Blood Thinners, Coumadin, and DVTs

[Double Wide]

Hey gang--

I have a serious question regarding health issues on the trail. I plan on leaving NOBO next March, and besides saving up a little bit more money and maybe switching out a little bit of gear, I'm pretty well ready to go.

Except for one thing.

2 1/2 years ago I had a huge blood clot that almost killed me, (a *very* close call), but I recovered. Then a year ago, I had another episode, this time several small ones made their way to my lungs and put me in the hospy for a week on a Heparin drip. I've been on monitored Coumadin ever since and have had no other problems. In the meantime, I've lost over 160 lbs, too. I feel better than I have in the past 20 years.

Anyhow, I went to the Oncologist yesterday (have to go to the cancer clinic to have your blood worked on) and as much as he loves my improved health and all the negative results on all my tests I've had (nothing at all on a lower-extremity ultrasound I had done last week), he told me that he doesn't want me to walk the trail. Ever. Said it's too much of a risk.

My question is, is there anyone out there on the trail, or who has thru-hiked that was on blood thinners of some sort? He said if I insist on going, there may be a different drug I can take without monthly monitoring and lab work, but I forgot the name. I can't imagine that I'm the first person to attempt a thru hike that has had problems with blood clots in the past.

Other than that, I'm very healthy, except for the extra lbs I'm still dropping. Great blood pressure, low cholesterol, and all that. My doc is afraid that if I'm out in a remote area, a couple days away from the hospital, and get symptoms, it may be too late. Unfortunately, the main symptoms are shortness of breath and leg cramps, which I jokingly told him happens every time I put on a backpack... And I said I don't want to live the rest of my life limited to being a few minutes away from a hospital...

I'm still going to go, (at least I say that now) but do any of y'all have any experience with this type of thing? Anything my regular doctor can do as far as different meds go? I haven't talked to him yet. It was just a bummer walking out of the oncologist office yesterday...

[Hoop]

The med you can take without monitoring is Pradaxa (I'm on coumadin). No limitations hiking (sections only), but I haven't dealt with your issue.

If you have a primary or a pulmonary doc you trust (nothing against oncologists) I'd get another opinion.

[NCMedic]

I would definitely talk to your primary doctor about this as well. I am not a doctor, but I would imagine that if you could tolerate the change in medicines, the exercise and walking would help prevent DVT's and clots and the loss of weight would be positive changes. However, I wonder if his concern is because of the multiple episodes of clots, they are worried about a reoccurrence and limited or no way to get you to definitive care quickly while out on the trail. That could be a major problem.

[gunner76]

Have you had genetic testing ? I got tested and I have Leiden factor 5 http://en.wikipedia.org/wiki/Factor_V_Leiden which means I am in a 20% group of people (Caucasians) that are at a higher risk for blood clots.

I am also on the rat poison. Have a long talk with your doctor. Maybe you will need to consider being a section hiker to be on the safe side.

If you do decide to thru hike then be be prepared for the risk. I tell my wife that if something does happen to me and I die on then trail then know that I was doing something I loved to do.

On a side note, when I started the coumdin, the doctor said I should not drink alcohol. At the time I had one coors beer in the fridge. Every day when I came home from work I would look at that beer and tell it...One day I will drink you. Then one day I came home to find my wife drinking that beer. I told her that she just took away my will to live. She said that if she had know that she would have drunk that beer a long time ago. The good news was that she said she had given up her plans to poison me as she figured I have built up immunity to the rat poison.

[jbenson]

I'd get a 2nd opinion. I have been on coumadin (3 mg per day) for 12 years now after a mitral valve replacement. My heart doc and family doc have both said I can do anything I want. They just want me to be aware that the further away I am from good medical care the more likely I would bleed to death after a serious injury. My only concern has been eating the same amount of greens so that my clotting time stays the same.

[OCDave]

Firstly, You're nuts for soliciting health advice here.

Secondly, variability in your INR will be impossible to predict once you start hiking. Change in diet and activity both can dramatically alter warfarin efficacy. However, INR is an easily accessible test. You certainly can have this lab drawn where ever the trail nears a healthcare facility. Alternatively, there are INR point of care devices. You could carry your own lab with you and alter you warfarin dose based upon a preset algorithm or calls in to your MD's office.

Certainly, there will be a solution that will allow you to reach your goals without putting yourself at too much risk.

Good Luck

[dink]

There are multiple alternatives to Coumadin/warfarin therapy. Eliquis, Pradaxa, Effient, Xarelto are a few of the new ones that require no diet restrictions and no frequent labs either. Please discuss all your options with a doctor who knows your medical history!!

[Venchka]

You might want to investigate one of the satellite based personal S.O.S. Devices on the market. More reliable than a cell phone.
I have a clot prone chromosome. Two doctors and I concluded that a low dose aspirin a day was good for now.
All the best to you.

Wayne



Sent from somewhere around here.

[rocketsocks]

Firstly, You're nuts for soliciting health advice here.

Secondly, variability in your INR will be impossible to predict once you start hiking. Change in diet and activity both can dramatically alter warfarin efficacy. However, INR is an easily accessible test. You certainly can have this lab drawn where ever the trail nears a healthcare facility. Alternatively, there are INR point of care devices. You could carry your own lab with you and alter you warfarin dose based upon a preset algorithm or calls in to your MD's office.

Certainly, there will be a solution that will allow you to reach your goals without putting yourself at too much risk.

Good Luck

Why, I think you gave him some good advise as a jumping off point to then have a discussion with a Doctor.

[Shutterbug]

There are multiple alternatives to Coumadin/warfarin therapy. Eliquis, Pradaxa, Effient, Xarelto are a few of the new ones that require no diet restrictions and no frequent labs either. Please discuss all your options with a doctor who knows your medical history!!

I have been taking Xarlto. It would meet your needs, but it is very expensive. My copay is $10 a day!!! Insurance companies prefer Coumadin.

[Leanthree]

My mother, a Physical Therapist, has a saying: If you go to a surgeon, they will recommend surgery. If you go to a chiropractor, they will recommend chiropractic therapy. If you go to a Physical Therapist, they will recommend Physical Therapy.

I'd add that If you go to a hikers forum they will recommend you hike...after finding a doctor that thinks you can hike.

Always seek a second opinion, but don't just go looking for a doctor who you agree with. Agree with their reasons you can or can't hike such as a different medication that would allow for such a thing.

[Dogwood]

This is a yr old thread that was dragged up. I would like to hear from Blueberry about what his MDs advised and what he's done medically to prepare for his desired hike in the past yr since he started his thread. Since no one else did I will. First, congrats to Blueberry for losing 160 lbs. That is incredibly awesome Blueberry! GREAT accomplishment! Agree 100% with OCDave.

[Dogwood]

Rarely are two people in exactly the same medical situation but YES people on blood thinners including Coumadin and Pradaxa have long distance hiked.