Resources and Reflections

The information herein has been gleaned from a number of sources around the Net with links provided at the end f the article. The author is NOT a physician and is not attempting to prescribe or recommend medical treatment, but merely to inform fellow endurance athletes of a significant risk to their health resulting from the otherwise beneficial consequences of regular vigorous physical activity, and to summarize the literature on treatment and prevention.

DVT or Deep Vein Thrombosis, also referred to as “Economy class syndrome” results from the pooling and coagulation (thrombosis) of blood in the deep veins of the calf, thigh and occasionally the abdomen due to lack of motion and/or constriction of the blood flow to these areas. The immediate symptoms include some or all of the following; pain, swelling, discoloration of the painful area and, when in the leg, distended veins in the foot or leg. The longer term pathologies include possible permanent damage to the smaller veins from lack of circulation resulting in phlebitis and/or cellulitis. Worst of all is the possibility that the thrombosis or clot can become mobile and lodge in the lungs causing pulmonary embolism (PE), chest pain, coughing up blood and potentially, death. If a clot gets lodged in the brain, this can cause stroke or cerebral embolism and a clot in the heart can cause heart failure.

Various studies show that endurance athletes, with their low resting heart rates, large leg muscles and tenancy to dehydration are especially vulnerable to DVT, up to 85% more likely to suffer DVT than non-athletes under certain circumstances. Since endurance athletes tend to become dehydrated more often and more severely than the sedentary population, and dehydration causes the blood to thicken and coagulate more readily, attention to hydration is even more important than just for the obvious and better known reasons of managing electrolyte imbalance and exhaustion.

Misdiagnosis of DVT is extremely common, even by physicians who suffer from it, so it is incumbent upon endurance athletes to vigorously advocate for themselves if they feel they are suffering from DVT. Unfortunately, it is very easy to just blow off a sore leg as the result of some unnoticed strain of overwork. Fortunately, a sonogram and blood test are highly accurate, minimally invasive and generally will provide an unambiguous diagnosis, so, if you have persistent swelling and pain in your leg, generally only on one side, seemingly without cause (no recent sprain etc.) you have a low resting heart rate, even if you have not taken a recent plane ride, GO TO THE ER or your Doc, and INSIST on DVT screening. Untreated DVT can be fatal or cause debilitating permanent damage to your circulation.

With proper diagnosis and treatment many have resumed their training and event schedules, but the standard medical treatment; coumadin, warfarin (rat poison to dissolve the clot) and/or various other anti-clotting agents, can be quite unpleasant and many physicians may recommend a lifetime course of treatment. Fortunately, there are a number of herbal, dietary and physical measures that have been recommended by various practitioners either to prevent or treat DVT. These “alternative” treatments are the subject of debate and are provided here for informational purposes only.

First and most important is to prevent DVT by avoiding long (>2 hrs) confinement in positions which constrain circulation, like extended airline flights and even sitting at a desk and proactively managing your hydration even when no exercising. If you MUST take a long plane ride, sit at a desk all day or otherwise submit to potentially aggravating conditions and talking a regular five minute walk is not an option, then a couple simple measures can greatly reduce the probability. Those with low resting heart rate and/or other predisposing conditions should perform a simple stretching routine every 15-30 minutes; to do this, fully extend the legs if you can, if you can’t, push them forward as far a possible. Next, rotate the ankles and feet forward as far as possible, pointing the toes, then rotate the feet back upwards, toward the calves. Five repetitions of the foot extension should be followed by strongly contracting then relaxing the thigh muscles five times. This is intended to assist the return of blood to the upper body, preventing pooling and coagulation in the legs. It has been found that plain water is not effective at preventing dehydration specific to blood thickening, but electrolyte drinks or powders are. So when traveling by plane of just sitting at your desk, 8oz. of electrolyte beverage every hour is recommend. Beverages with carbohydrates should be avoided, as digestion of carbs diverts blood flow to the gut and away from the extremities. Also, avoid crossing the legs or ankles for more than a few minutes. Another simple intervention is medical grade compression socks. According to Wikipedia; ”

Travellers

There is clinical evidence to suggest that wearing compression socks or compression tights while travelling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression tights. The group wearing compression hosiery had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers. ^[31].”

Various herbs and food products that have been used to enhance circulation, thin the blood, and reduce coagulation are being used around the world and may or may not provide actual clinical benefit; garlic and garlic extracts, soy natto or nattokinase extract, lemon juice, grape skin extract, Butcher’s Broom (herb), Ginkgo Biloba (herb or extract), nitric oxide containing topical creams and foods (like popcorn), horse chestnut, cod liver oil and vitamin E. Since having had a couple sever dehydration episodes while riding in the Mojave Desert, I’ve taken great care in addressing hydration WHILE RIDING, but it had not occurred to me that it was equally important to pay close attention AFTER riding, and even in ordinary, day-to-day activities, like sitting at a computer for hours and hours.

It is strongly recommended by some authors that we perform a fifteen minute warm down after training; walk or ride in circles slowly and keep moving till the tendency of blood to pool in the extremities is lessened by constriction of the leg veins from coming to a resting state, and if you simply MUST lie down, then elevate the legs well above the heart. My Clark North American hammock, when properly deployed naturally raises the feet and I’ve found that this does have a beneficial effect on ordinary lower leg discomfort after a long ride, unaware till now of the potential benefits vis-a-vis DVT. Endurance athletes are deservedly notorious for wearing our post-workout pain as a kind of badge of honor, and  I’m pretty sure there’s a strong element of masochism in the whole enterprise (maybe a little OCD as well, hmmm?). So it is not surprising that many of us will simply brush off DVT as a minor irritation, ignore it, and go undiagnosed till a bad one goes all the way to PE or CE and possible death of permanent disability. Not to mention the “who knew?” factor; who knew that our cherished avocation, with its many unequivocal health and quality of life benefits, could have such a potentially downside? Well, now you know.

Do a search on “DVT” or “deep vein thrombosis” and a few of the thousands of references you’ll find are listed below;

Wikipedia

Listen to your body

Athletes and DVT Free Article provided by Ames Walker Medical Hosiery. … either I had an Achilles tendon injury (very rare in cyclists) or a blood clot. …
www.graduatedcompression.com/athletes.htm – Similar -

Tales of the Trail Goddess: Endurance Athletes and DVT’s (blood clots)

Aug 9, 2009 … This surprised me, as I always think of DVT’s (blood clots) as something … .

Frey Bird: Deep Vein Thrombosis for Cyclist, Triathlete, Athlete …

That’s because I am hoping to find other athletes, triathletes, cyclists, runners, etc. who’ve had DVT’s. I’ve searched google, and I’ve found a few people …
freybird.blogspot.com/…/deep-vein-thrombosis-for-cyclist.html – Cached – Similar

Hidden danger: DVT in endurance athletes | Active.com

Have you heard of DVT? Well, if you haven’t you are not alone. DVT stands for Deep Venous Thrombosis, and being a fit endurance athlete doesn’t make you …
www.active.com/cycling/…/Hidden_danger__DVT_in_endurance_athletes.htm – Cached – Similar -

Deep Vein Thrombosis Natural Treatment

Jan 16, 2009 … Deep vein thrombosis (DVT) is most known as being caused by sitting in a confined space for long periods of time leading to blood clot …
www.nutralegacy.com/…/deep-vein-thrombosis-natural-treatment/ – Cached – Similar -

Deep Vein Thrombosis Prevention The Natural Way

Aug 8, 2009 … The term ‘deep vein thrombosis‘ (DVT) is well and truly embedded in the … the latest cutting-edge treatments that are achieving remarkable …
www.thehealthierlife.co.uk/…/deep-vein-thrombosis-prevention-natural-00183.html – Cached – Similar

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