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Endurance athletes and blood clots
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 2009-07-07 7:06 PM |
 Subject: Endurance athletes and blood clotsThis is an e-mail I sent out to my tri club. Having some extra time on my hands has allowed me to do some research on this issue which frankly, I was ignorant of. No idea if they'll publish it to the club, but thought it might be of interest. I invite true medical professionals to identify or correct any misstatements, or add any additional info. First, I am not a physician, nor able to offer medical advice. However, I hope the LATC mods see fit to allow this e-mail through, as I think every AG triathlete (and pro) should be aware of the issue (I admit previous ignorance). I do not think, in 5 years of tris, from sprint to Ironman, that I have ever heard about it in an LATC e-mail, or read about it in Competitor or Triathlete (not that I've read every word, nor to fault any source for not mentioning it). Second, this is not written to scare, but hopefully to educate. There are things you can do to lower the risks. I encourage people to read the attached links and do your own research and follow the advice. This is the time of year people start flying to Lake Placid, Madison, Penticton, etc., and spend 10 to 17 hours hammering ourselves, pushing our bodies further than we thought possible, dehydrating our systems, and suffering through injuries, so we can hear Mike Reilly's voice at the finish (and I get that, really). After the race, we wrap ourselves in space blankets, lie down in the grass, maybe get a massage, drink a beer, but in general stop moving as soon as we can, and crawl into our beds. The next day, we spend several hours stuffed in planes or cars coming home. Then we go back to work and sit idly at our desks for several hours writing race reports. As triathletes we often consider ourselves healthier and fitter than the average person in the next cubicle over. And that's true. And good. But it's not necessarily always a good thing, it turns out. I had heard of DVT (deep vein thrombosis, or blood clots in deep veins, usually in the legs), and frankly outside of scuba had never heard of PE, or pulmonary embolism (PEs usually occur when a DVT breaks free, travels through the heart, and lodges in the lungs, although there are other less common causes). I always assumed DVTs were suffered by overweight and out of shape scotch drinking business flyers. Or, more publicly, David Bloom, a war correspondent who spent hours a day in a cramped Humvee in Iraq (turns out it was the PE that killed him). I certainly didn't think these were things that we triathletes needed to worry about. Hell, I've done an IM and a bunch of HIMs, lead an active life, young, relatively healthy, no way this happens to me. That is, until I was diagnosed last week with multiple bilateral PEs. My symptoms started several weeks ago with a shortness of breath, starting on exercise but soon while at rest as well. Just in general I felt sorely out of shape. I had gone from completing IMAZ last November to utterly out of shape, suffering through WF long course in May. Weeks of CBCs, x rays, EKGs, CT scans, pulse ox tests, spirometer tests, showed that my heart was strong and my lungs were functioning properly, leading to misdiagnoses of bronchitis, walking pneumonia, pleurisy, exercise induced asthma and post viral bronchospasms. It wasn't until last Wednesday (ironically, the day I got my CBC panel showing me to be in "perfect health" and a pulmonologist giving me an inhaler and telling me that the pain in my side on breathing was probably a pulled muscle from coughing) when I drove myself to the ER in excruciating pain on breathing, that a lung CT was finally done, showing the emboli. Upon which I was promptly admitted to the hospital, where I spent the next four days, suffering further indignities such as peeing in a bottle and wearing one of those gowns. But I could have buck naked for all I cared at that point. One of the articles linked states that you will find "the zenith of your pain threshold" with a PE. I can attest. Vicodin could not touch it. It was not until I got IV drugs, which made the TV run down the wall, that I could finally breathe without pain. Thankfully, it wasn't until a few days later that I learned how dangerous PEs are, and that most are not diagnosed until the autopsy. Sobering. Where did mine come from? We don't know yet. Perhaps a DVT following Wildflower long course and then the 5 hour drive home? Perhaps genetics? Perhaps some other cause? Yet to be learned. I have been put on blood thinners, which means, if I am smart (and my wife locks up the bikes), I am off the bike for the next 6 months or so. Since my blood will clot very slowly on the thinners, falling and hitting my head would be a "not good thing." I have gone from IMAZ and Wildflower to brisk walks on the Esplanade as my main source of exercise. Some info (as read from the literature): one study says 85% of DVT cases involve endurance athletes - marathoners, triathletes, runners, etc. Because you are young, healthy and active, DVTs and PEs are often misdiagnosed (like mine was), up to 70% misdiagnosis 30% or so of first presentation PE are fatal Most case of PE are diagnosed on autopsy Are endurance athletes more prone to clots? I haven't seen anything saying yes. But there seems to be some connection between the two. Or perhaps a connection between the way we "recover" which raises the risk factors What can you do. Read the attached articles (sorry they seem to be poorly titled), but primarily it appears that staying well hydrated, taking frequent breaks if driving or standing up every few minutes if flying, cooling down properly, and perhaps even compression stockings when traveling, help to prevent them. Listen to your body, and watch for signs. Press your doctor, make sure they look at all the angles. Some links to look at http://www.stevelehmantours.com/html/tips.html Edited by ChrisM 2009-07-07 7:11 PM |
| 2009-07-07 7:55 PM in reply to: #2268705 |
Master  1790     Tyler, TX | Subject: RE: Endurance athletes and blood clots Chris, thank you for the great info. It's something we all need to be aware of, particularly if air travel is involved (though I gather that wasn't a factor in your case). I hope you're feeling better now. |
| 2009-07-10 10:37 AM in reply to: #2268705 |
| Subject: RE: Endurance athletes and blood clots Just bumping this to say that I am very surprised, i sent this as an e-mail to my tri club. I would think that this is an issue that athletes, and the tri club, would want to know about and take steps to lower the risk factors we have from racing. They screen all the emails, but this one never came through. I guess if I was shilling for a sponsor it would be allowed. LA Tri is a joke for such a large tri club Edited by ChrisM 2009-07-10 10:37 AM |
| 2009-07-21 12:14 PM in reply to: #2268705 |
| Veteran 167 | Subject: RE: Endurance athletes and blood clots super helpful - thanks. I hope you recover fast! |
| 2009-07-21 3:27 PM in reply to: #2298960 |
Master 1420 Victoria, BC | Subject: RE: Endurance athletes and blood clots Great article - thanks for posting it. |
| 2009-07-21 3:32 PM in reply to: #2268705 |
Master 2010 Falls Church, VA | Subject: RE: Endurance athletes and blood clots Thanks for the info. i had no idea. |
| 2009-07-22 1:12 PM in reply to: #2268705 |
| Subject: RE: Endurance athletes and blood clots I hope no one ever has to use the info. To clarify a post above, LA Tri did publish it, the mistake was mine in sending from a different address so it never went through so sorry, LA Tri  |
| 2014-06-23 10:40 AM in reply to: ChrisM |
Expert 1202 Montana | Subject: RE: Endurance athletes and blood clots Years later, this article is very valuable to me. Thank you so much for posting it. |
| 2014-06-24 4:46 PM in reply to: Shoeless |
| Subject: RE: Endurance athletes and blood clots Hopefully not with a personal experience... As a long overdue update, I did my 6 month stint on thinners, then three months later clotted again with more PEs. So now I am a lifer since March 2010. Since that time I've done a 10K swim, five half ironmans (with another in October), Escape from Alcatraz and Ironman Canada. So really, other than being a little more careful, life is not much different. |
| 2014-06-25 10:03 AM in reply to: 0 |
Extreme Veteran 475 Traverse City, MI | Subject: RE: Endurance athletes and blood clots A friend and fellow training partner for IM Chatt was diagnosed with DVT a few weeks ago. She had been having some pretty severe knee pain and had been getting cortisone injections and doing pt, because, of course she was over doing it with training. At the pool one day she began having lower leg swelling. Other teammates (one a PA and the other a PT) looked at her. Her leg was hot to the touch and they told her to get to the ER. Now she's on blood thinners and awaiting a follow up ultrasound. She got lucky. I work in healthcare and have read articles relating to this. I wear compression socks when traveling long distances because of this. Edited by emferg 2014-06-25 10:05 AM |
| 2014-08-07 1:25 AM in reply to: ChrisM |
| 16 | Subject: RE: Endurance athletes and blood clots I was first diagnosed with DVT over 14 years ago. I had no idea what PE was and how fatal it can be. The first time it happened, my left leg was swollen almost 3 times its normal size. During my stay in the hospital, I was informed that had the clot dislodged and went to my lungs...I would've been dead...the nurse said: "You are lucky". The second time, my left shoulder was so swollen...there was no hesitation...it was straight to the emergency room. Another clot was discovered. I have been on Coumadin (blood thinners) ever since. I was told to stop any "contact" sports because I will bleed easily. Worse, if it's internal bleeding, I could just die. I have been running since the early 70's (even owned one of the original Nike Waffles) and in relatively great shape. I ran a 1:45 half marathon last year in the 55-60 age group. Perhaps it's my competitive nature, (more likely stupidity), but I started doing triathlons only 2 years ago. Absolutely love it. I would also like to know what causes DVT and how to prevent it. Regrettably, no one really knows. All I know is I will be on Coumadin for the rest of my life. I'm sure there are physician/triathletes out there that can perhaps shed a little light on this subject. Note: I am currently nursing a badly sprained left calf. I felt it snapped during my run last week. RICE: Rest, Ice, Compression, Elevate...is what I've been doing the past week. Being on Coumadin, my calf was bruised (black and blue) more than the average runner. Here's the crazy part...before triathlons, I would've been depressed not being able to run. Now, I can still swim even with a sprained calf. I can also still ride my bike using a compression sleeve around my calf. You will never hear me complain...life is good. |
| 2014-08-07 7:42 AM in reply to: ChrisM |
Extreme Veteran 909 Westchester, NY | Subject: RE: Endurance athletes and blood clots After my PE in late April this year, everyone was saying that the DVT was an "endurance sports" thing. Of course I dove into everything related to PE. I even conversed with ChrisM a bit. Since I am a , I went biking a few times in June and crashed pretty bad in July. I was in the hospital an extra 3 days trying to get my INR back up. Also, my hematologist gave me the go ahead to go off Coumadin and go on a low dose aspirin. This is still a grey area for me and will continue to have my blood monitored. There is also an article in the September 2014 Men's Health magazine (Christian Ronaldo is on the cover) that has the race car driver Brian Vickers story of his DVT - he drives the Xarelto car. Also take a look at all the blood thinner drugs available. Xarelto, eliquis, pradaxa are different from Coumadin or warfarin. |
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