Evondo's Group - CLOSED! (Page 36)

 Gold member

This 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