Q: Normally I am(was) an energetic person. I do not have any habits like smoking/drinking etc. I also take very normal food without much spices. My job also invloves lot of movement and physical exertion like walking, climbing etc. Last year in the month of January, I had a left carotid stroke at the age of 37 years. Due to the stroke, I had partial paralysis on the right side of face and right hand and the speech was totally disturbed. I normal BP, blood sugar and blood cholestral. My blood was sent to Ranbaxy lab, Mumbai for analysis of C & S protein activity and both were found to be below normal which was reconfirmed by another at NIMS, Hyderabad. Since then I have been put on anticoagulants (Acitrom 2mg) for last 23 months. In addition to that since last 4 months I am taking Atocor 5mg. I am regularly checking up the PT/INR and currently they are at 26 sec/2.52. Since last 7/8 months, I have pain in my right knee. The pain was very less in the beginning, only mild aching while climbing the stairs. But it has grown rapidly and now a little bit walking also is thoroughly tiresome. In addition to that for last 3 months right elbow started aching on a little exertion. Other joints are feeling stiff sometimes. Now please let me know whether the pain in right knee and elbow has any connection to the stroke I had last year or it is due to use of mdication or it is beginning of arthritis. I will be greatly obliged if you reply.

A:The joint pain you have is not due to stroke or medicines. It is a form of arthritis. This is if the pain is only at knee and shoulder. If the entire right side is paining that is likely to be due to stroke. Recently we have found that high serum homocysteine and low Serum B12 are common in strokes in India and this is particularly so in vegetarians or occasional non veg eaters. As you have done several tests you could do serum homocysteine and serum B12 and rheumatoid arthritis (R.A.) factor test and ESR to see what type of arthritis.