Training with a DVT

[DavidA]

I very reluctantly make this post. I recovered from a DVT in 2011/12. Was on Coumadin for almost a yr, discontinuing it mid-2012. No reason for my DVT. Blood chemistry all checked out. Now, here I am in June, 2014 with another DVT in my other leg this time. However, it is much more onerous. Last time, after a couple of weeks there were few signs of the DVT and I was already starting to exercise. This time, the clots are more extensive. They exist from ankle to groin with a great deal of thigh pain. In fact for a few days I had to have morphine and valium to stand the pain. The docs have me on Xarelto, the new anti-coagulant med, to prevent more clotting and hopefully dissolve at least some of the clotting. The pain continues in the thigh some 23 days later. I get by with Ultram for the most part. I suspect that I will be taking Xarelto the rest of my life.

I do this post partly because DVT's are not exactly like an injury. Injuries can be prevented - DVT's for the most part cannot. A DVT is a silent condition that sneaks up on one in the night and slams you in the back of the head. If you have ever had a DVT, your chances of having another are quite high. Secondly, I just hate all of this. I'm potentially a pretty decent rower, but I can't avoid medical issues. I've constantly been starting over from issues like back problems, a hip replacement, statin drug reactions, and now two DVT's. Be thankful if you are getting older, whatever that means, and have managed to avoid these kinds of issues. I'm not giving up. I'll be on the exercise bike soon.

I'm very sorry to hear that you have had a recurrence.
Since you joined the forum I have seen how very good you are on the erg.
I don't see why being on a blood thinner should really effect your performance, once the current clot(s) and pain are gone.
I am no where near as good as you on the erg, but I have a similar DVT history My first one was ankle to groin, and I also the last type of person that anyone, physicians included, thought would get a DVT. They ran every test in the book (the lab had even heard of many of them, and had to look them up, since they are so uncommon.) Everything came back negative. After staying on coumadin for 6 months to a year (I forget already how long it was.) I stopped. A year later - another DVT. My physician (a venous specialist) said two strikes, and your out - coumadin for life, but because of exercise routine/weight/etc. and begging , I got him to let me have one more chance. After another similar length of time on coumadin, I stopped. I started to train for a 15 km run some friends wanted me to do with them, and I strained my ankle, and had to wear a boot. A week later a got a DVT in that leg - coumadin for life
I have not had to change my erging at all (except when I had the clots.)
I hope you are doing well soon, and I hope to see you still excelling at erging.

David

[Cyclingman1]

Well, seeing someone with three DVT episodes makes me feel a little better - there is hope. I will not be trying to talk the hematologist out of staying on Xarelto, however. I agree that blood thinners, per se, do not cause lower performance. My lesser performance is more a result of my many medical issues that have interrupted training for months at a time, of which this DVT episode is merely the latest. I think it will take quite a while to overcome this one. I am using an exercise bike with variable resistance because it is the easiest aerobic piece of equipment that I have and there is limited compression of the veins around the knee. Just doing easy spinning. And I'm doing some light weightlifting. Although there is an element of complaining in these posts, they are intended to be informational. Until age 65, I had done well in athletic endeavors for 50+ yrs, then things started to go wrong. Stuff happens.

I hope you are doing well soon, and I hope to see you still excelling at erging.

Thanks, Jim G

[SlickC2]

Back on the erg after a bout of prolong cold/cough and travelling. I'm dragging this topic out again as I've just come across an article that suggests strenous exercise may cause DVT in a minority:

Upper-extremity deep vein thrombosis (UEDVT)

Primary UEDVT is a rare disorder (2 per 100 000 persons per
year)4 that refers either to effort thrombosis (the so-called
Paget-Schroetter Syndrome) or idiopathic UEDVT. Patients
with Paget-Schroetter Syndrome develop spontaneous
UEDVT, usually in their dominant arm, after strenuous
activity such as rowing, wrestling, weight lifting, or baseball
pitching, but are otherwise young and healthy. The heavy
exertion causes microtrauma to the vessel intima and leads to
activation of the coagulation cascade. Significant thrombosis
may occur with repeated insults to the vein wall, especially if
mechanical compression of the vessel is also present.

Full article available at: http://circ.ahajournals.org/content/106/14/1874.extract

Rowing is mentioned and from my experience I know I can quickly get up to my max HR and beyond so I'm now going to take it easy and just row at AT at most for extended periods. I suspect it will be ok to work at TR and AN for very limited periods rather than the gut-busting long rows to best a 2K time. I'm just in this for improving my fitness and would like to enjoy better health! I know it is a rare problem but a bit scary to think that it could occur to someone who is actively exercising.

Cheers

[Cyclingman1]

I don't know about this dread of a possibility of a medical condition impacting what you do, especially something so nebulous as a DVT. Serious, hard exercise can result in any manner of medical situations, even non-contact activities. Rowers, for example, do have a tendency to hurt their backs. That really is something that one has to guard against by ensuring good form. I don't see not rowing hard because of the possibility of a DVT, especially for someone who has never had even one. Me, with two, maybe I should be leery. However, taking Xarelto and seeing no hint of circulatory problems I don't plan on backing off. If someone is genetically predisposed to a medical condition, then I would be concerned. One could have blood factors that are worrisome. It takes special testing to determine that. I doubt if anyone gets those tests beforehand.

[Robert Wildes]

Thanks for the post SlickC2.

I recall answering all the questions from the ER Doctor and seeing a puzzled look on his face when I did not fit into any of the neat little categories of being a candidate for a DVT. The Doctor
left and the next few minutes I was being treated by a nurse. She told me about an extremely fit coach at Georgia Southern, I think, that she had treated. I guess that her point was that
I was not that special.

[dustin]

For clarification, effort thrombosis or Paget-Schroetter Syndrome is not truly what you are thinking it is - while yes, these individuals are usually young and healthy (i.e. athletes) the etiology behind this syndrome is extrinsic compression of the subclavian vein by what is known as the thoracic outlet. This outlet is made up of bones (1st rib and clavicle) as well as muscle. An artery, vein and nerve pass through a very small window. The way I describe it to patients is that this is normal anatomy behaving abnormally. There is usually some degree of overhead arm motion (swimmers, pitchers) that may lead to muscular hypertrophy. So yes, while these patients do develop clot, there is a distinct reason for it. Treatment is usually aggressive - blood thinners (even lytic therapy which is medicine used in the vein that is dripped over 24-48 hours to break up acute clot) and then 1st rib resection.

dustin

[Cyclingman1]

The effort thrombosis that dustin refers to is way different than what those of us posting in this thread have experienced. I wish a cause could have been or could be determined for my DVTs. But, alas, none has been found by my docs - all well regarded hematologists, pulmonologists, vascular docs, etc. Dehydration was perhaps a factor the first time around. I do tend to have cold hands and feet which perhaps is indicative of circulatory issues.

I wonder if those with effort thrombosis have warning signs? I'm thinking, yes. There are no warnings for DVTs. All of a sudden one gets inexplicable swelling. In my case in the calves, although the clots were from knee to groin.

[dustin]

Cyclingman1,

I am sorry to hear about your DVTs - you sound frustrated and for good reason.

Unfortunately, those with effort thrombosis generally don't have warning signs. They often present to the ED emergently with a swollen and often blue arm. I just wanted to clarify what this condition was because like you said, it is a very specific reason that one develops clot and it is not the norm. I just didn't want people thinking that they were prone to develop upper extremity clot due to rowing, etc.

Which leg of yours is affected? I ask that because you alluded to it being your left in an earlier post right? Has anyone discussed the possibility of May-Thurner disease with you? If not, it warrants investigation in my mind. When I see a patient in the office with a unilateral left leg DVT with no other etiologic factor, I find it important to rule this cause out. This condition is extrinsic compression of the left iliac vein by the right iliac artery. Again, normal anatomy behaving abnormally. Sounds like you have had a pretty extensive workup though so I assume that this has already been entertained.

Regards,

Dustin

[Cyclingman1]

Dustin, latest DVT in May, 2014 was in right leg. Aug, 2011 was in left leg. Yes, there is plenty of frustration for several reasons. In the first case a vascular doc actually sent me home after an office visit with obvious DVT symptoms. I returned a couple of days later for a venous Doppler. Within a min I was on the way to the ER where I was admitted for DVT and PE. The second time around, the ER sent me home with directions to administer shots in the abdomen. I had to return a few days later with excruciating pain in my right knee. I was admitted and put on morphine for a few days and started Xarelto, which I will always be on. The ER's handling of me was completely inadequate. The second case was way more painful than the first and it took me months to recover.

Yes, I'm p**sed and frustrated. The medical people could have been far more proactive in my cases. Had I been a professional athlete, super star, I would have been covered up with docs, etc. Perhaps an attempt could have been made to dissolve the clots. Most people do not understand that no attempt is made to remove DVT clots. Xarelto and Coumadin only prevent future clots. If one is lucky, the clots will somewhat dissipate on their own.

I'm not exactly overjoyed that several medical situations have set me back in rowing. At one point about three yrs ago, I was doing well. Since then, I've been trying to catch up. It's just not going to happen. On the other hand, being nearly 69, I actually am thankful that I am where I am. Injuries and medical situations are part of getting old. Some are way worse off than am I. I could have died from my DVTs. I hope that I get no more of those.

Thanks for the technical insight into DVT's. It might turn on a light for someone.

[chayes56]

I am very happy to have found this thread - though it's been going for years - I hope people are still reading.

I have similar experiences to many prior correspondents. I'm now 58 years old, been sculling for years - with periods of heavy erging. Noticed unusual pain behind the knee and calf a few years ago. Ultrasound revealed a clot from ankle to groin. But the pain felt familiar from over the years. I think it's been growing for a long time. I don't think you get a clot like that overnight. Next year, another big one in the other leg. Went to a vascular surgeon ... "nothing we can do ... can't clean out those ankle veins and the rest will go away". I complained about chest pains (my heart is certified fine) and got the Naval Reserve salute (shrug). Circled around on the same day to the other side of the hospital from these monkeys office and went into the ER. Got scanned and one of those very same Vascular Surgeons came in after looking at the images - said my lungs were 1/3 clogged up with clots ... I should be more ... "Dead?" I asked. "Well, yeah, sort of". So even these guys seem to think that PE means dead - but I remember the feeling of the little biting pains in my upper lungs for years, even though I felt like I had great lung capacity. Seems you can be sort of sprinkling in those little bitty pieces of clots that travel all the way out to the edge of your lungs before stopping. Supposed to go away after awhile - but if they're still accumulating ... heck, what to do? ... stay on blood thinners for life? I guess so

Most doctors (all that I've talked to - two GPs, two Hematologists, three vascular surgeons) know nothing about the connection between athletics and DVT. All asked the standard questions "Lots of flying? .... injury? ... surgery?" no, no, no. So nobody has had a clue as to why.

But it seems there's plenty of evidence that rowing ... and cycling and apparently running downhill ... that cause this little micro muscle fiber damage in the lower legs ... can cause DVTs ... but mostly if you stay still for the day after the workout and especially of you don't get plenty of water during that period.

So I'm one of those guys who doesn't drink water unless I specifically feel thirsty. I always thought running around with a water bottle was for wimps (still do). But it seems that getting more water over the day after the work - from right after through the next day I guess - is important. And not staying still ... like going to an office job in a cold cubicle and sitting still in front of a computer all day (taking meetings on WebEx! so not even walking to a conference room).

There's an article from the American Medical Association - a research study done five years ago - that goes into all the chemistry and biology of why athletes get clots after a race - especially when they then get on a bus or plane and stay still for a while afterwards. I'll see if I can find the link and post it later.


Guess who works out hard and then goes to sit in an office all day the next day? .... tens of thousands of masters rowers - that's who! Anybody have any data on masters rowers and DVTs? Someone should look into it.

So the way I see it, many people (and some in this thread) have missed the point that their rowing is the cause of their DVTs as well as their salvation - as long as we learn to hydrate and wiggle our ankles around a bit the next day.

Chris Hayes - DVT sufferer ... but Filippi owner

[chayes56]

Here's the article.

I think many rowers with DVT experience will find it very interesting and suggest the idea, as it did to me, that rowing is actually the cause of my DVT as well as the salvation. Since I have good lung capacity from rowing, and because continued rowing should work the problem out through absorption by the body of at least some of the clot material and the emboli in the lungs. but only if I am careful not be sedentary the day after the workouts and drink extra water during that period (whether I feel like it or not). I now have a little foot rest under my desk at work from a company called Fellowes that makes a variety of things for rotating the ankle while sitting at a desk.

"Deep Vein Thrombosis in Athletes: Risks of Racing and Resting"
JOURNAL OF THE AMERICAN MEDICAL ATHLETIC ASSOCIATION
Volume 23, Number 1
Winter 2010

http://www.amaasportsmed.org/Assets/Ame ... ournal.pdf

I think that rowing coaches everywhere should get the word out. It would seem to potentially affect the young, the young-ish and the old and old-ish.

By the way, the docs that did this study way back are still at it and may be doing a follow-up study. I actually wrote to the lead Doc and described my case, suggesting that she include masters rowers in future study, to which she agreed.



Chris Hayes
Cary, NC

[Cyclingman1]

What caught my attention in the article is the frequency of misdiagnosis of DVT and the sheer ineptitude of doctors. In my first DVT a well-known vascular surgeon in ATL sent me home from his office saying I had no serious issue, even though my leg was the size of a watermelon. Next day I went back and insisted on an ultrasound. One min later I was on the way to ER with DVT and PE. He never admitted to being full of crap. The next DVT I had, I was jerked around in the ER for four visits before I was finally admitted with excruciating thigh pain. I could write a book on the actions of those set of goofballs. I wrote a letter to the hospital administrator, who insisted they gave me the best possible treatment along with a deal for swamp land in FL. What gets me is that the docs are totally unwilling to undertake clot dispersing actions. Clots can and do leave permanent damage. All one gets is meds that supposedly prevent future clots and the hope that the body will absorb the current clot. I too suspect that these two major episodes are only half the story of my clotting issues and PE's. I had some symptoms before my first DVT that felt like someone had a vice around my lungs. Even then, long ago, I was sent home from another ER with a pat on my hand. If I come across as ungrateful and pissed over my DVT episodes, I am. For me, I'm sure cycling was my problem. I never put in the meters on a rower. I used to have extensive dehydration after 50-60 miles bike rides in Atlanta. I'm actually on a long break from posting in C2 forums, but this topic just gets me going.

[gregsmith01748]

Jim, It sure sounds like your experience with the medical establishment was pretty lousy.

I haven't had nearly the same level of horror story, but I've notice a real lack of awareness how the health needs of someone who does vigorous exercise is very different from typical sedentary health care consumers. I've been thinking of looking around for a primary care physician who is also a runner, cyclist, rower or nordic skiier, just so they would understand me when I ask them about this kind of stuff. Right now I get blank stares.

Chris and John: If you don't mind a question...Why don't standard clot buster drugs work for acute DVT symptoms?

Chris: Thanks for posting the article. I shudder to think of the number of times I have gone from an intense workout straight to the airport to sit on a plane for 6 hours or longer. I have to figure out how to modify my training to reduce these risky combinations. It's freaking me out a little.

[Cyclingman1]

The use of clot busting drugs comes with increased risk. Unless a filter is put in the main vessel(s) leading to heart and lungs, there is a chance that parts of the clot can break off and travel to heart, lungs, and/or brain. Also, these drugs have to be administered soon after the clot forms, which is another reason that misdiagnosis is unacceptable. BTW, stroke patients are almost always given clot busting drugs to limit brain damage. Also, the entire procedure of injecting the clot busting drug is several times more expensive than simply giving a patient anti-coagulants by mouth. Which one do you think insurance companies will approve? To hell with a complete solution to the problem.

As far as worrying about getting clots, it really is pretty rare among athletes. Old sedentary people get clots for the most part or those who have undergone surgery. I don't believe that any PCP would know hardly anything about DVT's or other obscure health issues that pertain to fitness. Do you think that Greg Lemond's PCP would have known about his mitochondrial myopathy? It really is hard in this country to get to the right person to understand one's condition. One can go through endless shopping among specialists until one of them sees the light. Of course, if one is in a large college or professional program, there is a far greater chance that many eyes can be directed to a problem. But a weekend athlete has no such access.

[sharp_rower]

(My PCP recently read "The Boys in the Boat" in his book club. Not bad.)