My bike "incident" and coumadin

[Jen]

So.. I had an "incident" on my road bike 12/21. Those damn speed play pedals! My AVR was June 7, 2011, been doing great but can't seem to stay off the injured reserve list. Sprained my ankle in Sept, poison ivy, now falling on my bike. I feel great, so I want to keep moving, but something else has different plans for me! I fell on a curb and have a HUGE complex hematoma (about the size of your hand) on the lateral posterior side of my right thigh. Bruise has gone all the way down my leg(which I knew would happen), and I was told at lunch time the results of my ultrasound and the DR. recommends I see a surgeon to get it taken care of. That is the part that "freaks" me out... I could at least prepare for AVR, I knew what to expect.. this I have no idea if they have to cut, use a drain tube....
All I can say is accidents happen, either on coumadin or not. I would not change my valve choice if I had to do it again(hopefully I won't!)

 

[Lynlw]

OUCH!! that sounds painful. I hope it is a relatively easy thing having it drained and that your luck is MUCH better in 2012

 

[spartangator]

Sorry to hear about the accident. That is the downside of cycling, right? We all end up with too much road rash :thumbd: It sounds like you've resolved to keep being active, though, and that we'll soon be hearing about your great rides.

 

[bradvo]

Keep us posted Jen, hopefully you will recover fast and be back on the bike.

 

[ski girl]

What are they going to do Jen, do you have blood clots in there?

 

[Jen]

Thanks everyone.. I don't know how they will do it - that is what bothers me the most - the unknown. My Dr's office is supposed to call me today with the surgeon appt. hopefully it is soon, it hurts! Ski Girl- the ultrasound showed no DVT but the hematoma is about the size of your outstretched hand..My INR has been running 2.3-2.5. It was actually too high the day of the accident 3.6 - I think that is why it ended up being so bad. I landed directly on the curb I have been on the trainer in my garage since she did not give me restrictions. I will be there until spring! I will let you all know what the surgeon says.

 

[ski girl]

All fingers and toes crossed for you Jen! And realistically, after you've been thru OHS, everything else is minor - 'oh yeah is THAT the best you've got?' But I'm with you, not knowing what they're going to do is the worst part!!!! Sometimes I think I'd be best wrapping myself up in cotton wool, but I think I'm more like you and don't want ti change who I am even if that means I risk getting hurt. Best wishes from down under!

 

[scott.eitman]

Thanks for sharing. The hardest part of making the mechanical decision was getting info on what to expect after a bicylce accident. I now talk about confined spaces and the head. I am glad to have this to share as well.

In fairness to Speedplay, I am guessing you would have gone down with any pedal. I don't have them, I am an old school Look guy.

 

[wcasey5]

SPD's maybe? It's tough to unclip in tight quarters in any pedal, but keep active. I'm sure this will pass with time. Good luck with the hematoma.

 

[sarahsunshine]

Jen, definitely try some arnica. Arnica can be found at any health food store in all sorts of forms - bruise cream, oral homeopathic, etc... I would try both the bruise cream and the oral pelelts. Talk to the sales associate at a prominent health store and they can help you out.

I find it difficult when people say "take this", so here is some background. Arnica is a homeopathic bruise/hematoma healer. I play hockey and stop slapshots periodically with the back of my legs and a friend's son plays Lacrosse. Since we discovered arnica, it TOTALLY changed the speed I have healed. It DOES NOT affect your INR at all, so we use it for Skyler all the time, including immediately after heart surgery. It's amazing how fast it works too. I would go out and get some and try it. Honestly, I had a MASSIVE bruise on the inside of my thigh the size of a soccer ball that I left for a week, and then pulled out the arnica and it was gone in a couple days. I was sure that I would have a deep hard bruise and potentially permanent alcium deposit under it. If it can save you surgery, it is definitely worth it.

Here's from wikipedia: "Arnica is currently used in liniment and ointment preparations used for strains, sprains, and bruises. Commercial arnica preparations are frequently used by professional athletes.[4] The thymol derivatives concentrated in the plants roots have been clinically shown to be effective vasodilators of subcutaneous blood capillaries. A study of wound-healing after surgery to treat varicose veins found a trend towards a beneficial effect of reduction of pain and hematoma following surgery.[5]"

Here are some links about Arnica:

http://en.wikipedia.org/wiki/Arnica
http://www.umm.edu/altmed/articles/arnica-000222.htm

 

[Lynlw]

You might want to check with your doctor before you take Arnica since it CAN interact with Coumadin and cause other heart issues

 

[Duffey]

You might want to check with your doctor before you take Arnica since it CAN interact with Coumadin and cause other heart issues

Ok, I don't take coumadin so this won't affect me either way, but I am concerned that Sarahsunshine says that they used it with her stepson immediately after surgery and I imagine that others would like to know if there is or isn't an interaction.

 

[sarahsunshine]

Ok, I don't take coumadin so this won't affect me either way, but I am concerned that Sarahsunshine says that they used it with her stepson immediately after surgery and I imagine that others would like to know if there is or isn't an interaction.

Curious... I have never heard that it interacts with coumadin, and all the doctors gave us a clear go-ahead. I am talking about the oral homeopathic preparation, or the homeopathic cream.

I wonder if the interaction that Lyn is concerned with is if there is actually any real level of the plant/herb arnica in the form you are taking. If you are talking about the levels in a homeopathic preparation, the levels are so low that they considered non-existent (extract of an extract of an extract, and at .001% or less). I do know that if you are actually considering taking the herb arnica, it is a completely different story, and I do NOT advocate that. The plant arnica can have some terrible effects.

Lyn, can you expand on your comments in relation?

 

[tobagotwo]

Some quick arnica (wolf's bane) references. Arnica contains some coumarins, which is why there are concerns with Coumadin/warfarin. Warnings seem to be specifically related to taking it internally...

http://my.clevelandclinic.org/heart/prevention/alternative/herbals_theheart.aspx

Other supplements are known to cause heart problems, whether or not the consumer is also taking heart medications. These include:
Aloe - used internally to relieve constipation and externally to soothe irritated skin and burns. When taken internally, aloe can cause abnormal heart rhythms in pregnant women and children.
Arnica ( Arnica montana) - applied externally to reduce pain from bruising, aches and sprains, and to relieve constipation. Arnica is potentially toxic to the heart and can raise blood pressure if taken internally.
Black cohosh ( Cimicifuga racemosa) - used to relieve menopausal symptoms. Can cause lowered blood pressure when taken at high doses.

http://www.australianprescriber.com/magazine/25/3/54/6/

Many herbs contain coumarins that maypotentiate the activity of warfarin.14These include alfalfa (Medicago sativa), angelica (Angelica archangelica), aniseed (Pimpinella anisum), arnica (Arnica montana), asafoetida (Ferula spp.), celery (Apium graveolens), German chamomile (Matricaria recutita), Roman chamomile (Anthemis nobilis), fenugreek (Trigonella foenum-graecum), horse chestnut (Aesculus hippocastanum), prickly ash (Zanthoxylum americana, Z. clava-herculis), quassia (Picrasma excelsa), and red clover (Trifolium pratense).12

http://www.longevinst.org/nlt/newsletter11.htm

If you are taking one of the following Pharmaceuticals containg Warfarin or acetyl salicylic acid (Aspirin) :

Acuprin(Richwood)
Butalbital(Watson)
Coumadin tablets, Coumadine for injection (DuPont Pharma)
Darvon Compound-65(Lily)
Endodan(Endo generics)
Encotrin enteric coated aspirin(SmithKline)
Equagesic(Wyeth-Ayers)
Excedrin(Bristol-Meyer)
Fiortal(Geneva)
Florinal(Novartis)
Gelpirin(Alra)
Halfprin(Kramer)
Lortab(UCB)
Metocarbamol(Par)
Norgesic(3M)
Percodan(Endo labs)
Propoxyphene(Teva)
Robaxisal(Robins)
Roxiprin(Roxane)
Soma compound(Wallace)
Synalgos(Wyeth-Ayers)
Talwin compound(Sanofi)

Be aware that the following Nutraceuticals may interfere with their activity :

Easier bleeding :

Allium Sativum Garlic
Angelica sinensis Dong quai
Anthemis nobilis Chamomile
Apium graveolens Celery
Arnica montana Arnica
Capsicum Cayenne
Chinchona Quinine
Chrysanthemum parthenium Feverfew
Foenum graecum Fenugrec
Ginkgo Biloba Leaf Ginkgo Biloba
Salvia miltiorrhiza Dan-shen
Zingiber Officinalis Ginger

http://www.mskcc.org/cancer-care/herb/arnica#field-herb-warnings (Memorial Sloan-Kettering Cancer Center Site)

Warnings

Internal use of arnica is not advised. The effects of arnica on the lungs, heart, and uterus have not been sufficiently tested to justify the risks associated with oral use. A fatal case of poisoning has been reported following ingestion of 70 g of arnica tincture. The FDA considers oral Arnica an unsafe herb. External use appears to pose no risk. (13) (16)

Adverse Reactions

Common (oral): GI distress, tachycardia, shortness of breath, coma and death
Infrequent (topical): Contact dermatitis, irritation, burning (5)

Herb-Drug Interactions

Antihypertensives: Arnica may reduce hypotensive effects.
Anticoagulants / Antiplatelets: Arnica may potentiate the anticoagulant effect due to the coumarin constituents. This effect has not been documented in humans. Use with caution.

Best wishes,

 

[Luana]

I've taken several meds, Rx and supplements, that could interfere with INR, but haven't, and some that have. Just check INR a bit more frequently to make sure you're in range and adjust dose if needed.

 

[Freddie]

ARNICA (in Arnica) may interact with WARFARIN SODIUM (in Warfarin Tablets)

Anticoagulants, such as warfarin, are taken to reduce the risk of blood clots. Chemicals in arnica also may decrease blood clotting. When arnica is taken together with warfarin, the risk of excessive, possibly dangerous, bleeding may increase. Individuals who take warfarin should not take arnica. If both are taken, more frequent blood tests may be needed to make sure that blood is clotting properly. Those who experience problems may need to stop taking arnica until after warfarin is discontinued. You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

 

[Lynlw]

Sorry I havent checked back earlier, but beside bob's post and Freddies, there are others who warn about the cream if used on open wounds
http://www.livestrong.com/article/145339-side-effects-of-arnica-cream/


Arnica cream, or arnica montana cream, is a homeopathic medicine obtained from the arnica plant. Arnica extracts, obtained from the fresh or dried flower of the plant, have been used since the 1500s as a treatment for various muscle issues, including sprains, muscle aches, rheumatic pain, inflammation caused by fractures and insect bites, as well as to treat bruises and heal wounds. However, arnica must be used with caution as serious side effects can occur.

Effects on the Skin
Arnica cream is typically applied directly to the skin to treat the affected muscle. While generally safe, arnica cream used for prolonged periods can cause skin irritations including eczema, peeling or blisters. In addition, allergic reactions to the arnica plant components are possible, which can cause contact dermatitis. The Nutritional Supplements Health Guide also reported cases of mouth ulcers caused by arnica-containing mouthwash.

Side Effects When Ingested
Taken internally, arnica extracts are extremely toxic. Side effects include dizziness, tremors, irritation of mucous membranes, muscle weakness, an increase risk of bleeding, vomiting and heart irregularities. It can also cause stomach discomfort and nausea, damage to the liver and kidneys and organ failure.

Arnica creams contain very small amounts of arnica and therefore do not usually exhibit such side effects. However, if used on an open wound, Arnica can enter the bloodstream, causing the same effects as when taken internally. Large doses of arnica taken internally can be fatal



Read more: http://www.livestrong.com/article/145339-side-effects-of-arnica-cream/#ixzz1jDB1sGsv

 

[coffeelover]

Jen,
Hope the hematoma is getting better...Wishing you a speedy recovery so you can have lots of fun riding your bike this spring!
Take care!

 

[sarahsunshine]

Wow, lots of stuff against use of arnica with Warfarin. I would never take any arnica based on the internet stuff posted here. However, I would like to clarify. I was talking about homeopathic arnica (miniscule amounts), not herbal arnica (much larger amounts that do seem to show many side effects). However, please do what you consider safe.


I hope your hematoma is improving!

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Is Arnica toxic? (http://www.alpinepharm.com/faqs/)

The herb Arnica Montana is toxic. The Homeopathic Medicine made from Arnica Montana is NOT toxic, due to the small doses of Arnica used in Homeopathy.

Herbal doses are commonly found to be large enough to provide physiologically active levels of pharmacologically active constituents of the herb. In contrast, Homeopathic doses rarely provide sufficient quantities to yield adverse effects. In accordance with classic rules of pharmacology, the smaller doses seen in Homeopathic preparations may exhibit the reverse effect of the larger doses used in herbal medicine. However, even Homeopathic doses may be cumulative over time. Prolonged pre-operative dosing regimens of Arnica Montana, for example, may increase intra-operative bleeding, whereas the single pre-operative dose used in the SINECCH™ protocol has been reported to increase intra-operative bleeding in only one case out of over 300,000, and in this case there may have been other factors involved in the increased bleeding. Prolonged pre-operative dosing is not necessary with SINECCH™, since SINECCH™ contains an appropriate Homeopathic dose of Arnica Montana for the significant level of trauma seen in plastic surgery, general surgery, and trauma patients.

Alpine Pharmaceuticals recommends against using herbal forms of Arnica Montana in either oral or topical forms.
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