OT - Bosh & Hypercoagulability

[exculpatory]

As you know, I am an endocrinologist, but all internal medicine subspecialists are also internists & I know a fair amount about the other internal medicine subspecialties - including hematology.

If Bosh has one of the genetic hypercoagulable diseases predisposing him to thrombotic events (they have publicized at least 2), & therefore must be treated with lifelong anticoagulant therapy (Coumadin or 1 of the NOACs), it is beyond me how he might be returning to the NBA. Pro basketball is not exactly a non-contact sport.

Something is off here!

PS Tedy Bruschi was transiently anticoagulated because he had an embolic CVA due to a paradoxical embolus related to a previously undetected atrial septal defect (ASD). Once the ASD was repaired, anticoagulation was discontinued & he returned to the Patriots for a year or two.

[Green89]

The Heat have tickets for next season to sell. If they knew he wasn't going to play this year, or his career was ending, they most likely will wait until the last possible moment to announce it. They're already having to use Goran Dragic's face as the model for their team, so this would be a huge blow they won't be too quick to announce.

[truth18]

Man, my mother would get along well with you Ex (she's a neurologist).

I talked to her about this last year. She said that he absolutely needs to retire and get on Coumadin (which, fun fact, was originally in rat poison before they figured out its benefits to humans).

I agree with her. He's going to return and not take coumadin most likely which is terrible. Dude is going to have another stroke. Better than dying on court but why not just **** retire, man? Whole thing really upsets me. Bosh is one of the few decent guys the Heat has had and he is going to screw his life up. He doesn't need the money, he's extremely intelligent unlike most of the league.

Probably the people around him pressuring him to do this. **** sad, man. I really hope he retires.

[max powers]

I don't know what the actual risk is however I suspect it might be a bit overblown. Has an NBA player ever had a subdural hematoma, traumatic sub arachnoid hemorrhage, splenic or liver laceration? He would risk worsening fracture associated hematoma with leg or ankle fx. Just not much mechanism for more serious trauma even if anticoagulated, of course it's never been studied so he'd be making himself a Guinea pig.

[exculpatory]

Man, my mother would get along well with you Ex (she's a neurologist).

I talked to her about this last year. She said that he absolutely needs to retire and get on Coumadin (which, fun fact, was originally in rat poison before they figured out its benefits to humans).

I agree with her. He's going to return and not take Coumadin most likely which is terrible. Dude is going to have another stroke. Better than dying on court but why not just **** retire, man? Whole thing really upsets me. Bosh is one of the few decent guys the Heat has had and he is going to screw his life up. He doesn't need the money, he's extremely intelligent unlike most of the league.

Probably the people around him pressuring him to do this. **** sad, man. I really hope he retires.

1. Warfarin = Coumadin was originally used as rat poison >100 years ago.
2. I believe his first event was a DVT (deep vein thrombophlebitis) & I KNOW that his second event was a PE (pulmonary embolus) (more than likely consequent to a DVT) which indeed can be life threatening. (Bosh is not currently in Neurology territory, Truth. He is on Internal Medicine/Pulmonology/Hematology turf. If he has a thrombotic stroke, we can dial in your mom.)
3. I am curious whether they have uncovered an underlying "hypercoagulopathy" (which predisposes him to thrombotic events in multiple places). There are many - ATIII deficiency, Protein C deficiency, Protein S deficiency, Factor 5 Leiden etc). I guarantee you that the best hematologists on the planet have already worked him up thoroughly.
4. He IS being treated with Xarelto - a newer anticoagulant which is an alternative to Coumadin for certain diseases - including DVT & PE. See TV ad below!
http://heatzone.blog.palmbeachpost.com/2015/10/29/bosh-golfs-with-arnold-palmer-kevin-nealon-brian-vickers-in-xarelto-commercial/
5. If he has an underlying hypercoagulable disease, anticoagulation therapy must be lifelong.
6. Even if they have not diagnosed a clear cut underlying hypercoagulable disease, he has already had at least 2 thrombotic events in 2 successive years. That is also probably a reason for lifelong anticoagulation therapy.
7. I do not comprehend how he can continue Xarelto & play a professional contact sport. He would be at enormous risk for bleeding after significant (or even relatively insignificant) trauma - brain, spleen, kidney, etc.
8. If he stops the Xarelto, he is at major risk for another thrombotic event including DVT, PE, thrombotic cerebrovascular vascular accident (CVA)/stroke, etc.
9. From a liability point of view, I cannot imagine that the Heat physicians would advise him to play on Xarelto (risk of trauma-induced bleeding).
10. From a liability point of view, I cannot imagine that the Heat physicians would advise him to discontinue his Xarelto in order to play (risk of a new thrombotic event).

To Curm & other lawyers on our board, would the Heat be free from liability if Bosh signed some sort of waiver excusing the Heat from all liability if he played on OR off Xarelto?

[ZeroTolerance]

Man, my mother would get along well with you Ex (she's a neurologist).

I talked to her about this last year. She said that he absolutely needs to retire and get on Coumadin (which, fun fact, was originally in rat poison before they figured out its benefits to humans).

I agree with her. He's going to return and not take Coumadin most likely which is terrible. Dude is going to have another stroke. Better than dying on court but why not just **** retire, man? Whole thing really upsets me. Bosh is one of the few decent guys the Heat has had and he is going to screw his life up. He doesn't need the money, he's extremely intelligent unlike most of the league.

Probably the people around him pressuring him to do this. **** sad, man. I really hope he retires.

1. Warfarin = Coumadin was originally used as rat poison >100 years ago.
2. I believe his first event was a DVT (deep vein thrombophlebitis) & I KNOW that his second event was a PE (pulmonary embolus) (more than likely consequent to a DVT) which indeed can be life threatening. (Bosh is not currently in Neurology territory, Truth. He is on Internal Medicine/Pulmonology/Hematology turf. If he has a thrombotic stroke, we can dial in your mom.)
3. I am curious whether they have uncovered an underlying "hypercoagulopathy" (which predisposes him to thrombotic events in multiple places). There are many - ATIII deficiency, Protein C deficiency, Protein S deficiency, Factor 5 Leiden etc). I guarantee you that the best hematologists on the planet have already worked him up thoroughly.
4. He IS being treated with Xarelto - a newer anticoagulant which is an alternative to Coumadin for certain diseases - including DVT & PE. See TV ad below!
http://heatzone.blog.palmbeachpost.com/2015/10/29/bosh-golfs-with-arnold-palmer-kevin-nealon-brian-vickers-in-xarelto-commercial/
5. If he has an underlying hypercoagulable disease, anticoagulation therapy must be lifelong.
6. Even if they have not diagnosed a clear cut underlying hypercoagulable disease, he has already had at least 2 thrombotic events in 2 successive years. That is also probably a reason for lifelong anticoagulation therapy.
7. I do not comprehend how he can continue Xarelto & play a professional contact sport. He would be at enormous risk for bleeding after significant (or even relatively insignificant) trauma - brain, spleen, kidney, etc.
8. If he stops the Xarelto, he is at major risk for another thrombotic event including DVT, PE, thrombotic cerebrovascular vascular accident (CVA)/stroke, etc.
9. From a liability point of view, I cannot imagine that the Heat physicians would advise him to play on Xarelto (risk of trauma-induced bleeding).
10. From a liability point of view, I cannot imagine that the Heat physicians would advise him to discontinue his Xarelto in order to play (risk of a new thrombotic event).

To Curm & other lawyers on our board, would the Heat be free from liability if Bosh signed some sort of waiver excusing the Heat from all liability if he played on OR off Xarelto?

I'm prescribed to take Elequis (which is really the same as the Zarrelto) 5 mg in the morning and 5 mg at night cause the doctors are worried that I might have a stroke in my sleep. And when I take this dose I do nothing but bleed out the stool if I take that dose more than 3 or 4 days in a row....Of course this dose also makes me anemic too...And I've begged the the Doctors to give me a smaller dose ( 2.5 mg three times a day) but the doctors are scared to do that mostly because, as the pharmacist told me, they haven't tested to see if smaller doses of those drugs will work.

So I've taken it upon myself to "self medicate" and I find that the smaller dose works just fine for me without any bleeding... i've been doing this now for almost a year.

What the doctors don't know won't hurt them. and I feel so much better. And i'll bet my medicare part "B" insurance company is happier too?

I think we trust these drug companies way more than we should. You know? For them, it's all about selling the product and making money while the patent rights protect any generics from being produced that would lower the consumer costs.. I'd also bet that right about the time when a generic becomes available for Eliquis and Zarrelto, those studies will be done and less of that type of medicine will be prescribed.

Anyway, I'd also be willing to bet that Bosh is "self medicating' too!

That's probably why he feels better?

Anyway, it's no secret to those of us who take maintenance drugs every day that by and large, we in this country are pretty much over medicated. And the reason....Medical malpractice suits and Drug company greed. JMO

[165bows]

Man, my mother would get along well with you Ex (she's a neurologist).

I talked to her about this last year. She said that he absolutely needs to retire and get on Coumadin (which, fun fact, was originally in rat poison before they figured out its benefits to humans).

I agree with her. He's going to return and not take Coumadin most likely which is terrible. Dude is going to have another stroke. Better than dying on court but why not just **** retire, man? Whole thing really upsets me. Bosh is one of the few decent guys the Heat has had and he is going to screw his life up. He doesn't need the money, he's extremely intelligent unlike most of the league.

Probably the people around him pressuring him to do this. **** sad, man. I really hope he retires.

1. Warfarin = Coumadin was originally used as rat poison >100 years ago.
2. I believe his first event was a DVT (deep vein thrombophlebitis) & I KNOW that his second event was a PE (pulmonary embolus) (more than likely consequent to a DVT) which indeed can be life threatening. (Bosh is not currently in Neurology territory, Truth. He is on Internal Medicine/Pulmonology/Hematology turf. If he has a thrombotic stroke, we can dial in your mom.)
3. I am curious whether they have uncovered an underlying "hypercoagulopathy" (which predisposes him to thrombotic events in multiple places). There are many - ATIII deficiency, Protein C deficiency, Protein S deficiency, Factor 5 Leiden etc). I guarantee you that the best hematologists on the planet have already worked him up thoroughly.
4. He IS being treated with Xarelto - a newer anticoagulant which is an alternative to Coumadin for certain diseases - including DVT & PE. See TV ad below!
http://heatzone.blog.palmbeachpost.com/2015/10/29/bosh-golfs-with-arnold-palmer-kevin-nealon-brian-vickers-in-xarelto-commercial/
5. If he has an underlying hypercoagulable disease, anticoagulation therapy must be lifelong.
6. Even if they have not diagnosed a clear cut underlying hypercoagulable disease, he has already had at least 2 thrombotic events in 2 successive years. That is also probably a reason for lifelong anticoagulation therapy.
7. I do not comprehend how he can continue Xarelto & play a professional contact sport. He would be at enormous risk for bleeding after significant (or even relatively insignificant) trauma - brain, spleen, kidney, etc.
8. If he stops the Xarelto, he is at major risk for another thrombotic event including DVT, PE, thrombotic cerebrovascular vascular accident (CVA)/stroke, etc.
9. From a liability point of view, I cannot imagine that the Heat physicians would advise him to play on Xarelto (risk of trauma-induced bleeding).
10. From a liability point of view, I cannot imagine that the Heat physicians would advise him to discontinue his Xarelto in order to play (risk of a new thrombotic event).

To Curm & other lawyers on our board, would the Heat be free from liability if Bosh signed some sort of waiver excusing the Heat from all liability if he played on OR off Xarelto?

Any idea if it could be PED related?

Also pretty sure they still use warfarin as go to rat/mice poison.

[SuperDeluxe]

I sincerely hope he doesn't play basketball ever again, and I don't think he will -- he's too smart not to realize what's at stake here.

[ZeroTolerance]

Probably the people around him pressuring him to do this. **** sad, man. I really hope he retires.

It could be that Truth18? But I don't know?

He probably feels fine on the Zarrelto which is a time release version of the same....advantage being you don't have to test your levels....

They recently put my lady friend on the Eliquis because they couldn't keep her regulated by testing and prescribing the proper levels of Worfarin.

BTW...She takes the same dose that I'm supposed to with a different result...She dosen't bleed...so you see it effects everyone differently....two five MG a day is working for her...

[truth18]

Appreciate the response Ex. And yeah, my mom is an MS specialist was just speaking generally.

I really hope Bosh just **** retires.

I'm not a lawyer but I believe I read an article last year saying the Heat would not be liable.

[ZeroTolerance]

I sincerely hope he doesn't play basketball ever again, and I don't think he will -- he's too smart not to realize what's at stake here.

Certainly he takes a certain amount of chance. but he is still a young man.

Diabetics who are younger are encouraged to exercise.

Why would this be any different as long as he is regulated?

[Smitty731]

I sincerely hope he doesn't play basketball ever again, and I don't think he will -- he's too smart not to realize what's at stake here.

Unfortunately I think you are wrong. I happen to agree with you that he shouldn't, but I think he will play again.

I talked to a couple of people from Miami about this in Orlando and Las Vegas at Summer League and they all said he desperately wants to play. The exact quote I was told he says is: "I'm a basketball player. I don't do anything else. If I don't play basketball, what am I?"

I think that mindset it prevalent with a lot of pro athletes. They don't have anything but the sport.

I was also told that Bosh under no circumstances wants to forfeit any of the money he has coming his way. That is a real fear for him apparently, so it is an additional motivating factor to play.

One thing that was talked, but neither the Heat nor Bosh were interested in was him playing in home games and select road trips, since flying is apparently one thing that is risky given his "condition". I used the quotes because I'm not quite sure how to accurately describe it and I don't want to be disrespectful to him at all.

I hope eventually he either sits out or is 100% (or as close as humanly possible) cleared to play without issue. Different situation, but I remember seeing Reggie Lewis collapse on the court in the playoffs vs Charlotte and thinking "I hope he's ok, but he shouldn't play if he's not." About 3 months or so later he was dead. I hope to never see anything like that happen again.

[exculpatory]

Partial responses to the comments made by multiple guys:

1. Caveat: I obviously have not reviewed his medical records & I do not know 1) if he has been diagnosed with an underlying hypercoagulable disease & 2) numerous other details regarding his history & evaluation. However, based on what is public knowledge (he has had 2 thrombotic events including a PE AND he is being treated ?long term? with Xarelto), conservatively speaking, his best path going forward is NEVER to play again, & to take his Xarelto for life carefully followed by an excellent internist with access to excellent hematology & pulmonology support.

2. Truth: The question I posed in my last detailed post remains unanswered. If he signs a waiver releasing the Heat from all liability, will this stand up in court if he plays on Xarelto & sustains a serious bleed OR plays off Xarelto & has another PE/DVT - and Bosh/his family decides to sue the Heat - in spite of the waiver he signed? Do we have an attorney in the house willing to offer an opinion?

3. 165: Anabolic steroids as PEDs DO increase the risk of thrombotic disease. I doubt very very much that he was juicing to begin with &, even if he was, it is unimaginable to me that he would have continued to juice after his first thrombotic event.

4. Xarelto & Eliquis are both Factor Xa inhibitors & have been approved by the FDA as an alternative to Coumadin/Warfarin for the treatment of DVT/PE & chronic atrial fibrillation (AF). Multiple dosing regimens were evaluated prior to approval of each drug for each indication, and the dosing regimens for each drug which resulted in the best combination of efficacy (preventing new DVTs/PEs, decreasing the risk of embolic stroke in patients with chronic AF) & safety (least risk of bleeding) were the dosing regimens approved. I cannot overstate that it is VERY VERY unwise & EXTREMELY foolhardy to self-medicate. You hopefully find a doc who knows his/her ****, you put your trust in him/her & you do what the **** he/she says. Period. And BTW, if you develop rectal bleeding on ANY anticoagulant, it is ABSOLUTELY MANDATORY that you make your primary doc immediately aware & get referred to an excellent gastroenterologist for a colonoscopy & upper endoscopy to determine the exact source of the GI bleeding precipitated by the anticoagulant. You do NOT decrease the dose of the anticoagulant by yourself & sing kumbaya.

PS: It is a lot easier to URGENTLY REVERSE (such as when there is a need for urgent surgery or in the presence of an intracranial bleed or a severe bleed in the gut or retroperitoneum) the anticoagulant effects of Warfarin/Coumadin (Vitamin K & FFP) than the anticoagulant effects of the Novel Anticoagulants (NOACs) = the Factor Xa inhibitors (Xarelto/Rivaroxaban, Eliquis/Apixaban, Savaysa/Endoxaban) & the direct thrombin inhibitors (Pradaxa/Dabigatran). An antidote for Pradaxa HAS been approved & a generic antidote which will hopefully reverse the anticoagulant effects of ALL Factor Xa inhibitors is under aggressive development as I write this.

5. Lastly, another comment was made above which reflects a very poor understanding of therapeutic anticoagulation. Even if your Coumadin/Warfarin dose has been carefully adjusted to obtain the desired amount of anticoagulation (as determined by the INR), & even if the dose of Xarelto or Eliquis prescribed is the precise amount approved by the FDA for the indication for which it was prescribed (monitoring of the INR is not required with Xarelto or Eliquis - an advantage over Coumadin/Warfarin), YOU ARE BY DEFINITION AT RISK for a bleeding complication - EVEN WITHOUT A PRECIPITATING TRAUMATIC EVENT. You accept that risk of a bleeding event because of the BENEFIT - the prevention of a new thrombotic event. Get it?

Forgot to address Smitty's comments:

It is well known that people (especially if they have a hypercoagulable diathesis - but ANYONE) who sit for prolonged periods of time (such as frequent long plane rides) (wherein blood pools in the legs) are at greater risk for DVTs/PEs. That is why it is a good idea for anyone taking a long plane ride (or bus/car ride) to periodically get up & walk up & down the aisle. (BTW, in this regard, I am pretty certain that Dr. J developed a DVT circa 1980.)

Smitty, are their standard clauses in NBA contracts which allow a team to offer a settlement of some kind & dissolve a contract if the team & its physicians believe that it is medically dangerous for a player to continue to play? Also, do you have any thoughts about the waiver question I posed in #2 above?

[exculpatory]

I don't know what the actual risk is; however I suspect it might be a bit overblown. Has an NBA player ever had a subdural hematoma, traumatic subarachnoid hemorrhage, splenic or liver laceration? He would risk worsening fracture-associated hematoma with leg or ankle fx. Just not much mechanism for more serious trauma even if anticoagulated. Of course it's never been studied so he'd be making himself a Guinea pig.

I do not think the risk is overblown at all.

As you well know, totally appropriately anticoagulated patients have bleeds all the time without a smidgen of precipitating trauma. It is part of the inherent risk they MUST accept to diminish the risk of another thrombotic event (DVT), another thromboembolic event (DVT/PE) or to prevent a de novo thromboembolic event (chronic AF complicated by an embolic CVA consequent to an atrial mural thrombus).

Even absent a properly designed study, I think the risk of an acute extradural or subdural hematoma or an acute subarachnoid bleed after a blow to the head by a very large/strong opponent, & the risk of an intraabdominal (liver, spleen) or retroperitoneal bleed after a very forceful blow to the body, would be DRAMATICALLY increased in a NBA baller who was appropriately anticoagulated & even more dramatically increased if he was unintentionally over-anticoagulated.

[ZeroTolerance]

Ex.. I respect your opinion the same way I respect my doctor's opinion.

And yes, I've been told that I will need to have another colonoscopy.

But I think for all of your knowledge of these medicines, you miss my point in that I don't bleed at all unless I take this ridiculous dose of this stuff.

Then there's this little issue of the quality of life. And the patient should always be a good little boy and have blind faith in the medical profession, even though it would seem that the drug companies often wag the tail on the dog.

My feeling is I'll take that chance and continue to do what my body tells me. And not just go along with conventional thinking unless I start bleeding on my own terms. It should be my decision, not theirs.

[exculpatory]

Ex.. I respect your opinion the same way I respect my doctor's opinion.

And yes, I've been told that I will need to have another colonoscopy.

But I think for all of your knowledge of these medicines, you miss my point in that I don't bleed at all unless I take this ridiculous dose of this stuff.

Then there's this little issue of the quality of life.

And the patient should always be a good little boy and have blind faith in the medical profession, even though it would seem that the drug companies often wag the tail on the dog.

My feeling is I'll take that chance and continue to do what my body tells me.
And not just go along with conventional thinking unless I start bleeding on my own terms.
It should be my decision, not theirs.

Absolutely your decision.
Your body.
Your health.
Your decision.
No argument.

However, my advice as written above stands.
If you trust your doc, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
If you do not trust your doc, get a doc you do trust, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
In either case, if you decide to take a lesser amount than the dose recommended in the FDA's prescribing label, make sure your doc is totally aware of what you have decided to do. Do not blindside him/her. It is not in your best interest.

Your colonoscopy should have been performed VERY soon after the first time you noticed rectal bleeding.
[And if the blood was blackish = melena (VS maroon/red), an upper endoscopy should have been performed as well to R/O an upper GI source of bleeding.]

Drug companies have NEVER EVER wagged my tail.
And I hope that is the case with your internist or cardiologist as well.

[ZeroTolerance]

Ex.. I respect your opinion the same way I respect my doctor's opinion.

And yes, I've been told that I will need to have another colonoscopy.

But I think for all of your knowledge of these medicines, you miss my point in that I don't bleed at all unless I take this ridiculous dose of this stuff.

Then there's this little issue of the quality of life.

And the patient should always be a good little boy and have blind faith in the medical profession, even though it would seem that the drug companies often wag the tail on the dog.

My feeling is I'll take that chance and continue to do what my body tells me.
And not just go along with conventional thinking unless I start bleeding on my own terms.
It should be my decision, not theirs.

Absolutely your decision.
Your body.
Your health.
Your decision.
No argument.

However, my advice as written above stands.
If you trust your doc, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
If you do not trust your doc, get a doc you do trust, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
In either case, if you decide to take a lesser amount than the dose recommended in the FDA's prescribing label, make sure your doc is totally aware of what you have decided to do. Do not blindside him/her. It is not in your best interest.

Your colonoscopy should have been performed VERY soon after the first time you noticed rectal bleeding.
[And if the blood was blackish = melena (VS maroon/red), an upper endoscopy should have been performed as well to R/O an upper GI source of bleeding.]

Drug companies have NEVER EVER wagged my tail.
And I hope that is the case with your internist or cardiologist as well.

I appreciate your concern.... when I bleed it is bright red = melena as you called it...

I have been taking the prescribed dose for the last few days after talking to my trusted Cardiologist on Thursday. He had me stop taking a prescribed baby aspirin that I had also been taking right along......that could have thinned the blood enough to cause some of this?.... So i'll see how that goes?

I think my theory is getting through to them at least a little bit?

Again Ex...thanks for your concern!

[Smitty731]

Smitty, are their standard clauses in NBA contracts which allow a team to offer a settlement of some kind & dissolve a contract if the team & its physicians believe that it is medically dangerous for a player to continue to play? Also, do you have any thoughts about the waiver question I posed in #2 above?

There isn't anything necessarily standard. There are procedures putlined in the CBA that outline being examined and signed off by independent doctors as to the relative health of a player.

It would ultimately land in some form of arbitration of Bosh and his doctors say he can play and the Heat and their doctors say he can't. The league and NBPA would pick an independent doctor and arbitrator and go from there. The entire thing would get very, very ugly if it got that far.

As the waiver question, I really have no idea. I'll ask around and see if I can dig something up on that.

[exculpatory]

Ex.. I respect your opinion the same way I respect my doctor's opinion.

And yes, I've been told that I will need to have another colonoscopy.

But I think for all of your knowledge of these medicines, you miss my point in that I don't bleed at all unless I take this ridiculous dose of this stuff.

Then there's this little issue of the quality of life.

And the patient should always be a good little boy and have blind faith in the medical profession, even though it would seem that the drug companies often wag the tail on the dog.

My feeling is I'll take that chance and continue to do what my body tells me.
And not just go along with conventional thinking unless I start bleeding on my own terms.
It should be my decision, not theirs.

Absolutely your decision.
Your body.
Your health.
Your decision.
No argument.

However, my advice as written above stands.
If you trust your doc, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
If you do not trust your doc, get a doc you do trust, discuss this bleeding issue in detail, get his/her advice, & then make your decision.
In either case, if you decide to take a lesser amount than the dose recommended in the FDA's prescribing label, make sure your doc is totally aware of what you have decided to do. Do not blindside him/her. It is not in your best interest.

Your colonoscopy should have been performed VERY soon after the first time you noticed rectal bleeding.
[And if the blood was blackish = melena (VS maroon/red), an upper endoscopy should have been performed as well to R/O an upper GI source of bleeding.]

Drug companies have NEVER EVER wagged my tail.
And I hope that is the case with your internist or cardiologist as well.

I appreciate your concern.... when I bleed it is bright red = HEMATOCHEZIA as you called it...

I have been taking the prescribed dose for the last few days after talking to my trusted Cardiologist on Thursday. He had me stop taking a prescribed baby aspirin that I had also been taking right along......that could have thinned the blood enough to cause some of this?.... So i'll see how that goes?

I think my theory is getting through to them at least a little bit?

Again Ex...thanks for your concern!

Bright red = hematochezia = Colonoscopy.
Black & tarry = melena = Upper Endoscopy

The combination of the ASA inhibiting platelets & the Eliquis inhibiting Factor Xa in the clotting factor cascade = 2 entirely different mechanisms of ANTICOAGULATION or what lay people call "blood thinning".

Perhaps Eliquis in the proper amount WITHOUT the ASA will not cause the rectal bleeding!
Time will tell!
Good luck!

PS You still need the colonoscopy!

[exculpatory]

Smitty, are their standard clauses in NBA contracts which allow a team to offer a settlement of some kind & dissolve a contract if the team & its physicians believe that it is medically dangerous for a player to continue to play? Also, do you have any thoughts about the waiver question I posed in #2 above?

There isn't anything necessarily standard.
There are procedures outlined in the CBA that outline being examined and signed off by independent doctors as to the relative health of a player.

It would ultimately land in some form of arbitration if Bosh and his doctors say he can play and the Heat and their doctors say he can't. The league and NBPA would pick an independent doctor and arbitrator and go from there. The entire thing would get very, very ugly if it got that far.

As to the waiver question, I really have no idea. I'll ask around and see if I can dig something up on that.

Thanks!