Ice Hockey w/ mech valve / warfarin

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ramjet

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Joined
Jun 24, 2012
Messages
74
Location
Brisbane, Australia
...I think you would have been much better off going the tissue route and reop than going without anticoagulation therapy and a mechanical valve. .e.
Go steady fundy, remember FC didn't have much time for valve choice, and in fact may not have had any choice at all given the valve op was shortly after an emergency aortioc repair procedure, and in fact in some instances, where there is aortic dissection and aortic root involvement, the patient may indeed be better off with a mechanical valve, because a redo operation to replace a tissue valve can indeed be more challenging in this paarticular instance....thats what my very experienced surgeon told me anyway. Given the emergency nature of the aorta reapir operation mechanical may have absolutely been the best way to go....unfortunately there is now the ongoing warfarin issue with someone who plays a sometimes violent contact sport, but it was a life and death situation as oppposed to many valve repalcements, which are a planned procedure with time to make informed decisions.

JC, the other issue is that if you are on warfarin, and you take a significant blow to the head, and they take you to the emergency department, you are much more likely to get a CT image of the head to look for a bleed due to the increased risk of bleeding. However, not all emergency departments have a CT, so you may have to be transferred to another hospital , and CT images are not without risks in themselves due to radiation exposure, and depending on your insurance cover there may be quite a cost involved. I was on warfarin until my tissue valve had settled in (so to speak), and a couple of months after I was taken off warfarin I was involved in a car accident where my head hit the side window and I saw stars for a while. A couple of very senior doctors said I was very lucky that I didn't have the accident while I was still on warfarin, because they have had patients die due to intracranial bleeding, one had fallen from a ladder while on warfarin, and another had fallen down the steps at a train station.

I guess it all really depends on how you play the game, and at what level, you simply can't have a CT of the head every few weeks every time you get clobbered about the head, so there just comes a point where you will either have to stop because of either bleeding on the brain or because of too many CT images of the brain. I guess it will really come down to how hard you play the game, how likely you are to get a serious knock to the head, what sort of protection you are wearing, what sort of insurance cover you have and what sort of risk you are prepared to take. Personally I wouldn't be worried too much about cutting yourself or bruising elsewhre, its all about bleeding in such important places that you can't access to stop any bleeding, like in your brain from a blow to the head. Personally I would be loath to play around with altering the target INR levels. Maybe you could look at getting a super dupa, top of the line, custom fitted protective hockey helmet (if you don't already have one.)

But anyway, best of luck with it all, and remember you did indeed survive an event that many many people simply do not survive ( a major aortic dissection), and the mechanical valve and aortic root was almost certainly the best option in your particular instance (having already had an emergency aortic dissection repair which might hae made a valve reoperation much more risky and difficult) ...take care....I like the idea of continuing to play hockey ...but not a the top"MAD" level....its hard to get the image of ice hockey palyers out of your mind that we used to see in the "MAD" comic series, where the hockey player had all these stitches in the head, teeth missing, eyes gouged out, ears bitten off, hockey sticks jambed into their throat etc....if its a bit softer than that it might well be worth considering continuing with the sport. You might have to check insurance cover etc,a nd the hockey club may in fact have a rule that you need a medical clearance to play :)
 

epstns

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Joined
Dec 26, 2002
Messages
5,075
Location
Chicago area
Hey, Ovie! Remember, my army drill sergeant (an airborne trooper) told me, "There's only two things come out of the sky. Bird crap and fools!"

But you're young. It is OK to be "a fool" as long as you know what you're getting yourself into. I say, Go For It! If I was your age, I would, too.
 

ski girl

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Joined
Sep 14, 2010
Messages
683
Location
Perth, Western Australia
Ovie why will the doc say you can't skydive??? The way I see it, if the parachute works all is good, if it doesn't, then frankly the warfarin ain't gonna be what kills you. This from a person who has never sky-dove so maybe there is some other way to hurt yourself that I don't know about!!
 

Rachel

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Joined
Feb 1, 2012
Messages
539
Location
Holland, Michigan
JCrown,
I completely agree with Ramjet on the ice hockey topic, that was an excellent post IMO.

The sky-diving topic that Ovie brought up - all I can say is that I'm glad I did my sky-dive (only once) when I was young and clueless....I like what Steve said: "There's only two things come out of the sky. Bird crap and fools!"

In my experience my adrenaline was so high for HOURS - during the training, during the preparation and during the event - that's the only thing that might be hard on your heart- again IMO

Rachel
 

ramjet

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Jun 24, 2012
Messages
74
Location
Brisbane, Australia
Regarding Skydiving and warfarin, its not about the adrenaline and the excitement I am sure, even though skydiving gets the adrenaline flowing... else doctors would be concerned about other "private nocturnal" activities, (if you know what I mean). Once again, its all about knocking the head and the increased risk of an intracranial bleed whilst on warfarin, or a seriour internal; bleed elsewhere inside the body where bleeding can't be controlled by direct pressure or elevation. I did skydiving when I was at university many years ago, and its not about the person who "bounces" as they called it if you go splat with a complete chute failure, its about all the other "incidents" that might happen where you hit your head (or chest, abdomen, pelvis, femurs) and the bleeding can't be stopped easily. Its not uncommon to have someone end up with a hard landing, of "land" in a tree etc. I know I had the wind absolutely knocked out of me, and that was on a fairly routine landing. I tell you what, I am meeting with some senior surgeons and neurosurgeons over the next month, how about I ask their thoughts and opinions...in terms of "what would you do if YOU were on warfarin". I may not be able to get back to you until mid next month as we have a busy training program lined up, but one person I will speak to is one of the most senior Trauma surgeons in Australia, the grandfather of general surgery if you like, and he is a friendly, straight shooter who will give an honest opinion about any increased risks, and what happens if someone ends up in his surgery and they are on warfarin. Lets see what he says, as I am interested also, as I will likely have a mechanical valve to replace my tissue valve sometime in the next 10 to 15 years. I kind of hope that warfarin is long replaced by something else by then. I know I won't go skydiving again, but I certainly do lots of other "risky" activities, and I really want to know some facts about the actual risks...watch this space.
 

MarkU

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Joined
Jul 22, 2001
Messages
1,057
Location
Sarasota, FL
When I had my AVR and started my Coumadin twelve years ago, the generic advice was to avoid any activities that required helmets. The list included the previously discussed skydiving along with other obvious pursuits like auto racing and American football. No hard data or studies to back anything up, it just seemed to be common-sense type advice.

Interestingly, cycling wasn't on the list, probably because most folks don't wear helmets when riding their bikes. On the other hand, I consider riding my triathlon bike to probably be the riskiest thing I do and I wouldn't even think about taking a short ride around the block without wearing my helmet.

I also had folks telling me that for the rest of my life I would run the risk of dropping dead in the street from a "spontaneous brain bleed".

With all due respect, I have mixed feeling about asking doctors "What they would do if they were on Coumadin?" if they're not actually on it. Too much possibility of CYA answers, IMHO, likely due in part to our current litigious society.

Quick story: When I knew I was going to get a mechanical valve, I read all the Coumadin/Warfarin literature issued by the drug companies and it all said "avoid alcohol". I casually mentioned to my surgeon that I would miss my glass of red wine with dinner, but that I was OK with it if that was what I needed to do. His response was "What are you talking about? You don't need to give up alcohol, just drink responsibly and don't binge." He even called me at home a few days later to tell me that he had double-checked all the research and found no reason to give up alcohol. It was all just CYA on the part of the drug companies. As far as the Coumadin, it comes down to the classic "dose the diet, don't diet the dose".

Mark
 

Scott

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Joined
Dec 23, 2010
Messages
127
Location
Atlanta, GA
I agree. I just try to be a little extra careful with everything I do now. Try and reduce the risk. I use a helmet now when I ride my bike. I where gloves if I am hiking in a really rough and rocky area. Things I should have been doing before. I just try to think and be a little more careful. I too thought a small cut would send me to the hospital. In my case it hasn't been true. Just a band-aid. My inr is 2.0-3.0.
 

normofthenorth

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Joined
Nov 1, 2010
Messages
861
Location
Toronto, ON, Canada
My contact-sports-with-Coumadin experience was with downhill skiing (a week at Whistler), not ice hockey. It's all on my long blog, search for "Norm's Story So Far. . ." and you'll find it. Tissue valve, on a moderate INR (2.5-ish?) for 3 months, had a scheduled ski trip in there. (I was also on Metoprolol.) I asked for and got three opinions: from my (fancy) heart surgeon, my (fancy) cardiologist, and my (fresh out of Med School) GP.

My Cardiologist said that anybody on Warfarin who skis downhill is crazy, but guessed right that I was probably going no matter what he said. My GP said "go, but take it easy, stay on the groomed runs, and try not to fall". And my heart surgeon said "Sure, go, have fun!" I did take some extra precautions -- a helmet, a chest-strap heart monitor and some extra padding around it in case I fell on it (and my sternum) -- and I stopped frequently, when my HR went high, which happened pretty quickly because I was less than 2 months post-AVR. But I went and had fun.

Since then I've gone off the two drugs, and returned to Whistler twice a year and skied fast and hard and steep, but that's not remarkable (even for my cardiologist) without the Coumadin.

My bottom line was that the professional "expert" advice I got, based on a significantly elevated risk of a terrible -- but still relatively unlikely -- outcome, was all over the map. I think of my fancy doctors, with totally different advice, were both "right", and just had very different approaches to the same information.
 

TheGymGuy

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Joined
Jan 3, 2011
Messages
974
Location
Rockville, MD
Regarding Skydiving and warfarin, its not about the adrenaline and the excitement I am sure, even though skydiving gets the adrenaline flowing... else doctors would be concerned about other "private nocturnal" activities, (if you know what I mean). Once again, its all about knocking the head and the increased risk of an intracranial bleed whilst on warfarin, or a seriour internal; bleed elsewhere inside the body where bleeding can't be controlled by direct pressure or elevation. I did skydiving when I was at university many years ago, and its not about the person who "bounces" as they called it if you go splat with a complete chute failure, its about all the other "incidents" that might happen where you hit your head (or chest, abdomen, pelvis, femurs) and the bleeding can't be stopped easily. Its not uncommon to have someone end up with a hard landing, of "land" in a tree etc. I know I had the wind absolutely knocked out of me, and that was on a fairly routine landing. I tell you what, I am meeting with some senior surgeons and neurosurgeons over the next month, how about I ask their thoughts and opinions...in terms of "what would you do if YOU were on warfarin". I may not be able to get back to you until mid next month as we have a busy training program lined up, but one person I will speak to is one of the most senior Trauma surgeons in Australia, the grandfather of general surgery if you like, and he is a friendly, straight shooter who will give an honest opinion about any increased risks, and what happens if someone ends up in his surgery and they are on warfarin. Lets see what he says, as I am interested also, as I will likely have a mechanical valve to replace my tissue valve sometime in the next 10 to 15 years. I kind of hope that warfarin is long replaced by something else by then. I know I won't go skydiving again, but I certainly do lots of other "risky" activities, and I really want to know some facts about the actual risks...watch this space.

Hey Ramjet,
Did you end up hanging out with senior surgeons and neurosurgeons, I am curious about their thoughts. Honestly, I am agreeing with everyone else in regards to living your life and taking calculated risks. Shoot, if I was not afraid of heights I would totally sky-dive, even now ;) Still, let us know your findings.
 

Jcrown

Member
Joined
Oct 7, 2012
Messages
8
Location
Abu Dhabi, United Arab Emirates
LONG TIME since being on here.
Little bit of an update. I do some stick & puck skates from time to time, but don't really play as I struggle playing 'down' and unless I 'know' the guys I'm playing with, it's just too much of a risk. I've had some TERRIBLE bruises and many of the guys I play with are ex pro/elite players. I am also a long time official so some IIHF work convinced me that I'm satisfied with the stripes and occasional playing here and there, but nothing too serious. I am back in the states now and officiating AAA, Juniors and ACHA College hockey and that's been a pretty good stand in. With a family and all, I just don't wanna take the risks of some guy that 'hasn't' played or knows the game doing something stupid.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
6,067
Location
Queensland, OzTrayLeeYa
Hi
Jcrown;n881128 said:
LONG TIME since being on here.
but glad you're back :)

Little bit of an update. I do some stick & puck skates from time to time, but don't really play as I struggle playing 'down' and unless I 'know' the guys I'm playing with, it's just too much of a risk.... I just don't wanna take the risks of some guy that 'hasn't' played or knows the game doing something stupid
yep, understood. I did the same with Aikido back years ago before I even had a mechanical valve (but I had a homograft). Why? Because at the ripe age of 30 I knew that broken wrists and dislocated shoulders were permanent injuries. I chose my dojo sparring partners based on this.

Glory is Temporary, Pain is Forever.

Have fun :)
 

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