It’s hard to explain the impact of being told I need to be on a prescription blood thinner for the rest of my life due to an increased likelihood of stroke (yup…another lupus thing…). How do I bring this new information (blood thinner) into alignment with my lifestyle? Does it mean no more fun (or, at least, what I consider fun)?

I turned to the internet: surely, I can’t be the only adventure-lover who’s experiencing serious medical issues! There must be other backcountry lovin’ folks that have learned how to continue living and doing what they want while still incorporating whatever medications they’re on. And yet, Google failed me! Chat forums related to blood thinners and exercise are mostly related to the…errr…inactive type. In fact, as I’ve asked around, my pharmacist explicitly stated the people she knows on blood thinners are on them as a result of inactivity.

It’s pretty hard to find objective guidelines on activities that are “safe” or, more importantly “unsafe” to be participating in. The respirologist explicitly informed me sports such as contact hockey, rugby, or football are out but what does this mean for skiing? mountain biking? backcountry travel (summer or winter), in general? What are the risks? What are the factors? How do I assess what risks are worth taking and which aren’t? My medical team has told me to avoid risky or dangerous activity. But what the heck does that mean?! I didn’t think I was doing anything too risky this summer when I broke my shoulder biking but…accidents happen.

The term “risk” is way too subjective. What one constitutes as a “risky” behaviour, another deems as every day life. It brings me back to my original question: how do I now incorporate this new information with my lifestyle? And/or, does it mean I have to completely give up everything I enjoy doing?

My first step is to understanding what the risks are of being on a blood thinner. What are the injuries most likely to be impacted now? These are the top concerns that I’ve figured out:

1. “Bleeding out” from a cut/wound.
   • If it’s superficial, it’s not that big of a deal. The easiest way to deal with this concern is simply to throw some extra gauze in my first-aid kit. Yes, it will take longer for the scrape to heal but on a general mountain bike crash/road rash type of injury (not uncommon!), there is no real concern. Annoying, sure. Life-threatening? Nope.
2. Bleeding out from a puncture/artery, etc.
   • Ok – this one is a bit more serious! But, again, covering it and getting to a hospital is the key. Whether it’s a large bone break (such as a hip or femur) or somehow cutting a main artery, a serious blood wound could be disastrous for me…but…
   • It could also be disastrous for you! Time is of the essence and getting to a hospital ASAP – on a blood thinner or not – is of paramount concern. I don’t minimize the fact that I’ll need to get there faster but as far as excessive worry about it? I don’t wish to rate it that high on my concerns list, at least, not really any higher than I did before.
3. Head injury
   • Think concussions, a pretty common injury for bikers or skiers/snowboarders. What’s the mitigating factor? Wear a helmet. And a good one. Don’t cheap out on it.
   • Well…I don’t. We’ve always invested in good head gear so that’s taken care of.
4. Internal bleeding
   • This was the biggest injury surprise for me: understanding that I’m at heightened risk of internal bleeding. What may have been a deep bruise in the past may, now, result in internal bleeding (also see: head injury). This was also the biggest hurdle for me to figure out and question.
   • The answers: invest in a chest protector for mountain biking and truly limit risks when skiing amongst trees and people. Not that I have to give it up, but I do have to ensure I’m in full control (errrr…and shouldn’t we always be?).

It’s taken me awhile to figure this out and, like I mentioned, integrate this knowledge with what I like to do. It’s up to me and my comfort level. Stick with levels and activities that I know I have better control in. I have to figure out what my enjoyment-to-risk factor benefit is. Does the enjoyment outweigh the potential risk/consequence?

For example, I may not participate in downhill (lift-access or shuttle) mountain biking anymore.  In lift-access biking, it’s all about speed! And, traditionally, it ends up being a full day of high-adrenaline, smile-cramping, fun! So my enjoyment level is typically quite high but the consequences seem like they may be a bit too high now: a crash, even with my gear, may prove too much. Conversely, when one has to pedal, you typically are out for anywhere between 1-3 hours and it’s a slower pace. Even if there’s a downhill section, the same adrenaline factor that pumps you up on a pure downhill ride is significantly lower.

My overall conclusion? Not to worry too much. Do what I keep loving but perhaps dial it back just a wee. I do have a habit of just “jumping in” to things so now I need to just take a breath and, I don’t know, actually look at the run/trail that I’m thinking of doing instead of going in blind. And buy a few items!

• Chest protector
  • Okey dokey – pretty easy!
• Emergency beacon or satellite phone (I’m leaning towards the Delorme InReach)
  • We should have one already for emergency evacuation in the backcountry, anyway!
• Throw extra gauze in the first-aid kits
• Invest in helmet/head gear

I’d LOVE to hear from you if you’re in a similar situation! I’d really like to speak with someone who does this kind of stuff and has managed to figure out what their risk tolerance level(s) are so please contact me!