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  1. #1
    Long Distance Cyclist Machka's Avatar
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    DVT, Warfarin, and exercise

    Has anyone here been diagnosed with DVT, been through all those abdominal shots, and been put on Warfarin for an extended period of time?

    If so, how long was it before you were back to exercising at the rate you were prior to the DVT?


    I developed DVT on a 17 hour flight to Australia on June 12 ... felt like a really nasty calf cramp, and I figured I'd eventually just stretch it out and walk it off. On July 28th I went to see a Dr because my leg had swollen right up and I had what I thought were a lot of bite marks around my ankle. The Dr sent me for an ultrasound the next day ... and the ultrasound technician wouldn't let me leave the hospital after she did the test. I was admitted less than an hour later.

    I was in hospital for 14 days before finally being released ... reluctantly. They weren't too keen on letting me go even then.

    I've been put on quite a high dose of Warfarin and I have to have my blood INR levels checked about once a week. I've been out of hospital about 3 weeks now, but my blood INR levels still haven't stabilized, and my leg still swells when I exercise.

    I'm finding it really difficult to exercise ... either the Warfarin is tiring me out, or the blood flow in my leg still can't keep up ... or both.

    Yes, I will be visiting a Dr again soon ... I have to visit one about once a week for the blood test ... and will mention the exercising thing, but I was wondering if any of you have had experience with this.

  2. #2
    Senior Member DX Rider's Avatar
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    Machka, I work for a company that manufactures DVT treatment devices. Have you discussed compression stockings or sequential compression devices with your doctor as an alternative to pharmacueticals?

    I don't care for pharmacueticals if there is another option available. If Warfarin is anti-coagulant/blood thinner/diauretic it will make you feel fatigued. It'll also probably make you more sensitive to cold temperatures.

    My mother has really bad circulation in her legs and has worn DVT stockings for over thirty years. I also have a friend who is in her early 30's who wears them and loves them. She says her legs never get anywhere as fatigued like they previously did from standing all day.

    Here is our website if you'd like to see some of the other options are out there. Our brand of TED stockings are more short-term, in hospital use, so they're probably not the best option for you, but there are other companies out there. I'm unimpressed with the quality of continuing care stockings. And the compression rating of our stockings is fairly low. Although, there is at least one NFL team that uses them in their physical therapy treatment.

    I don't know about healthcare in Australia, but in the states some insurance companies will even cover the expense of leasing an in home sequential device if the condition is serious enough.

    FWIW, DVT is really, really common when sitting for long periods of time, like long flights. I actually encourage anyone to wear stockings if they are planning a long trip, since it will help to deter the pooling of blood in the lower extremities. It doesn't matter your age or fitness level, gravity works on everyone, and it's a very serious medical condition.
    Last edited by DX Rider; 09-02-09 at 10:08 AM.
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  3. #3
    Not the gum drop buttons! Gingrbreadchick's Avatar
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    I had a very large DVT in 2006, went through the shots, hospitalization, unstable INR and 6 months of warfarin. My leg had cramped up so bad when I first got the DVT I couldn't walk without crutches for weeks. I now have post thrombotic syndrome, so swelling is always a problem, but compression stockings help a tremendous amount with swelling and with pain.

    I would check with your doctor to see if they're ok with you exercising because part of the DVT can break off and potentially travel to your lungs or if you fell while on warfarin bleeding can be hard to stop. I did notice that I was always cold and tired, and my dvt leg wasn't as strong as my good leg. I actually took up cycling to help get it back into shape and hopefully get my muscle to the point where it can pump blood up my leg better, and so far it's working out really well.

  4. #4
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    I've had multiple blood clots. The first was a DVT in my left leg that went from my ankle up into my adbomen, since then it's been a couple other DVT's, pulmonary embolism... needless to say i have a clotting disorder and will be on blood thinners the rest of my life.

    14 days of hospitalization is a pretty long time, did they perform any surgeries on you? Anything to clear the clot out or perhaps implant one of those umbrella filters to catch a clot before it gets to your lungs?

    Obviously consult your Dr. but with all of my clots i was told once i was on the blood thinners i could exercise at whatever pace felt good to me. I had 2 dvt's where they performed surgeries to remove the clots and both of those recovery times were longer than where i had just been put on lovenox or warfarin. I don't remember exactly how long but i'd say a 3-6 months, without surgery it was probably just a couple months or less.
    While on the warfarin your body will naturally break down the blood clot and even expand the blood flow through other veins or actually create new ones but obviously this takes time.

    Ive found running feels like it helps the circulation in my leg better than biking does... not sure why but it does for me...

    Getting stable on warfarin can be annoying to say the least. A consistent diet and stable weight will make it easier but sometimes it's just hard to get dialed in. In college my INR was all over the place, now i get tested every 3-4 weeks and it's virtually always in the therapeutic range.

    I don't think warfarin should be tiring you out... is it your legs getting tired or are you getting out of breath? Do you elevate your leg before exercising to make sure you have no swelling before starting out? Are you using compression stockings? They can definitely help but i've always found they don't really breathe as much as i would like them to, I'm thinking of trying out some of the ones they are marketing towards triathletes.

    14 days of laying around in a hospital definitely doesn't do anything to help your conditioning... that could be a big part of why you're feeling so tired...

    Stuff like this is annoying, scary, and even depressing but stay positive, keep working on the exercise, and you'll bounce back

  5. #5
    Long Distance Cyclist Machka's Avatar
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    No, I did not have a surgery of any sort while I was in hospital. But I didn't just lay around the hospital ... I was allowed out for an hour or two during the afternoons to exercise. They wanted me around for the two shots a day, and to monitor things.

    My left leg is full of clots from about mid-thigh down. When I was first admitted, the clot highest up in the thigh had blocked the vein entirely, and my body had created a small new vein to get around that clot. The clots in my calf also block the vein, but my blood has created small channels through the clots.

    One of the things that is going on ... I think ... is that my blood is backing up in the foot.

    I burned my left foot to the bone in 2001 and thus burn the veins down there. What happened then is that the blood would flow into my foot, and would pool there because there was no way for it to return to my heart. My foot would swell and tingle so badly I could only stand up for about 10 minutes at a time.

    I'm feeling the same sort of thing again this time, especially if I've been up and walking around for a while. It feels like the blood is pooling in my foot because only a trickle of blood is returning to my heart because of the blockage in the leg.

    So one of the tiredness factors is my leg. However, there's another tiredness factor going on too. I get a good long sleep at night ... but if I go for a walk or something, I feel like I need a nap and often do take a nap. That's just not me.

    I'm also feeling the cold more than I used to.

    I'll be going for another INR test on Monday ... here's hoping I've stabilized!!

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    Good luck with all that, looks like you're on the road to recovery. I was most amazed about the length of your hospital stay. Is that the usual for this diagnosis, just wondering.

  7. #7
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by ironhorse3 View Post
    Good luck with all that, looks like you're on the road to recovery. I was most amazed about the length of your hospital stay. Is that the usual for this diagnosis, just wondering.
    Apparently it is not unusual here in Australia.

  8. #8
    Senior Member DX Rider's Avatar
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    Jeff, did you have non-invasive surgery?

    There is a product that was devoloped by Bachus Trellis that was designed to break up clots in DVT patients, did they use that?

    My company know owns the rights to the device, I've seen it in use. Made me a little weak in the knees to watch the procedure. Anyhow it's supposed to be less traumatic to DVT patients than traditional surgery.

    http://salesandmarketingnetwork.com/...hus%20Vascular
    Quote Originally Posted by stronglight View Post
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  9. #9
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    Machka,
    Good luck with the blood test! Since it's been fairly recent you probably haven't had to get refills but one thing to help keep your INR stable is always get your refills at the same pharmacy if possible. Changing between coumadin and warfarin or even just different manufacturers of the generics can throw off your INR a bit.
    If you're not wearing the compression stockings now I'd definitely recommend getting some, certainly sounds like you could use them. I found I'd always need to wear them after getting a clot but once my body recovered I didn't need them anymore, although i do still wear them from time to time on long trips.
    3 weeks out of the hospital certainly isn't very long and I would expect you to have the swelling problems you're talking about, just stick with the blood thinners and exercise and it will get better. As for the overall tiredness, not sure about that, do you think it's possible it's just cause you're not getting your normal level of exercise?

    DX Rider,
    My first surgery was 14 years ago before all the non invasive stuff came out and that one obviously wasn't much fun. My last surgery was with an angiojet http://www.possis.com/products/prod_system.php. To be honest I really feel I shouldn't have had that done, i did not have 100% blockage and only had minor swelling and discomfort, simply being put on blood thinners would have cleared it up but i let the Dr's scare me into having that done. I felt MUCH worse after the surgery i did before it. The other Dr's I've talked to since then would not have recommended me having that surgery... it simply wasn't necessary.

  10. #10
    Long Distance Cyclist Machka's Avatar
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    Yes, I've been told I can't mix and match my warfarin brands ... and I will likely get my refills at the same place since it is in the only town around here that has a clinic with the ability to do the instant fingerprick blood test.

    Good to know, I guess, that some of the swelling and pain is still normal at this stage in the game.

  11. #11
    Long Distance Cyclist Machka's Avatar
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    I just had an ultrasound today and I only have one tiny little bit of a blood clot left in my left leg. The rest of the clots are GONE!!

    And even better ... there is no damage to my veins. One of the issues with this sort of thing is that there can be permanent damage to the veins which can cause on-going issues even after the clots are gone, but mine look good.

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    ^^ Yay, great news! :happy:

    Hope everything progresses as it should so that you can enjoy the upcoming warm weather. While we start to delve into the colder weather

  13. #13
    just another gosling Carbonfiberboy's Avatar
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    Thanks for posting, Machka. How do you like that Australian health care, eh?

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    Hi Machka,

    I've been on warfarin for about 25 years now. I've had 5 episodes of DVT. I'm on warfarin for the rest of my life and wear special socks (I teach college so am on my feet a lot). My left foot is a bit larger then my right and looks permanently bruised from blood vessel ruptures. BTW INR levels and associated medication dosage can change over time. I get mine measured once a month and it can be a hassle.

    Anyway exercise: The calf muscle is one of the largest "pumps" in the body. While exercise cannot change blood chemistry as it relates to blood "thickness" it still remains beneficial. However I have been told by various specialists from various institutions over the years that it is crucial not to let the blood "pool". Therefore I elevate my legs after hikes, skiing and bicycling as well.

    I have taken the route that recurrent DVT is NOT going to prevent me from the activities I love doing. So I am diligent about having my INR measured, elevating my legs, wearing support stockings, etc. etc.

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    Hey Machka, that's great news!
    ...

  16. #16
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by Carbonfiberboy View Post
    Thanks for posting, Machka. How do you like that Australian health care, eh?
    The Australians I've encountered all the way through the health system here have been great! I've rarely been treated so well ... and so quickly. And the Australian health care system is all right ... although not quite as comprehensive as the Canadian system in its coverage.

    The main difficulty I've been having is with my Canadian Health/Travel Insurance.

  17. #17
    just another gosling Carbonfiberboy's Avatar
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    That's very good to hear. It's a wonderful thing to feel like someone gives a **** about you. I hope you get it worked out. My US health insurance doesn't have a travel component - so I have to depend on the kindness of strangers.

  18. #18
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by Carbonfiberboy View Post
    That's very good to hear. It's a wonderful thing to feel like someone gives a **** about you. I hope you get it worked out. My US health insurance doesn't have a travel component - so I have to depend on the kindness of strangers.
    In Canada, and here in Australia, you have to buy the travel insurance separately from any other insurance plans you might have. From experience now, it is a very good idea to purchase the separate travel insurance.

    One of the people I was most impressed with was the ultrasound technician. I'm used to ultrasound technicians processing people like they were on a conveyor belt. Wave the magic wand and "Next". But this one talked to me through the procedure, showed me what she was seeing on the screens she had positioned around the room for the benefit of the patient, and then when we had determined that my leg was chock-full of clots, she would not let me leave the hospital until I had been seen by a Dr and admitted. There was none of this ... "Your Dr will get the results of the test in 2 weeks and if there are any concerns you'll get a call" stuff.

  19. #19
    Member toddtone's Avatar
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    Interesting discussion. I had a lower leg DVT about 4 years ago caused by the "boot" I was wearing for a wicked bout of achilles tendonitis. When I went to the the family doc, he sent me for an ultrasound, results positive, admitted me to the hospital, gave STRICT orders that I remain there.

    Upon admission, the hospital internal med physician asked if I was able to give myself the shot of Lovenox in the abdomen as described, told me that current practice is that patients with this type of problem self-manage...with appropriate follow-up, blood tests, etc. Needless to say, I was elated! One hour in the hospital. Oh, plus I was put on coumandin.

    My tendonitis improved enough over four weeks, and I returned to regular, vigorous, no limit cycling.

    And no more coumadin after a couple of months.

    Maybe I was just lucky...but whatever, I am thankful to have been able to resume my routine.

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    i have been taking warfarin for 5 years after a-fib and av ablation. heart is powered by pacemaker. will be on warfarin until maybe next year when the fda aproves a replacement. biggest hassel for me is cold when temps go under 60 and the never ending inr's. have made mind up to just forget and live with it.
    thanks

  21. #21
    Long Distance Cyclist Machka's Avatar
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    It's been over 5 months now since I've been officially diagnosed with DVT, and almost 7 months since I developed DVT. I developed DVT on a very long flight on June 12, 2009 and was admitted to the hospital on July 29, 2009. I don't rush to the Dr for every little thing ... I tend to wait until the last minute.

    A couple weeks ago I had another ultrasound and the last remaining clot (out of a leg jammed full of clots) is still there, but the veins still look good. The Dr seemed a little bit surprised about that clot and I'll be on Warfarin for a while yet.

    But what sent me to have another ultrasound was the fact that my left foot/ankle was swelling up while I was at work. For the month prior to Christmas, and a few days after, I was working long hours and many days in a row, standing all day long. Right near the end of all that, I got compression stockings and really like them. The ones I got are very comfortable, although a bit hot on hot days. They make my leg feel so much better when I'm doing a lot of standing. I waited to get them because I'd heard from others that they are very uncomfortable, but that's not the case at all! I really like them, and would be tempted to wear them even if I didn't have DVT.

    Something I'm noticing, however, is that I'm having a lot of trouble picking up where I left off in terms of exercise. I've done four 1200K randonnees, plus all the qualifying brevets, plus racing in 24-hour races, plus being able to knock off centuries whenever I felt like it ... even after not riding a bicycle or doing any sort of exercise for several weeks. I'm used to being able to get on the bicycle .... and successfully complete the ride.

    Now I know I haven't done much exercise since the end of May (I rode 1000K in May including an imperial century, a couple metric centuries, and a whole bunch of other rides), but November wasn't too bad ... I did do 500 km in November (including a successful 100K in mid-November), but when I attempted an imperial century at the end of November, it was a very slow and difficult process. My legs just didn't have anything to give me. It took 11 hours for us to complete that century.

    Yesterday (Saturday), I tried to ride another metric century but had to call it a day at 88.5 km because of the heat in this area, and because of awful cramping, particularly in my left leg ... the DVT leg. I've never cramped that bad before. I don't know if the cramping was completely because of dehydration and heat ... or if it might have had something to do with that last remaining clot as well.

    If you've had DVT, how long has it taken for you to return to your pre-DVT activity and fitness level? Did you experience an increase in leg cramping when exercising?

  22. #22
    just another gosling Carbonfiberboy's Avatar
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    I wish I had a clue, Machka, but I don't.

    Whenever I come back from an injury, I try to ride every day, gently. Very gently. No pain, or at least very little. And I just gently ramp up the volume first, then try to get back to more normal effort. I would think that if your weekly volume were up around 8 hours for a month, a metric would go OK. I'd further guess that all that standing has tired you out more than you realize.

    Do keep the effort down when you bike until that clot is gone. We know you love to bike but please don't endanger yourself.

    More guessing: the cramping was just because you weren't in shape for it. Too big a bump. Give it time. The older we get, the faster we lose it. It's noticeable. OTOH, the cramping might have had something to do with reduced blood flow, but then I would think it would have been localized to the affected muscles.

  23. #23
    Long Distance Cyclist Machka's Avatar
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    I've started taking a different approach to rebuilding my fitness level.

    In the past I was able to cycle relatively short distances during the week (20-ish kms), and then hop on my bicycle on the weekend and do a century (160 km) with no difficulty at all. I can't do that now.

    So what I've been doing is riding longer distances more regularly. I aim for 30-50 km a day, about 5 days a week. Building up a base again. And I must say, I'm feeling much better about things.

  24. #24
    Long Distance Cyclist Machka's Avatar
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    Evidently I'm a mutant. Turns out that I have a genetic mutation which increases my risk of developing DVT. I also have a high homocysteine level which, when combined with this particular genetic mutation, puts my cardiovascular risk into a high risk level. Vit B and Folic Acid are supposed to reduce my homocysteine level.

    The mutation is the methylenetetrahydrofolate (MTHFR) Gene Mutation (C677T). Apparently 8-18% of the population has this mutation.

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    Sorry to hear that. Will you have to stay on Warfarin indefinately?

    I've started eating onions to help improve my bloodflow, supposedly they reduce the risk of clotting. Here's the technical explanation:

    Cardiovascular Help
    Onions contain a number of sulfides similar to those found in garlic which may lower blood lipids and blood pressure. In India, communities that never consumed onions or garlic had blood cholesterol and triglyceride levels substantially higher, and blood clotting times shorter, than the communities that ate liberal amounts of garlic and onions. Onions are a rich source of flavonoids, substances known to provide protection against cardiovascular disease. Onions are also natural anticlotting agents since they possess substances with fibrinolytic activity and can suppress platelet-clumping. The anticlotting effect of onions closely correlates with their sulfur content.
    http://www.vegetarian-nutrition.info/updates/onions.php


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