DVT, PE and blood thinners.

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Sparx
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Re: DVT, PE and blood thinners.

Postby Sparx » Fri Jun 30, 2017 9:19 am

There's plenty of anecdotal evidence on the net about athletes and DVT, with theories from dehydration, sitting around lots after exercising, to a low resting HR causing blood to pool. And certainly it does not seem uncommon amongst endurance athletes in particular. But this anecdotal evidence does not really seem to be given much credence by the medical professionals I have seen as there have been no widely quoted studies.

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CKinnard
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Re: DVT, PE and blood thinners.

Postby CKinnard » Fri Jun 30, 2017 2:19 pm

Sparx wrote:There's plenty of anecdotal evidence on the net about athletes and DVT, with theories from dehydration, sitting around lots after exercising, to a low resting HR causing blood to pool. And certainly it does not seem uncommon amongst endurance athletes in particular. But this anecdotal evidence does not really seem to be given much credence by the medical professionals I have seen as there have been no widely quoted studies.


dehydration? yes possibly. If blood volume is low, the vasa vasorum (vessels that supply vein and artery walls with O2 and nutrients) will not be perfused as richly.

sitting around a lot after exercising? hmmm. I don't buy that. blood flow is determined very much by metabolic need for more O2 and nutrient....and waste removal. These things dilate vessels accordingly.

a low resting HR? I totally don't buy that. Athletes who have low HRs compensate with higher stroke volume, ergo their cardiac output is just as high if not higher, as a sedentary person of equal bodyweight and lean tissue.

It is more likely that lots of higher intensity exercise causes higher sustained cardiac output. This will mean the veins have to carry a higher volume of blood back to the heart...and may spend more time stretched by that higher volume. Venous pressure may also be elevated for longer. If one has a crap diet and poor sleep, their veins may not endure that additional mechanical stress as well and begin to stretch. Further riding in a TT position is likely to impede venous return in the iliac veins due to mild kinking. This will increase vein pressure distally in the lower limbs.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Fri Jun 30, 2017 8:00 pm

Sparx wrote:There's plenty of anecdotal evidence on the net about athletes and DVT, with theories from dehydration, sitting around lots after exercising, to a low resting HR causing blood to pool. And certainly it does not seem uncommon amongst endurance athletes in particular. But this anecdotal evidence does not really seem to be given much credence by the medical professionals I have seen as there have been no widely quoted studies.


I'm with the top DVT specialist in the country. I am the only one out of 10,000 something patients to have a clot like this.
As a result, he has no evidence for cause and is therefore playing it safe.
I've read quite a few cases of cyclists and endurance athletes getting clots, many of them after travelling long distance after an event.
In contrast, i got my DVT a couple of days after i pulled a muscle during my warmup on the trainer, although they found no evidence of a muscle strain on the MRI 6 days after the event. Maybe the muscle strain was enough to tip me over the edge, I don't know. As there was nothing on the scan due to the delays getting the MRI, it's like it didn't happen.

Anyway, my leg feels fine so I just have to convince the doctor to let me resume riding, and see how closely he wants to monitor me. He's already said he'll be doing follow up on me for life.
'11 Lynskey Cooper CX, '00 Hillbrick Steel Racing (Total Rebuild '10), '15 Cervelo S5

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Thu Oct 05, 2017 10:56 pm

So, I had my 6 month post-DVT checkup today.
My aneurysm in the EIV has significantly reduced in size (5cm down to 3cm), and the clot in my common femoral vein has reduced.
I still have near occlusive clot in the EIV, and this may never resolve. I have collateral veins assisting with the venous return, so my leg is mostly ok. My left leg is larger than my right leg by about 4 to 5cm, and this is unlikely to change. Apparently that is related to Post Thrombotic Syndrome.
I have no sign of clot below the knee, so that was completely resolved.

The doctor is keeping me off the bike another 3 months to see if the size of the aneurysm comes down any further, so that will be 9 months off the bike by the time I see him in January. His reasoning is that should I resume cycling and then have another DVT, he will blame the cycling and then that will be it for riding for life. So, he wants to see my condition stabilise before there is any resumption of riding. My feeling is I’ll be off the bike for at least 12 months, maybe longer, as the anti-coagulation treatment just takes time.

In the meantime, I made a decision to give up racing, and sold my race bike & wheels. On the flip side, I am organising a new frameset for doing some adventure riding, with the hope that I’ll actually get to ride it at some stage.

As far as other options are concerned, there is no need for any further intervention at this time, as the anti-coagulation appears to working. I’ll never be back to my pre-DVT condition, so I will just have to adjust and ride to whatever my new limits will be.
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Sparx
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Re: DVT, PE and blood thinners.

Postby Sparx » Fri Oct 06, 2017 7:39 am

Hells bells, sounds like I got off pretty scott free compared with you. Sounds like a long term recovery but I am sure you will eventually get back to riding, hopefully at the same level. I really feel for you, it's not a pleasant experience.

Incidentally - I finished my HR double. It was brutal...but amazing also.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Sat Oct 07, 2017 12:04 am

Sparx wrote:Hells bells, sounds like I got off pretty scott free compared with you. Sounds like a long term recovery but I am sure you will eventually get back to riding, hopefully at the same level. I really feel for you, it's not a pleasant experience.

Incidentally - I finished my HR double. It was brutal...but amazing also.


Well done on the HR Double. I was following along the whole time. Even though I didn’t get to ride it, I just got given all my events kits this week. Not so sure about wearing them given I didn’t get to ride any of the climbs, so they might be saved until I actually get to go.

I don’t do anything by halves, so naturally my DVT had to be of a type that no medical professional in Australia has ever seen before, with no known cause (hence, doctor blames cycling, as it’s the only thing I do that a “normal person” with DVT doesn’t do). There is no way of knowing my pre-DVT state, so maybe I always had an enlarged vein. The doctor has zero evidence on which to base a diagnosis, so it puts me in the odd position of having to go and get another DVT without cycling in order to demonstrate it’s not cycling that caused it. Of course, I don’t want another DVT, nor do I want to sit around waiting to get another one without riding.

Anyway, at the very least I am getting an extended rest after 9 years of solid riding, and I am being as positive as I can about it. Hopefully I do recover. The hunan body is pretty amazing, and I was very surprised that the aneurysm shrunk by 40% over the last 3 months. It’s still almost totally clotted, but collaterals are bypassing that, and my leg is mostly ok other than being bigger than my right leg.
So, I’ll see how it goes in January, and my with my new frameset coming around February, I’ll have a project to work on, and will hopefully start to ease back into riding.
Hopefully being on the anti-coagulation long term will minimise the chances of a recurrence, and I’ll be able to get a relatively normal life going again, with a HR attempt somewhere in my future.
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Re: DVT, PE and blood thinners.

Postby g-boaf » Tue Oct 10, 2017 9:28 pm

queequeg wrote:So, I had my 6 month post-DVT checkup today.
My aneurysm in the EIV has significantly reduced in size (5cm down to 3cm), and the clot in my common femoral vein has reduced.
I still have near occlusive clot in the EIV, and this may never resolve. I have collateral veins assisting with the venous return, so my leg is mostly ok. My left leg is larger than my right leg by about 4 to 5cm, and this is unlikely to change. Apparently that is related to Post Thrombotic Syndrome.
I have no sign of clot below the knee, so that was completely resolved.

The doctor is keeping me off the bike another 3 months to see if the size of the aneurysm comes down any further, so that will be 9 months off the bike by the time I see him in January. His reasoning is that should I resume cycling and then have another DVT, he will blame the cycling and then that will be it for riding for life. So, he wants to see my condition stabilise before there is any resumption of riding. My feeling is I’ll be off the bike for at least 12 months, maybe longer, as the anti-coagulation treatment just takes time.

In the meantime, I made a decision to give up racing, and sold my race bike & wheels. On the flip side, I am organising a new frameset for doing some adventure riding, with the hope that I’ll actually get to ride it at some stage.

As far as other options are concerned, there is no need for any further intervention at this time, as the anti-coagulation appears to working. I’ll never be back to my pre-DVT condition, so I will just have to adjust and ride to whatever my new limits will be.


Man, that's tough. But also really lucky too. And your doctor seems really switched on and really wants to give you the best shot at getting back riding.

As for the HR kit, don't sweat it - you put in the work and I think you would have gone fine over there. Wear it.

If you choose to do a HR again it doesn't need to be a full speed. You can ride along and enjoy the scenery, have a coffee at the top of the climbs (CafePod van). That's what I did. There will be HR events I'm sure for years to come.

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Re: DVT, PE and blood thinners.

Postby trailgumby » Wed Oct 11, 2017 10:11 pm

I had a PE about 6 weeks ago. Almost didn't make it. Had to drop to hands and knees one morning after walking 120m from my front door to avoid a fall if I passed out, which I came close to doing - vision was showing the full swirling kaleidoscope. I had no idea how much trouble I was in until I saw the CT scan results on the monitor in the emergency department. My response was a single word: "!! BAN ME NOW FOR SWEARING !!!" Doctor's report stated "massive bilateral saddle pulmonary embolus".

I need to head off to bed now, but I am on Rivaroxaban, and seem to be progressing well. Back on the bike for *very* easy laps around Lionel Watts Reserve in Belrose. There's a bit of a story to tell, including being made redundant 2 days after handing in the medical certificate that said I was fit to return to work.

Will tell more when I get back from court (unrelated matter) tomorrow.

Sparx
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Re: DVT, PE and blood thinners.

Postby Sparx » Thu Oct 12, 2017 7:45 am

trailgumby wrote:I had a PE about 6 weeks ago. Almost didn't make it. Had to drop to hands and knees one morning after walking 120m from my front door to avoid a fall if I passed out, which I came close to doing - vision was showing the full swirling kaleidoscope. I had no idea how much trouble I was in until I saw the CT scan results on the monitor in the emergency department. My response was a single word: "!! BAN ME NOW FOR SWEARING !!!" Doctor's report stated "massive bilateral saddle pulmonary embolus".

I need to head off to bed now, but I am on Rivaroxaban, and seem to be progressing well. Back on the bike for *very* easy laps around Lionel Watts Reserve in Belrose. There's a bit of a story to tell, including being made redundant 2 days after handing in the medical certificate that said I was fit to return to work.

Will tell more when I get back from court (unrelated matter) tomorrow.


Holy ban me for swearing also! WT actuall F is going on??

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trailgumby
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Re: DVT, PE and blood thinners.

Postby trailgumby » Thu Oct 12, 2017 4:05 pm

Here's the story in full:

viewtopic.php?f=49&t=95552

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Thu Oct 12, 2017 7:08 pm

trailgumby wrote:I had a PE about 6 weeks ago. Almost didn't make it. Had to drop to hands and knees one morning after walking 120m from my front door to avoid a fall if I passed out, which I came close to doing - vision was showing the full swirling kaleidoscope. I had no idea how much trouble I was in until I saw the CT scan results on the monitor in the emergency department. My response was a single word: "!! BAN ME NOW FOR SWEARING !!!" Doctor's report stated "massive bilateral saddle pulmonary embolus".

I need to head off to bed now, but I am on Rivaroxaban, and seem to be progressing well. Back on the bike for *very* easy laps around Lionel Watts Reserve in Belrose. There's a bit of a story to tell, including being made redundant 2 days after handing in the medical certificate that said I was fit to return to work.

Will tell more when I get back from court (unrelated matter) tomorrow.


Crikey. As bad as my DVT was, given it’s size and unusual location, I had no PE, and other than a sore leg a few days after pulling a left hip flexor muscle, I had no symptoms. The ED didn’t even diagnose it and sent me away for an MRI for suspected muscle tear. To think i went 3 days with a massive clot in my pelvis and nothing broke free...shudder. I was in hospital for 2 weeks, and had to have wires stuck up my leg to dissolve the gooey clot, but other stuff had already hardened, and that will be with me for life.
There is no known trigger for my clot. I fall into the “we’ll never know” category. I have large collaterals that suggest clotting over a long period, but there is no way of really knowing.

I’m on apixaban (Eliquis), which has given me no obvious side effects (thankfully), and my Dr is the top DVT specialist in the country. At the moment I am on the anticoagulants for life, but no further intervention recommended. I do have a temporary IVC filter at the moment that needs to come out by April. That was put in during my CDT procedure back in May to protect against PE.

I fully intend to get back on the bike, but it is unlikely I’ll be 100% Again, so it’s a case of readjusting my goals and just doing what I can. I have given up racing and ordered a gravel adventure bike so I can have a project to work on while I go through this long recovery process.

Hopefully I’ll be able to do the HR Triple at some stage, but purely as a “just want to finish” thing.
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trailgumby
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Re: DVT, PE and blood thinners.

Postby trailgumby » Thu Oct 12, 2017 8:49 pm

I'm in the "NFI what happened" group too. Lung guy, haemotologist, vascular surgeon and my GP are all scratching their heads. No real symptoms for me either, except for this persistent dry cough and a bit of minor fluid buildup in my lower left leg. I didn't think too much about that because a pre-flight DVT scan came up clear a year ago and that symptom hadn't changed.

The big DVT in my thigh dissolved over the course of two weeks :shock: , but I still have clots in my left calf running up to the back of my knee. I get another dye CT scan mid-November to check on progress in my lungs.

The Rivaroxaban doesn't dissolve the clots, that apparently happens naturally. It just stops new ones forming so the body can get on top and deal with what's already there.

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Thu Oct 12, 2017 11:01 pm

trailgumby wrote:I'm in the "NFI what happened" group too. Lung guy, haemotologist, vascular surgeon and my GP are all scratching their heads. No real symptoms for me either, except for this persistent dry cough and a bit of minor fluid buildup in my lower left leg. I didn't think too much about that because a pre-flight DVT scan came up clear a year ago and that symptom hadn't changed.

The big DVT in my thigh dissolved over the course of two weeks :shock: , but I still have clots in my left calf running up to the back of my knee. I get another dye CT scan mid-November to check on progress in my lungs.

The Rivaroxaban doesn't dissolve the clots, that apparently happens naturally. It just stops new ones forming so the body can get on top and deal with what's already there.


It will depend on the stage the clot is at as to whether the anti-coagulants will assist the body is getting rid of it. I was on clexane injextions in hospital to stop it getting worse while they figured out what to do with me. That helped the clots below the knee but did nothing to the clot in my pelvis. For that, I needed the full works of a thrombolytic enzyme delivered via catheter up my left leg, and in through the right side of my groin and up and over the IVC to the left side where the clot was. They put on that for 48 hours while also giving you IV heparin to stop you clotting while they dissolve the existing clots. I was in ICU for 3 days. Walking was difficult for a couple of weeks afterwards and I didn’t return to normal walking stride for about 6 weeks.

Right now my left leg is about 4 to 5cm circumference larger than my right leg, and this is not likely to change. I’ve got a top physician keeping the surgeons away from me lest they do more harm than good by sticking stents in my veins or cutting me open to scrape all the hardened clot out. The surgical options carry a higher risk than continuing on the current course of treatment, at least for now.

Once I have a computer that can read the DVD they gave me, I’ll see if I can pull up a 3D image of the clot from my MRA pre-treatment. Should scare a few people!
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foo on patrol
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Re: DVT, PE and blood thinners.

Postby foo on patrol » Fri Oct 13, 2017 10:30 am

Hope you blokes with these clot problems can get it sorted for good, soon. :(

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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Fri Oct 13, 2017 4:20 pm

foo on patrol wrote:Hope you blokes with these clot problems can get it sorted for good, soon. :(

Foo


If anything, I am heartened by the fact that clots are not uncommon, and I am not the only one where there is no explanation for it.

What I would like to know is how many of you have a doctor who automatically blames cycling as the cause when he can't find any other cause? This was my first time in hospital. Even in ICU I was still healthier than 99% of the staff at the hospital. It's killing me being off the bike and physically idle - 6 months now and counting. Hopefully there is a light at the end of the tunnel.
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Fri Oct 13, 2017 7:36 pm

queequeg wrote:This was my first time in hospital. Even in ICU I was still healthier than 99% of the staff at the hospital.


Yes, even ridiculously healthy people get serious illnesses. And those with the worst lifestyle live to 90.
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queequeg
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Re: DVT, PE and blood thinners.

Postby queequeg » Fri Oct 13, 2017 10:16 pm

ValleyForge wrote:
queequeg wrote:This was my first time in hospital. Even in ICU I was still healthier than 99% of the staff at the hospital.


Yes, even ridiculously healthy people get serious illnesses. And those with the worst lifestyle live to 90.


I was probably lucky that it was a private ICU, so there was no Trauma patients there, and maybe 3 or 4 other patients. But yes, every nurse that took my blood pressure kept remarking how crazy healthy I was...aside from the tubes stuck in my leg.
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Re: DVT, PE and blood thinners.

Postby ValleyForge » Fri Oct 13, 2017 10:27 pm

[quote="queequeg"]I was probably lucky that it was a private ICU, /quote]

You probably wouldn't have made it to first base in a Public ICU. :lol:
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