Deep Vein Thrombosis [DVT]-A Head’s Up

March 9 2018. This is a head’s up based on the experiences of two Masters Runners who have had DVT episodes. Anyone experiencing any of the symptoms below should check with a physician or other health professional. DVT is a serious threat.

About a week after the 2017 USATF 15K Championship at Tulsa last fall, I heard from Morris Williams, one of the stalwarts of the Atlanta Track Club’s 70+ team. He had run at Syracuse, Boston and Tulsa. At the 5K Championship on the 1^st of October, his quads hurt so much he had to walk part of the race; that had never happened before. He was able to run okay in Boston at the 5km XC Championships but had severe cramping on the way home. In the 15K Championships at the end of the month, his quads hurt severely. He finally went to the ER the following Thursday and learned that he had had DVT for some time, but failed to recognize the symptoms.

Morris had frequent occurrences of leg cramps and night sweats. Both can be symptoms of DVT but Morris did not know that. It was the swelling and pain in his lower legs that led him to the ER. A runner for the past 60 years, Williams was concerned about his future.

He had learned that Jan Frisby might have had a DVT a few years ago. Here is what he learned from Frisby who did have a DVT 3 years earlier, by coincidence, with very different weather conditions, after the 2014 Masters 15K Championship at Tulsa. It was a very hot day for a race—70 to 80 degrees and Frisby notes that he made a series of mistakes: (1) he failed to rehydrate properly post-race; then, because he wanted to get a sick teammate home as quickly as possible after the race, jumped into the car and made the 11 hour trip home, stopping only to gas up as needed. That night, at his teammate’s house he felt a sharp pain in his right shin and thought, “I hope that’s not a blood clot.” By the next morning there was no pain and Frisby forgot about it. He ran several 8 mile workouts the next week with no problem. Then the Saturday evening the week after Tulsa he felt a sharp pain in his lower right side. Soon he was sweating profusely and called 911. When the ambulance arrived he was on his hands and knees in agony. Tests eventually pointed to a pulmonary embolism; the clot had broken off and moved to his lung. They put him on Coumadin and said to stay away from running for a week or two lest more of the clot break loose and cause problems. After a week off, he began fast daily walks of 4 miles. He continued that for 4 weeks and then returned gradually to running. By late February he competed in the 8K National Masters Championship and finished 4^th, although a few minutes further off the podium than he was used to. The good news is that you can come back from DVT.

Jan Frisby, the tall fellow on the far right of the picture, with his Boulder Road Runner M60+ teammates at the 2017 USATF 15K Championships in Tulsa OK on October 28

What was Frisby told were his risk factors?

·         Taller than average—well over 6’ for Frisby, a tad over for Williams

·         70 years of age and older at greater risk-Frisby was 70 at the time, Williams 72

·         Slower heart rate than normal (because blood pools in the lower leg with long sitting times)—distance runners tend to have lower pulse rates. Frisby’s at rest pulse is just 40 after 60 years of distance running

What behavior changes did Frisby make to ward off a future recurrence of DVT, which he referred to as ‘an insidious, life-threatening issue?’

·         On long car or plane trips, he wears compression socks

·         He stops every two hours or so on long car trips and walks around

·         On long plane flights he gets up and stretches every hour or two to stretch for a minute or two—he also has his shoes untied and loose and wears loose clothing

·         He also makes sure he has plenty of leg room, opting for an aisle seat. He even goes for the Economy Plus extra leg room option the airlines offer

·         He drinks a reasonable amount of fluids on long trips

·         The doctor has recommended an 81 milligram a day aspirin regime but not blood thinners, as Frisby has no heart disease symptoms

Williams notes that his leg felt better each day and he began walking a week after his trip to the ER in early November. He was put on a blood thinner for three months and now the aspirin. He walked an hour a day for the first month and felt ready to start running again. He ran half a mile or so. But then Williams came down with the flu which set him back a month. In January he started running very slowly with lots of walk breaks but would go for an hour at a time; some days it was just walking and others more running. The longest run without a walk break was probably half a mile. He has now tried his first 800 meter race at an Indoor Track meet. The recovery is slow but it is proceeding.

Morris Williams, the tall fellow in the back row, right, with his Atlanta Track Club M70+ teammates at the 2017 USATF 5K Championships in Syracuse on October 1st

Neither Frisby, Williams, nor I are health professionals. That’s the disclaimer—Consult a health professional if you want to learn more or have any of the symptoms or risk factors above.

Here’s a few things that Williams found online about air travel after a taxing race far from home:

·         Despite what Frisby was initially told about age, Williams found that 85% of air travel thrombosis victims are athletic, endurance athletes and that 80% are under the age of 60

·         Post-race fatigue and altitude can increase coagulation factors (www.airhealth.org/athletes.html, July 11, 2004)

Behaviors to help reduce chances of developing DVT

Post race

·         Don’t sit for 10 minutes after crossing the finish line; walk or jog instead—stretching is good too

·         Once back at your hotel after the race, take a cool bath to reduce inflammation [An RN I consulted notes that taking two 200 mg. tablets of ibuprofen will also reduce inflammation]

·         Eat small meals and sip fluids to replenish energy and electrolytes

·         Avoid alcohol

Mid-Flight

·         Avoid crossed legs, remain hydrated, and do some leg exercises – point and flex your feet 20 times every 15 minutes—Get up every hour and walk in place, perform toe raises and leg extensions. Contracting and releasing the calf muscles to increase blood flow is key

·         Schedule your flight home for more than 24 hours after the race

·         Book an aisle seat if possible; if not try to avoid putting your carry-on luggage under the seat in front of you-- so you can stretch your legs and do simple exercises while sitting, like ankle circles and such. If that’s not an option, make sure you get up and stretch your legs every hour or so

·         Be aware and move regularly. If a dull pain presents itself and persists, see a doctor immediately.

Signs and symptoms for blood clots

·         Sensation of a muscle cramp that doesn’t let up

·         Swelling in one leg

·         Bruising or tenderness in lower leg or behind the knee

·         Warm feeling in a particular area that may worsen when standing or walking

[Note: Except for the reference to Airhealth.org, I do not have links for the sites Williams found.]

Needless to say it is a complicated issue. You want to be aware of symptoms and signs and take reasonable precautions to avoid developing a DVT. But you do not want to obsess on it. Consult a health professional if you feel you have any of the symptoms or signs.

In some of the online literature, they note that women are at risk of DVT as are men and apparently, according to the Runners World study (2^nd on the list below), risk factors include “pregnancy or recent childbirth”, as well as “estrogen-based medication” such as “oral contraceptives or hormone-replacement therapy.”

Here are some online resources you might consult for further information. I do not vouch for these articles and you should, as always, use common sense and consult a health professional if in doubt. But don’t let DVT sneak up on you!

http://www.americanrunning.org/w/article/clinic-dvt-concerns-and-running

https://www.runnersworld.com/columns/a-doctors-take-on-runners-and-blood-clots

www.active.com/articles/hidden-danger-dvt-in-endurance-athletes

http://www.nydailynews.com/sports/more-sports/oddly-runners-susceptible-deep-vein-blood-clots-efficient-vascular-systems-article-1.990275

https://fightdvt.com/tag/running/

https://runnerclick.com/runners-guide-to-deep-vein-thrombosis-dvt/

https://ultrarunning.com/features/deep-vein-thrombosis-what-it-is-and-how-to-prevent-it/

https://www.medscape.com/viewarticle/802267

http://journals.lww.com/cjsportsmed/Abstract/2011/03000/Effect_of_Air_Travel_on_Exercise_Induced.9.aspx

https://www.stoptheclot.org/news/athletes-and-blood-clots.htm

http://circ.ahajournals.org/content/128/25/e469

https://www.dailystrength.org/group/deep-vein-thrombosis-dvt/discussion/dvt-and-running

http://www.ironman.com/triathlon/news/articles/2015/01/athletes-and-blood-clots.aspx#axzz4yqkEj7pC

http://patientblog.clotconnect.org/2011/03/02/athletes-and-blood-clots/

https://www.thefreelibrary.com/DVT+concerns+and+running.-a0161752151

https://forums.runnersworld.co.uk/discussion/35968/dvt