Emergency Pack for Trail Running or Mountain Biking While on Anticoagulants (Coumadin, Xarelto, Pradaxa, Plavix)

This article is a work in progress and is only a description of my strategy for the time being. I hope to learn from readers of this blog about how to better plan for a trail debacle.

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Heading out for a trail run on the Pacific Crest Trail

What kinds of things should a person like me, who is dealing with atrial fibrillation and is taking an anticoagulant (I take Pradaxa), carry on a long run in the wilderness? Or during a long mountain bike ride in remote areas?

When the high country in our local wildernesses is not covered with snow, I will generally do runs, nearly every weekend, of anywhere between six to twenty miles. I almost always run alone (except for my trail buddy – Ringo).

Dangerous and a bad idea? Possibly. But this is what I enjoy in life so I don’t plan on stopping any time soon.

The most important piece of equipment is a phone. People complain that everybody is always on their smartphone, and they should NOT be talking on their phones on mountain summits when everybody else is trying to get all Zen-like and self-actualized, and whatever – that’s a different discussion. You certainly don’t even need to have your phone on; but you absolutely should take it with you, and it should be fully charged. The days of getting hopelessly lost and spelling out SOS with rocks hoping a search plane will find you are fading into the past. A smartphone is a GPS and a direct link to help.

I always carry my iPhone in a baggie with my ID and a sheet of paper towel (which I use for unrelated toilet purposes).

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Fully charged and protected from water

Even if there is poor cell phone coverage in your local high mountain or deep canyon wilderness, and a phone call isn’t always possible, I find that a text message can often still be sent. It might take a while but it eventually will be sent, especially if I am moving along a trail.

There is the standard emergency gear that most people take, often called the “ten essentials” which most people carry while in the wilderness. Of course there is truly no such thing as a standard ten essentials and the list of things you carry will vary depending on the season, your skill set, your location, and your past experience.

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My generic survival gear

I got out my little survival kit that I typically carry in the wilderness, and of course not everything is pictured here, and I might not even have all of this stuff with me on any given trip. Naturally I will also have other things like food, gels, electrolytes, a jacket, and plenty of water.

What I found in my default wilderness pack is:

Two knives – a mini-leatherman tool and a standard knife. I will only actually carry one of these.

Two lights – a headlamp and a tiny LED flashlight (one is plenty).

Fire starter – a cigarette lighter, birthday candles, a tampon, and hand sanitizer (which I discovered has completely evaporated).

A space blanket, a compass.

Repair gear (Shoe laces, tenacious tape, dental floss)

Pain pills: Vicoprofen samples – okay they expired in 2000 but I’m guessing they are still good (at least for a placebo effect). Missing: Benadryl for allergies or yellow jacket stings, and I probably should have some of my Pradaxa in case I end up unexpectedly staying out overnight. Also missing: small roll of duct tape, safety pins, and my whistle!

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Saint Christopher Medal

Oh, and there is a Saint Christopher medal. This one belonged to my grandfather. Well it probably won’t change anything, but it certainly couldn’t hurt. Feel free to substitute your own personal good luck charm.

But what about specific items for the runner on an anticoagulant? Is there anything else beyond the “ten essentials”?

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Other stuff: Map with reading glasses (if needed) and some rope

Obviously having a major bleed while running alone in the wilderness would be a disaster. Death is certainly a possibility. How can a trail runner prepare to increase the odds of a good outcome?

I always make sure to let somebody know (usually my wife) where I’m going and I also send her a text (I text “OOTW” short for “out of the woods”) when I get back to my vehicle.

I also wear a Road ID. This way if somebody finds me they will know I am on an anticoagulant. Maybe this won’t help, but it certainly is worth wearing. At least they will be able to figure out why I bled out so quickly (I know – not funny).

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My Road ID

Another item I always carry is a bandanna. This can be used for a number of purposes, such as making a field dressing; but I want to have it in case I need a tourniquet. Plus – I have an extra one because my trail dog always has one draped around his neck.

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Bandanna

My bandanna came in handy a week ago when my wife Margo (not on an anticoagulant) crashed her mountain bike and punctured her left thigh with her brake lever. I used it to make a compressive dressing before we road our bikes back to where we could get a ride to the hospital.

One item I do not currently have but definitely need to obtain is a Quickclot field dressing. Evidently these things really work and are routinely used in combat situations. It is a topical coagulant (an anti-anti-coagulant?) which helps clot blood and also serves as a physical barrier to bleeding. I’ve been meaning to obtain one of these for a long time. They are available online via amazon.com, and I just ordered one.

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Quickclot

Question: Will the Quickclot sponge even work on bleeding in an individual who is on a direct thrombin inhibitor like Pradaxa? Answer: I have no idea. I’ll let you know if I ever get a chance to find out.

In case of bleeding the most important first step is to apply direct pressure. As a surgeon I have a lot of experience with this. Usually sixty seconds of direct thumb pressure will stop or slow most bleeding, but of course if you take an anticoagulant it will take longer. Apply direct pressure as long as necessary. Elevate the wound if possible. Don’t try to clean out major wounds as this will restart bleeding – that can be done later at the hospital.

A tourniquet is a last resort, but the bandanna can be used as a compressive dressing if needed.

Please understand that an anticoagulant doesn’t completely stop clotting of blood, it just makes it take longer. Eventually bleeding will stop. Hopefully before all the blood leaves your body!

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Ringo always has a spare bandanna for me

Bonus – How to stop a nosebleed:

I have been plagued by frequent nosebleeds since I was a child but, oddly enough, I haven’t had a single nosebleed since I started Pradaxa a couple of years ago. The best method I have found is to pinch the nose, fairly tightly, just above the nostrils, and lean forward. Don’t lie with your head back – that doesn’t work. Hold for a full sixty seconds. Repeat as necessary.

If you are, like me, a trail runner or mountain biker on an anticoagulant, I would love to hear from you. Please leave comments and suggestions in the comments area below.

Thanks.

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Mountain Bike Injury – Thigh Impaled by Brake Lever

Not me – my wife, Margo.

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Before Crashing

While I have been trail riding and trail running on technical trails since 1988, my wife Margo, although fit, generally stays off of steep, rocky stuff. She likes rail trails, or the easy trails near Lake of the Woods (Oregon) – but she only gets on single track about once per year.

I was delighted, of course, last Sunday when she agreed to do a “real” mountain bike ride with me. We headed out from home and rode to Moore Park via the Link River Trail, then up the Ridgeview, Blueberry and Linda’s Trails then we descended via the Half Gallon and Big Sky Trails.

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Note small hole in tights

As we rode I tried to let her know when various hazards were coming, and we both walked through most of the rock gardens. We were almost to the bottom of Big Sky Trail, and ready to finish up on a couple of easy trails, when I (foolishly) commented, “Well, you made it. No crashes. Great job.”

And while we rode the last bit of trail I was hoping that she would suddenly start to love “real” mountain biking, and was thinking how if she did like it she would really need a newer, better bike than the super heavy ten year old hard tail she rides – I heard her crash behind me.

It was sort of a freak accident on a slightly rocky downhill section approaching the last switchback on Big Sky Trail. I turned back to see her prone on top of her bike – she had evidently done an endo.

“Are you alright?”

“I don’t don’t know which way to move my leg,” she said. She couldn’t get her left leg off of her bike. She was stuck.

I dismounted and ran back to her, and immediately lifted her, by her hips, straight up off of the bike, rotated her to a supine position, and placed her on the ground next to her bike.

“Are you hurt?”

“I don’t think so.”

She stood up and I noticed she had a little hole in the front of her (brand new) tights. The upper, inner left thigh.

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“We better check that.” She pulled down her tights and there was a small wound about one square centimeter with some subcutaneous fat bulging out and a small trickle of blood. It looked just like an incision for a laparoscopic port. “Shit! It went in. We need to get you to the emergency department to deal with this.”

Surprisingly, she seemed fine. No pain. Very little bleeding. She did not appear to be in distress other than being understandably freaked out. It’s fortunate that Margo didn’t realize what had actually happened until much later.

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Before Treatment

I made a makeshift bandage out of a bandanna I carry with me for this exact purpose, we pulled her tights back up, and began to ride out. I didn’t want to have to ride all the way home so I called a friend to meet us at Moore Park to take Margo to the hospital. It turns out she was 100 miles away on a kayak trip. We then called our son Terry and he loaded up his three small children and met us at the gingerbread house at Moore Park.

I don’t recall ever seeing Margo pedal a mountain bike so quickly on a trail as that last mile or so back to the gingerbread house! I trailed behind her marinating in “survivor guilt.”

Terry dropped us off at the Emergency Department and brought our bikes home. This was our first ED visit in twenty plus years. I’m sorry to admit that I “pulled the doctor card” and asked them to tell the ER doc on call that I was there (we’re personal friends) and we got right in. So much for hours of waiting in the ED reception area.

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“She’s a rock.”

From there it was uneventful. This was a very blunt trauma; but it was clear from the bruise on the back of her thigh that when she crashed the brake lever handle went all the way through her and hit the back of her thigh. Luckily, because the end was so blunt (it actually had a bulb-like tip) it didn’t cut anything and surely went right around any nerves or blood vessels.

Treatment consisted of a tetanus booster, a gram of Ancef (antibiotic), flushing the wound out with sterile saline, and then trimming the rough areas and bulging subcutaneous fat. She was also given a prescription for ten days on an oral antibiotic. No sutures (so it could drain if need be).

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After Debridement

Margo was a rock. It reminded me of the line in Repo Man where Bud lies to Otto that his wife is pregnant and he needed Otto to take her car (actually getting Otto to repo a car for him). Later Otto asks, “What happened to your old lady?” Otto replies, “My old lady? Oh, shit, I forgot all about her. Well, she’ll take the bus. She’s a rock.”

After it was all over and she finally realized what had happened, and how far that stupid brake lever handle penetrated her thigh, well, she started getting a bit dizzy. Every time we got up to leave she had to lie down again; but we eventually went home. Poor Margo.

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Relaxing after a bike ride

At this point, four days later, she’s doing fine and still only has minimal pain. But “it’s creepy pain” she says – because it is only in the back of her leg, not where it went in.

Doing an internet search on this injury I find that it really isn’t an uncommon injury, although I hope to never see it again. In some cases the brake lever had become stuck in the injured rider. And the thigh is the most common site, but not the only site. There are some pretty gruesome descriptions of this injury if you want to check them out.

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She didn’t want to put the tights back on

I’m happy I just pulled her up off of the brake lever immediately. Some of these poor people were clowning around for hours with a person stuck to the bicycle. That sounds unpleasant and might be an example of people making things more complicated than they need to be. See the video below for an example of a brake lever that actually became stuck in a young woman’s thigh.


This young woman had an injury similar to Margo’s injury

After this injury I doubt that I will get Margo back out on the single track any time soon – but I truly do think it is important that she at least get back on her bike again soon; otherwise she may have difficulty enjoying riding her mountain bike again.

As for me, I already rode that some trail again. Here is a photo of my bike placed at the spot (and position) where she crashed:

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This is my bike at the site of Margo’s crash

If anybody has any experience with this type of injury, or if you have any comments at all, please reply below.

Sorry about the lack of atrial fibrillation content in this post. Scroll down for plenty of a fib content.