Activity restrictions

[Lada1]

Would like to hear your thoughts on the warfarin life style guidance that one heart transplantation center of excellence has on their website and how it comes together with my activities road cycling, motorcycling, occasional chainsaw use:

· Avoid activities that could cause abrasions, bruising or cuts (eg contact sports, gardening, sewing) or at least wear protective gear.
· Use a soft toothbrush, waxed dental floss.
· Be extra careful when shaving (prefer to use an electric shaver).
· Try to avoid insect bites, use protective repellents.
· If you hit your head hard, have a car accident, or suffer any other serious injury, seek immediate medical attention. Internal bleeding may not be noticeable at first glance.

 

[pellicle]

Hi

Would like to hear your thoughts on the warfarin life style guidance that one heart transplantation center of excellence has on their website

my thoughts ....
where does all this bull5h1t come from?

you get cut you bleed, if you manage your INR properly you may not even notice the difference

I take head injuries more seriously than I did but you know, age is a bigger factor in the whole picture.

https://cjeastwd.blogspot.com/2014/06/skid-lids-aka-helmets.html

at the time I wrote that I'd been on warfarin 2 years

more recently






I build with steel (which requires cutting and drilling and ladders
https://cjeastwd.blogspot.com/2022/01/two-sheds.html

and how it comes together with my activities road cycling, motorcycling, occasional chainsaw use:

I recently cut down two large trees in my back yard and cut up all the trunks and branches with a chainsaw.

Frankly no matter who you are if you're stupid with a chainsaw you'll suffer and maybe die. Warfarin ain't got nothing to do with it.

· Avoid activities that could cause abrasions, bruising or cuts (eg contact sports, gardening, sewing) or at least wear protective gear.
· Use a soft toothbrush, waxed dental floss.
· Be extra careful when shaving (prefer to use an electric shaver).
· Try to avoid insect bites, use protective repellents.

· If you hit your head hard, have a car accident, or suffer any other serious injury, seek immediate medical attention. Internal bleeding may not be noticeable at first glance.

all things like that are dangerous and accidents can be "walk away from WTF" through to dead over nearly nothing. Its a craps shoot

A previous reply of mine has some additional good video
https://www.valvereplacement.org/threads/how-to-choose.889370/post-933295

all my points on warfarin are here: https://cjeastwd.blogspot.com/search/label/warfarin


Best Wishes

 

[pellicle]

from that blog post:

https://cjeastwd.blogspot.com/2014/06/skid-lids-aka-helmets.html

...
3) Standards: Man have I got some beefs with Standards.

First, I encourage you to head over to this site and read their article. Its well written and makes a lot of good points (as well as describes the basics for the person just getting their head into this subject). For instance:

To minimize the G-forces on your soft, gushy brain as it stops, you want to slow your head down over as great a distance as possible. So the perfect helmet would be huge, with 6 inches or mosre of soft, fluffy EPS cradling your precious head like a mint on a pillow.

Now, how many helmets do that? None, instead they do something actually counter intuitive, they try to not absorb energy by not deforming the Expanded Poly Styrene liner. This means that they have to transmit no more than 300G (that's gravities) to your head.

FFS ... 300G? That's a lot ... let me quote from that article again:

Doctors and head-injury researchers use a simplified rating of injuries, called the Abbreviated Injury Scale, or AIS, to describe how severely a patient is hurt when they come into a trauma facility. AIS 1 means you've been barely injured. AIS 6 means you're dead, or sure to be dead very soon. Here's the entire AIS scale:
AIS 1 = Minor
AIS 2 = Moderate
AIS 3 = Serious
AIS 4 = Severe
AIS 5 = Critical
AIS 6 = Unsurvivable

Ok, so then:

a 250 G to 300 G impact corresponds to AIS 5, or critical; and that anything over 300 Gs corresponds to AIS 6. That is, unsurvivable.

which isn't good ... but it gets worse for us older folks

You can even calculate your odds using the Injury Severity Score, or ISS. Take the AIS scores for the worst three injuries you have. Square each of those scores—that is, multiply them by themselves. Add the three results and compare them with the ISS Scale of Doom ... For a 45- to 64-year old guy such as myself, an ISS over 29 means I'll probably die

So essentially as you get older the effectiveness of the helmets which pass the test at protecting your brain becomes less and less.

But it gets worse ...if you happen to like Snell ratings ...

The killer—the hardest Snell test for a motorcycle helmet to meet—is a two-strike test onto a hemispherical chunk of stainless steel about the size of an orange. The first hit is at an energy of 150 joules, which translates to dropping a 5-kilo weight about 10 feet—an extremely high-energy impact. The next hit, on the same spot, is set at 110 joules, or about an 8-foot drop. To pass, the helmet is not allowed to transmit more than 300 Gs to the headform in either hit.

so the "desirable" helmet actually requires the impact to be twice on the same spot, which means that it can't actually compress that point to absorb the impact because it has to take another hit.

 

[pellicle]

Oh and I forgot to add ... I used to drink normally (for an Australian) but had to give that up a couple of years back due to an arrythmia (so the Finnish sisu isn't there)

So live your live and be merry, there is some reason to be careful, but you don't need to cut them off and pack yourself in cotton wool

Best Wishes

 

[dornole]

The earlier entries in the list are absurd. Sewing? Do they think sewing happens with a sword? How is it that they can draw blood every dang hour in the hospital, and weekly or monthly in the warfarin lab and yet I don’t bleed to death?

I truly don’t understand it. I notice ZERO difference in blood draw pokes since starting warfarin. There is a tiny dot of blood on the bandaid. I actually bruise LESS than when they had me on 325 mg aspirin.

I myself am opposed to head injury for many reasons and didn’t do high risk activities before so I can’t speak to that. I would follow the last rec and get checked out if I had a hard fall. But these nicks and cuts precautions are truly nuts.

 

[Gail in Ca]

No sewing? Ha ha ha! Since I’ve been on warfarin I’ve sewn coats, dresses, curtains, bed topper for a friend, and lots of hemming. If I prick myself with a needle, I just wash and put a band aid on it. As for gardening, I would never give that up. I only notice that bruises are larger and take more time to go away.
I’ve stopped snow and water skiing since I wasn’t that great at either. Awhile ago I tripped on a raised piece of sidewalk and hit my jaw/ head on the grass. When I told my GP about my fall she said I should go to urgent care or ER if I ever hit my head like that again. She was quite serious about this.
Anyway, the only sewing issue at my house happened when my curious blue point Siamese played with a needle and thread (unbeknownst to me), and it got lodged in her mouth with the thread going down her throat! I never leave needle and thread out after that!

 

[dick0236]

Lada1.....I consider your list, with the exception of "if you hit your head real hard you might consider getting professional help" BS. The rest of the advice is wrong!! I've been on warfarin for 57+ years and have never seen a more ridiculous list. Live your normal life....you are not gonna break.

 

[Windfinder]

What a silly list, even if you are not on warfarin if you hit your head real hard you could consider getting professional help so the whole list is nonsense.

 

[Lada1]

As I dont take pictures of mine I will link the other ones typical road cycling bruise/rash stories: https://www.google.com/search?sca_e...jG7sOP98eLAxVAg_0HHaohB1kQxKsJegQIDxAB&ictx=0

Would those be also OK being on warfarin?

 

[dick0236]

Would those be also OK being on warfarin?

Some of those look pretty bad and would need medical attention.......on warfarin, or not. I've had some dandy bruises over the years, but nothing like those........but I don't bike. If you expect a lot of that kind of bruising/lacerations, I'd stay away from warfarin.

I just reread your original post. It appears those instructions were for someone who had a HEART TRANSPLANT.....not a simple valve replacement. I would imagine those folks have to play by a more stringent set of rules.

 

[Woodcutter]

I'm not a cyclist but I do plenty of things that occasionally draw blood. I'll share some anecdotes and learnings. Basically if you do something that causes a bleed or bruise and you are on warfarin it will take longer to stop.

Just last fall I went out for a trail run. Not at all unusual to trip and fall. I was on a bike trail ... and you know how those bicyclists make the trail concave and expose roots . Well I tripped and somehow fell exactly right so I impaled a palm on a sharp root. Plenty of blood but I quickly determined everything worked and I wasn't going to need stitches so went back to the car to clean up a bit. It was a new car for me and I had not yet put a first aid kit in it. I scrounged enough stuff to flush the puncture and stop the bleed and get back to my running . .. . . but it was sure a reminder to have a first aid kit around.

Hydrogen Peroxide is my friend. When you get blood on things (particularly clothes) it is always good to have this around.

I use all sorts of blades and cutters (mostly for woodworking) almost daily. I wear gloves more than I used to. When I am removing/installing/folding blades for my sawmill, I am wearing leather gloves (fyi - these blades are about 4 meters in length and have pretty aggressive teeth). When I am changing/sharpening a chainsaw blade I usually do not wear gloves. If I were to touch a chainsaw or sawmill when it's running, candidly it would not make any difference if I was on warfarin or not! I did learn to have some type of bleed stop powder in my nearby first aid kit. I used it once when I pinched a fingertip rolling a log. I have a scar from that but the bleed stop worked quite well.

I have played paintball twice in my life. Once in my 20's pre-warfarin and once in my 40's while on warfarin. The dime/centimeter sized welt in my 20's was a softball sized bruise on warfarin. I have no interest in playing paintball again.

So my overall experience is quite simply that once you get to your 30's or 40's, you can do just about anything that you want to. Possibly with some accommodation knowing that any bleeding is going to take longer to stop. When you are younger, doing anything/everything, often with insufficient knowledge and minimal appreciation for risk . . . . . maybe I'll stop and just say that when I was a youngster regularly getting stitched up, warfarin would have been a bigger concern for me.

 

[pellicle]

Basically if you do something that causes a bleed or bruise and you are on warfarin it will take longer to stop.

totally agree ... but its an annoyance not a fatality

as well as hydrogen peroxide I've had good experiences with superglue:

https://cjeastwd.blogspot.com/2021/06/superglue-wound-dressing.html

no doubt that inr of ~2 means that you take twice as long to stop bleeding ... but if its an artery its going to require a hospital (or a morgue) anyway.

When you are younger, doing anything/everything, often with insufficient knowledge and minimal appreciation for risk . . . . . maybe I'll stop and just say that when I was a youngster regularly getting stitched up

agreed ... I also did some pretty stupid things back then too

 

[3mm]

some type of bleed stop powder in my nearby first aid kit.

Good start! But bleedstop will not help if a major artery is cut, so you should also have a tourniquet for a major cut to a limb. Tourniquets save many lives by controlling bleeding for the trip to an emergency room. A good friend saved the life of a chain saw accident victim with a tourniquet.

If you have any concern about an injury to the torso above the diaphragm, then add a pair of chest seals. They allow the lungs to continue breathing during a trip to the emergency room. Even around shops and construction sites, occasionally a tool such as a drill bit breaks and punctures someone's chest.

 

[pellicle]

Even around shops and construction sites, occasionally a tool such as a drill bit breaks and punctures someone's chest.

reminds me of the time I saw a guys circular saw explode (he was resting the framing ply on the 3phase cable...) and the blade embedded into the concrete wall.
Construction sites ... ¯\_(ツ)_/¯

 

[3mm]

the blade embedded into the concrete wall

Wow! Bad things can happen in an instant if we are not careful!

It's like those Cassowary birds in Australia - 1 minute they're eating some fruit under a bush, and the next minute they're kicking you in the chest with their 3 inch (7.62 cm) talons!

 

[Chuck C]

Avoid activities that could cause abrasions, bruising or cuts (eg contact sports, gardening, sewing) or at least wear protective gear.
· Use a soft toothbrush, waxed dental floss.
· Be extra careful when shaving (prefer to use an electric shaver).
· Try to avoid insect bites, use protective repellents.
· If you hit your head hard, have a car accident, or suffer any other serious injury, seek immediate medical attention. Internal bleeding may not be noticeable at first glance.

I agree with @dick0236 and the others. In my view, that list is mostly BS. No gardening or sewing?

Avoid insect bites? What?

Ok, if the mosquitos in your country look like this, maybe you should avoid getting bit, regardless of whether you are on warfarin:



Of course, you should always listen to your doctors. After all, we are just random internet people. But, having been on warfarin for about 4 years, from my experience that list does not seem realistic.

Of course, if you hit your head hard, get in a car accident or have a serious injury, get medical attention. That is common sense and what everyone should do, regardless if they are on warfarin.

I'm active in martial arts with lots of contact, as well as other sports. I have not had a problem, just use common sense. I use common sense and avoid sparring hard, but at my age that is advisable anyway. I'm about to head out right now to hike up a local moutain and then run the downhill.

You can be active on warfarin, but just be sensible.

 

[pellicle]

You can be active on warfarin, but just be sensible.

The bottom line

 

[Gail in Ca]

I was just dremeling my dogs toenails and she pulled back the paw I was working on and the dremel sanding wheel zapped my knuckle. It started bleeding, so I washed it, added a bandage and carried on.
Many things I do on a regular basis I haven’t given a second thought that it could cause bleeding! I probably wouldn’t stop to wash it if I didn’t have a history of bacterial endocarditis!