Coumadin & Sports

[erik]

Dear all,
I am scheduled next month for a second AVR. My first operation was a bicuspid aortic valve repair, but lasted unfortunately only 3 years :-(
(if you want the know the whole story or considering an aortic valve repair, just message me).

Since i am 43 now, probably (95%) i will choose for a mechanical valve this time.
It is quite difficult to predict the implications of coumadin when performing sports. I really love kitesurfing and I would like to continue doing so.
Anybody has experience with doing watersports? such as surfing, windsurfing or kitesurfing when on coumadin/warfarin?

I kitesurf quite a lot and never had bleeding issues so far. I am more concerned if the 'normal activity' of kitesurfing (hitting small waves, small jumps; comparing to riding on a bumby road) can have complications on the functioning of the mechanical valve? Maybe you can compare the 'normal activity' of kitesurfing to mountain biking through rough terrain.

Anybody has experiences with this? thanks so much!
Greetings Erik

 

[pellicle]

HI

Since i am 43 now, probably (95%) i will choose for a mechanical valve this time.

wise ...

It is quite difficult to predict the implications of coumadin when performing sports. I really love kitesurfing and I would like to continue doing so.

sure ... why not ... I ride motobikes ... harder hits when you are riding along a bumpy road quick ... and I do skiing too ... falls commonly (like if you're not falling you're not trying hard enough ... right?)

Anybody has experience with doing watersports? such as surfing, windsurfing or kitesurfing when on coumadin/warfarin?

no but impact is impact right? I mean you don't expect to get water leaking in and damaging the valve?

...comparing to riding on a bumby road) can have complications on the functioning of the mechanical valve? Maybe you can compare the 'normal activity' of kitesurfing to mountain biking through rough

I simply can't imagine it having any effect.

I just went sprawling (insert litany of curses) on my bicycle when the road turned to ice and I didn't notice. Nothing any thing special (well ok, my neck is jarred and my wrist now annoyed and I have a purple knee).

Last week I fell face first when my skis broke through the crust of ice (it had sunk from -2 to -17 overnight, but the snow below the crust was still soft) and I went from being on top to shin deep and slowing fast. ... nothing worth mentioning (except I now have a hole in my glove because the ice is sharp) and left a little red stuff on my jacket.

I've been to concerts where the beat is "solid" and really "resonates" your chest ... all good. [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/6\/5241\/5227849460_c6091e547e.jpg"}[/IMG2]







lifes too short to have "another" valve pack in and "another surgery" you don't need.

I've had 3 so far so I know what I'm talking about on this point at least.

PS: I know a few here who kite on lakes here in Finland ... to me the biggest issue is "didn't see those rocks" beneath the water ... whoops ... broken leg.

My biggest issue is that I'm getting too old (53) for this "gravity" ****.

 

[Agian]

This evening I took my INR and it was 3.2, after which I slipped in the rain and landed on my arse, driveway first. I've been waiting patiently to bleed out, but nope.

I too have a clapping monkey with cymbals in my chest.

 

[pellicle]

I too have a clapping monkey with cymbals in my chest.

Hey, you're right, it's close

 

[pellicle]

I guess that boxing and Warfarin isn't a good idea:

or maybe just boxing isn't a good idea ...

 

[dick0236]

I kitesurf quite a lot and never had bleeding issues so far. I am more concerned if the 'normal activity' of kitesurfing (hitting small waves, small jumps; comparing to riding on a bumby road) can have complications on the functioning of the mechanical valve? Maybe you can compare the 'normal activity' of kitesurfing to mountain biking through rough terrain.

Wear a helmet and enjoy your "kitesurfing". You may get a few more bruises.....but maybe not. Hitting small waves will not cause bleeding unless there are rocks under the waves........and that will cause you to bleed, warfarin or no warfarin.

 

[erik]

Thanks so much for your stories. Good to hear you guys that you have such an active lifestyle!
I don't kitesurf between rocks and i will start using a helmet & a professional impact vest, so i hope it will be fine...
About the bruising issue; why people with coumadin have more bruises? is it because after a bump, small blood vessels under the skin rupture easilier for people with coumadin?

 

[dick0236]

About the bruising issue; why people with coumadin have more bruises? is it because after a bump, small blood vessels under the skin rupture easilier for people with coumadin?

Good question. I've never really thought about it but I believe bruising has more to do with the longer clotting time of the blood released at the point of injury (rupture) and not because warfarin causes the blood vessels to rupture easier. We've got some experts on the forum that can give you a better answer.

BTW, welcome to the forum!

 

[pellicle]

Hi

About the bruising issue; why people with coumadin have more bruises? is it because after a bump, small blood vessels under the skin rupture easilier for people with coumadin?

nope, that's not how it works. A bruise is caused by a blood vessel rupture (as you've suggested) but what warfarin (coumadin is a brand name, so a Honda is a brand of car and coumadin is a brand of warfarin) does is slow the time taken to form a clot (which stops the blood spreading). This makes any bruise a bit bigger. Being on wafarin makes no difference to the blood vessels, only the clotting time.

Modern valves usually have a target INR of about 2.5 , so if you are over 3 then a bruise will be a little bigger than if you were 2

Myself I've whacked myself many times when doing house renos and I can say that I can't really see any differences between before and after being on warfarin.

I monitor my INR myself and make sure that my INR is between 2 and 3 ... not difficult and allows me the freedom to do whatever I want to do (like move between countries)

Best Wishes

 

[pellicle]

Good question. I've never really thought about it but I believe bruising has more to do with the longer clotting time of the blood released at the point of injury (rupture) and not because warfarin causes the blood vessels to rupture easie

SNAP (I say grabbing the pack)

 

[pellicle]

Erik

a quick point:

I don't kitesurf between rocks and i will start using a helmet & a professional impact vest, so i hope it will be fine...

as you get older you need to be aware that there are changes happening all the time, most people are in denial about them but deny or not they are there. For instance as you age everything looses its elasticity, accordingly your body can't take the shocks it once could.

I recommend you read this blog post of mine:
http://cjeastwd.blogspot.com/2014/06...a-helmets.html

its about helmets but it has some important points about the ability of the body to withstand shocks / trauma from that on the subject of accident scores used to determine "triage" in hospitals in ER

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

...
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 (to quote an old saying) there are old motorcyclists, and there are bold motorcyclists ... but there are no old bold motorcyclists.

So what I'm saying is "enjoy your kite surfing but take fewer risks so you can be able to keep on enjoying it ... that's how I keep on enjoying skiing and motorcycling

 

[Warrick]

My 2 cents, I find the bruises that come up looking real bad are the ones I never felt happen... figures,

I wear a helmet now when I'm out on my quad bike hunting, and if anything I should have worn one years ago, it's great when it's a howling wind with chunks of ice and you can put the visor down and not get your face pummelled
still do the same things as before, clapping monkey.. haha I love it

 

[erik]

Thanks so much for that information. The blog you mentioned is very interesting, especially this sentence:

"Risk compensation is a theory which suggests that people typically adjust their behavior in response to the perceived level of risk, becoming more careful where they sense greater risk and less careful if they feel more protected. Although usually small in comparison to the fundamental benefits of safety interventions, it may result in a lower net benefit than expected"

Applies to kitesurfing too, somebody mentioned me that he instinctly takes more risk with a helmet and also mentioned that he is less aware of what was going on around him when being on the water.... Something to meditate on....

Is it true or a fairytale that the ON-X valve requires lower INR that the St Judes? normally people talk about INR between 2.5 and 3.5, but you mentioned 2 - 3....
Actually, the blog is yours??? thanks dude for sharing your experiences to the world...

 

[dick0236]

Is it true or a fairytale that the ON-X valve requires lower INR that the St Judes? normally people talk about INR between 2.5 and 3.5, but you mentioned 2 - 3....
Actually, the blog is yours??? thanks dude for sharing your experiences to the world...

A normal non-anticoagulated person will have an INR of about 1.0 which means their blood will clot (PT) in about 12 seconds. A 2-3 INR means your blood will clot in 21-30 seconds and an INR of 2.5-3.5 means a clotting time of 26-34 seconds.......not a big difference. My INR range has been 2.5-3.5 since the inception of the INR system and my only problem (stroke) occured years before the INR system (1974) when my INR must have gotten close to 1 when I went on a several day boating trip without my Coumadin. I only get a little concerned if my INR falls below 2.0 or above 4.0 which seldom happens. I personally think 2-3 or 2.5-3.5 is splitting hairs. I try to stay between 2.5-3.5 but do not "freak out" with an occasional INR within 2-4.

 

[pellicle]

Hi

"Risk compensation is a theory which suggests that people typically adjust their behavior in response to the perceived level of risk, becoming more careful where they sense greater risk and less careful if they feel more protected. Although usually small in comparison to the fundamental benefits of safety interventions, it may result in a lower net benefit than expected"

Applies to kitesurfing too, somebody mentioned me that he instinctly takes more risk with a helmet and also mentioned that he is less aware of what was going on around him when being on the water.... Something to meditate on....

Its well documented ... out of interest was that word meant to be instinctively or distinctly? Either works but meaning changes (both within scope of autoincorrect features of phones)

As it happens on my "main bike" (which is a YamahaT-Max 500cc scooter) I use an open face around town and a full face on the highway. I do this for almost exactly the same reasons your friend mentions. On the highway (where speeds are of course much higher) I value the visor (as Warwick observed) and the face protection provided in a "knockout" where you may slide face first for some time (observational experience involved in this one) and you may loose part of your jaw and some teeth foundation material too.

Around town I prefer the open face because I prefer to feel the breeze (I always wear safety glasses) and the increased visibility.

Also around town I often wear shorts and a T shirt (with gloves always ... I once had a small "off" that ripped my fingertips badly ... made the function of the daily wiping of ones butt awkward for a while) because it makes me more concerned and more aware ... I've had a few "slides down the road" in leathers and one or two without. I know which I prefer and why. Around town however my view is that an impact with a car at an intersection is the more likely problem and leathers don't help much with that.

Is it true or a fairytale that the ON-X valve requires lower INR that the St Judes? normally people talk about INR between 2.5 and 3.5, but you mentioned 2 - 3....

I think your wording there of "requires" is helpful to explain this. On-X is a company, a new one in the area of valves. They are looking for a "niche" to provide a differential for themselves. So they went to the trouble of getting approval for the lowered INR.
Does this make them different to St Jude or Medtronics / ATS? I don't think it does as the GELIA study clearly demonstrates that we are still a little conservative on our minimum INR levels for Aortic mechanical valves. GELIA suggests a minimum of 2. is safe from thrombosis.

However the reality of being at 2 is like the reality of flying on the edge ... very easy to drop over the line into danger zones. If you were attempting to be hovering around 1.7 you'd make inevitable dips into 1.2 ... dangerous area that. I'm quite sure that On-X would be keen to investigate your INR history if you attempted to sue them.

I manage my INR by the method of using a "target" and accepting some variance but minimising it. This is functionally equivalent to a range of (say) 2 ~3

For instance
my "mean" is (based on last year) 2.6
my standard deviation is 0.4

so even at 2 standard deviations from my mean (meaning rare as you see below) my INR would still be above 1.7 [IMG2=JSON]{"data-align":"none","data-size":"full","src":"http:\/\/2.bp.blogspot.com\/-QKNj9Jl-dhw\/U205uh7lgwI\/AAAAAAAAFB8\/l0ovwh2qaHs\/s1600\/standardDeviationBellCurve.jpg"}[/IMG2]





Read this post of mine for more on this point:
cjeastwd.blogspot.com/2017/01/2016-inr-data.html

Actually, the blog is yours??? thanks dude for sharing your experiences to the world...

yes, the blog is mine ... covers interests, publications, help which I wanted to centralise (rather than type it again and again as punishment in class) for distribution when Frequently Asked Questions arose on forums, humor and just daily life.

Glad you like it.

Should you get a mechanical you'll find this "series" of posts helpful:

http://cjeastwd.blogspot.com/2014/09...ng-my-inr.html

http://cjeastwd.blogspot.com/2015/10...r-example.html

http://cjeastwd.blogspot.com/2014/05...ocks-dose.html

I think that's not just a good starter for a newbie on warfarin but a good reference for anyone who is more interested (but not a University researcher)

 

[erik]

Thanks for those blogs, surely I will read them into more detail when my time has come... I have red quite some posts now saying that the whole INR lifestyle isn't so bad as one may think initially.
Hopefully that will be also the case in my near future...
Each body is different i guess. I asked my cardiologist if i could do some pre-test with coumadin, just to be sure that i will react 'fine' to it. no allergic reactions or something else unexpected.
My impression was that he didn't like the idea very much. Maybe because it is not a standard procedure. Allergic reactions are rare, but you don't want to be one of those as this article writes
"Various types of warfarin-induced skin reactions have been reported includ-ing vesicular, maculopapular, and urticarial lesions. More serious dermatologic skin conditions caused by warfarin
include skin necrosis and ‘‘purple-toe syndrome.’’
http://onlinelibrary.wiley.com/doi/10.1002/clc.20554/pdf

Does anybody know about these genetic testing methods?CYP2C9 and/or VKORC1 or any other way of testing sensitivity to warfarine?
https://labtestsonline.org/understanding/analytes/warfarin-sensitivity-testing/tab/glance/

 

[pellicle]

...I asked my cardiologist if i could do some pre-test with coumadin, just to be sure that i will react 'fine' to it. no allergic reactions or something else unexpected.

yes, I've noted that the answer to that is always NO ... I expect its because of:

1. there are risks with starting warfarin and so they wish to avoid this (which is dumb cos you're going to have to start soon anyway?) OR
2. they don't like to be told what to do and have it seem they can't think outside the box

Allergic reactions are rare, but you don't want to be one of those as this article writes

the only documented case I now of turned out to be an allergic reaction to the dye in the pills ... solved by a brand change.

"Various types of warfarin-induced skin reactions have been reported includ-ing vesicular, maculopapular, and urticarial lesions. More serious dermatologic skin conditions caused by warfarin
include skin necrosis and ‘‘purple-toe syndrome.’’
http://onlinelibrary.wiley.com/doi/10.1002/clc.20554/pdf

normally this is associated with a whole raft of co-morbidities like obesity and diabetes ... with some poor circulation thrown in for good measure.

Does anybody know about these genetic testing methods?CYP2C9 and/or VKORC1 or any other way of testing sensitivity to warfarine?
https://labtestsonline.org/understanding/analytes/warfarin-sensitivity-testing/tab/glance/

as I understand it its not normally done because its actually just as easy to tune you in with actual INR measurements and actual empirical data ... unless the clinic are morons ... way common btw

My advice is "don't over think this" and when its time jump the hurdle ... it's not hard

;-)

 

[Warrick]

http://www.trademe.co.nz/toys-models/battery-windup/other/auction-1255162283.htm

Yip it's an aussie monkey too

 

[pellicle]

...Yip it's an aussie monkey too

probably made in China ... do we make anything except shipments of rocks anymore?

Interesting work from the early 1900's
http://gutenberg.net.au/ebooks/e00062.html
THE GLUGS OF GOSH

by

C J DENNIS

With Illustrations by Hal Gye

FIRST PUBLISHED 1917

But a Glug stood up with a cast in his eye,
nd he said, "Far too many baubles we buy;
ith all the Gosh factories closing their doors,
And importers' warehouses lining our shores."

 

[Warrick]

probably made in China ... do we make anything except shipments of rocks anymore?

not much that isn't here these days , we probably sent them the coal to run the power station to melt the plastic...


cool link too!