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Diving with Factor V Leiden and Anticoagulants
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Just another point of consideration:
If vacation diving for an extended period, your PT/Anti-coagulation levels may go out of whack if the agent you're on is Warfarin/Coumadin.
Warfarin/Coumadin is Vitamin K dependent. Travelling to a new exotic country and eating new "never tried before" foods (basically, different from your usual/regular diet) may alter the intake of Vitamin K and cause changes in your anti-coagulation levels.
Not that you can't dive, but if travelling to a new place, make sure you know what you're eating and its Vitamin K content.
Cheers!
If vacation diving for an extended period, your PT/Anti-coagulation levels may go out of whack if the agent you're on is Warfarin/Coumadin.
Warfarin/Coumadin is Vitamin K dependent. Travelling to a new exotic country and eating new "never tried before" foods (basically, different from your usual/regular diet) may alter the intake of Vitamin K and cause changes in your anti-coagulation levels.
Not that you can't dive, but if travelling to a new place, make sure you know what you're eating and its Vitamin K content.
Cheers!
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I'm not sure. I think it would be hard for me to sign off on the Medical Statement, simply because every hyperbaric doctor I've talked says that coumadin is contraindictsted with diving. I think if I did sign off, it would be with excellent documentation and warnings, like Lynne explained. The thing is, diving itself is really not the risk. Hyperbaric environments shouldn't be a problem, at any depth. It's getting in and out of the water that could pose a risk, depending on what type of diving it is. Diving in a spring with easy stairs going for the entrance should be fairly benign. Off-shore wreck diving in inclement weather? Maybe a bigger issue.
BTW, my step daughter has Leuyden Factor. She had a DVT when she was around 30 years of age. Worst DVT I've ever seen and no other risk factors.
I'm on anticoagulation for anticardiolipin antibodies and osteonecrosis. I did 90 days of lovenox, per a protocol, and when I tried to get off the lovenox I. Started to have joint and muscle pain. I began having pain in my calves with just 24 hours off the shots. Keeping my fingers crossed that the Coumadin works as well.
Did you talk to your doctor about the newer anticoagulants? They have less chance of cerebral hemorrhage. The bad thing is there is no reversal. But, xarelto has a 12 hour half-life so it wears off quickly if bleeding is a problem.
As a physician, I'm more comfortable with coumadin, since I have far more experience with it. I also like that I can have my PT checked and make sure my dose is appropriate. There was a recent warning concerning bleeding risks and the newer anticoagulants, which is part of why I decided ( with my hematologist) to go the Coumadin route.
It's a tough call. I've also been told not to ride my horse. I've been riding ( and jumping, fox hunting) since I was 5 years old. I've had many world champion horses and riding is a big part of my life. I've chosen to continue riding, but not jumping. I will fox hunt but stay in the slower, non-jumping group. I will make sure I have a sturdy horse and be very careful on muddy or icy footing.
Heck, what are the chances of a random fall or car accident? I simply can't live my life sitting indoors, watching television all day.
---------- Post added January 15th, 2014 at 06:30 PM ----------
Very good point.
Tracy, you hit the nail on the head. Are we, as physicians, going to tell all our anticoagulated patients to sit on the couch? Honestly, the worst head injuries I see on a regular basis come from car accidents. Should anticoagulated patients not be permitted to drive, or be passengers in automobiles? I ride horses and dive. I fall more often diving than I do riding, but I think most people would think the risk of head injury higher when riding horses.
If you are active at all -- if you hike, if you climb, if you ride a bicycle, if you ride a horse, if you ski, if you dive . . . if you MOVE, you run the risk of getting hurt. I saw a woman with a HORRIBLE trimalleolar fracture of her ankle from walking across a field and getting hit by a . . . DOG. I am honestly not okay with telling anticoagulated patients that they have to wrap themselves in cotton wool. I think that would take all the joy out of life, and the inactivity would probably have a bigger negative impact on them than the risk of their activity is likely to have, unless they free solo climb or GS slalom ski race or are out to take away Evel Knievel's laurels.
People need to know that a) their risk of bleeding is higher with any injury; b) specifically it is higher for HEAD injury, where the outcomes could (but probably won't be) bad; c) that their level of anticoagulation needs to be monitored closely and can vary, so any given day's risk may not be accurately quantitated. If the patient understands all of those things and chooses to continue the activity in the fact of the best information we have, I do not feel compelled to tell them they can't do that.
If I think what someone is doing is going to kill them, I will try to stop it. If I think it has a significant possibility of killing them, I'm not going to approve it. If I think it might kill them, I'm going to have a good talk with them about why I think that, assess their analysis of risk and I may approve it. I think people should be allowed to be adults, if they appear to be, and make their own decisions.
If you are active at all -- if you hike, if you climb, if you ride a bicycle, if you ride a horse, if you ski, if you dive . . . if you MOVE, you run the risk of getting hurt. I saw a woman with a HORRIBLE trimalleolar fracture of her ankle from walking across a field and getting hit by a . . . DOG. I am honestly not okay with telling anticoagulated patients that they have to wrap themselves in cotton wool. I think that would take all the joy out of life, and the inactivity would probably have a bigger negative impact on them than the risk of their activity is likely to have, unless they free solo climb or GS slalom ski race or are out to take away Evel Knievel's laurels.
People need to know that a) their risk of bleeding is higher with any injury; b) specifically it is higher for HEAD injury, where the outcomes could (but probably won't be) bad; c) that their level of anticoagulation needs to be monitored closely and can vary, so any given day's risk may not be accurately quantitated. If the patient understands all of those things and chooses to continue the activity in the fact of the best information we have, I do not feel compelled to tell them they can't do that.
If I think what someone is doing is going to kill them, I will try to stop it. If I think it has a significant possibility of killing them, I'm not going to approve it. If I think it might kill them, I'm going to have a good talk with them about why I think that, assess their analysis of risk and I may approve it. I think people should be allowed to be adults, if they appear to be, and make their own decisions.
I know anticoagulated people who skydive, paraglide and ride motorbikes, these seem really high risk activities to me. As long as they know the risks it it their choice to do it, information is the clue.
As for checking your anticoagulation level while travelling and eating food with unknown vitamin K content, (admittedly expensive) POC INR-analyzers http://www.roche.com/products/product-details.htm?type=product&id=23 are available.
As for checking your anticoagulation level while travelling and eating food with unknown vitamin K content, (admittedly expensive) POC INR-analyzers http://www.roche.com/products/product-details.htm?type=product&id=23 are available.
I spoke with a local Dive instructor and he suggested that I go to a local physician who is also a Dive Master. He believes that a doctor who is not very familiar with diving will quickly dismiss me and tell me that I should never dive. I think I will take him up on it.
As for the diet part, being on vacation and traveling could certainly throw one's INR into a tizzy. Many years ago I had some issues with certains foods. Fortunately in my case it's been pretty easy for me to manage. I've been living with this for more than half of my life and I happen to be a Food Scientist/Chemist.
I'm a pretty cautious individual by nature and I don't believe that Diving would put me at an extreme risk. If I believed that I wouldn't be here. When I learned about my condition I stopped my football and hockey immediately. I continued to play baseball. I was a really good ball player but learned that some colleges and minor league baseball teams weren't willing to assume the risk and felt I was a liability. There was always the risk that I would be hit by a pitch or struck by a batted ball, which did happen and I was no worse for the wear.
I've inquired multiple times about Coumadin alternatives and some of the newer medicines. The response that I have received from multiple doctors was that the drugs were not approved for use for my specific condition. I suspect that will change but how soon I'm not sure.
I'd like to thank everyone for your experiences and thoughts. I actually did not expect to get this many responses. It's very much appreciated.
John
As for the diet part, being on vacation and traveling could certainly throw one's INR into a tizzy. Many years ago I had some issues with certains foods. Fortunately in my case it's been pretty easy for me to manage. I've been living with this for more than half of my life and I happen to be a Food Scientist/Chemist.
I'm a pretty cautious individual by nature and I don't believe that Diving would put me at an extreme risk. If I believed that I wouldn't be here. When I learned about my condition I stopped my football and hockey immediately. I continued to play baseball. I was a really good ball player but learned that some colleges and minor league baseball teams weren't willing to assume the risk and felt I was a liability. There was always the risk that I would be hit by a pitch or struck by a batted ball, which did happen and I was no worse for the wear.
I've inquired multiple times about Coumadin alternatives and some of the newer medicines. The response that I have received from multiple doctors was that the drugs were not approved for use for my specific condition. I suspect that will change but how soon I'm not sure.
I'd like to thank everyone for your experiences and thoughts. I actually did not expect to get this many responses. It's very much appreciated.
John
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Unless I overlooked something, DAN's website didn't list coumadin as a contrindication to diving. It just goes with some stiff warnings.
I'm taking coumadin now but I can't speak for anyone but myself and what my doctor/cardiologist/surgeon discussed with me. They have no problem with my diving as long as I use my brain while doing it. I was also warned me that my style of diving has probably changed from what I used to do. I will need to dive a more conservative profile, be more aware of my NDL's and if I feel any squeezes at all, abort the dive. My cardioligist and I had a good discussion about diving. His words to me were, I'll know when I feel ready to dive again but to be sure and use my head for more than a mask rack. A group of us is heading for Bonaire next month so I'll find out how ready I'll be. I figure I'll get in about half of the dives that I normally do but I will be running in very conservative mode for quite a while.
I'm taking coumadin now but I can't speak for anyone but myself and what my doctor/cardiologist/surgeon discussed with me. They have no problem with my diving as long as I use my brain while doing it. I was also warned me that my style of diving has probably changed from what I used to do. I will need to dive a more conservative profile, be more aware of my NDL's and if I feel any squeezes at all, abort the dive. My cardioligist and I had a good discussion about diving. His words to me were, I'll know when I feel ready to dive again but to be sure and use my head for more than a mask rack. A group of us is heading for Bonaire next month so I'll find out how ready I'll be. I figure I'll get in about half of the dives that I normally do but I will be running in very conservative mode for quite a while.
As an ER doc, I'd be happier if my patients stayed on Coumadin. We can measure the degree of anticoagulation easily, and we can reverse it. The newer medications are far more difficult to assess, in terms of the degree of anticoagulation any given patient is experiencing, and reversing their effect is more difficult. Yeah, monitoring Coumadin is a pain, and dosage has to be individualized, and every other medication in the universe changes it -- but at least we can KNOW how bad the situation is that we are dealing with, and we have effective and readily available methods for reversing the action of the drug.
I'm learning to hate the new ones.
I'm learning to hate the new ones.
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Taking and monitoring the coumidin isn't much of a hassle, if you consider the alternatives. Remembering to take it is my biggest hurdle.. I have computer and phone alarms everywhere to remind me.
Tippytoes12
Contributor
Hi there
Definitely get the advice of ideally more than one doctor with alot of experience in diving medicine. You need to balance any theoretical risk of problems with the anticoagulant against the fantastic enjoyment and improvement in your quality of life you will definitely get from diving.
Best fishes and good luck
Definitely get the advice of ideally more than one doctor with alot of experience in diving medicine. You need to balance any theoretical risk of problems with the anticoagulant against the fantastic enjoyment and improvement in your quality of life you will definitely get from diving.
Best fishes and good luck
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