Blood thinners

[Beartown]

With respect, patients having discussions of this sort can be a way we learn about what questions to ask our medical professionals. We know it's the Internet and full of crap and we learn how to filter the crap.

As you know, doctors have limited time to spend with their patients. Doctors are also often wrong. On the flip side, it could be considered reckless for a patient just to trust their doctor. At least get a second opinion, and third... you'll be surprised how different the answers may be.

There are a lot of smart people on forums like this. Their experience can be exceedingly helpful, especially when it comes to details like how skiing might impact one's medical condition. They have lived it.

Slowtwitch, for example, is a triathlon forum that has a culture of constructive medical discussions in which a good number of smarts docs participate. I would prefer to see replicated here rather than just shutting down conversations with the standard "ask your medical professional."

@fatbob here's a search on Slowtwitch showing conversations about Eliquis that might be helpful:
http://forum.slowtwitch.com/forum/?...search_type=AND&search_string=Eliquis&search=

There is a difference between experience and advice. I find others' experiences very helpful to provide context and consideration, as well as allowing one to see outside their own "box" and be presented with alternatives they may not have considered. For example, @Grizzly777 above provided an experience that others may wish to look into (hopefully under medical direction). The reason we seek expert opinion (from a doctor, boot fitter, car mechanic, whatever) is for both their training and experience. Experts have seen many many different conditions/situations and how those situations have played out. Whereas "internet rando" usually has their own experience to swear by and preach about (n=1), an expert will have seen hundreds or thousands or more cases with all types of variables. The difference between car or boot advice and medical advice is that car or boot advice rarely has the potential for severe harm or death attached. I am not the internet police. I have shared my opinion, and that is all I can do. To each her own, and buyer beware.

 

[Beartown]

OK in my serious font.. Do you think you're not at risk of a brain bleed problem if your INR is under 3? @Beartown and @SkiNurse is the risk mostly related to elevated INR instead of it being in the normal range.. i.e. if they have over thinned? Just wondering if the risk is patient or med error more than simply being on the product when it's actually dialed in right?? I was under the impression that even dialed in right 2-3 range, natural clotting is still impaired when using the product correctly.

I would again defer to your physician on this one, but a layperson explanation of blood thinners provides the answer.
-why do people require blood thinners? because they have some propensity toward non-physiologic clot development, either mechanical or metabolic.
-what do blood thinners do? very complicated at a micro level, but at a macro level they decrease the body's ability to produce clot.
-Because the clotting cascade is very complex and each individual blood thinner type only affects certain parts of the system, it's basically impossible to treat someone back to a completely normal level of clotting
-because all of the reasons for being on blood thinners (history or risk of DVT, PE, stroke, heart attack, etc) is pretty serious, the therapeutic goal of treatment is to have the blood "on the thin side". An INR of 2-3 is very much "on the thin side". I have personally taken care of many people with therapeutic INR levels who had subdural hematomas (requiring operative intervention) related to minor, standing level falls at home (tripping over dog leash/coffee table/etc). Most elective surgery would be cancelled for an INR greater than 1.5-1.6 and would basically never be performed with an INR >2.

So, the reason physicians would generally not advise doing "risky" sports with a therapeutic INR is because there is a real risk of injury (from bumps/bruises to fatal hemorrhage). It's not because they're trying to ruin your life. Everything we do in life requires a personal risk/benefit analysis. Only you (with the appropriate information provided from experts and others' experiences) can make the value judgement about what is right for you.

 

[crgildart]

It would seem that any decision to take that risk should be accompanied by the BEST helmet available. My wife's INR went sky high right before my father's 2006 funeral across the country. We had planned to drive to KY to be at the services but had to wait until the level came back down. They suggested she stay at home, take it easy, and wear a helmet until the levels went down. I was able to get the family there the day after the services... and he had a 2nd service with the burial at Arlington everyone was able to make together.

Anyway, if someone is going to ski anyway, would be double dumb to not wear a good helmet IMHO..

 

[fatbob]

With respect, patients having discussions of this sort can be a way we learn about what questions to ask our medical professionals. We know it's the Internet and full of crap and we learn how to filter the crap.

As you know, doctors have limited time to spend with their patients. Doctors are also often wrong. On the flip side, it could be considered reckless for a patient just to trust their doctor. At least get a second opinion, and third... you'll be surprised how different the answers may be.

There are a lot of smart people on forums like this. Their experience can be exceedingly helpful, especially when it comes to details like how skiing might impact one's medical condition. They have lived it.

Thanks for this which expressed my opinion better than I could. While I understand @Beartown's position it does come across a bit as "these things can only be discussed on the clock with one's own physician" - while it is effectively from a personal risk mgt perspective for docs it hardly encourages ordinary citizens to research widely in order to make informed decisions. Plus if we are investigating things for family members we may not be at the actual consults etc etc.

I find it hugely problematic - people are going on meds to save them from one thing but then facing huge lifestyle consequences from that treatment.

 

[crgildart]

I find it hugely problematic - people are going on meds to save them from one thing but then facing huge lifestyle consequences from that treatment.

I can relate. Mrs crgildart can't even ride a roller coaster without putting herself at risk for a huge and potentially fatal disaster should her head snap too far in any direction and smack the side of the car or head rest. She doesn't like to go on ski trips (or hiking and camping) where she's stuck sitting in the lodge... especially if there is no good free wifi there. We did have fun at Yellowstone last summer where she did hike the easy stuff. We hike easy stuff around here 2-3 times a week but that's about it for her regular exercise other than shopping.

Granted though she did go on a couple short weekend ski trips to do the lodge mom duties when the kids were too small for me to take out both at the same time or ski on their own solo.. Now she just opts out and stays home unless there is another tourist attraction she can go check out while we're skiing.

 

[Posaune]

[QUOTE="fatbob, post: 171841, member: 59"

I find it hugely problematic - people are going on meds to save them from one thing but then facing huge lifestyle consequences from that treatment.[/QUOTE]

It's a lot better than death, which is what most of us were faced with if we didn't do it.

 

[John Webb]

With the username MDSKIER, I thought you were a doctor yourself, John. Either that or from Maryland...

from Maryland. Now Lake Tahoe, CA

 

[John Webb]

nil

 

[crgildart]

[QUOTE="fatbob, post: 171841, member: 59"

I find it hugely problematic - people are going on meds to save them from one thing but then facing huge lifestyle consequences from that treatment

It's a lot better than death, which is what most of us were faced with if we didn't do it.

Agreed, in the same diagnosis and regimen my wife does I'd still ski... with a better helmet. Probably stay out of the terrain park although I've ventured in there less and less post age 50 anyway. I'd still skateboard cruising hills and a mini ramp, again with a better helmet.

I wouldn't be trying to learn anything new with similar risk though. I'd only stick to things I have a lot of experience doing and know my limits, staying more within those limits knowing the penalty for smacking my head or a deep laceration is much higher, possibly ultimate..

 

[MountainMonster]

I'm on thinners from a heart attack 2015, took what I consider a minor fall this past tues. I woke up wed. to swelling and a large bruise, left butt cheek, the swelling , bruising , & pain have increased daily , Im in a hospital waiting room after a CAT scan as I type, they think I broke some blood vessels, & continue to bleed inside.
Here is a lovely pic from yesterday, the bruise has grow some since.
I don't know if mods will allow pic, it's medical after all.....

Will follow up if I survive this ass bruise.......

 

[newboots]

OMG! I hope you are okay! Keep us posted.

 

[pchewn]

Fair points but I asked here for 3 reasons:

1 being pretty sure that there would be some people here who participated in skiing despite being on anti coags

2 The teensy problem of asking your physician being official medical advice which might then void insurance cover if breached.

3 Physicians tending toward the conservative in their advice.

The lack of reversibility does concern me about the modern anti coags. An otherwise minor car accident or a simple slip and fall could have vastly worse consequences.

Concerning your item #2 above: I know of no insurance that will deny coverage if you do things outside of a doctor's advice. In fact, most insurance will cover drug abuse treatment, alcoholics, smokers ....... all of these are against medical advice.

So I'm not sure that item #2 is a valid concern.

 

[pchewn]

@MountainMonster : THAT's a good reason not to ski while on blood thinners. I hope that can be treated somehow!

 

[Fuller]

That's an ass whuppin for sure! Hope there's no complications for you.

I was able to drop all my blood thinners last month - and very glad of it, My ass is too nice to survive a bruise like that!

 

[Mothertucker]

I'm on thinners from a heart attack 2015, took what I consider a minor fall this past tues. I woke up wed. to swelling and a large bruise, left butt cheek, the swelling , bruising , & pain have increased daily , Im in a hospital waiting room after a CAT scan as I type, they think I broke some blood vessels, & continue to bleed inside.
Here is a lovely pic from yesterday, the bruise has grow some since.
I don't know if mods will allow pic, it's medical after all..... View attachment 39290

Will follow up if I survive this ass bruise.......

They may have to amputate. Major MOAC points for that one!

 

[MountainMonster]

They may have to amputate. Major MOAC points for that one!

The ego bruise was worse, right under the chair !!

 

[Sibhusky]

Asking for a family member

I know the standard medical advice re anti coagulants avoid activities which may need to cuts, bruising or head injuries so skiing is under conservative advice not recommended.

However there is also the issue of quality of life if someone is potentially going to on the medication for an extended or even lifelong period - long time to go without riding a bike, taking a hike on rough ground or mountains or skiing. Think it's clealry logical to avoid sports like hockey, rugby etc. Any experiences of managing? Anti-coag in this case is Eliquis (apixaban).

Major concern I guess is cranial bleeds which make things like concussions higher orders of severity. Plus modern anti-coags seem less easily reversible than a shot of Vit K on the old rat poison.

I skied Friday fine. Came home and slipped and fell inside the kennels (no ice involved), slammed my head on the concrete hard. Went to the ER, and over the course of things saw four different people. Every single one of them wanted to know first and foremost if I was on any blood thinners, including aspirin. (I'm fine, by the way, lots of parts hurt, but had a scan done and no head issues.). The point is, it's living that's dangerous, not just skiing. And when I'm skiing I'm wearing a helmet, but I'm not wearing one in the house (although you could argue I should).

 

[fatbob]

@pchewn

It is a valid reason for Euros at least. We take out travel insurance policies for $100-300 pa to cover us for medical when outside our home system. These typically have exclusions or additional criteria re pre existing criteria primarily to discourage health tourism. I'm fine with this as it keeps premiums far lower than your sky high health premiums. So if I have e.g. a heart attack while in US it will have cost me much less than you.

Put it another way with an extreme example. Say I broke my leg skiing and had pins and plates. Despite medical advice re recovery and rehab I immediately go out skiing again and suffer a far worse fracture. I think you are saying under your system I'd still be covered for my doofus action. No wonder your premiums are high.

 

[john walker]

Asking for a family member

I know the standard medical advice re anti coagulants avoid activities which may need to cuts, bruising or head injuries so skiing is under conservative advice not recommended.

However there is also the issue of quality of life if someone is potentially going to on the medication for an extended or even lifelong period - long time to go without riding a bike, taking a hike on rough ground or mountains or skiing. Think it's clealry logical to avoid sports like hockey, rugby etc. Any experiences of managing? Anti-coag in this case is Eliquis (apixaban).

Major concern I guess is cranial bleeds which make things like concussions higher orders of severity. Plus modern anti-coags seem less easily reversible than a shot of Vit K on the old rat poison.

I have been on warfarin and skiing / snow boarding for the past 3 years. I have a home INR tester and my Doc. suggested I let my INR get on the low side (2.0 vs 3.0) before I ski and bring it back up. I always check my INR the night before and adjust my dose accordingly.

I told my doc I have been skiing since I was 4, I haven't missed a season and am now 62. I was a ski patroller, had a 60 day season and rarely fall. Maybe once every 30 ski days. And those are more slide outs vs tumbles. I keep Vitamin K with me but it is slow acting. But I am getting concerned about snow boarding as the falls are much more traumatic. Right now I won't snow board if the snow is hard. If we can get some slushy spring skiing I will do it but I see the risk as being higher. I am trying to decide if I should give that up.

I think you need to access your proficiency in any sport, you risk of injury, your over all physical fitness, your underlying reason for being on an anticoagulant, and what you are taking, then discuss it with your doctor.
My doc has been trying to get me to go one something besides warfarin but I don't want to do it so I can better manage my risk.
I welcome any and all comments.

 

[john walker]

I'm on thinners from a heart attack 2015, took what I consider a minor fall this past tues. I woke up wed. to swelling and a large bruise, left butt cheek, the swelling , bruising , & pain have increased daily , Im in a hospital waiting room after a CAT scan as I type, they think I broke some blood vessels, & continue to bleed inside.
Here is a lovely pic from yesterday, the bruise has grow some since.
I don't know if mods will allow pic, it's medical after all..... View attachment 39290

Will follow up if I survive this ass bruise.......

I would really like to know what blood thinner you are taking if that was from a minor fall. I did a feet in the air down on my butt in the garage and bruised my tail bone but no ass bruise even remotely like that.