Osteoarthritis pain, AF and Warfarin

Mornin’ all,

Can I have a minute of your time, need some thoughtful comments from you talented guys and gals who may have some experience of Osteoarthritis pain (OA) and AF and Warfarin, especially MarkS and ILowe if you are lurking.

My OA pain is now beyond pain, well beyond it, sleep deprivation, unpleasant moodiness but so far no AF at all. This damn thing (OA) is beyond unbelievable. Started in right knee some 5 or 6 years ago ( easy fix - knee replacement), then to right shoulder but not very severely. Now left shoulder in three distinct locations in the shoulder and its beyond unbelievable.

My Osteopath has recommended an injection into left shoulder, my GP guardedly supports him she has ( bless her) prescribed some night time pain relief but I can’t handle the stuff due to laxative side effects. Xray coming on on 24 Sept, then heading to physiotherapy. Not really convinced that this is the go. GP is guarded because of the risk of internal bleeding in injection area due to Warfarin. So, pain relief is now down to CoCodomol 30/500.

So, Warfarin and I are bloody good buddies, I love it, it loves me. I have decided that after we have the Xray results to ask my GP for support in getting a date for an injection and 6 days before hand STOPPING Warfarin altogether, then after injection, restart Warfarin, possibly with the help of a dash of ‘bridging’ anticoagulant. I have done this twice before in order to cope with two procedures, once with a CT Scan and once for Knee Replacement surgery. Absolutely no issues. I have statistics of these two procedures to demonstrate how my INR behaves.

So, whaddya think of my scheme above ? Any thoughts would be welcome ..... don’t hold back

John

[Kaz747]

Can you take Tumeric with Warfarin? I swear by it. The pain in my knees has been relieved greatly. My knees still click every time I stand up but they don’t hurt.

[Hidden in reply to Kaz747]

Hiya Kaz,

Thanks for that. Research suggests that I cannot take either Tumeric or Curcumin while taking Warfarin. Both tend to work against the benefits of Warfarin. My GP has diplomatically suggested I might like to move from Warfarin to one of the NOAC's. I declined. If it ain't broke don't fix it.

My word, how times change, it wasn't so many years ago here in UK that you couldn't get a GP to prescribe an NOAC on account of cost ....unless you just, absolutely couldn't handle Warfarin. It was easier to pull hens teeth back in the day 😂😂

Hope you are well there in WA and staying clear of this highly intelligent CoVid. My cousin, living outside Perth ( Bridgetown ???) keeps me informed, I gather you guys are relatively clean and certainly not in the mess the Eastern States are in. Keep your border closed is the go I think.

Stay safe and thanks again for the suggestion.

John

[Kaz747 in reply to Hidden]

You fix one problem and you get another 😉. Life is pretty normal in WA. The only cases we’ve had in the last few months are returned travellers who have to undergo 2 weeks mandatory hotel quarantine. There are 3 active cases being monitored - all in quarantine. The border closure has certainly helped us. Bridgetown is about 3 hours south of Perth and is a very picturesque town.

[Hidden in reply to Kaz747]

Planning the trip Kaz although goodness knows when we can do it - unmasked !

[Kaz747 in reply to Hidden]

Well when you eventually make it over this way, make sure you look me up 😉

[Hidden in reply to Kaz747]

Hi Kaz,

Thanks for that, will certainly do that.

The plan is flying Heathrow to Perth, then train, Indian Pacific to Adelaide, then Ghan up to The Alice then fly across to N. Qld, and the road trip down the East Coast. Then back to UK.

Stay safe over there.

John

[Kaz747 in reply to Hidden]

Sounds like a great plan. Just need the world to settle down and the borders to open 😉

[Hidden in reply to Kaz747]

Yep indeed. So for a good while longer I think it'll remain just a plan ..............😊

[BobD Volunteer]

I think your strategy is good John. Your AF is rare and well controlled so your risks are extremely low.

[Hidden in reply to BobD]

Thanks for that Bob. Always comforting to get some sort of endorsement to a plan.

[MarkS]

Hi John,

I was lurking! I sympathise as I have some OA discomfort in various joints. I would classify it more as mild OA. My left shoulder is uncomfortable so I find it difficult to sleep on that side for any length of time.

It would be good to get a diagnosis of your shoulder problems. They may be due to a frozen shoulder. I've had that on both sides in the past and had an injection of a steroid and pain killer which worked well after a couple of months.

I've also had an injection of Ostenil Plus in my knee which has worked to a certain extent.

Both shoulder and knee injections were done whilst on warfarin. It's OK as long as the person doing it is experienced and does them regularly. I made sure my INR was towards the lower end of the 2-3 range.

I think my shoulder is aching as I don't do my regular exercises at the gym. The shoulder exercises were 1, holding my elbow close to my side with forearm extended, then working against the resistance first towards chest then 2, opening the other way. Then 3, holding my elbow out horizontally to the side, pulling up against resistance. Then 4, doing a sweeping motion of the whole right arm from my left hip over to about 45 deg above my right shoulder against resistance. Those are designed to improve my rotator cuff muscles (you can google these). I need to start doing these with a resistance band but I haven't had enough time!

I hope this is of some use.

Cheers

Mark

[Hidden in reply to MarkS]

Hi Mark,

Thanks for that. Yep, thats what my GP said, do it when the INR is at 2.0 and since I self test with Coagucheck and since I am at about 2.6 at the moment maybe pausing it for a couple of days would be all I need do to get it to drop. Thanks also for the rotator cuff exercise hints. I'll have a look at them as short videos on Youtube I get your drift though. At the moment down here we have nice warm sunny weather with humidity at 52% and barometric pressure at 1013mb and steady but when the crap weather blows in off the Celtic Sea and humidity gets to 95% and barometric pressure gets to 900 mb or lower then pain really kicks in. Hey ho 😑

Thanks again Mark

John

[mavisrich]

had many injections for arthritis and never had to stop warfarin. It has always been okay. They are done by the physio at the surgery and give lots of relief from pain.

[Hidden in reply to mavisrich]

Many thanks Mavisrich. How long do the benefits of the injections last in your experience?

John

[mavisrich in reply to Hidden]

Months in my case even as long as twelve in my knee. I have them when needed in my shoulders and knees and I swear by them. I am lucky with my docs surgery having their own physio. If it is offered to you I would have no hesitation in saying go right ahead. Good luck

[RobertTonkiss]

Hi John you have my sympathies. I suffer with a form of Rheumatoid Arthritis which has meant I have required joint injections from time to time especially since being on wafarin the main consideration is the anticoagulation but if your GP or the dept doing the joint injection liase with the haematology dept they should be able to come up with a plan of action. In my case it’s just meant a bit of pre and post injection planning usually involving Stopping my wafrin and being put on short acting anticoagulation like heparin or heparin analogues pre and post injection and then restarting my warfarin and having careful monitoring of my INR until stable. For me also pain relief has been more problematic as most analgesia that is effective for arthritic conditions tend to be non steroidal analgesics which are in the main are contraindicated with warfarin.

[Hidden in reply to RobertTonkiss]

Thanks Robert. Stopping Warfarin as you describe is pretty much the process I went through when I had my knee replacement. Fortunately I self test for my INR anyway so I am well able to monitor the movement in INR values. I reckon that coming off Warfarin for a couple of days or so will get my INR down to below the value of 2.0 . Anyway will chat to my GP about it. Will also need to review the X-Rays tomorrow as I am sure the pain is coming from three separate locations in the shoulder which may influence where they place the injection.😮

John

[Hatten28]

Hello, I also take warfarin and have osteoarthritis.

About eight years ago I had injections in my wrists and once in one knee.

Was advised to stop warfarin for two days prior to injections and restart the same night.

No side effects and my wrists have been much better ever since, however the knee was not so good, get terrible pain upon standing up or sitting down.

Oddly I can walk quite well on flat surfaces.

These injections were in our Docs surgery, but I think are usually done at hospital.

Good luck to you

[RobertTonkiss in reply to Hatten28]

Joint injections can be given in your GP surgery quite successfully what is needed is some extra training to A do them right and B)to correctly diagnose the cause in order to correctly place the injection, as the actual sighting of the injection even by a centimetre or 2 can make all the difference as I found out last year when I had problems with one of my shoulders it had turned out the first 2 injections into the shoulder had been to the wrong area when I was sent to another practitioner they sighted the injection into another part of the shoulder which resolved the problem practically immediately. When I asked why the change in location I was told although the shoulder pain I had been suffering was quite common and where I had been injected normally resolved matters my actual cause had meant I needed the injection in a different area of the shoulder. Also knee injections especially in osteoarthritis can be a bit hit and miss though this is only what I’ve been told by other sufferers.