Sharing a bad mistake: My stack led me to bleeding emergency (after Septoturbinoplasty surgery)

#1

Hi all,

i want to share a bad experience, made by my mistake, bringing me to an emergency bleeding after a Septoturbinoplasty surgery i underwent in order to optimize my breathing.

Here’s my actual daily stack:
Nmn, bernerine, fisetine, omega-3, astaxanthin, AEON Longevity complex (curcumin, resveratrol, quercetin), Swisse multivitamin for man, EGCG, bromelain, magnesium, niancin, melatonin, finasteride, minoxidil, acarbose, Merformin, semaglutide, vitamin D, K2, taurine.

In the aftermath of the surgery, i kept loosing blood with little coagulation, the surgeon had to intervene by providing anti-bleeding drugs and applying extra tampon into my nose (i now have 4 tampons stretching all along my turbinates).

I have no history of having blood coagulation problems.

I made at least 3 mistakes:

  1. I didn’t stopped my stack “weeks before” but only “two day before” the schedule surgery
  2. I didn’t reported to the hospital the full stack list, but only what’s categorized as a “pharmaceutical”
  3. I’ve never evaluated the anti-platelet/anticoagulant effects of my stack

The lesson learned here is that (according to ChatGPT), Bromelain + EGCG + Omega-3 have a strong anticoagulant effect, bundled together with Niancin + Curcumin + Resveratrol + Quercetin that feature an mild antiplatelet effect, i put myself into an emorragic-friendly human.

I wanted to share this story, because my incident happened within an hospital context and within a scheduled surgery, but if i had any bleeding accident outside a controlled environment, for a stacking of supplements, i could had encountered way more serious consequences.

I don’t know how many of you evaluated this specific aspects of antiplatelet/anticoagulant effect of a protocol stack and/or established measurement biomarker to ensure to avoid this situation.

I do wanted to share with you my experience, of a real mistake with real consequences, as not all biohacking experience works well, and sharing mistakes is maybe more important than sharing success.

Below photo of me before and after bleeding experience a couple of hour after surgery, now i’m fine and recovery taking tranexamic acid to support coagulation.

How would you suggest to keep under control the level of antiplatelet/anticoagulant effects in order not to encounter such a surprises?

Fabio

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#2

Similar here, I’ve used all of those supplements, but the only regular one I use now is Omega3, but I also take a baby aspirin every other day, BUT I’ve found if I do it long term (over a month at a time) my observable blood clotting decreasees to a notable and for surgery dangerous degree. I don’t have fancy tests but I pick at my cuticles and if I peel off too much I bleed quite readily, and that doesn’t happen without the aspirin. Have cataract surgery coming up so stopped aspirin. I’m afraid to mention what all I’ve taken to the cataract surgeon, he’d write me off as a loony, (and he might be right:)

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#3

Sorry to hear.

I’ve heard about this side effect from high dose Omega-3. What amount were you taking if you want to share?

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#4

‘’Never Lie To Your Doctor or Lawyer’’
German proverb/advise

I’d add “never withhold”.

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#5

Surely the supplements didn’t help things but of course the nose is incredibly vascular and vessels are superficial.

Tampons for this existed well before bio hackers. Even without surgery.

Most surgeons (particularly neuro, Ortho and ENT) usually state to stop everything for a couple of weeks.

As a general and bariatric surgeon, it is mostly annoying bleeding and bruising rather than life threatening. Even aspirin and plavix. So not all surgery is the same.

And how many obits have you seen that listed nose bleed or any post surgical bleed as cause of death? I did have a partner die of one after a Whipple but it is typically surgical misadventures rather than supplements.

Platelets and factors can be replaced easily but most serious problems we refer to as silk deficiency (hope the meaning of that is apparent). Hard to use silk on turbinates I bet.

I never had people stop any supplements and mostly chuckled at the idea. But again, not ENT.

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#6

I take 2 brands; the Nordic EPA Extra and NOW Ultra Omega, 2 of each, so about 4 grams of fish oil partially fractioned to increase the percentage of EPA. And I don’t think that’s what pushes me over into slight bleeding, pretty sure its the aspirin. When I stop the bleeding stops, but then I’ll read something about aspirin’s benefits and consider my high CAC and family history of cardio mortality, and I’ll start taking it again. I’ve done this at least a dozen times and I’ll no doubt repeat myself again.

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#7

I am taking Eliquis bled thinner. And in recently re-evaluating my entire stack, I also discovered this problem. Two actions that I took were:

  1. Stopped using curcumin
  2. Lowered my omega-3 dose to 3 g per day
#8

Also be aware that your stack has several supps that can potentially interfere with iron absorption - Metformin, EGCG, curcumin, quercetin, resveratrol for example. It is a good idea to check your ferritin on occasion. I overdid it with my supplement regime and drove it down too low.

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#9

I’m so sorry this happened to you!! Glad you are doing better.

It’s important you shared this, so thank you.

I have always known to stop baby aspirin and omegas prior to getting Botox because even the derms will mention increased bruising if you take them.

Considering I get those generic forms from a dermatologist, I’m surprised to hear that your surgeon’s office didn’t provide a list of things to stop prior to surgery.

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#10

FYI - tadalafil like viagra can cause light nose bleeds.

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#11

I am a believer in baby aspirin. Omega 3, not so much. If you are taking it for lowering lipids, I believe there are better alternatives. For CVD not particularly effective:
" * A Cochrane systematic review of many randomized trials concluded that increasing omega-3 intake probably makes little or no difference to overall deaths, heart attacks, or strokes in general adult populations. ref

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#12

My understanding is that, while on supplements that may have anti-platelets or anti-coagulant functions, as part of standard biomarker measurement the KPI to be added should be the LTA ( Light Transmission Aggregometry ) Platelet Function Testing: Light Transmission Aggregometry to test the functionality of clot formation.

Would that make sense as a preemptive measure to ensure to balance the dosing in avoiding to be in a risky bleeding condition, if there’s an accidental injury ?

Fabio

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#13

Someone will chime in with a more general answer, but I’ll share what my doc has told me about me and baby aspirin.

For me, who is high risk for an MI, he said even when I’m old and feeble and have a high risk of falling and hitting my head and causing a brain bleed, he’d always recommend I stay on baby aspirin because my risk of an MI is always going to be greater than the risk of falling and hitting my head.

That is a common sense framework that helps me think about the entire issue.

When I think about an accident and potential bleeding vs the benefits of omegas, I think most of the time, omegas will win. But, when I read about nattokinase, I decided that extra bleeding risk, on top of what I already use, was probably not offering a lot of extra upside for the added risk.

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#14

I generally like that logic. We die of trauma less with a modern world and more of CVD.

That being said, the head hitting issues are mostly with Eliquis, Coumadin and the true anticoagulants. So that logic for aspirin gives me pause.

My memory is the adverse events with aspirin were more from GI bleeds. That is the adverse events that caused the general vibe against primary prevention with aspirin. So unless you have an iron stomach, the logic may not hold.

As a physician, I feel like I get to rag on other doctors…

No one doctor knows everything. And no Internet forum doctor knows all your risk factors either.

I checked and there is a 58% increase in GI Bleeds and this is why it shouldn’t be used for primary prevention. Risk higher with age - studies were for over 60 but over 70 an even greater risk. Now it seems to me that if your cardiac risk is at least 50% above baseline, then maybe asa still beneficial. But you of course should work on getting the cardiac risk to baseline - which you obviously do. And wouldn’t your risk be below baseline at this point?

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#15

So sorry you experienced this. My father has to be careful about anticoagulants but also has a tendency to buy cool sounding combination supplements without taking a close look at the ingredients (despite being a retired medical researcher). I’m often doublechecking his stack for him. I’m also personally sure to get a lot of K vitamins both bc I need them and bc they can help offset these risks in my stack.

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#16

Use of Aspirin should be based on prior cardiovascular event, not age.

@desertshores
“I am a believer in baby aspirin”. Have you had a cardiovascular event?

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#17

Have you investigated the amount of fish oil taken daily and its relation to causing atrial fibrillation?

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#18

Thanks David. This is food for thought. And rag away!

He’s a very smart doc, but indeed, he is definitely not perfect… and to your point, no one is. In this case, I think I actually brought up falling and having a brain bleed, so that one was on me. If I recall, my doc told me to have it with a meal to protect my stomach… and I had forgotten this, so I’m glad it came up!!!

I have high lp(a), apoe3/4, bad family history, CAC almost 500 at 50 (almost 60 now),I have not had an event, but I’m trying to keep it that way! My lipids are now very low, thanks to repatha!

Multiple cardiologists have told me to take baby aspirin (many years ago one advised EOD, and then the ones more recently have said daily), my sister and brother’s cardiologists have told them to take on daily, too.

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#19

David,

i like a lot the risk balance logic you’re bringing and because i’m an IT guy going to develop an opensource biohacking software, i would love your feedback on the algorithmic thinking about it:

Doing biohacking, in a way or another, we will always stack-up interventions (being supplements, drugs, therapeutics, lifestyle, exercises) in a very customized way in order to reduce some risk-factors → improve some hallmark of aging.
However stacking up 10 intervention with very mild anti-platelet effect may end-up increasing the overall risks of having a high-risk bleeding person (with all the consequences, especially for unexpected trauma/incidents).

I do want to make an algorithmic decision making system that would spot that behavior and it’s entirely based on measurable numbers.

Let’s say that we have the biomarker LTA that tell us our platelet function and (entirely invented number) >10 is the lower part of healthy ange while <5 is high bleeding risk.

Let’s say that we have expected multiple health/longevity benefit from 10 supplements and drugs. We measure LTA as a “baseline under protocol” and it come up to be 6, almost “high bleeding risk” .

At this point i do want an algorithmically defined way to intervene on the protocol, in order to adjust it up until the LTA is within defined safety range.

To do that i expect that for every supplement/drugs, the algorithm would need to know:

  • How much impactful of anti-platelet/emorragic is in a ranking among the other compounds, giving an impact number per mg of compound
  • If that compound is dose dependent in it’s effect of plasma concentration or not

Based on those two information, the algorithm would need to report to the biohacker to:

  • Either reduce the quantity of the top impactful compound taken daily
  • Either alternate the compounds that stack-up from a daily basis to one day on/off (o two day on/off) kind of schedule

What do you think of this way of thinking?

I’m definitively going to write a piece of software to do that, modelling the impact of most of the supplements and drugs on biomarkers, bringing alert-warning based on the biomarker results, in order to maintain a reasonable individual efficacy-risk profile.

I am not a doctor, i’d rely on acquiring knowledge via multiple LLM prompting in automated and content curated approach, to ensure it’s not just magic, but i think many people here (including me) doesn’t have such an assistant in providing algorithmic efficacy-risk analysis for what’s being taken.

Fabio

#20

when i went for a routine colonoscopy (not even surgery) here in singapore, the snr consultant asked if i was taking any medication that could slow blood clotting and i told him i was taking 1g dha daily and he asked me to stop it at least a week before the procedure.

it sounds to me like u weren’t prepared and briefed properly beforehand

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