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.
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).
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.
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!
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”?
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).
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.
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.
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!
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.
A Fib Runner - Distance Running and Mountain Biking With Atrial Fibrillation 
Hi…throughly enjoy your blog, look forward to it every mo. I’m 61 yo male who went into A-Fib almost two years ago following a hard summer of roofing our lil house near the Dalles. We live in Ptld,have ran most of 40 + years, not the extreme distance you have achieved but have enjoyed trail running fora good part of those years. In Portland Forest park has been my path to tranquility for decades, also love desert and mtn running. A-fib like most , has left me tired, slow and unable to run daily. Sone of that is due to age too and a work schedule that keeps me too long tied to desk. Since being dig. w A’Fib I have been able to cont. running but slower and shorter with longer days in between. 8-9 miles is a good run for me anymore, reg runs 3 to 5. I am scheduled for cardio ablation end of summer, hopeful that it has pos. results.
Thanks again for your words of inspiration and adventure..Love the pics esp of Ringo, my trail buddy went with me everywhere except when overseas.
May your trail be long and filled with adventure and end safely
Tim stearns
Thanks so much for your kind words. I truly appreciate your input.
Good luck on your upcoming ablation. I’d love to hear about it.
Much appreciate the tips and inspiration. I have been loving road cycling over the past several years, just getting into the swing of self-supported touring when atrial flutter clipped my wings and devastated me. I’ve decided I can’t live my life in a bubble and am going to start getting back out onto the road again. Had already followed some of your tips in the past, simply as I was taking aspirin. But with Eliquis now I realize the risks have significantly bumped up. Nervously I’m heading out tomorrow for my first ride of the year. Enough of being a bystander! Gotta get me some sunshine out on the open road! 🙂
Don
Hello,
Sorry for the delay in “approving” your comment. I guess I saw it on my phone, but overlooked it when I finally got home. Sorry, my friend.
I feel that I really have to decide what activities are acceptable while on a potent anticoagulant. I have an article about that around here somewhere. I receive the most criticism for mountain biking, which I do several times per week. People seem to think mountain biking is jumps and mountain dew commercials. I think road biking is less safe. I live in rural Oregon, and there isn’t much traffic, but half of the traffic seems to be guys in gigantic pick-up trucks with mirrors as long as my arms!The other half is very old people with poor eyesight or very young people texting their friends or talking on their phones. Okay – I’m sounding obnoxious. I still road bike, btw. I love it.
I’m a hard-core road cyclist…totally “infected”…! Especially since doing a self-supported tour of Cape Cod last fall, I’m like: gimme the bike, the open road, good company and this is as close to heaven as life gets! 🙂
I’m on Eliquis now almost two months.
Did a google search on Eliquis and biking and lo and behold your blog comes up in the search. Intrigued me because I see an old guy using a mountain for fitness and talking a lot about it.
I’m 55 a fitness lap swimmer in Chicago. It got warm out today and I’m gonna break the bike out. Urban cycling in tons of traffic. This made me think about what some doctors have told me: “There’s no antidote for this type of blood thinner if you have head trauma right now, these drugs are new”. So I was thinking about what could happen to me in an accident on the street.
Guess if you are speeding down an unpaved trail at 20MPH statistically it has to be more of a risk that me tooling around city streets.
Hoping a good helmet is enough insurance! 🙂
Great blog. I’ll be back.
I honestly believe, for me, cautious mountain biking is safer that road riding. They are all on their cell phones here. I grew up in Chicago and used to road bike a lot on the southwest forest preserves and suburbs. I’m glad I live here.
I’ve been switched to warfarin. – more on that later.
I would agree on the road safety. There’s a wacko driver every 200 feet here on the Northwest side. I’m going to be going slow stoplight to stoplight on neighborhood thoroughfares not speeding around on a fixie at 20MPH blowing red lights.
I’m 58 and have been doing Eliquis for over a year…last June after a few months of staying off the bike I couldn’t stand it any longer. Tossed a towel in my pannier, hit the road, stopped only because of the awful winter. Did a 4 day self-supported tour of the Catskill Mountains last Sept. will be doing a 6 day tour of the Adirondacks this Sept.
On some select downhills, with the right conditions, I’ll hit 50+ mph…woo WEE! 🙂
Don
Great to find your post! I was diagnosed with PEs in 2013 and went on xarelto for 6 months. I essentially lived in a bubble for that time. Well unfortunately I was diagnosed again this past month and have to go on thinners for life. Ugh. This is a huge bummer for me since I love epic (risky) sports, especially road bike racing (where there are crashes all the time). I know my race days are over, but I still want to ride my bike in a group (still risky) and mountain bike on awesome single track. But I am very hesitant to go out and risk it.
I have gone out only a handful of times just with one other person. My clots are still healing and I can’t push it yet. It felt great to get out though. I carried a med kit with a tourniquet and quick clot.
I just don’t know how to go forward. No more skiing? Or what about going on 5 day backpacking trips? New mountain bike trails? I guess you just decide how much risk to live with each day?
I know I’m lucky so need to be more glass half full! Trying to stay positive. Just trying to adjust to this new lifestyle.
I think I wrote a blog article here about what activities may or may not be safe while anticoagulated. It is important that you come to some sort of agreement with your doctor about what is safe. It sort of surprises me that a lot of doctors don’t go over that with their patients. Why? Because most people don’t do much to begin with.
I won’t advise you as to what to do but I can tell you what I am doing at this point. Realize that I am on two anticoagulants now, warfarin (Coumadin) and aspirin. My bicycling is mostly mountain biking on safer trails – no crazy downhills or highly technical trails. I have often even avoided new trails, which is sad – but I still enjoy the well known (to me) trails I’ve been riding for years. I mostly have been doing “Gravel grinder” type rides either on my gravel grinder (Specialized AWOL) or on my mountain bike. I call it “geriatric mountain biking.” It’s fun, though.
I still do road rides, but I’m slow now because of the beta blocker so I generally go alone.
I won’t downhill ski – I have poor skills for downhill so I stick to cross country skiing. Downhill skiing has always been dangerous for me.
Backpacking – I don’t hesitate. It’s ultimately your decision – you could certainly play it safe and just run on a treadmill. My activity profile has changed to a certain extent; but also I’m a bit older now.
Hello, glad I found your blog, I road and mtb and now having been diag. w/afib I’ve been prescribed Pradaxa a month ago but haven’t started it yet because I felt once I did my riding days would be over. After reading your blog i’m more comfortable about starting my meds. Also, you stated that you switched to Warfarin from Pradaxa and I am curious why (before I start Pradaxa). Thanks
I took Pradaxa for quite a while and never had any problems – no bleeding, no GI upset, etc. I never missed a dose. Regrettably I had a small stroke while on Pradaxa and an echo revealed that I had a small blood clot in my left atrium – there is an article somewhere on this blog all about it. So I had a treatment failure with Pradaxa and was switched to warfarin. Obviously I liked Pradaxa better – “set it and forget it” – no labs – no dietary restrictions – but I failed on Pradaxa. It isn;t easy bening vegetarian on warfarin.
Thanks for your lightning fast reply, I thought there might be some new information about serious side effects or something on Pradaxa. I’m not a vegetarian but I chose Pradaxa because of the “set it & forget it” apeal you mention above. Also found your articles just now and have read through a few and have to say, you’ve done a fantastic job with this site (blog), loads of information…thank you! Hope to make some more post here after I start my Pradaxa and get some miles and med realted experiences riding my bikes.
Thanks so much for creating this blog! I wish to follow all the posts.
Thanks for your kind words.
I started Eliquis a year ago. My cardiologist never once mentioned anything about exercise precautions. We talked a little bit about surgery and dental work. But that’s about it. So I’m going to be very interested to hear what you all have to say. Plus I want to read the archives. I just started the Eliquis and didn’t change anything else in my life. I guess just the fact that I take less Naprosyn for pain.
It doesn’t surprise me – the vast majority of pts at a cardio clinic aren’t running and mountain biking. My EP doc told me they generally spend a lot of time just trying to get people to exercise. Not many like us, I think.
And especially at age 66!