and the one thing I really hate is taking so many drugs. Now I am off all cardiac meds, lost weight and got off insulin and take only 3 meds now plus occasional alprazolam for anxiety. I feel good re a-fib and am 74. Happy to help at any time. Take care. irina
BTW (irina again). I have knee problems I have to begin dealing with. I plan to soon-am already under the care of a good orthopod. But first I want to get my thyroid inshape as I have(make that had!) a PCP/GP who has delivered substandard thyroid care for 2 years. Now have a good endo and am on the upswing so soon will tackle the knees. I like to work on getting oneproblem at a time in working order if possible, This works for me. So-Afib fine, thyroid-a work in progress and knees-soon.🐱 irina
I hurt my back last week as I fell in the bathroom! So I’ve had to take strong co-codamol but trying not to take too many mainly 2 a day at bedtime. Hope you get well soon.
Post Ablation
What ! is the brief of the anticoagulent clinic is respect of NOAC (Apixaban) ????
Taking part in Watchman trial to establish if it’s safe to come off anti-coagulants like Apixaban
No Afib since starting Ivermectin prophylaxis
Using the Alivecor Kardia Mobile post ablation
