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DanaB
climber
Philadelphia
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Dec 13, 2010 - 04:28pm PT
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eMedicine (Not WebMD) is a good source of reliable medical information. You can also go to the National Library of Medicine, log on to PubMed and get access to online medical journals.
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Gene
Social climber
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Dec 13, 2010 - 04:28pm PT
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I think gene takes blood thinners and still climbs.
A nasty result of my knee reconstruction surgery in 2000 was that I ended up with blood clots in my leg. I was put on Coumadin after going through a regimen of injections of something in my tummy for a couple of weeks. After six months or so of Coumadin and follow up ultrasounds, my doc allowed me to climb. YMMV. It helps to have a MD who knows you and that you can trust. I confess that I don’t know the factors that let the MD make his decision. Could be size &/or # of clots, their encapsulation, dosage of Coumadin, other factors, I don’t know. I’ve been off Coumadin for years, but still have a swollen ankle as a result of the clots. Get a damn good doc involved. Every situation is different.
Best of luck.
g
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steveA
Trad climber
bedford,massachusetts
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Topic Author's Reply - Dec 13, 2010 - 04:38pm PT
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Thanks-as well-HFCS. It's nice to read opinions from others-since it looks like I'm headed towards blood thinners- perhaps in the near future.
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the museum
Trad climber
Rapid City
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Dec 13, 2010 - 08:42pm PT
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steveA, I suffer from afib - since 1998.
the museum
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Paul_in_Van
Trad climber
Near Squampton
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Dec 13, 2010 - 09:56pm PT
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Isn't there another thread on this on the Taco already with lots of good info?
Quick search might turn something up (I'm too lazy to do it for you, sorry).
P
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jogill
climber
Colorado
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Dec 13, 2010 - 10:56pm PT
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Steve, For what it's worth: I had spells of SVT tachycardia for years, then ended up in the hospital twice a couple of years ago, and had an ablation, which cured the tachycardia, but an underlying PAC problem then came to light. I started getting atrial flutters - 200+ beats per minute for about 10-12 beats, frequently - while hiking. Didn't bother me going up, but coming down I would get light-headed and felt faint, plus lots of irregular beats while recovering from exercise for about a half hour. I took sotalol for several months, and this helped quite a bit, but I was always tired and forgetful (I'm going on 74). Then my cardiologist (electrophysiologist) prescribed Flecainide tablets. These can be taken if you don't have a regular afib condition - mine is pre-afib. They work well and I feel good. Still have irregular beats after exercise or eating, but not really significant. He told me an ablation might be 60-70 percent effective for the fluttering, and I'm not enthusiastic about another procedure, especially if the odds are not high. As for clots, I take a few aspirin a day and don't worry about it. Good luck.
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Brian
climber
California
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Dec 14, 2010 - 12:19am PT
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You can read my background on the post Mighty Hiker linked above. Long story short: I had one episode of a-fib almost 6 years ago (when I was only 36 going on 37). Since then nothing but some episodes of PVC/"skipped beats." I've been climbing, skiing, and so on at a pretty good clip and at a pretty good level (at least for me), so nothing holding me back on that front.
I'm not a medical doctor, but here are some things I'd chime in with after a few years of seeing my cardiologist and a couple of different electrophysiologists (I still get a check up every 6 months or so, even though things have been more or less "clean" since the initial episode).
(1) Ablation surgery can fix something like 60-70 of a-fib cases. In my case it is not called for, even if I get another case or two of full a-fib--at least that is what the docs say. Given my overall cardiovascular fitness, no other red flags, and so on, a-fib is just not a real life threatening arrhythmia (yeah, I know about the stroke risk, more on that below). However, if I had a persistent or regularly recurring a-fib, one that might really put a damper on my active way of life, I think I might roll those dice (with a really, really good surgeon) and see if I fell into that 60-70 percent. So, you might want to see if you are a good surgical candidate. True, all surgery has risks, but you might at least want to see about the odds.
(2) Long-term persistent a-fib (lasting over 48 hours or so) begins to run a risk of clot formation. Thus, I'm on 81mg of aspirin a day as a precaution, even though I've never had a second episode of a-fib (was on 325mg for a good while). If you can get the a-fib to convert back to a normal sinus rhythm--either yourself or in a emergency room--in a reasonable amount of time, it's just not a big deal. I asked cardiologists and electrophysiologists specifically, "what if this happens halfway up El Cap," "what if this happens in the Gorge of Despair," "what if this happens in the backcountry in another country where high-class medical treatment is not easily available." They all said, stop worrying about it. Come down, hike out slowly, get to medical care (even basic care as the drug they use to convert you to sinus rhythm are pretty common in even dodgy hospital settings). Anyhow, take that advice for what it's worth. I'm sure my case is different from yours. I'm younger (43) and only had one episode of a-fib 6 years ago, so maybe the docs are a bit less concerned. However, the one take-home message I've gotten over and over from folks including some of the best electrophysiologists in the nation is: stop worrying about it and go climb.
(3) Regarding blood thinners: my 74 year old father is on blood thinners after a TIA a couple of years ago, and he beats the shite out of a wooden dummy (Wing Chun), so I don't think blood thinners are necessarily a 'death sentence.' However, again, this must be something measured on a case-by-case basis.
(4) The OP is right. I can't in my wildest dreams imagine having a-fib and not being aware of it. From my one experience, it's not the kind of thing you ignore, and (as I mention on the other thread) I'm so sensitive to it now that I feel the PVC/skipped beats that we all have but that most of you don't notice.
Anyhow, good luck with your treatment. I hope it works out for you, and hope it works out in such a way that you can maintain the sort of life that is important to you. I'm really grateful that my own experience has not gotten in the way of my climbing and other pursuits. However, ultimately, if it did, I'd like to think that I'd be able to handle the transition (not to say it wouldn't be difficult). Remember, there are lots of ways to be happy.
Brian
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maldaly
Trad climber
Boulder, CO
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Dec 14, 2010 - 12:45am PT
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I'm post-cardiac and was put on statins, blood thinners, ACE-inhibitors, diuretics and beta-blockers. When I left the hospital I had prescriptions for 14 drugs, all of them indicated by heart attack survivors and few of them indicated by reality. Now I'm down to 4, all taken with much reluctance.
A neurosurgeon who is a close acquaintance put it succinctly: Cardiologists love Coumadin--it saves lives. Neurosurgeons hate Coumadin--it kills active people. It's simple. If you participate in sports where a bump on the head is likely, don't take blood thinners, especially Coumadin. Plavix is almost as bad.
Now I take an 81mg aspirin every day and I still climb, ride bikes, ski, hike and yoga.
Mal
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illusiondweller
Trad climber
San Diego, CA
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Dec 14, 2010 - 01:55am PT
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Well that was a pretty good read, interesting first hand experiences, a plethora of education levels on the subject.
Back to the original post, my first impression after reading it was, here's a guy with an apparent history of A-fib, now complaining of increased episodes of symptoms, on Coumadin, and doesn't want advice from a doctor, "Aside from seeing your doctor; test etc.;"...hmmm? What other medications does he take/is he suppose to be taking? Non-compliance was my first suspect because that seems to be the most common culprit in the field (Paramedicine) . In my experience (17 years) A-Fib in the young, <50, is the exception but it obviously happens. There's controlled A-Fib and uncontrolled A-Fib. Most of the patients I met with a history of A-Fib live with the dysrhythmia, usually controlled with pharmacology and or pacemaker, and the uncontrolled candidates, (non-compliance), we end up treating symptomatically. As far as Coumadin (rat poison) is concerned, enough has been said on that.
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steveA
Trad climber
bedford,massachusetts
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Topic Author's Reply - Dec 14, 2010 - 06:58am PT
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Thanks guys for all the comments:
Illusiondweller, I'm not on Coumadin yet, nor have I seen a cardiologist yet.
I had a recent EKG confirming afib. Right now, I'm taking one baby aspirin a day. I'll be having an echocardiogram done in a week, ordered by my primary doctor. Then we will go from there. My resting heart rate is around 50, so for my age of 64, I'm in pretty good cardio shape.
Supertopo is definitely a valuable source for all types of information on many subjects.
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stilltrying
Trad climber
washington indiana
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Dec 14, 2010 - 08:05am PT
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Unfortunately I have dealt with A-Fib for a Decade now and am in permanent a-fib and will be forever I suppose. Two heart attacks and substantial heart damage brought on the arrhytmia problems. For several years I dealt with the a-fib and took coumadin, aspirin, drugs etc. Right in the middle of a lead climb I would go into a-fib and that was always interesting. I had a mini- maze ablation 4 years ago and was on the table 13 hours as I went into shock and then had bleeding issues and finally the surgeon split my chest open and did the procedure that way. Needless to say it was a difficult time. Currently I am totally Pacemaker dependent, have an ICD but no longer feel the a-fib since I am 100% ablated (AV Node Destroyed).
1)Coumadin is a pain in the rear - but necessary in permanent a-fib cases.
I have had times where my blood would not clot and that was scary. Had to have plateletts infused to get back to normal. You have to get checked once a month to make sure things are in the right range as far as your cloting (INR) parameters go. No big deal. WEAR YOUR HELMET when climbing, biking etc.
2)Lots of people have A-Fib and are active. Despite having a third of my heart dead, permanent a-fib, pm/icd, stent and various meds I still climb, mountain bike road ride, lift weights etc. I have decked from 35 feet on lead and had some good bruiseing on my ass :) but no bleeding issues. I,ve endoed on my Mtb. bike many times and no problem. I do try to avoid impacts but unless you stay on the couch - things happen.
3)Get a good Electrophysiologist who knows their stuff. If you ever opt for surgery get the best i.e. Cleveland Clinic.
4) None of this is a death sentence or a reason to quit. It is hard to be sure. I suck and am slow but I keep going and I have FUN. In the end each person must decide their own limits and accept the responsibility for what they decide to do - but hey ain't that what climbers do anyway :)
5)Currently there is a new blood thinner being introduced that does not require the constant checks. Don't know much about it but it's out there.
The two schools of thought on a-fib are (a) Rate Control (b)rhythmn Control. If you can control your rate with meds then that may be all that is necessary.I just keep on keepin on as best I can cause as Locker says "yer gonna die" and I want to enjoy each day till then to the fullest degree possible.
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rick d
climber
ol pueblo, az
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Dec 14, 2010 - 08:29am PT
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There is a Coumadin replacement Pradaxa that came out in October- something to look into. In any case, you don't want to stroke out and your episodes are getting longer with age.
best of luck.
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steveA
Trad climber
bedford,massachusetts
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Topic Author's Reply - Dec 14, 2010 - 09:25am PT
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Stilltrying
You are an inspiration to all of us. These young climbers will someday be old, and many will have their health issues. Keep on truckin!
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Gimp
Trad climber
Grand Junction
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Dec 14, 2010 - 10:19am PT
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I am not at expert on this topic but my wife is.
First eliminate caffeine from your life.
Aspirin can be a viable option to coumadin, talk to your physician about this. There have been have been well designed controlled trials comparing these two drugs and there are published criteria. You Doctor should be able to tell you the risk and benefits of each drug.
There are options for ablation, an invasive procedure with catheters where the focus of the arrhythmia is "ablated". To get the true facts on these suggest you get a referral to a Cardiac Electrophysiologist not a general cardiologist. They will be able to accurately tell you if you are a candidate, and the short and long term success rates.
If you are a candidate for ablation and choose to pursue it definitely go to a high volume center. This is a difficult procedure with a steep learning curve.
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Mikemcee
Social climber
Mill Valley, CA
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Dec 14, 2010 - 11:09am PT
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Hey SteveA,
I had an ablation 5 years ago to treat my Afib. Best thing I've ever done.
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Barry Bates
Boulder climber
Smith River CA
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Dec 14, 2010 - 11:54am PT
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Steve A
I've been in chronic A-Fib for almost ten years, plus I have a pace maker due to a congenital slow heart beat, at one point my resting heart rate was around 30 with pauses up to eight seconds between beats. As far as the coumadin use and climbing I have not let it bother me or worried about it to much, The main thing is to keep monitoring your blood with the doctor and keep your INR around 2.5 which means your blood is about 2.5 times as thin as a normal persons. As far as climbing I get out 3-4 days a week putting in 500- 1000 feet a week of 5.10 5.11 climbing plus easy free solos. I also run and weight train and do laps on a H.I.T. board in my garage. The main thing is don't panic, if you have to go on coumadin its not he end of the world or your out door activities, I have yet to have a doctor or cardiologist tell me to stop climbing or quit any other activity due to coumadin. I bleed a little more from the normal nicks and cuts from crack climbing, and I place a little more gear to prevent a big fall beyond that not much has changed except feeling the normal aging of a 61 year old. For me the quality of life issue has always been the biggest factor. My best days climbing are the ones I spend on the rock with my wife and son
If you have any questions send me an email
Barry
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steveA
Trad climber
bedford,massachusetts
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Topic Author's Reply - Dec 14, 2010 - 01:05pm PT
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Thanks Barry:
Eight seconds between beats! Yikes!
I have probably learned more here on S.T. than I ever would by sitting down with a doctor. You ought to approach the maker of your pacemaker. Your story would make a good add for them.
I just did a little search on you here. I noticed that Kevin Bein was a good friend of yours. I hung out with him alot when he was a member of the HMC. A really great guy. Supertopo is a great place to hang out when you get old and sentimental.
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illusiondweller
Trad climber
San Diego, CA
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Dec 14, 2010 - 06:09pm PT
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Sorry Steve, my mistake (imagine that). Most of your family members with afib are on coumadin which you want to avoid. Resting HR of 50 bpm at 63 y.o?! Is that in sinus rhythm (regular HR) or afib (irregular HR)? Interesting to discuss even though I can't do anything for you directly. Sounds like your are concerned for your own health and are doing something about it. Keep us updated on your progress if you so choose. Happy holidays and seek the Truth.
Glory to God
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illusiondweller
Trad climber
San Diego, CA
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Dec 14, 2010 - 07:38pm PT
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That's pretty hardcore Barry, especially the part where you put your climbing before your wife!
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