I want to apologize to you all for being missing in action.  This is my first year as a teacher and my time is being eaten away.  I will be more actively writing articles come summer.  Please feel free to fill out a comment form if you need support or resources.  I will keep my eye on my email for your submissions.

Activity trackers can be amazingly useful in pulmonary embolism recovery.  Many of them are able to track the amount, time of, and frequency of activity throughout the day.  This tracking is automatic and easy.  When I was in recovery I was tracking some of this information by hand.  Now there are sleek little gadgets to do the work for you.

Activity trackers are small wearable devices that track the wearer's movements throughout the day.  They are similar to a pedometer but they are able to track more than just steps.  They are very easy to use.  Charge the battery, wear the tracker, and sync it with your phone or computer.

I have long been an advocate of tracking your recovery.  I found that logging data allowed me to see my own growth as a progressed through recovery.  I had my pulmonary embolism in 2008.  There were no activity trackers available.  I took walks that I timed, used a pedometer to count my steps, used a heart rate monitor watch, and measured my blood pressure.  Each of these measurements was hand tracked in a paper notebook.

The Fit Bit One is one of the many activity trackers on the market.  I bought one a few weeks ago after seeing family members with them at a family reunion.  My goal for my Fit Bit was simply to move more.  I have just started a work at home job and I know that it will be easy to gain weight.  As I have worn my Fit Bit One I have realized that it has a lot of potential in pulmonary embolism recovery and in the prevention of blood clots.  I am going to share some of the features of the Fit Bit One with you.  While I own a Fit Bit One, I know that other activity trackers have similar features.  I will share some of the other brands and the end of this article.

One of the best things about the Fit Bit One is that it is tiny and unobtrusive.  In my picture you can see my Fit Bit inside of its rubber clip case.  I wear it clipped to my bra.  You can't even tell that it is on when I wear it.  If you don't want it on your bra, or if you are a guy, you can wear it clipped on your pants waistband.  Fit Bit and other brands also offer models that can be worn as a bracelet.

Activity trackers often have the ability to track steps, calories burned, exercise activities, floors climbed, calories consumed, and sleep patterns.  Activity trackers also record time.  This lets you see when you were active and how active you were at times throughout the day.  (Check the specific models to see which of these features are available.)  Most activity trackers, like my Fit Bit One, sync with a smart phone and computer so that all of the tracking data can be stored, analyzed, and compared.  These features make activity trackers very useful for pulmonary embolism survivors.

Activity trackers are very useful in pulmonary embolism recovery because of their ability to automatically track and record data over time.  Many of the new trackers don't even need a cable to sync with your smart phone or computer; they just automatically connect over a wireless connection as you go about your day.  This means that all you have to do is make sure that you have your tracker on.  As long as it is on, you are good to go.

Pulmonary embolism survivors can wear an activity tracker during recovery to track improvements in activity level.  My Fit Bit One sends me an email once a week with updates on my stats.  It gives me a little arrow to show me if I have improved that statistic from the previous week.  I can also go through my days one at a time on the Fit Bit website and or flip through my data throughout the day on either my iPhone or Fit Bit One.  Data is a great way to get an unbiased snapshot of recovery.  The more stamina that you have, the more steps you will walk in a day.  These numbers should improve throughout recovery.  

You can also use this data to set recovery goals for yourself.  Fit  Bit and other trackers allow you to set personal activity goals.  I started my Fit Bit One journey at 2,000 steps a day.  It took a while to get that number every week.  I then upped it to 2,500 steps a day.  You can set goals for any of the things that Fit Bit measures (calories, floors climbed, active minutes, and etc.). 

Another use for an activity tracker is to monitor weight during recovery and to assist in weight loss.  Weight loss decreases the risk of future clots and is a common recommendation from the medical community.  Fit Bit is able to track the calories that I eat and the calories that I am expending.  I can set calorie goals based on my weight loss needs.

I got my Fit Bit One to help me to increase my activity levels and to assist in weight management.  As I have worn my Fit Bit One I have realized that it is helping me to monitor my movement throughout the day.  Weight loss and movement are two of the most effective pulmonary embolism preventatives.  My activity monitor is assisting with both of these preventatives.  I knew that my Fit Bit would help me to track calories.  What I didn't realize was how useful its data logging is in my own pulmonary embolism prevention quest.

If you look at my Fit Bit dashboard you will see the graph in the upper left hand corner.  This shows me the hours of the day on the bottom and then puts a line in whenever I walk throughout the day.  i can also look at the floors that I climb or the calories that I burn.  This lets me check myself to see if I am getting up enough throughout the day.  You can see that on this day I didn't walk much after 6 PM or before 10:00 AM.  The later steps were likely missing because I looked at my computer around 5 or 6 PM.  The morning appears to have been largely inactive.  This tells me that I need to review my activity throughout the day to ensure that I am moving.  Individuals with a history of pulmonary embolism should move at least once every two hours.  My Fit Bit keeps an eye on me and lets me know when I am not doing this well.

(Different activity monitors will handle their data in different ways.  Many are able to sync with a computer and a smartphone.  Make sure to check the models out though as some only store data on the unit.  I believe that the computer tracking that you see above is vital for a pulmonary embolism survivor.  I highly recommend that you pick out a tracker that is able to hook up with a smart phone and/or a computer.)

Throughout the day when I am not at my computer I use my iPhone to check on my progress.  I can look at my Fit Bit but it doesn't give me as much data and I wear it clipped to my bra so I can't see it in public.  The FitBit uses bluetooth to automatically update my iPhone as the day passes.  While you dot have to have a phone to use it, it comes with a USB dongle to sync with a computer, I love that I don't have to think about it when it is set up with my iPhone.

Each of these lines can be tapped.  When you tap the specific type of data, a chart comes up with a timeline.  Like the computer program you are able to see how that measurement varied throughout the day.  I find that simply watching steps to see when I have moved helps me to track myself.  I work at home and making sure that I am moving throughout the day is important.  This bit of feedback let's me know if I need to modify my habits.

MTHFR is a genetic mutation that will sometimes increase the risk of blood clots.  MTHFR is caused by a change in the methylenetetrahydrofolate reductase (NAD(P)H) gene.  This gene is also known simply as MTHFR.  MTHFR carries the instructions for making an enzyme called methylenetetrahydrofolate reductase.  One of the most important things that this enzyme does is to convert an amino acid homocysteine into another amino acid, methionine.  The body then uses the new amino acid to make a number of different proteins in the body.

HOW DOES MTHFR AFFECT CLOTTING?
Some individuals who have the MTHFR gene mutation develop elevated levels of homocysteine.  Elevated levels of homocysteine have been associated with an increased risk of blood clots.  Individuals who have a MTHFR mutation and have normal levels of homocysteine are not at an increased risk of clotting.  It is the elevated homocysteine that raises the risk of clots, not the MTHFR mutation.

HOW IS MTHFR DIAGNOSED?
MTHFR is diagnosed by measuring the levels of homocysteine in the blood.  MTHFR is not a large risk factor for blood clots.  For this reason, some doctors will limit homocysteine testing to individuals who are under 30 years of age who have a blood clot or have a history of repeated blood clots.

TREATMENT
The best way to prevent clots is always to use good clotting hygiene.  Make sure to keep moving, be careful on long car rides and flights, stay hydrated, and to speak with a doctor for extended illnesses or surgeries.  If blood clots are a problem, anticoagulation therapy may be useful.  Vitamins B12 and B6 are involved in lowering homocysteine levels in the body.  Studies haven't clearly shown a decrease in blood clotting risk when patients take B6 and B12.  If you have elevated homocysteine levels, it would be worth asking your doctor how he or she feels about using B vitamins to prevent clots.

REFERENCES
How MTHFR Testing Works. (n.d.). CEPMED. Retrieved October 22, 2013, from https://cepmed.dnadirect.com/grc/patient-site/mthfr-pregnancy-complications/how-mthfr-testing-works.html

Moll, S. (2010, November 19). Thrombophilia Testing – Who Should be Tested? Clot Connect. Retrieved October 22, 2013, from http://patientblog.clotconnect.org/2010/11/19/thrombophilia-testing-%E2%80%93-who-should-be-tested/

Treating High Homocysteine. (n.d.). CEPMED. Retrieved October 22, 2013, from https://cepmed.dnadirect.com/grc/patient-site/mthfr-pregnancy-complications/treating-high-homocysteine.html

Varga, E. A., Sturm, A. C., Misita, C. P., & Moll, S. (2005). Homocysteine and MTHFR Mutations Relation to Thrombosis and Coronary Artery Disease. Circulation, 111(19), e289–e293. doi:10.1161/01.CIR.0000165142.37711.E7, from http://circ.ahajournals.org/content/111/19/e289.full

What Is MTHFR? (n.d.). CEPMED. Retrieved October 22, 2013, from https://cepmed.dnadirect.com/grc/patient-site/mthfr-pregnancy-complications/index.html

Who Should Consider MTHFR Testing? (n.d.). CEPMED. Retrieved October 22, 2013, from https://cepmed.dnadirect.com/grc/patient-site/mthfr-pregnancy-complications/who-should-consider-mthfr-testing.html

Many supplements interact with anticoagulants.  These reactions may make the medications less effective or may increase the risk of bleeding.  This post has links to places where you can get information on drug/natural supplement interactions.  Make sure to check for interactions, talk to your pharmacist, and talk with your doctor before adding or removing supplements from your treatment plan.  This will help you prepare for possible problems.

From Health Notes:

• Warfarin (Coumadin)
• Lovenox
• Heparin
• Xarelto

Other reliable references:

• The Mayo Clinic
• Medline Plus

Today, we will learn about some of the risks of natural medications and supplements.  Before we get to that topic, I want to review the answers to the questions that I posted in the last entry.  Let's review the different mystery substances:

Substance #1 is warfarin (coumadin).
This substance was discovered when a farmer noticed his cows were bleeding more than a healthy cow should bleed.  He did some research and found out that the cows had consumed a large amount of a certain plant while munching the grass in their pasture.  This natural substance is very effective at preventing clots and is still used for this purpose to this day.

Substance #2 is water.
This substance is fine when taken in certain amounts.  It is very effective in preventing clots and often recommended by doctors.  If the patient takes too much of this substance he or she will suffer muscle contractions, headache, seizures, nausea, and unresponsiveness.  If this overdose is not addressed, it will lead to coma and death.

Substance #3 is aspirin.
This substance is starting to show promise as a means to prevent pulmonary embolism.  Although the research is conflicting, some doctors are recommending that patients use this substance.  This substance increases the risk of fatal bleeding.  Other side effects of this substance include vomiting, stomach pain, hives, rash, facial swelling, difficulty breathing, fast heart rate, fast breathing, clammy skin, loss of hearing, and death.

As you can see, anything that you put into your body can have side effects.  It doesn't matter if the substance is over the counter or if it is a prescription.  As a patient it is important to read the labels and talk to medical professionals.  For natural substances you will need to dig a little deeper to find information.  It is much more difficult to find the side effects profile of natural supplements.  When the information does show up, it is even more difficult to know if you can trust the source.

Some Supplements Are Dangerous
Although many sources will tell you that supplements have no side effects because they are not medicine, this is not the case.  Supplements are medicine and they do have side effects.  In the last two weeks articles have come out about the dangers of some very common supplements.  I wanted to share this information because the dangerous supplements are often used by blood clot patients.

Fish Oil May Cause Bleeding And May Increase The Risk Of Aggressive Prostate Cancer
While we often hear that omega fatty acids are healthy, research is beginning to show that they may only be healthy when they are consumed as fish rather than fish oil.  The UK Daily Mail  reported on July 10, 2013, that omega-3 fatty acid fish oil supplements may increase the risk of aggressive prostate cancer by 70%.  Aggressive prostate cancer is fairly rare, however, if you are male, you may wish to reconsider using fish oil as a post clot preventative.  Another problem with fish oil is that it does not mix well with anticoagulation therapy (blood thinners).  If you are on anticoagulation therapy, fish oil raises the risk of suffering a major bleed.

Supplements That Increase The Risk Of Bleeding
Supplements can change how the liver creates and processes blood clotting enzymes, change ow much vitamin K is in the body, reduce platelet counts, or decrease thrombin effectiveness.  All of these effects can increase the risk of bleeding, especially if you are on anticoagulation therapy.  In 2010 a study of 100 common herbal remedies was conducted.  It found that 69 out of 100 of the remedies affected how warfarin worked in the body.  If you are on anticoagulation please talk with your pharmacist and physician about mixing herbs and supplements with warfarin.  Here are some of the most common natural supplements that significiantly raise the risk of bleeding and of requiring a blood transfusion:

• Ginko Biloba
• Ginsing
• Garlic
• Fish Oil
• Dong Quai
• Feverfew
• Chamomile
• Ginger
• Nettle
• Cayenne Pepper
• Bromelain

References:
Macrae, F. (2013, July 10). Taking omega-3 fish oil supplements may increase the risk of aggressive prostate cancer by 70%. Mail Online. Retrieved July 17, 2013, from http://www.dailymail.co.uk/health/article-2359466/Taking-omega-3-fish-oil-supplements-increase-risk-aggressive-prostate-cancer-70.html

Story, C. (2013, July 10). Could the Herbs You’re Taking Cause Life-Threatening Bleeding? Renegade Health. Retrieved July 17, 2013, from http://renegadehealth.com/blog/2013/07/10/could-the-herbs-youre-taking-cause-life-threatening-bleeding

U.S. National Library of Medicine. (2012, July 23). Fish oil: MedlinePlus Supplements. MedlinePlus. Retrieved June 3, 2013, from http://www.nlm.nih.gov/medlineplus/druginfo/natural/993.html

Student teaching is over and I am finally getting back to this website.  I want to start by taking a moment to welcome all of the new Clot Spot readers.  Today I want to talk about a new article that was just added to The Clot Spot.  Today I wrote a lengthy post on natural alternatives to warfarin.  It can be found here.  I wrote this article because this is something that feel very strongly about.  I use natural medicine for my migraines under supervision of my doctor.  The supplements were carefully chosen and well researched.  I take them, not because I am afraid of pharmaceutical preventatives, but because those preventatives simply did not work for me.  Before I started taking them, I did a lot of research.  I wanted to know what side effects might occur due to these supplements.  After understanding my risks, I started the supplements.  

I strongly encourage all of you to do this research for both pharmaceutical and natural treatments.  Some natural treatments are more harmful than you can imagine.  There are no requirements for supplement companies to run a disclaimer on their ads or their bottles.  These companies even try to market supplements as a "drug free" alternative.  Natural supplements are drugs.  They have side effects.

I have chosen not to use supplements that will change how my blood clots.  Some of you may choose a different path.  I do not trust my blood to unregulated supplements.  Many of us struggle with different brands of warfarin and those variations are less than 4%!  If 4% bothers your body, imagine what an unregulated variation may do to your body.  Bleeding and clotting are important.  I want to know how much of a substance is in me.  Those natural supplements are chemicals and I want to have them carefully controlled.  I do not want to bleed to death or clot due to variations in dosage.  Also, I want a medication that is well tested.  

Recently, I read an interesting article on this topic at Slate.  I highly recommend it.  It got me thinking a lot about our fear of "chemicals" and "drugs".  

With that article and my recent addition to The Clot Spot, I want to play a guessing game.  I will describe three common substances that can be used to prevent clots; you will guess what they are.  Please leave your guesses in the comments.

Ready?

Substance #1:
This substance was discovered when a farmer noticed his cows were bleeding more than a healthy cow should bleed.  He did some research and found out that the cows had consumed a large amount of a certain plant while munching the grass in their pasture.  This natural substance is very effective at preventing clots and is still used for this purpose to this day.

Substance #2
This substance is fine when taken in certain amounts.  It is very effective in preventing clots and often recommended by doctors.  If the patient takes too much of this substance he or she will suffer muscle contractions, headache, seizures, nausea, and unresponsiveness.  If this overdose is not addressed, it will lead to coma and death.

Substance #3
This substance is starting to show promise as a means to prevent pulmonary embolism.  Although the research is conflicting, some doctors are recommending that patients use this substance.  This substance increases the risk of fatal bleeding.  Other side effects of this substance include vomiting, stomach pain, hives, rash, facial swelling, difficulty breathing, fast heart rate, fast breathing, clammy skin, loss of hearing, and death.

I will be back on to share the answers in a few days.

This week, doctors have shared another risk factor for pulmonary embolisms, DVTs, and other types of venous thrombosis.  The good news is that we now have another risk factor that we can avoid.  The bad news is that the risk factor is a critical treatment for many patients.  Glucosteroids, one of which is cortisone, have been found to increase the risk of having a venous blood clot by two to three times.  Even more problematic is that the form of the steroid doesn't matter.  Inhaled, injected, or swallowed, all glucosteroids increase the risk of a clot (although some forms are more risky than other forms).  

Doctors are already cautious about using glucosteroids due to their lengthly list of frequent, serious side effects.  This caution should continue.  The risk of clots is the highest after beginning a new steroid regimen.  The risk continues throughout the steroid use and then for at least a year after the steroid is discontinued.

The important thing to learn from this study is that every patient needs to discuss this risk with his or her doctor.  It would be a good idea to discuss the risk of the steroid, other risks that the patient has, and possible ways to lower the risk of clotting.

To read more about the study see http://ow.ly/jYWTF 

Picture By Kevin Dufendach [CC-BY-3.0)], via Wikimedia Commons