Sunday, August 09, 2009

Endurance Athletes and DVT's (blood clots)

Two of my running friends have developed DVT's in the past six months. Two healthy runners in their early 40's. This surprised me, as I always think of DVT's (blood clots) as something that happens to an older, more sedentary, less healthy population.
As I did some research, some very interesting information has come to light. If you are an endurance athlete, please read on. DVT's do not just happen to folks in hospital beds, if you are an endurance athlete, you need to be aware of this condition and a few facts!!

What it is: DVT- deep vein thrombosis. Layman's term: blood clot. Why this is bad: this blood clot can break off from where it's formed, travel through your bloodstream, block oxygen and blood to your brain, and KILL YOU. Or the blood clot can stay in your leg (or arm) and cause swelling, pain, even tissue necrosis in the area if left alone long enough.

SO why is this happening to an otherwise fit athlete? Atheletes tend to have a lower resting heart rate. This results in blood flowing slower through the body.
Dehydration-this plays a factor in your blood viscosity. More dehyrdation leads to thicker blood.
Trauma? Falls, bruises? Nah, this never happens in an ultra. (Non runners would call this "trauma") Ultra runners? Well, we took a face plant eight hours ago. No big deal, right? I got a little banged up. Due to this trauma, there may be a clot forming at the spot in the cell wal. This is your body functioning normally.

After the race is over, we get into our car, or onto an airplane, and travel hours back to where we came from. We spend hours in a cramped position. Meanwhile, the thickened blood is pooling.The body is still dehydrated. The body is forced into the worst position to get the blood pumping throughout the body again. This is where the start of a clot in the legs (in the deep veins) can begin.

According to a 85% of air travel thrombosis are atheletes.

What can you do to help minimize your risk of a DVT?
Keep hydrated or get hydrated after the event. Keep hydrated on the plane! Keep legs moving. Get up and move every 15 minutes. Do not stay seated for prolonged periouds of time. Stop the car every 1/2 hour and get out and walk. Move your legs and change position during the car ride. If you inured yourself or became dehydrated you are at a higher risk!

What are some symptoms of a clot forming?
If a clot forms, it usually feels like a cramp in the leg, sometimes causing significant pain and swelling. There may also be a bruising or swelling behind the knee. If your doctor says it's just a sprain ask for an ultrasound of the area.

If you have chest symptoms and you are being told you have a chest infection, anxiety attack, heart attack, or anything else other than PE (pulmonary embolism), ask for a blood oxygen measurement. They will attach a pulse ox to your finger. If the reading is less than 80, you should be checked for a PE.

What else can you do?


Movement-as much as possible after a race

Compression Stockings-compression stockings (not support hose) work by being very tight around the ankles, and become looser up the leg. By being constrictive, they will force the increase of the velocity of the blood. The blood will move faster.

Being aware of your body. publishes a free leaflet that you can use as a wallet card to help remind you of what else to do after that long run!

Oh, it won't happen to me.....
It happens to athletes. ALL THE TIME. I have 2 friends in 6 months. Some other names and their accounts:
Frey Maxim professional triathlete
Steve Lehman endurance biker

More articles:

And on a personal note, I am going to have my calf checked out. I've had a pain in my left calf for about 2-3 months now. The pain comes and goes. I've had a massage, which has not helped, and the pain is still there. I've been thinking it is just a knot, but with all the reading I have been doing, I think I would like to rule out a clot!


JolietTom said...

Hi Kim. I am currently recovering from a DVT which also spread into both of my lungs (PE). Though I am a little older (age 56), I have been keeping myself very fit for the last five years. My first full year of running I ran 2237 miles, currently I am more around 1300 per year. After I run I stretch, and do exercises with my dumbbells, cable machine, and dip and chin-up station. I also had gone to yoga twice weekly over the last eleven months. And I am a UPS service provider with 32 years of service which is sort of an industrial athlete-like life. Around ten days ago I awoke with significant pain in my right calf and a bad limp. I finished out the last two days of the work-week in this condition. Over the weekend, thinking that I had a bad calf strain, I used Rest, Ice, Compression and Elevation, but things continued to get worse. Finally on 8/4/09 I went in for the duplex doppler on my right leg, they found a thrombosis which is around a foot long, and I went straight to the emergency room, and was later admitted to the hospital. I was released on Lovenox, and Coumadin on 8/6/09, and I know that I will be recuperating for weeks if not months. I am hoping that I recover enough to return to my job, and eventually to full fitness. If you or your friends want to say hi, I am Tom, Joliet, IL

Mike said...


BRILLIANT post. You are the trail goddess in so many ways, one of which was the time you took to research and write this motivating piece. I think it is a great thing you did here.

Your worshipper...


Rob "Buckeye" Powell said...
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Rob "Buckeye" Powell said...
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Rob "Buckeye" Powell said...

I am lucky to be alive today and I mean that with all of my heart. Even though I was receiving recent medical care I had a blood clot not treated in my left calf. I think sharing my story; my signs and symptoms may educate you on this scary event and just may save your life.

As you know I have spent past 7 days in the hospital with DVT in my left leg and PE in both of my lungs and multiple clots at that. I do believe that when I completed the Pig May 3rd I failed to hydrate and keep stretching as I then drove home for 3 hours. I do carry 98 to 99 % O2 in my lungs even with the PE.

My DVT symptoms were pain in my left calf that it felt like a muscle pull. My PE symptoms was I had some limited shortness of breath when running but severe pain in my back to lower rib cage in the front. This pain felt like a muscle pull but came and went and hurt more when I breathed in. I also was coughing some blood.

As I lay in my hospital bed the past week I reflected over the past few months and trying to figure out what has been happening to my health.

At 38 years of age, I recently ran a 4:12 at the Green Jewel 50k and a 3:34 at the Cincinnati Pig Marathon all while maintaining 50-70 mile training week(s). The high mileage weeks were to train for my need complete the Mohican 100 Mile trail race. Not bad for a 190-195 lbs man.

In the period of time from my marathon in May to today I have been hospitalized for 9 days so far with two of those days the result of back surgery. The past week (7 days), I have been hospitalized for blood clots in my left leg and both lungs. I am sharing this with you now to try to get the word out about Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE).

The cause of my blood clots is really not know for sure as of yet. I am receiving tests to help determine if I have a genetic predisposition to having blood clots or a medical condition. It is possible that it occurred as a result of my back surgery (June 4th). I think that you will draw the same conclusion that I did my signs and symptoms developed before my back surgery.(read my blog)

In fact I think it is likely I have had a blood clot (leg) since May the 6th and I received blood clots in my lungs in the last two weeks. I think that I received the blood clot in the leg after the Cincinnati marathon after not taking a break and then driving home while having limited stretching.

This is a very serious situation and I am lucky to be alive. Time will tell if I will ever be able to run again. I will need medication that will make me bleed like crazy and presents a new hazard. Of course the Drs found other things to poke and prod so go get a physical blood work chest x-ray etc.

billcooey said...
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Rainmaker said...

Great post. Until recently I thought the same as you. Given how much travelling I do, I was a bit surprised to find out the same as you.

Also, pretty astounding stories in the comments here...

Thanks for sharing!

Traci said...

Thank you for that post, I had NO IDEA about the percent of travelers being athletes. I'm not an extreme athlete, but up until I messed up my knee I considered myself in decent shape. I only just turned 30 this spring, so, I'm not in the "high-risk" age group. But here's what happened to me. I had to go in for knee surgery in February, and within a day after the surgery I had a cramp in my calf that just would not go away. I figured it was just a part of the process. I went in for my 10 day post-op appt, the cramp was still there, and my calf was all swollen. The surgeon sent me for a doppler, where they found a DVT that stretched from my ankle to mid-thigh. I was immediately wheeled to the ER and triaged into the hospital. I was also coughing, thinking it was a chest infection, I didn't say anything about it, but the nurse couldn't even listen to my lungs I was coughing so much. My oxygen reading was below 70%, my lips and finger nails were starting to turn blue at this point, and she insisted on doing the CT scan. As it turns out, I had a bi-lateral PE as well. I was put in the ICU and stuck in the hospital for a week. Once I was discharged, it was still over a month and a half before I was back to work. It's almost September now, and I'm still seeing my doctor every other week for check ups and lab draws. I discovered the hardway, this is not something that you can mess around with.

bboston88 said...

Thanks for the information, this was passed along by another. I have had a constant battle with a left calf "injury" and I'm really now wondering if this should be checked out. They ruled out stress fractures and settled on nerve compression and it's better but the tightness never really goes away (comes and goes especially after runs). Did you intially go see a primary care physician to get it checked???

Anonymous said...

I am so happy to find this article. I just found out today I have a blood clot in my left leg and it has already spread to my knee. The doctors did not tell me how common blood clots are after knee surgery. I had knee surgery on my left knee over a week ago and my post-op was scheduled 2 weeks later. I personally think the post-op should never be 2 weeks out...1 at the most! I had to call and call to get someone to listen to my symptoms, which were VERY mild! I had mild tightness in my left calf that felt like a small muscle cramp...that's it. I didn't think it could possibly be a blood clot because I'm very active and don't have a history of blood clots. I went in for the ultrasound today and was shocked at the news. They already gave me my first shot of coumadin today and now I'll have 7 more shots this week plus pills I'll be taking for a good 6 months! I have no idea how long it will be before I exercise again. I teach fitness classes so I'm very concerned. Thank you for your post and anyone who is reading this with info please share! Also, if you have knee surgery be extra careful! I followed all of the precautions and still ended up with a blood clot so they can happen to anyone!

Anonymous said...

Hi there,
I am 41. Was on the Pill for 20 years (Yasmin for 4-6 years) & ran a half-marathon on Nov 8, 2009. Five days later I developed pain in my left calf & achilles. Eight days after that, I decided to go to the doctor. After being (mis)diagnosed as an achilles pull or partial tear and put in a soft cast, the doctor ordered a D-Dimer just to rule out clot. It came back positive. I was put on 2x day Lovenox 6mg injections & 24 hours later on 1x night Coumadin 4mg tablets. Three days later I developed sudden onset shortness of breath & rapid heart beat (no pain). I went to the hospital and a CT scan confirmed 2 small-ish PEs in the periphery of my right lung. In the hospital, my blood pressure was high but eventually came down, my heart rate was steady (except when I got up to use the bathroom or shower) & my oxygen levels good. I was released after 2 nights in the hospital.
Two days after that (last night) I had to go to urgent care clinic with more shortness of breath, rapid heartbeat and pressure around my neck and back. It's unclear whether these are symptoms persisting from the existing clots in my lung or new ones that have developed. My INR is now at 2.5 so just into the 'therapeutic range' but the continuing symptoms are worrying.
Just want to make a couple comments on your posting. DVTs apparently do not lead to clots in the brain--only the lungs. But they obviously can be fatal. The lung acts as a filter so any blockage would remain there & not go on to the brain or heart. If it's a large PE, however, it can be taxing on the body and cause respiratory and heart distress, or failure.
As far as going to the ER and getting your vitals checked, because we are atheltes our lung capacity is better and therefore in some cases our pain threshold higher, which is why perhaps (a doctor suggested) I haven't had much pain associated with my PE. This is a blessing and a curse. Obviously no one likes pain, but sometimes it acts as a warning--It means we need to be more vigilant about the other symptoms we get and insist they be checked out. Remember, my only symptoms when I presented with the PE were shortness of breath and rapid heartbeat.
Be aware as athletes your symptoms could be masked or downplayed because you're in such good shape.
Good luck everyone & stay healthy!

duchossois said...

Thanks for posting this. I wish I had read it before I got my pulmonary embolisms. I ended up in the hospital. I won't repeat all of the details, they are basically the same as have been already stated. I will be very careful from now on, that is a given.

Anonymous said...

my God, i thought you were going to chip in with some decisive insght at the end there, not leave it with ‘we leave it to you to decide’.

Anonymous said...


Anonymous said...

Hi Kim, I am glad I found your post and see that I am not alone with this condition. I am 43, not an athlete but a physically fit guy, who is currently recovering from a DVT/PE. Doctors believe the DVT came from a calf strain after exercising too hard on a step machine - combined with dehydration - caused the clot that traveled to my lungs. And as a risk factor I have varicose veins on my calves. Before having my PE, I was exercising 4 or 5 times a week, and probably not paying attention to hydrate myself properly before going to the gym. I also made lifestyle changes, like stopping alcohol, going to bed earlier on every night and making healthier choices with my diet. Also drinking lots of fluids everyday. When I returned to the gym, I felt like my dignity was given back to me... I started exercising agin with moderation. That has been so beneficial!!! Doctors put me on coumadin for a year or so. I thank God that I am still here to write this post... Thank you again for your support.

atsirt13 said...

Hi Kim, thanks so much for your post. And thanks for everyone else for posting their stories.

I am a healthy and active 33 year old female who has recently been diagnosed with bilateral PE. I was absolutely shocked.

I race kayaks in both short (12 km) to long (32 km) to ultra (125 km) races. So there's a lot of time spent in the boats. After a 32 km race over two months ago I started to feel pain in my side and it hurt to breathe. After a doctor's visit I was told it was likely that I had pulled my lat and told to take anti-inflammatories. The pain increased until 2 nights later I found myself in the ER with intense pain each time I took a breath. X-rays were taken and once again I was told it was a pulled muscle, given some Tylenol 3 and sent on my way. Two days after the pain was starting to subside but then I started noticing that when I cleared my throat, a little bit of blood was coming up. So back to the doctor I go. This time they send me for a saliva test and once again I'm sent on my way. In the next two months I would see three more doctors due to the blood and discomfort in my side. I was given 2 more xrays and blood tests and each time I was sent on my merry way.

All the while I continued to train and exercise.

After my last big race two weeks ago the pain came back pretty strong. So this time I head to the doctor and demand to see a specialist. Reluctantly I get a referal from the doc. Upon visiting the specialist, he immediately sends me for a CT scan to check for clots (and I'm thinking "well that's a waste of time") and I was absolutely floored when after the tests I was told I had multiple clots in my lungs and I was told to go to the ER immediately. I was then admitted.

I had no pain in my legs which preceeded this and had none of the traditional symptoms. After reading these and other posts I realize that I was lucky to only have to spend one day in the hospital. Of course they immediately put me on heparin and they are currently working out my warfarin dose. I also have to give myself deltaparin injections as they regulate my INR.

My biggest concern after I got over the shock of the diagnosis was "how will this affect my lifestyle?" I was told that as long as I didn't cause trauma to my body or cut myself, I could continue on as normal. As I recover I just need to listen to my body.

As of yet they don't foresee that they will find the cause of the PE. In the past I've had a horrible habit of sitting with my legs curled up beneath me for long periods of time. I also have poor knees and when running or hiking I would use knee bands. So while I don't think this is the only reason, I'm sure it was a contributing factor. And while I never felt any pain in my legs or had any swelling, the chance of the clots first developing there is still pretty high.

Thanks again everyone for your stories. I will certainly incorporate you suggestions for future training.

Anonymous said...

Me too. Very fit, very active runner, cyclist, swimmer who has been running forever. Last fall, ran Chicago Marathon in 3:30 and felt fine despite the heat. Jogged a 10-K the following weekend and a 10-miler the weekend after. Also several flights. When I ran San Antonio Half I was in very good shape but just couldn't run much faster than 7:20-7:30 miles. I finished and was fine. But a few days later, I couldn't complete an easy 4-mile run or swim. SO I took a few days off and instead of getting better, I got worse. Had trouble breathing through my mouth. The doctor said I had bronchitis and gave me antibiotics and I felt better for a few days. Then it felt like I had broken ribs and I began spitting up blood. Uh oh. I had some test and the doctor immediately ordered me into the hospital. Yikes! Blood clots in my lungs. Made no sense and they still can't figure out the cause. My guess is dehydration (I live and train in Texas). I'm much better, but still on blood thinners and leading my normal active life (I'm 60). Hopefully, they won't return.

Kimberly said...

As an aside, it is important to be checked for blood disorders if you do get a blood clot...there are many rare and common clotting problems that put people at a higher risk for clots. Also, vein problems and varicose veins increase risks. Add this to dehydration and limited mobility during travel and/or after a race or training and you have a recipe for a blood clot.

I have 2 blood disorders--my blood is too thick, so I am at a higher risk. I just developed my first superficial clot in a varicose vein. Knowing the symptoms, I got myself to the ER. I have since had 3 leg procedures to help lessen the varicose veins that put me at an even higher risk. My veins reflux, so vein & blood issues for me. I have worn compression stockings for 15 years as my legs swell and hurt every single day. Compression hose are a wonderful thing. Thankfully they are just now getting popular in the running world as well as everyday.

I am 39 years old, and the healthiest (always exercised & been healthy though) I I have been in years. I am training for a marathon and I am at a healthy weight & eat right. I still got a clot doing all of the right things and knowing all of the risks. PLEASE don't ever mess around with a blood clot. A PE from a blood clot killed my mother much too young. This is a very serious issue that isn't discussed nearly enough or given the attention it needs.

Anonymous said...

Five time ironman, kona, 2:42 marathoner, cyclist. 36 years old. Rode 100 miles Saturday, couldn't go up stairs Sunday. On Coumadin now, racing as fast as ever, trying not to crash. Endurance athletics is not a well known risk factor for PE among doctors, but it's real.

Michelle said...

I am a 33 year old runner and I was just diagnosed with a DVT. I thought for sure it was a stress fracture and almost didnt get an ultrasound. I run daily up to 24 miles a day and had calf pain for almost a week before I had it checked. No flights and no long car rides. They think that dehydration and change of diet, long runs and family hx may have been factors but I am glad that we caught it before it moved. Thanks for all the info the dr's didnt seem to know how much it happens in runners until I saw the vascular dr.