Deep Vein Thrombosis

[chipmunk]

Anyone ever experienced this lovely problem?

 

I had minor knee surgery last week to remove torn cartilage, but developed two blood clots in my calf as a result. My knee is doing great, but my calf is incredibly painful. The doctor put me on blood-thinners - which I need to stay on for 3-6 months

 

Anyone out there that has taken blood thinners? Do you take any precautions when you head out on trips? Also, does anyone know how long I can expect my calf to hurt like hell?

 

Thanks.

[catbirdseat]

You should keep that leg elevated as much as you possibly can. No standing around on it. Apply hot compresses to promote circulation.

[scheissami]

Are you on Lovenox (injections) or warfarin (coumadin)? Either way, you're much more susceptible to bleeding. If you don't wear a helmet already, now's a great time to start--bleeding into your skull is no good. Little things like remembering to bring band-aids, gauze, and good tape in your pack will help. Direct pressure is the key to controlling any bleeding, whether you're on anti-coagulation therapy or not!

 

Your calf will be painful until the clot starts to resorb, a process which usually begins after several days. The blood thinners prevent the natural propagation of clotting (which is usually beneficial) so your body's natural means of breaking down old clot can predominate. Unfortunately it just takes time....

 

Hope you feel better soon....

[chipmunk]

Thanks for the info. I was just diagnosed and started the therapy yesterday. The doctor is having me take the Lovenox injections for 3 days until the warfarin kicks in. I'm glad I don't have to take those injections long term - those little buggers hurt!

[iluka]

Thanks for the info. I was just diagnosed and started the therapy yesterday. The doctor is having me take the Lovenox injections for 3 days until the warfarin kicks in. I'm glad I don't have to take those injections long term - those little buggers hurt!

 

You should touch base with your physician about the timing of the Lovenox and the Coumadin. It shouldn't be used for just three days, but, instead, should be used until 2 days after you have reached a therapeutic level of the coumadin in your blood stream (when your INR gets to between 2 and 3). Some people get to a therapeutic level in only 3 days but others require longer to get there and stopping the Lovenox early could leave you at increased risk for another blood clot.

 

I cannot second enough scheissami's advice about the increased risk of bleeding. You should absolutely wear a helmet but need to be aware that any cuts will bleed a lot longer without good pressure on them and any good whack somewhere (into your quad for example) could lead to a significant amount of bleeding.

 

If you have a headache or the like, I would stay away from aspirin (another blood thinner that works by a different mechanism than Coumadin) and perhaps Ibuprofen (or it's relatives) and, instead, rely on acetaminophen.

 

Finally, if you go to high altitudes, get closer follow-up of your INR as there is some data to indicate that the Coumadin levels in the blood can be altered in the high altitude environment.

 

Good luck with this.

[mneagle]

I take care of people all the time with DVT's. You're lucky, in a way. Clots below the knee tend to break free and travel to the lungs less often and the long term damage to the valves in the veins is usually less so long term problems with swelling are not a big deal most of the time.

 

Major bleeding is more likely to occur while on coumadin and bleeding into your head is the biggest concern. I strongly advise patients to avoid any activities that can result in head trauma. Here is Colorado that involves telling people they should not ski, climb or mountain bike while being treated. I get a lot of groans but after I tell them that I have also taken care of a lot of severely brain injured patients in the ICU who had head bleeds on coumadin, they usually comply.

 

My advice would be to take some time off from climbing and instead pursue those activities that you've been meaning to do (read more books, take guitar lessons, etc) but climbing has always gotten in the way of.

 

As for the pain, it's variable. Many people have no symptoms at all. In people who have pain, in my experience, it usually subsides in day to weeks. Heating pads can help. Stay away from aspirin and NSAIDS.

 

It concerns me a little that the doctors who put you on blood thinners haven't already talked to you about these things and you have to ask for advice on a climbing web site. I hope they have filled you in a little on how coumadin works. If not, it is a vitamin K antagonist. This means it impairs your liver's ability to make certain clotting factors that vitamin K is used in making. It is a competitive inhibitor, meaning that you need to balance the coumadin with the amount of vitamin K you are taking in. This doesn't mean you need to avoid vitamin K, just that you need to eat a fairly steady diet. For example, if you eat a pound of broccoli one day despite eating a diet usually devoid of green vegetables your blood will get too thick for the next several days, increasing your risk of more clots or the clot breaking loose and going to your lungs. If your blood levels are difficult to control, a nutritionist may help you sort out your diet. On the other hand, some drugs can accentuate the effects of coumadin and can cause you blood to get too thin, increasing your risks of bleeding. Antibiotics are frequent causes of this situation. Make sure whoever is giving you any new medications knows you are on coumadin and discuss the possibility of drug interactions with your pharmacist.

[chipmunk]

It concerns me a little that the doctors who put you on blood thinners haven't already talked to you about these things and you have to ask for advice on a climbing web site.

 

I appreciate the information and advice. I believe my doctors are doing a good job. My INR levels are being checked every 2-3 days to get the appropriate Coumadin dosing down, and they are keeping me on the Lovenox injections until the appropriate Coumadin level is reached.

 

My query on this website was not necessarily for medical advice (although what has been given is appreciated, and conforms to what my doctors have told me ), but more to find out experiences from others with this condition who are active in the outdoors.

[iluka]

One other piece of advice I would give... if you develop shortness of breath or chest pain at any point in the near future, I would head into see your physician as that could be a sign that the clot has migrated from your legs to your lungs (unlikely while you're on Coumadin but you should watch out for it).

[chelle]

If you develop the above problems (sudden shortness of breath or chest pain) and you are not able to reach your MDs by phone immediately (or their office is closed) you should have someone drive you to an ER and not wait around until the doc's office opens.

 

mteagle gives some good advice about activities in the outdoors. Now is the time to take a rest from climbing and maybe renew your interest in hiking (depending on knee recovery) and once your leg pain and swelling is resolved, in the mean time pursue other non-outdoor low impact activities you've been putting off or wanting to try.

 

Also, on the off chance you smoke now is the time to get serious about quitting. Smoking promotes clotting, even second hand smoke, so steer clear of it.

[iluka]

The data for smoking as a risk factor for DVT and pulmonary and pulmonary embolism isn't actually that clear cut. Several studies suggest there is a link while others showed no relationship. What is clear is that smoking while also taking oral contraceptives is a big risk factor for DVT and PE. I'm assuming the original poster is not taking those.

 

That being said... I'd hope there would be plenty of other reasons for giving up smoking. If you were going to do one thing for your long term health quitting tobacco would be the thing.

[Chad_A]

Ouch! Hope you feel better.

 

I don't know if you'll find too many people that have experience with this on this board...this is pretty rare in this demographic, I'd guess(?).

 

Here's to a good recovery. I wonder what effect has on DVTs?

[iluka]

Here's to a good recovery. I wonder what effect has on DVTs?

 

Well... if you drink enough over the years, you'll kill off enough liver cells such that you'll get cirrhosis and your blood won't clot very well at all. That will take care of your DVT risk.

[Chad_A]

Well, then here's to another

 

Hope you're feeling better, Becky!