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Old 12-04-2007, 05:20 PM   #1
Joe Martin
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CF while on Coumadin

I was wondering if anyone has been working out while taking daily doses of Coumadin. I have been on 7.5mg since August when I had a large dvt in my right leg and multiple pulmonary embolisms. The doc recomended that I start working out as soon as I feel comfortable and I have been since about a week after I got out of the hospital. I tweaked my back about mid Sept. and my body just doesn't seem to be healing the way it did before taking the drug so my workouts have consisted of mostly running with a Cindy, Fran, or Michael (or similar workout) mixed in. Healing from the back as well as recovery times seem much slower now. I guess I just wanted to see if anyone else had similar experiences with Coumadin.
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Old 12-04-2007, 05:56 PM   #2
Garrett Smith
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Re: CF while on Coumadin

Your healing and recovery will be worse for the entire duration you are on coumadin. Sorry.

If I were put on that drug, I'd be doing anything and everything possible to get off of it. IMHO.
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Old 12-04-2007, 06:11 PM   #3
Joe Martin
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Re: CF while on Coumadin

Yeah, it sucks a little bit. Luckily I'm supposed to come off it in Feb. Thanks for the feedback.
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Old 12-05-2007, 10:53 AM   #4
Daniel Freedman
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Re: CF while on Coumadin

I'm on lifelong Coumadin due to DVT/PE and very extensive family history of same. I'm doing CF with my doctor's approval.

I have researched Coumadin exhaustively and have never before seen anything that suggests it inhibits athletic performance. Can you provide details or references?

Exercise and diet can have a big effect on INR. You may need frequent tests and dosage tweaks. You have to make sure your doctor is willing to work with you on this. The idea is to adjust the medication to your lifestyle -- and not the other way around.

Deciding whether and when to discontinue Coumadin is a big decision. It may not be wise to accept the first opinion of the first family doctor you come across. Few family doctors have much expertise with Coumadin; fewer still have experience with athletes on Coumadin. You may want to consult a second family doctor, a sports medicine specialist, or a haematolgist.

Last edited by Daniel Freedman : 12-05-2007 at 10:56 AM.
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Old 02-29-2008, 09:56 AM   #5
David Johnson
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Re: CF while on Coumadin

Hi Joe and Daniel,

Just wanted to let you know that I was just diagnosed with a DVT in my right leg in early Feb 2008. No PE, though, so that's good for me. 3 days of injecting Lovenox and coumadin therapy, now I'm on a regular coumadin schedule for 6 months. I did a week of bed rest at home at my doctor's orders after the diagnosis, and then took a 10-day vacation (scheduled long before I knew about this DVT mess), so was not exercising much at all for 3 weeks.

The leg pain is gone, but the swelling in my calf is still bothersome. I'm finding that exercise seems to help, so that's good. I'm just now starting back into Crossfit slowly (with mostly upper body stuff and no running, per my dr.). I feel like I have a hard time communicating about my exercise routine with him since it's not traditional weights/cardio. For now, he says no heavy lower body stuff (deads, squats, etc) I'm imagining it's hard for him to come up with solid recommendations, too, since most DVT patients he sees are twice my age and not crossfitters. Doing some reading of medical journals online, however, exercise in general seems to be a pretty good idea to help with the post-thrombotic symptoms and preventing future clots.

As far as the coumadin goes, from what I've read it's widely prescribed and very effective (although there's substantial individual variation and interactions with other drugs and diet, which is why we monitor). The thinner blood makes me a bit more vigilant against droping a heavy snatch on my skull, but that's something I'd try to avoid anyhow.

I'd be happy to hear more about your experiences, and I'll check back here to share more as I get back into Crossfit. Any thoughts on when my calf will stop acting like a balloon?? (On the bright side, it makes the body builders at my gym jelous, lookin' all hypertrophied and veiny - like I've been doing some serious isolation on my right gastroc!!) Joe - did you wait at all to get back into running? How's it going?

And regarding the comment from Garret Smith, NMD" "If I were put on that drug, I'd be doing anything and everything possible to get off of it" - that's pretty nebulous advice. What's been shown scientifically to be more effective than coumadin at preventing serious complications from DVT (PE, death)? I don't particularly enjoy being on these meds, but DVT is no joke, and I plan to do anything and everything possible to get myself well.

Stay well and take care of yourselves!
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Old 02-29-2008, 05:40 PM   #6
Robert Pierce
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Re: CF while on Coumadin

Quote:
Originally Posted by Daniel Freedman View Post
Few family doctors have much expertise with Coumadin
Daniel, while I agree with most of your post, this is simply not true, at least in the US. Most family doctors manage the PT/INR for dozens of patients and are (or should be) quite familiar with the well-established treatment protocols for managing DVT/PE.

Quote:
If I were put on that drug, I'd be doing anything and everything possible to get off of it. IMHO.
This is simply dangerous advice, especially for those who might have an inherited thrombophilia or recurrent DVT/PE.

Quote:
I did a week of bed rest at home
This is no longer recommended or necessary (wfs): http://www.aafp.org/afp/20051215/tips/4.html

Concerning exercise in general after DVT (wfs): http://www.medscape.com/viewarticle/503029

David, the edema is probably due to the fact that the tiny valves in the veins that support the column of blood in the leg were damaged by the thrombus. These valves work with the muscles of the leg to pump blood back up through the veins. When damaged, the column of blood in the veins is unsupported and there is greater hydrostatic pressure, in the vessel, and edema. My experience is that it takes a long time for this to go away.

Disclaimer: My medically-related posts are not medical advice or treatment. Consult your physician for that information.

Last edited by Robert Pierce : 02-29-2008 at 05:43 PM.
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Old 02-29-2008, 06:08 PM   #7
Daniel Freedman
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Re: CF while on Coumadin

David:

I don't know all the facts. I'm not a doctor. Nor do I play one on the Internet.

But I note from Robert's profile that he IS a physician. So perhaps he is reluctant to write anything that might be interpreted as casting aspersions on the medical judgment of another doctor.

But, as I said, I'm not a doctor. And I'm not very diplomatic.

So I'll say it. The fact your doctor had you take a week of bed rest is eye-brow raising. It leads me to suspect he may not be the font of all wisdom in your particular situation. It's possible your doctor is too conservative in his approach.

If I were you, I would see another doctor to seek further advice. Perhaps there are other options.
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Old 02-29-2008, 06:26 PM   #8
Daniel Freedman
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Re: CF while on Coumadin

Some further thoughts on living on Coumadin. It's mostly a matter of common sense.

1) I wear a medic alert bracelet. When visiting a gym, I inform the trainer of my condition. In case of accident, it's important I get to the hospital ASAP. So the gyms I use are all within 10 minutes of a hospital where my family doctor works.

2) The gym risk is low. What's the worst that could happen....dropping a weight on my foot? Okay, knocking myself out with a KB would be bad, but that's pretty hard to do.

3) But getting hit by a car would be very, very bad. So running along a quiet country road is far more dangerous than the Filthy Fifty or Fight Gone Bad.

4) Trekking in Nepal is out. (Too far from a hospital.) But CF or distance running is fine. But these days I always run with a buddy or in heavily traficed trails. Fortunately, Toronto has a ravine system and a waterfront park that fill the bill. But I've given up solo mountain runs -- probably never a good idea, anyway.

In general, sweat is fine; collisions are not. Rugby, boxing and skydiving are out. But that still leaves plenty of stuff.
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Old 02-29-2008, 06:41 PM   #9
Robert Pierce
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Re: CF while on Coumadin

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Originally Posted by Daniel Freedman View Post
Some further thoughts on living on Coumadin. It's mostly a matter of common sense.
Daniel, it sounds to me as if you have plenty.
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Old 02-29-2008, 08:01 PM   #10
David Johnson
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Re: CF while on Coumadin

Daniel and Robert,
Thanks for the solid articles and advice. I really appreciate it, since it's a bit daunting to find yourself with a previously unknown medical condition.

Robert, I was unable to access the article on medscape, since I don't have an account on that site - if you see this message and get a chance, I'd appreciate the citation.

Thanks again and stay well!
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