Another Alcohol Thread

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Oct 27, 2017
Sorry for initiating yet another alcohol thread. I know there are already many and I have looked through them all, but i'm still left with a question or two.

Quick background: I'm going in for a valve replacement and aortic root graft in a few weeks. I'm 41. It's not 100% decided yet, but the standard seems to be mechanical. I'm becoming OK with all that entails, though my wife is still fearful i'll bleed out after my first paper cut and won't be able to do anything fun, (skiing, biking, drinking, etc.).

As I understand it, there seems to be 3 problems with warfarin and alcohol. 1. It can affect INR levels 2. You can become sloppy making it more likely for you to have an injury that causes bleeding. 3. It can cause a GI bleeding event that can be hard to predict, but when it happens you're in big trouble

Did I miss any other concerns??

I'll be home testing INR, so i'm not that worried about that aspect. I can start easy and test often and if things go out of range, then i'll know I have to scale back.

The becoming sloppy part is a concern, but I don't generally get to that point. I also don't mix drinking with other risky activity (skiing, softball, jet skiing, etc.) and I don't really get into bar fights these days (I usually drink at my home or a friends home)... I know you never know what can happen, but i'm usually pretty safe in that regard.

The question I have is about the GI bleeding.. I've searched the web for info and couldn't find exact answers, so I figure i'd ask here, hopefully someone knows...

Is the problem more that bleeding starts slows and progresses to a dangerous point over time and you just don't know it or do you really just burn a hole in you stomach in a single night of drinking and bleed out from there?

Could a home stool test such as EZ Detect that is supposed to detect tiny amounts of blood in the stool be a way to try to detect a problem before it becomes a big problem? Maybe testing once a month or at some fairly frequent interval...

My drinking habits: I consider myself a moderate drinker, but I know that is relative. According to medical standards, i'm actually a binge drinker, though I'm not doing keg stands or funneling, but whatever

I'm 6 feet, 185lbs, male. Generally I drink on two nights a week. One of the nights I drink maybe 6-8 12oz beers(probably 4ish percent alcohol, but it varies). On the other night I drink 1/2 of a 750ml bottle of wine AND 2-3 beers. On both nights it is generally over the course of 4 or 5 hours. I generally feel quite buzzed, but not falling down by any stretch.

Perhaps 2 or 3 times a year (usually around a holiday party or something) I may drink even more that that. Perhaps 10 beers and a few shots, though it is over a longer period of time. I can definitely see cutting this back, probably skipping the shots altogether and maybe scaling back a beer or two.

So in the end my main question was regarding the GI bleeding above and whether there was any other concerns i'm missing.

I know to people who don't drink it may seem foolish to even think about drinking more than 1 or 2, but it is a way to socialize for me and my friends. I can certainly try to cut back if that's what I have to do. But if possible, living life as close to I normally would pre-op would make everything much easier psychologically.

PS. Thanks to everyone who contributes here. I've read tons and tons over that past few weeks and all the information, stories, experiences etc. are so helpful to others in coming to terms with what is about to happen and relieving a little anxiety (though it's still wearing on me quite a lot, I kinda just want to get it overwith)...
All I can say from personal experience is that one of the benefits of Warfarin is that you won't need to drink as much to have the same feeling.

I could be wrong though. Maybe I'm just a light weight. Last time I drank, I was 6' 4" and over 230 lbs. I checked in under 207 this morning through.
I Personally can't drink much since the new valve, i used to though, i find alcohol really increases the heart rate & thump and because of the valve's ticking it's a really unpleasant experience as the ticking is amplified in me. ( 1 small glass of red for me now max )
touching on the lesser concerns you will be fine biking & skiing. again it seems an individual thing but in my case alcohol raises my I.N.R.
Upside is i've never had a hangover in 7 years.
Best of luck on your opp in a few weeks wishing you an easy journey.......
4 oz of wine or beer raises my INR. But we are different. My body is very sensitive to medication, drinks, etc.
So, when I know I’ll drink (which is social for me) I eat spinach or add it to my smoothie and lower my dose of Warfarin and recheck my INR after two days again. If I forgot to check it, if my nose bleed I would remember to!

With time, you’ll learn how to adjust your drinking, your warfarin dose, and your food. Also, seek such an advice from your cardio, who will give you best to suit you situation.
Thanks for the replies...
I am actually a bit concerned about the ticking as well.. I am pretty sure it will be fine, but of course it's hard to know how bad it will be until its too late to do anything about it.

Sounds like alcohol affects people quite differently, will have to wait and see I guess...

Some people make it seem like you're playing russian roulette if you drink more than 2... I don't mind scaling back if needed, but I don't want to based on over-paranoia, like Agian says... I worry too much :)
CazicT;n879859 said:
Sounds like alcohol affects people quite differently, will have to wait and see I guess...

I know one lass who goes red in the face , says stupid things and falls sleep after the second beer. Another who can drink three bottles of red, get stuck into the tequila , drag some drunk guy back home for the night (we shared a house) , and then get up for work at 6am ...often leaving me to let the guy out at 8

So yes to that
During my exit "interview" the PA that talked to me was on warfarin himself and it turned out to be one more blessing. Regarding alcohol, as well as all other things, he said consistency is your best friend. He suggested it was better for your system to drink daily, as opposed to only on weekends. I took that to heart! ;)

I have done a couple INR/drinking tests, and have found no INR difference for me, sober or sloshed. Since I very rarely drink that much, it was good to know how my body reacted.

Everything else in my life went back to normal, except taking pills daily now, and a ticking I rarely notice now.
One of the fears that many people have (and it see ms to occur more often in spouses than in patients actually GETTING the valve) is the fear of bleeding to death from a paper cut, or from some otherwise minor mishap. The level of risk is greatly overplayed, in my opinion.
INR is a measure of the ratio between the time it normally takes to clot versus the time that it takes when using coumadin. An INR of 2.0 means that it should take twice as long for the blood to clot than it would if you weren't taking the anticoagulant. Even with an INR as high as 4.0 (and possibly much higher), you shouldn't have to worry much about any risk of disaster if you happen to stub your toe, or do something similarly catastrophic.

As far as gastric bleeds go - you've demonstrated that you can handle the alcohol pretty well -- you probably don't get gastric bleeds when you're drinking now - you probably won't after you start taking warfarin. You may be at a higher risk if you take too much aspirin or another well documented stomach irritant if taken in large enough quantities (or if you're especially sensitive to it).

I was also 41 when I had my valve replaced. The only realistic choice was a mechanical valve.
After a while, you get used to the ticking - you probably won't hear it unless you listen carefully for it. It's possible that it may take a few years until the sound of the clicking gets softer (which it seems to have done in my chest -- but I'm not entirely sure that it's not as loud, or I just don't pay much attention to it).

There have been some reports about a component in red wines reducing your INR, but I'm not sure how much wine it takes to have this effect.

I wouldn't be extremely concerned about how being on warfarin will change your life. The main change would be in the probable boost in energy you'll feel once you have a well functioning valve.

Again - I wouldn't worry too much about alcohol consumption causing bleeding in your stomach. I don't think I've seen anything documented about a verifiable, direct relationship between alcohol and warfarin and uncontrolled gastric bleeding.
Like Protimenow states, there's a lot of misinformation about blood thinners. The only way to test effects is to try things out and measure INR.
I think lettuce lowers mine a bit. Spinach? No problem. You get a feel for things after a while.
Thanks again for your replies, it's nice to be able to get input from people who have gone through this. I am a week away from surgery and I think i'm pretty cool going mechanical...

My wife will of course support anything I decide, but I think she doesn't quite see the downsides of the tissue valve that I do (for someone my age that is)... The pre-op nurse said that tissue valves can last 20 years (in response to my wife's questions) .. And that it could be replaced using TAVR, etc. (To be clear she was answering questions, not really advocating it)

I wasn't in the mood to really challenge it, but 20 years is maybe attainable for an older patient, but I'd likely be doing well it if lasted over 10. Plus the TAVR may or may not be doable, but even if it is, those valves don't last particularly long. So bottom line, i'd need probably at least 2, probably 3 replacements (assuming I live as long as i'd like to)

Or just the one now and none later... with a few drawbacks like ticking and needing to be a bit more careful about some things and popping pills daily

Anyway, I didn't really mean to ramble on, I mostly wanted to thank everyone for their input.

CazicT;n880180 said:
... but I think she doesn't quite see the downsides of the tissue valve that I do (for someone my age that is)

what's her objection to it ...

... The pre-op nurse said that tissue valves can last 20 years (in response to my wife's questions)

is she expecting you to be dead or divorced from her in 20 years time? You on the other hand will still be stuck with you. Also please note the area I've underlined. It also needs to have "up to" added to that.

A Big Mac "can" look like this:

or what gets served to you might not ...

, but I'd likely be doing well it if lasted over 10. Plus the TAVR may or may not be doable, but even if it is, those valves don't last particularly long. So bottom line, i'd need probably at least 2, probably 3 replacements (assuming I live as long as i'd like to)

as probably everyone here knows, thats how I feel ... probably some late 60yo will chip in and say how happy they are with their tissue prosthesis, or someone else will say "I got 9 out of mine, but I'm ok with that because I went in knowing" ... lucky they didn't get a sternal infection on their second ... might change their views.

... with a few drawbacks like ticking and needing to be a bit more careful about some things and popping pills daily

to be carefully considered depending on your temperament ... also, any family history of needing hypertension pills?

Anyway, I didn't really mean to ramble on,..

rambling on is an important part of expressing your feelings and that's as much to yourself as it is to us...

Best Wishes and keep on thinking about things
Good thoughts. Sounds like you've reasoned things out in a way that hopefully allows you and your wife to sleep at night.

I've heard a lot of the same promises regarding how things will be. I have a friend who had surgery nine years ago in his 30's. He went tissue on the promises of no medication and TAVR when it is time for a redo. So far so good on the no medication. He's still only in his 40's. I haven’t seen any indication that TAVR is ready to go inside of a tissue valve in a patient that young. But he could get another 10 plus years so who knows?
Well that's it really: the ticking, the Warfarin and avoiding blows to the head. It might be worthwhile spending some time with someone with a mechanical valve to get a feel for the ticking. It does get a small minority of people down.
Just chipping in my experience: an early test (probably about 2 months after getting a mechanical aortic valve) seemed to find that alcohol had a big effect on my INR, so I stopped drinking completely. But after some more discussion on this board i repeated the test about 18 months later, and found alcohol has a negligible effect on my INR. I drink less than I used to, probably 2 to 3 20floz pints of ale in a session, often alternating with a soft drink, or a good half bottle of wine with a meal. Not had any GI bleeds, so can't comment on that, and no problem with the ticking.

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