Motorcyclists Choice

[Richie Rich]

Hi All,

Some of you may have seen my other post about valve selection and I’ve had some great responses.

However the main thing holding up me making a decision is that I ride a motorcycle.

I’m not keen on taking warfarin for the simple reason that I don’t fancy being in a motorcycle accident while on it and having a bleeding issue.

I’d like to see some responses from fellow motorcyclists who have had a valve replacement. Did you opt for tissue or mechanical? How did you decide? If mechanical has it caused you any problems? Have you been in an accident while on warfarin or do you know anyone who has, and what was the outcome?
Sorry for all the questions but I don’t have long to decide and I need to make the right decision for myself on this.

Thanks, Richie.

 

[pellicle]

Good morning
you've already heard from me, but I'm not sure how many other bikers are on here ... but to add to the thread for the benefit of other (perhaps anonymous) readers

I’m not keen on taking warfarin for the simple reason that I don’t fancy being in a motorcycle accident while on it and having a bleeding issue.

personally I think its a nothing burger and a severed artery from a broken bone will be a bigger threat. An IC bleed will be detected and addressed in ER

I’d like to see some responses from fellow motorcyclists who have had a valve replacement. Did you opt for tissue or mechanical?

yes

How did you decide?

it was to be my 3rd and the surgeon made the very good point that "I don't want a 4th"

If mechanical has it caused you any problems?

none

Have you been in an accident while on warfarin or do you know anyone who has, and what was the outcome?

no, and at 60 I'm more worried about having an accident at all than my concern about warfarin.

Lastly I suggest the following (from my blog); I encourage you to fact check and even better "double check my calculations and understandings

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.

If this strikes you as stupid then you won't be the only one, as researchers (including cited in that article) have been making this observation since the 80's.

Dr. Jim Newman, an actual rocket scientist and highly respected head-impact expert—he was once a Snell Foundation director—puts it this way: "If you want to create a realistic helmet standard, you don't go bashing helmets onto hemispherical steel balls. And you certainly don't do it twice.

But the ignorance of buyers to actually what is happening out there in "Standards Land" causes helmet makers to be merrily pied piperd away on a little path of "tougher" standards, more or less without evidence of benefit, seemingly just to make administrators happy with their increasing efforts at tougher standards.

I think Dr Newmans words are about spot on:

"The Snell sticker has become a marketing gimmick. By spending 60 cents [paid to the Snell foundation], a manufacturer puts that sticker in his helmet and he can increase the price by $30 or $40. Or even $60 or $100.

So, if you're starting to get interested in this subject let me link you to a study done in the 80's here in Australia, its about the best I've ever read and also makes recommendations on how to improve things. Not one of its recommendations has been implemented. That report is here, its really good reading for those who are interested. To me the most damning thing they say is this:

So, essentially the test makes helmets hard enough that they deform you head rather than absorb the impact. That in itself should get you thinking about this topic and your pre-conceptions.

Lastly I'll leave you with the point that having some uncertainty in my mind about if this helmet is or isn't the best of the best of the best (with honours - thanks Will Smith) is not actually a bad thing, as much research has been done on the psychology of risk taking because of perception of safety (engendered by safety gear). I recommend you read this.

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

Ok, I'm off on the scoot now

Best Wishes

 

[pellicle]

oh ... one last thing.

Ever since I can remember every surgeon I've ever sat with has at least once told me "you should give up riding a motorcycle". This started when I was about 12 after my first surgery.

No surgeon has mentioned "because warfarin" but some have mentioned because the bental, or because the valve ...

So in my entire career of motorcycling I've had more offs than I could mention (and that's leaving dirt bikes and MX out of this). I've broken bones and been knocked unconscious (best one was doored, bashed off the side of an oncomming van, then came to rest face first in the boot of a car that was stopped at the lights I was slowing down for. Broken wrist, no finger damage.

My worst accident was being hit head on by a car turning at an intersection while on my bicycle.

Accidents are unpredictable. Try real hard not to have one, but equally try really harder to do training and observation skills as well as advanced rider training and emergency braking (less critical now with ABS, but use your bloody front brake for gods sake).

Best Wishes

Stay Upright

 

[Standardvelocity]

I had surgery 3 months ago mechanical valve and warfarin, I rode motorcycles before and started again about 8 weeks post surgery on and off road. The only change is I bought and wear a full face helmet.

 

[Lisa from LJ]

How often do you plan on having an accident? I ride with my husband and never even think about it. I also don't think about it when I'm driving my car, riding my bicycle, or riding my e-bike. I've hiked hills and mountains, tubed rivers, ridden roller coasters, zip lined, and did iFly (indoor skydiving). I've fallen while walking the dog, had a cut to my head that required stitches, and cut myself when shaving and have yet to bleed to death. The biggest bleeding problem I had is that I was pre-menopausal when I had my surgery and bled almost constantly for more than a year before having a hysterectomy. If you have an accident, they'll start pushing Vitamin K in the ambulance and the bleeding will probably be similar to those who don't take Warfarin, or in other words, big cut=lots of bleeding, small cut=not much bleeding, road rash=lots of pain and oozy bleeding.

 

[tom in MO]

I don't ride a motorcycle but have ridden bikes for many years. Given the accidents I've had on bikes, I would never ride a motorcycle with or without warfarin. Force=mass x acceleration is enough to keep me off a motorcycle irrespective of warfarin. Knowing three people who barely missed death in motorcycle accidents also helps keep me off one.

I don't know how old you are, but as we get older our reaction time becomes longer. I know two people who stopped riding in middle age when they found out their reaction time had slowed with age. It got harder to avoid the turtles in spring.

 

[Jeff Lebowski]

I don't ride a motorcycle but have ridden bikes for many years. Given the accidents I've had on bikes, I would never ride a motorcycle with or without warfarin. Force=mass x acceleration is enough to keep me off a motorcycle irrespective of warfarin. Knowing three people who barely missed death in motorcycle accidents also helps keep me off one.

I don't know how old you are, but as we get older our reaction time becomes longer. I know two people who stopped riding in middle age when they found out their reaction time had slowed with age. It got harder to avoid the turtles in spring.

I am also among those who are in a dilemma in this regard. I must state that the motorbike provided me great convenience in my daily life before the surgery. The lack of parking space problems, moving without getting stuck in traffic, these are good things. I never like speeding, I never ride my motorbike without protective clothing. However, after the surgery, especially the use of Warfarin seriously worries me about using my motorbike. For example, the user in the post two posts before you encouraged me, but what you have been encouraged is so logical that I don't know...
I am 51 years old, although I believe that I still have sufficient physical abilities in realsion, it is another fact that the possibility of an accident on a motorbike is not only due to your mistakes.

 

[Lisa from LJ]

it is another fact that the possibility of an accident on a motorbike is not only due to your mistakes.

That is true, but it was also true before you started taking Warfarin. A motorcycle accident will almost guarantee some bleeding, warfarin or not. My son, who isn't on Warfarin, has had two accidents - one caused by him and one not. The first one caused quite a bit of road rash and oozy bleeding. The second caused a compound fracture where his tibia protruded through his skin. He bled. Fortunately he lived. I doubt the external bleeding would have been different for someone on Warfarin. Internal bleeding could be worse for someone on Warfarin, but good medical people should be able to manage that.

 

[pellicle]

it is another fact that the possibility of an accident on a motorbike is not only due to your mistakes.

I totally agree, but like so many things making an intelligent response to this take more words than stating your case. So:

1. last I checked experienced riders of motorcycle side cars are in so many less accidents per person / km than regular motorcycles. We're talking between 10 and 100 times less. This is attributed to rider experience and awareness (its usually not squids riding 'outifts')
2. I have argued for some decades now that you need to ride defensively; you can't just say "well its a green light, why do I need to look" ... because it does you no good being in hopital with grievous bodily injuries being smug in the knowledge "I was in the right"

So far and averaging over 50,000km per year I've not had a motorcycle accident in over 30 years. This includes riding in Japan, Europe and Australia.

Perhaps there is something to "active safety" and being strongly defensive.

Lastly I have never been in a motorcycle accident which was "my fault" ... but as stated above I've been hit a number of times. What changed was me and my recognition of those situations in a visceral way.

 

[Moddeydhoo]

One of the first things I was told by my surgeon post op (3years ago, mechanical valve), "You can never ride a motorcycle again."
Sorry, never going to happen! I've been riding since I was 12 years old (61 now). I lived on the Isles of Man, which for those that know, is a bikers heaven. Currently live in Thailand which is one of the most dangerous places to ride a motorcycle. My bike is my only form of transport to and from work and provides me with a great leisure activity as well.
Yes I have thought about the consequence of having an off, but the thrill and freedom, for me, outweigh the fear of bleeding out because of an accident while on warfarin. Minor nicks and cuts piss me off more because of warfarin. I promised myself not to become a victim just because of my condition.
Just thought I would throw my two penn'orth in.

 

[BradP]

I've ridden motorcycles for 45 years. That didn't change 2 years ago when I got my mechanical valve. Being on warfarin is not a big deal. I still regularly ride motorcycles, go mountain biking (doing that today), use chainsaws, hunt deer from a tree stand, etc. Indeed, after wearing a helmet, "riding defensively" is the best advice. Don't tailgate and keep your distance from other vehicles, always assume that motorist sitting at the hamburger stand will pull out in front of you, and expect people to run red lights. If you live in an area with lots of deer like I do, limit your night riding.

Don't let warfarin change your lifestyle. I mean, should you not ride in cars because if you crash you might get a bleed? Should you staff off airplanes since if you crash, you might get a bleed? I would recommend getting the durable valve, and taking my cardiologist's advice when he said, "Now go live your life."

 

[Richie Rich]

Good morning
you've already heard from me, but I'm not sure how many other bikers are on here ... but to add to the thread for the benefit of other (perhaps anonymous) readers

personally I think its a nothing burger and a severed artery from a broken bone will be a bigger threat. An IC bleed will be detected and addressed in ER


yes

it was to be my 3rd and the surgeon made the very good point that "I don't want a 4th"


none


no, and at 60 I'm more worried about having an accident at all than my concern about warfarin.

Lastly I suggest the following (from my blog); I encourage you to fact check and even better "double check my calculations and understandings

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:

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:

Ok, so then:

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

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 ...

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.

If this strikes you as stupid then you won't be the only one, as researchers (including cited in that article) have been making this observation since the 80's.


But the ignorance of buyers to actually what is happening out there in "Standards Land" causes helmet makers to be merrily pied piperd away on a little path of "tougher" standards, more or less without evidence of benefit, seemingly just to make administrators happy with their increasing efforts at tougher standards.

I think Dr Newmans words are about spot on:

So, if you're starting to get interested in this subject let me link you to a study done in the 80's here in Australia, its about the best I've ever read and also makes recommendations on how to improve things. Not one of its recommendations has been implemented. That report is here, its really good reading for those who are interested. To me the most damning thing they say is this:

View attachment 890231

So, essentially the test makes helmets hard enough that they deform you head rather than absorb the impact. That in itself should get you thinking about this topic and your pre-conceptions.

Lastly I'll leave you with the point that having some uncertainty in my mind about if this helmet is or isn't the best of the best of the best (with honours - thanks Will Smith) is not actually a bad thing, as much research has been done on the psychology of risk taking because of perception of safety (engendered by safety gear). I recommend you read this.


Ok, I'm off on the scoot now

Best Wishes

I do ware proper riding gear and a decent helmet and I understand that the testing of these is not always carried out in an ideal way. I always thought that I’d be no more likely to bleed on warfarin, but that if I did bleed it would be harder to stop. I can live with that, but the internet seems to suggest that I’d be far more likely to start bleeding in the first place and that a bleed on the brain would be certain if I banged my head which is worrying. My preference would be mechanical and possibly keeping my INR towards the lower end of whatever range Im given to minimize the risk of bleeding.

 

[Richie Rich]

oh ... one last thing.

Ever since I can remember every surgeon I've ever sat with has at least once told me "you should give up riding a motorcycle". This started when I was about 12 after my first surgery.

No surgeon has mentioned "because warfarin" but some have mentioned because the bental, or because the valve ...

So in my entire career of motorcycling I've had more offs than I could mention (and that's leaving dirt bikes and MX out of this). I've broken bones and been knocked unconscious (best one was doored, bashed off the side of an oncomming van, then came to rest face first in the boot of a car that was stopped at the lights I was slowing down for. Broken wrist, no finger damage.

My worst accident was being hit head on by a car turning at an intersection while on my bicycle.

Accidents are unpredictable. Try real hard not to have one, but equally try really harder to do training and observation skills as well as advanced rider training and emergency braking (less critical now with ABS, but use your bloody front brake for gods sake).

Best Wishes

Stay Upright

I’m not a regular crasher anymore, did all that in my younger days. However it is fair to expect a crash on a bike at some point and I don’t fancy bleeding out of having a brain haemorage. I’m not crazy on the bike but I don’t ride slow either. Oh, and I use front and rear brakes but mostly front

 

[pellicle]

I do ware proper riding gear and a decent helmet and I understand that the testing of these is not always carried out in an ideal way

which totally was not my point. My point is that all gear has limits and that the most important aspect of safety is active safety (meaning the rider, and their approach).

. My preference would be mechanical and possibly keeping my INR towards the lower end of whatever range Im given to minimize the risk of bleeding.

Sure, and I won't suggest otherwise but I think that you don't actually understand the "risk of bleeding" and I'm 90% confident its not what you think it means. Secondly I would not suggest you trend your INR towards the lower end of anything, you should consider a target and keep aiming at the target. Range is a dangerous way of viewing it and the trend has been towards a target for some years now. I target 2.5. Ranges are useful for explaining things but people do exactly what you've done and said "they'll stay to the lower end of the range" as if that's somehow safer. It isn't.

Please consult "that graph" and table carefully

your actual rise of a stroke goes up with a "sit on the lower end of the range".

Aim for the center of the target ...

Riding safe is not about gloves and helmets its about attitude. Gloves, jackets and helmets are a 'last resort' when you're already stuffed (in slow motion) because an accident is happening. Avoid accidents don't plan for them and don't believe "my gear will save me" .. it might, it might not.

I've personally witnessed deaths with no significant injuries due to a broken neck (in one case and a broken spine (in another).

Best Wishes

 

[Richie Rich]

I had surgery 3 months ago mechanical valve and warfarin, I rode motorcycles before and started again about 8 weeks post surgery on and off road. The only change is I bought and wear a full face helmet.
View attachment 890233View attachment 890233View attachment 890234View attachment 890234

Nice bikes, I’m glad you’re getting out on them and enjoying yourself. I’m hoping to continue riding after valve replacement just trying to weigh up if I’ll be happy to do it with a mechanical valve.

 

[Richie Rich]

How often do you plan on having an accident? I ride with my husband and never even think about it. I also don't think about it when I'm driving my car, riding my bicycle, or riding my e-bike. I've hiked hills and mountains, tubed rivers, ridden roller coasters, zip lined, and did iFly (indoor skydiving). I've fallen while walking the dog, had a cut to my head that required stitches, and cut myself when shaving and have yet to bleed to death. The biggest bleeding problem I had is that I was pre-menopausal when I had my surgery and bled almost constantly for more than a year before having a hysterectomy. If you have an accident, they'll start pushing Vitamin K in the ambulance and the bleeding will probably be similar to those who don't take Warfarin, or in other words, big cut=lots of bleeding, small cut=not much bleeding, road rash=lots of pain and oozy bleeding.

I don’t plan on having an accident, but ship happens and usually when you really don’t need it. Glad to see that you’ve stayed active and hope that I can too.

 

[Richie Rich]

I don't ride a motorcycle but have ridden bikes for many years. Given the accidents I've had on bikes, I would never ride a motorcycle with or without warfarin. Force=mass x acceleration is enough to keep me off a motorcycle irrespective of warfarin. Knowing three people who barely missed death in motorcycle accidents also helps keep me off one.

I don't know how old you are, but as we get older our reaction time becomes longer. I know two people who stopped riding in middle age when they found out their reaction time had slowed with age. It got harder to avoid the turtles in spring.

I’m 50, but my reactions are still pretty good and I’ve got lots of riding experience, but I know when riding a motorcycle to expect the unexpected.

 

[Richie Rich]

One of the first things I was told by my surgeon post op (3years ago, mechanical valve), "You can never ride a motorcycle again."
Sorry, never going to happen! I've been riding since I was 12 years old (61 now). I lived on the Isles of Man, which for those that know, is a bikers heaven. Currently live in Thailand which is one of the most dangerous places to ride a motorcycle. My bike is my only form of transport to and from work and provides me with a great leisure activity as well.
Yes I have thought about the consequence of having an off, but the thrill and freedom, for me, outweigh the fear of bleeding out because of an accident while on warfarin. Minor nicks and cuts piss me off more because of warfarin. I promised myself not to become a victim just because of my condition.
Just thought I would throw my two penn'orth in.

I’ve lived on the IOM too so motorcycles are in my blood. I really don’t plan on quitting riding but I want to be as certain as possible I’ll be happy to ride with a mechanical valve while on warfarin.

 

[Richie Rich]

I am also among those who are in a dilemma in this regard. I must state that the motorbike provided me great convenience in my daily life before the surgery. The lack of parking space problems, moving without getting stuck in traffic, these are good things. I never like speeding, I never ride my motorbike without protective clothing. However, after the surgery, especially the use of Warfarin seriously worries me about using my motorbike. For example, the user in the post two posts before you encouraged me, but what you have been encouraged is so logical that I don't know...
I am 51 years old, although I believe that I still have sufficient physical abilities in realsion, it is another fact that the possibility of an accident on a motorbike is not only due to your mistakes.

I understand your dilemma it’s so difficult to decide what to do. For me though it’s more about value choice. I don’t plan on giving up riding, i just need to be sure I’m happy to ride on warfarin or I’ll be choosing a tissue valve.

 

[Richie Rich]

I've ridden motorcycles for 45 years. That didn't change 2 years ago when I got my mechanical valve. Being on warfarin is not a big deal. I still regularly ride motorcycles, go mountain biking (doing that today), use chainsaws, hunt deer from a tree stand, etc. Indeed, after wearing a helmet, "riding defensively" is the best advice. Don't tailgate and keep your distance from other vehicles, always assume that motorist sitting at the hamburger stand will pull out in front of you, and expect people to run red lights. If you live in an area with lots of deer like I do, limit your night riding.

Don't let warfarin change your lifestyle. I mean, should you not ride in cars because if you crash you might get a bleed? Should you staff off airplanes since if you crash, you might get a bleed? I would recommend getting the durable valve, and taking my cardiologist's advice when he said, "Now go live your life."

Glad to see you are carrying on as before it sounds like the best thing to do. Hope I can get my head around warfarin and be as active as you on it