How hard can I play??

[Philip]

How hard can I SAFELY play on Coumadin??

As a martial artist (Taekwonodo) fighting by Olympic rules (full contact) I have decided that it is wise to give up the fighting aspect of the art. In our Dojang we do a lot of Hapkido as well, which always results in being thrown to the matt forcefully. The worst injury I have had as a result of Hapkido is having the breath knocked out of me. Does Hapkido need to be off limits? Please tell me that this is ok to continue.

Water skiing: Can I water ski aggressively? Barefoot tumble turns, aggressive short line salom etc..? Once again a hard fall may take your breath away and may rattle you enough to need a short break.

Snow skiing: Should I wear a helmet, stay out of the tress or just slow it down a bit?

Thanks for any info.

Philip

 

[PJmomrunner]

The following is excerpted from:
BETHESDA CONFERENCE REPORT
36th Bethesda Conference:
Eligibility Recommendations for
Competitive Athletes With Cardiovascular Abnormalities
Barry J. Maron, MD, FACC, Conference Co-Chair
Douglas P. Zipes, MD, MACC, Conference Co-Chair

PROSTHETIC HEART VALVES
Several general comments apply to all patients who have
undergone valve replacement. First, although most patients
improve after valve replacement and many become asymptomatic,
the long-term mortality after operation is greater
than that of a normal population of similar age. Second, a
transvalvular gradient of varying severity is present in most
patients after valve replacement (5,19). Third, although
hemodynamic variables at rest may be essentially normal
after valve replacement, many patients have an abnormal
response to exercise (20). Finally, after valve replacement
(with few exceptions) patients with mechanical prostheses
require anticoagulant agents, and those with bioprosthetic
valves in sinus rhythm usually do not. In assessing the
athlete?s capacity for physical activity, exercise stress testing
to at least the level of activity performed in the competitive
sport is valuable.
1338 Bonow et al. JACC Vol. 45, No. 8, 2005
Task Force 3: Valvular Heart Disease April 19, 2005:1334?40
Effects of exercise. There are insufficient data to determine
whether vigorous repetitive exercise after valve replacement
has any long-lasting effect on ventricular or prosthetic valve
function. The patient should be made aware of these
deficiencies in our knowledge before deciding whether to
participate in competitive athletics. Because mechanical and
most tissue valves have reduced effective valve areas, they
perform best at normal heart rates. Therefore, a sustained
heart rate greater than 120 beats/min might result in
elevated valve gradients and cardiac outputs that are less
than normally expected.
Recommendations:
1. Athletes with a bioprosthetic mitral valve not taking
anticoagulant agents and who have normal valvular
function and normal or near-normal LV function can
participate in low and moderate static and low and
moderate dynamic competitive sports (classes IA, IB,
IIA, and IIB).
2. Athletes with a mechanical or bioprosthetic aortic
valve, with normal valve function and with normal
LV function, can engage in low and moderate static
and low and moderate dynamic competitive sports
(classes IA, IB, and IIA). Athletes participating in
greater than low-intensity competitive sports (class
IA) should undergo exercise testing to at least the
level of activity achieved in competition to evaluate
exercise tolerance and symptomatic and hemodynamic
responses.
3. Independent of other considerations, athletes with a
mechanical or bioprosthetic mitral valve or aortic
valve who are taking anticoagulant agents should not
engage in sports involving the risk of bodily contact
(see Task Force 8: Classification of Sports -- link below) or the
danger of trauma.

http://content.onlinejacc.org/cgi/content/full/45/8/1364

 

[PJmomrunner]

How hard can I SAFELY play on Coumadin??

Well...not very hard if you go by the Bethesda guidelines for coumadin users (which seem so unrealistically restrictive that they are destined to be ignored). Even if you only restrict yourself to the guidelines for people with prosthetic valves, your martial arts and waterskiing are in a grey (or, in this case, yellow) area using the very most liberal interpretation.

As a martial artist (Taekwonodo) fighting by Olympic rules (full contact) I have decided that it is wise to give up the fighting aspect of the art. In our Dojang we do a lot of Hapkido as well, which always results in being thrown to the matt forcefully. The worst injury I have had as a result of Hapkido is having the breath knocked out of me. Does Hapkido need to be off limits? Please tell me that this is ok to continue.

I won't comment on this because I know nothing about it.

Water skiing: Can I water ski aggressively? Barefoot tumble turns, aggressive short line salom etc..? Once again a hard fall may take your breath away and may rattle you enough to need a short break.

You should not ski "all out" aggressively, if you decide to ski. If you have a history of skiing at 30 off, you should probably pull back to 10 or 20 off. Trying to ski shorter or faster or otherwise more intensely is probably never going to be advisable given waterskiing at all is questionable. Start back slowly being as easy on your body as possible--i.e. dock start on two skis to assess how it feels to be pulled, etc. Whatever you decide, I would recommend taking great care to ski in a high-quality ski vest that fits you perfectly. A full wetsuit would probably be a good idea too. My husband (who skis far more aggressively than I, but not so much as you probably) has broken ribs and punctured his eardrum twice--"knocking the wind out" doesn't really cover the possibilities. Barefoot anything, that I know of, requires speeds (40+ mph) that would push the static and dynamic components on the chart well into the red, and should simply be abandoned.

Snow skiing: Should I wear a helmet, stay out of the tress or just slow it down a bit?

Since the guidelines put downhill skiing well into the danger zone and out of the "open-to-liberal-interpretation" area...IF you decide to ski at all: Yes, you absolutely should wear a helmet. Yes, you certainly should stay out of the trees. And yes, you should slow down.

These have been thought-provoking questions to ponder. One has to presume that the doctors involved in creating the guidelines removed quality of life issues from their consideration and relied on quantifiable data like Max O2 and %MVC. They do state that one must interpret their recommendations for one's own specific set of circumstances and this is where those quality of life considerations come in. (Notably they also did not factor in the possibly dire consequences of being thrown to the ground or otherwise knocked around or stomped on--see motorcycling or rodeoing. Their intensity quantification covers only how much one's muscles are working and how hard the cardiovascular system is working.)

 

[Dr. Stupid]

Hello Phillip

Hello Phillip

Hello,
Paul (aka Dr. Stupid) here from the UK. If its of any benefit to you, up until a few weeks ago I studied Shotokan Karate (then my club shut). I entered competitions, won gold and silver medals, and yes, I did end up with numerous bruises - all of which healed up. Yes, I have received nasty injuries - ripped hamstrings for example. I was out of training for five weeks while they healed and the massive bruise disappeared.
I now do Jiu Jitsu together mixed martial arts fighting. Yes I end up with a few bruises - big deal. My doctor knows what I do. She isn't too happy about it, but as I told her I would rather end up with a few bruises from training in a controlled environment, learning how to fight and defend. The mugger on the street isn't going to care whether you are on Warfarin (Coumadin) or not when they go for you. At least in the Dojo, my Sensei accepts the fact that I am on Warfarin and trains me accordingly, as do all the other boys (oops - sorry and girls). I spent 2 hours non stop practising take downs and floor submission fighting last tuesday night. I have one bruise on my upper arm - as I said, big deal !!
So, in answer to your question - How hard can I play ? Only you know your barriers and limitations. Go for it and see what happens. If you bruise really heavily and/or become worried, then you might need to consider changing to a different style of martial art. You don't know what you can do until you try !!
Feel free to send me a message if you wish to talk some more.
All the best,
Paul

 

[Ross]

It all depends on just how much risk your willing to take. I for one, would say no to Tae Kwon Do, but there are others here that do not share that view and continue.

Hank water skis and so do some others, but I don't think they do any water tricks, just simple skiing.

Common sense and head protection is the name of the game.

 

[MarkU]

Hello,
So, in answer to your question - How hard can I play ? Only you know your barriers and limitations. Go for it and see what happens. If you bruise really heavily and/or become worried, then you might need to consider changing to a different style of martial art. You don't know what you can do until you try !!

Amen. I am fortunate not to bruise or bleed easily. In fact, I have taken up riskier pursuits (triathlons) since my surgery. Everyone is different. Don't limit yourself based on generalizations.

 

[Philip]

Thanks for all the info. It seems that the best approach for me is to very carefully find the edge of my new envelope. I am a long way from finding it but will begin probing as soon as I shake this darn pericarditis.
I plan on returning to the Dojang the 1st week in July and to water skiing as soon as the chest feels like it can take the strain and my wife will drive for me. I will limit the water skiing initially to a single trick ski (nice and slow with minimal upper body load.)
I will post results.

Philip

 

[geebee]

Phillip,
I think you are taking a good approach. Be cautious but don't limit yourself to a lifestyle that is unacceptable for you. The reason we all go through these surgeries is to have a longer life and to enjoy it. Otherwise there is no point. I am not saying we should thumb our noses at danger but to not have fun or do the things we want to do makes all this effort useless.
Enjoy.

 

[tommy]

Thanks for all the info. It seems that the best approach for me is to very carefully find the edge of my new envelope.

That articulates it well.

 

[Sir Reel]

Personally (and no offense meant to anyone who posted), I would have a long discussion with a couple of doctors who have reason to know what they are talking about rather than taking advice and encouragement off the Internet from people who aren't likely to really know the potential ramifications. It would be interesting to know what the reaction of the medical community is to the Bethesda Conference Report. I doubt that a bunch of doctors specializing in the area and having a professional interest sat around describing the report as unreasonably restrictive. It may be conservative and possible to exceed the stated limits, but I doubt it is something that is to be cavalierly ignored. Remember, deaths have been attributed to people on Coumadin or similar drugs bleeding to death internally from external injuries.

Good luck.

 

[msiwik]

No disagreement about importance of medical advice but

No disagreement about importance of medical advice but

Personally (and no offense meant to anyone who posted), I would have a long discussion with a couple of doctors who have reason to know what they are talking about rather than taking advice and encouragement off the Internet from people who aren't likely to really know the potential ramifications. It would be interesting to know what the reaction of the medical community is to the Bethesda Conference Report. I doubt that a bunch of doctors specializing in the area and having a professional interest sat around describing the report as unreasonably restrictive. It may be conservative and possible to exceed the stated limits, but I doubt it is something that is to be cavalierly ignored. Remember, deaths have been attributed to people on Coumadin or similar drugs bleeding to death internally from external injuries.

Good luck.

I certainly agree that everbody reading these posts needs to be talking with their doctors/physiologists first and to be relying on them. That being said, it's also useful to listen to the experience of others - if for no other reason than inspiration. Having a support system which is how I view this community is key to maintaining an active lifestyle (along with having some form of exercise you are passionate about and being able to set realistic goals). Mark

 

[MikeHeim]

Personally (and no offense meant to anyone who posted), I would have a long discussion with a couple of doctors who have reason to know what they are talking about rather than taking advice and encouragement off the Internet from people who aren't likely to really know the potential ramifications. It would be interesting to know what the reaction of the medical community is to the Bethesda Conference Report. I doubt that a bunch of doctors specializing in the area and having a professional interest sat around describing the report as unreasonably restrictive. It may be conservative and possible to exceed the stated limits, but I doubt it is something that is to be cavalierly ignored. Remember, deaths have been attributed to people on Coumadin or similar drugs bleeding to death internally from external injuries.

Good luck.

Interesting perspective. However, if you feel this way, why are you a member of this message board? Almost none of us are medical professionals, but people (presumably yourself, as well) come here looking for advice all the time. I think the real strength in this site is that people are able to draw off one another's experiences, and in essence get the advice of dozens of Cardiologists all at once. My Cardio may say that I should not run marathons (mine hasn't, but other peoples' on this list have) after surgery. Should I just accept that, or see what other Cardiologists have said as well before making major lifestyle decisions? Whenever I answer a question on this board, I am answering based on knowledge I obtained through my own experience, or what I have been told by a medical professional. I certainly hope nobody is "shooting from the hip" and giving advice with no real basis of understanding.

 

[geebee]

Sir Reel,
Asking for and listening to the advice of others who have been there does not preclude, nor do we suggest it should, the instructions from our doctors. This is a support website not a medical office and even the doctors who are members do not attempt to diagnose or give anything except guidance. We all always suggest the doctor be the last source of decision for a member seeking advice or support.
I think it is extremely unfair of you to imply that we are cavalier about any of this.

 

[dj/utvolsfan]

Amen, sister!

Sir Reel,
Asking for and listening to the advice of others who have been there does not preclude, nor do we suggest it should, the instructions from our doctors. This is a support website not a medical office and even the doctors who are members do not attempt to diagnose or give anything except guidance. We all always suggest the doctor be the last source of decision for a member seeking advice or support.
I think it is extremely unfair of you to imply that we are cavalier about any of this.

 

[Magnus]

I doubt that a bunch of doctors specializing in the area and having a professional interest sat around describing the report as unreasonably restrictive.

Yup, and none of them have any fear of law suits whatsoever. And they all take Coumadin themselves, of course.

Never take the advice of anyone who hasn't had your kind of trouble.

 

[Sir Reel]

Wait a minute - the original poster didn't ask for the experience of others or what they had been told by their doctors, he asked what he could do SAFELY: "How hard can I SAFELY play on Coumadin?? ... Does Hapkido need to be off limits? Please tell me that this is ok to continue. ... Can I water ski aggressively? Barefoot tumble turns, aggressive short line salom etc..? Snow skiing: Should I wear a helmet, stay out of the trees or just slow it down a bit?"

Not to pick on any particular aspect of the responses, but one said: "I certainly hope nobody is "shooting from the hip" and giving advice with no real basis of understanding." I don't see anything meaningful in the responses (other than the ones by pjmomrunner) describing any particular understanding of the risks you run by performing the sports enumerated by the original poster or relaying specifics provided by someone who does such as a doctor, some type of scientist, or even someone who has studied the matter a lot. Your definition of shooting from the hip and mine must be different.

If someone wants to help the original poster, why not tell him what you have heard about whether there is any particular risk to receiving a hard blow to the head or some other particular part of his anatomy while on Coumadin and what the risks might be. That would seem to be useful sharing of experiences.

Along these lines, I will throw in one experience. A frend's father was on Coumadin. He fell and died. The death was attributed by the physicians involved to internal bleeding to death as a result of the Coumadin. No autopsy was performed as far as I know, so I don't know whether the diagnosis is correct or supported by some further evicence or merely an educated guess or even a cover up. The father was in his 70s and clearly not in the same apparently good physical condition as the original poster. I don't know if the same thing could happen to someone much younger in good or excellent physical shape. FWIW.

I'm not even suggesting that the original poster not do the activities he describes as quality of life issues certainly play a role. (The original poster doesn't say whether he has kids who depend on him or other family who might have quality of life issues if he is incapacitated or worse.) I am merely suggesting that he have a proper understanding of the risks in advance on the off chance the "edge of his new envelope," as he puts it, happens to be a cliff with severe or fatal consequences beyond the limits. It is a free Internet, so those who wish to to encourage him to experiment without understanding the risks are free to do so. I only wished to provide him with the cautious (and in my opinion, more reasonable) view.

 

[geebee]

The research on what one can safely do while on coumadin comes from what people have done on coumadin in the past. All research is that way. Therefore, to imply that our experiences have no bearing is incorrect.

Along these lines, I will throw in one experience. A frend's father was on Coumadin. He fell and died. The death was attributed by the physicians involved to internal bleeding to death as a result of the Coumadin. No autopsy was performed as far as I know, so I don't know whether the diagnosis is correct or supported by some further evicence or merely an educated guess or even a cover up. The father was in his 70s and clearly not in the same apparently good physical condition as the original poster. I don't know if the same thing could happen to someone much younger in good or excellent physical shape. FWIW.

Without an autopsy, I would think it was impossible to even state that this person would not have died had he NOT been on coumadin. This is the kind of information that causes coumadin to get the bad rap that we keep fighting. Again, NONE of us imply it is without risks but this is not a good example of the "dangers of coumadin".

 

[DLStepp]

What is a reasonable risk for coumadin takers is an ongoing question for me being fairly new to the medication. I have read that it makes us near hemophiliacs and I have read that when correctly regulated the danger is not near as great as some would make out. When my surgeon first spoke with me about coumadin for life he mentioned motorcycle riding as a risky activity and I immediately replied that I was a near life-long rider who did not want to stop. He then said the risk depended somewhat on how and how much one rode and did not tell me I should stop riding.

I found this at warfarininfo.com:
Does taking warfarin increase my risk of being killed in a car accident? -- Rhiannon

I don?t know that I can answer that question directly. A recent report from Quebec found that taking warfarin did not appear to increase the risk of being involved in a car accident. I have asked quite a few trauma surgeons and nurses if they have ever seen anyone who bled to death from a cut to the arm or leg and the answer is always, ?No?. So I would have to conclude that taking warfarin might increase your chances of being killed in a car crash by a slight amount, but not enough that you need to put it high on your list of things to worry about.

Now this does not directly answer my concern about my increased risk when motorcycle riding, or the question the original but it is more comforting than some of the things I have read. I have invested in a top of the line full face helmet, I have never liked full face helmets, to add as much protection as I reasonably can.