No more EPO shakes for breakfast

[Legspeed]

This saga contains clues, beginning with the thread title, as to why I've been absent this past month. The only reward for correctly guessing my malady is the time you will not have spent reading the last half of this narrative.

My story begins
===========
In late March, I traveled to Houston for a 400k brevet. Given the terrain and weather forecast, I was hoping to set a personal record. The weatherman said an approaching cold front would arrive early in the afternoon. Perfect! Just enough time for me to make the northernmost turnaround point. I could sit up and practically coast back with the expected tailwind. Naturally, the weatherman was off by about 7 hours and we had a 20-25mph headwind almost from the start. Bye, bye PR.

There's no crying in randonneuring, so I just kept my head down and slogged it out. Of course, once I made the turnaround, the winds began to diminish. That's OK. The ride back would still be easier than the ride out.

We got back a little past midnight, had breakfast at a truck stop, and hit the sack. The next morning, we had breakfast again. This time, though, I tried to drink the diner out of coffee (hey, it was surprisingly good!) in preparation for the long drive home. Those wondering what all this has to do with my condition, here's clue #1: with all the coffee I drank, I only had to relieve myself once in the four hour drive home.

One week later
==========
I was out hill training the week before my next 400k. This one was very hilly (about 10k of total climbing). About midway through my workout, I thought I pulled an adductor muscle. Nice, a pulled muscle right before a hard ride. (Pssst, that's clue #2).

The muscle pull seemed to be getting worse (clue #3), even though I had reduced my workout volume to almost nothing. The night before the ride, I began thinking that I might not be able to finish a very hilly ride with a leg this sore.

Luckily, I never found out. I dutifully set my alarm for an early wakeup and even got to bed early. When it went off the next morning I never even heard it. I apparently turned it off and just kept on sleeping. When I finally did wake up, the event had already started.

Well drat, I thought. How embarrassing to oversleep and miss an event. Oh well, since I have some "found time" on my hands, what better way to spend it than catching up on honey-do's around the house?

It had been a fairly warm and humid day. My chores had me sweating almost as much as if I were riding my bike. I probably should mention I was only drinking water all day. It was no surprise then that later that evening, when I got up to go to bed, my calf cramped something awful (clue #4). Figuring I hadn't replenished my electrolytes, I took some electrolyte tablets and went to bed.

The big reveal
=========
The next morning when I woke up, my calf was still "cramped". It was now so bad, I couldn't walk on it. Time to go see a doctor. I decided to start with a visit to the Doc-in-the-box since it was (a lot) cheaper than going to the hospital. After a brief exam, the doctor wasn't sure what was causing my pain. My leg wasn't swollen , the #1 clinical symptom for a clot, but she encouraged me to get a sonogram immediately to rule that out. The only place to get a sonogram on a Sunday morning was the ER, so off I went.

ERs take potential blood clots pretty seriously. The Doc-in-the-Box had called ahead and before I could finish saying my name, an orderly was pushing a wheelchair under me and hauling me off to triage. Thankfully, it was a slow morning. After a brief discussion with the ER doctor, I was sent to radiology for a sonogram 30 minutes after walking in.

Standard procedure for a sonogram is to start in the groin and work down the leg. I was beginning to anticipate the news that I had a clot in my calf. There just wasn't any other reasonable cause. Imagine my surprise when as the first image appeared from my groin the tech said, "Sorry to tell you this, but you definitely have a clot."

"Wait a minute," I replied, "it's my calf... that... hurts..."

Then I remembered that "groin pull" that didn't get better. The tech continued imaging my leg and told me that I had clotting down one of the "sub-major" veins from my groin to my calf. Oh. My. Gawd.

After I was wheeled back to ER triage, I asked the doctor how long I might have had the clot. He said it looked very recent, within the last couple weeks. Hmmm, about the time of that Houston brevet...

The ER doctor said that had I gone riding the day before, there was a very good chance that instead of that clot stopping in my calf, it would have gone to my lungs. A pulmonary embolism is not a good thing to have on a rural Texas road with sketchy cell phone service. It's not a good thing to have in an ER for that matter. Whew! I had dodged a bullet!

Instead of being hospitalized, I was put on a heparin drip for the afternoon and given a prescription for a couple of blood thinners. When the bag was empty, I was discharged with orders with strict instructions to avoid vigorous activity.

About that dodged bullet...
=================
Who knew that frantically dialing the phone to get my classes covered constituted "vigorous activity"?

A couple of days later, all of a sudden I was breathing like a goldfish out of water. So this is what a pulmonary embolism feels like. A 911 call and a meat wagon ride to ER later, I was getting a CT scan to find out just where the clot (no, clots!) had ended up. Lucky for me, the three smallish clots I had thrown settled nicely into my lungs after a heparin bolus and blood flow was no longer compromised. Whew! I was so relieved to be breathing that I didn't mind feeling like I had three pieces of ragged metal sticking through my chest or that every breath was agony (RPE 9 on a scale of 10). That's what pain meds are for.

Let's skip forward to real time.
====================
My blood is now so thin it evaporates before it clots. I'm having a hard time stabilizing the blood thinner medication. It seems like all the good things in my diet interfere with the blood clot medicine. One week, the levels aren't high enough, meaning I'm at risk to develop more clots. On my second clinic follow up I was rushed to ER (again!) because my INR factor was way too high. That explains the nose bleeds and spontaneous bruising.

I'm weaned off the pain meds. The clots in my chest are slowly being absorbed and the pain is becoming manageable. I still get a bit out of breath after a long flight of stairs. I'm hoping it's just lost fitness after 4 weeks of largely sedentary life and not a permanent loss of lung function.

Time will tell.

And I'm thankful to have the time.

Postscript
=======
Turns out that endurance athletes are very susceptible to clots. Low resting heart rates, higher than normal hematocrits, and elevated protein metabolites (especially after events) all increase the risk, especially when dehydrated. Would you believe there are newsletters devoted to endurance athletes and blood clots?

[megale3]

Man take care Leg ~when you read it like this your a lucky man that you listened to what the body was saying. Have a nap and a blood thinner on the house. Kiddin :P
Meg

[Kelspin]

Leg,
WOW to the journal of events - very scary stuff!! Keep us posted on your progress!
Keli

[Julibird]

Wow - you are a miracle man. Wishing you a peaceful and full recovery.

Only other time I heard of such a scare was when a family friend (a serious marathon runner) developed a clot in his leg after a race. Never knew about the endurance connection there.

Thanks for sharing your story with all of us.

Julie

[Pink]

Legs, I am so sorry you are going through all this but tremendously grateful that you found things in time to ward off a catastrophe. I will certainly be sending get well, get back, get strong vibes to you. BTW, my hubby is a Pulmonologist/Intensivist so reading your story was like listening to him on the phone with an ER doc. I'm certainly not as nonchalant when the patient is someone I know. I wish you a tailwind recovery.

[lizardbiker]

Take care of yourself Legspeed! Cycling is for health and fun - don't let it kill you! Hope your back to feeling the road under your tires soon!!

[JFK]

Legs,

How many points do I get for diagnosing you from the title? :wink:

Seriously, glad to hear you are doing well. Stop taking advice from Dr. Fuentes, stay hydrated and stick around so we can continue to hear your unique perspective.

[Moonsavvy]

Thanks for enlighting us on the details. That is a pretty amazing story. So glad to hear you are recovering and doing well. Keep it up and come back and play! :D

During your break a few of us were banned from the other forum. You missed out on the draaama, it was pretty crazy.

Anyway it's good to see you, oh and get your avatar over here!

[like2bike]

I'm weaned off the pain meds. The clots in my chest are slowly being absorbed and the pain is becoming manageable. I still get a bit out of breath after a long flight of stairs. I'm hoping it's just lost fitness after 4 weeks of largely sedentary life and not a permanent loss of lung function.

Time will tell.

And I'm thankful to have the time.

If you were standing here with me you'd be getting the biggest bear hug of your life.

First, may I say it is wonderful news that the clots are being absorbed and your pain has lessened. I cannot imagine what that pain feels like now, let alone at its worst.

Remain the positive person that you are. Being so physically and mentally fit will get you to where you want to be.

And Legs? You're not the only one thankful to have the time. Your family and friends are thankful as well. You will win this one. Matter of fact, you already have.

[yvonne]

Wow!

as i'm sure your Randonneuring has taught you ... be patient! take your time with your recovery. allow your body and mind to heal so you can get back to doing what you love to do.

while you're on the mend, and feeling stronger, pull up a keyboard and spend some time with us ... we always benefit from your knowledge, your wit, and especially your sense of humor ... i STILL laugh out loud when i recall the "rest day" commentary piece you wrote for one of these forums back in 2001 ... this was right after Jan Ullrich misjudged a turn and went off the road endo-ing into the bushes! Your commentary was hilarious!you had Jan rolling down the stairs on the way to breakfast into the buffet. I wish i could remember which forum that was .. i'd re-post it today ... it was priceless!!!

really glad you're ok ~

[jsejt]

Thanks for sharing.....hope your feeling well soon....now on to the avatar business. :wink:

[joyofspin]

Legs - I do sincerely hope that you are on the road to recovery. It must have been a nightmare emotionally and physically. Hopefully you will recover and all will be fine. Please keep us updated.

[monical1]

What a mess! I, too, am glad that you are able to listen to your body. I have a sister who is unable or unwilling to listen to her body and it gets her in a lot of trouble. She had stomach cramps that were so bad that she would double over in pain. They would come and go over a period of about two weeks. She kept rolling right along like nothing was the matter, she told everyone she was sure it was just the flu. I made her go to a walk in clinic and they found protein in her urine. She was sent to the ER and emergency surgery was what was waiting for her there. She had 19 inches of her colon removed! Apparently she had Diverticulitis (sp) which became Paritinitis (sp) and her colon had a whole in it that was leaking toxins into her blood stream. She surely would have died had she waited much longer.

Continue to take it easy until you are fully recovered and let the people on this great forum help you heal with laughter, after all, it's the best medicine.

Monica

[melanieann]

Legs- Thank you for the update. Please take it easy and know we are all here for you! Sending positive thoughts your way!

[AC]

Glad they got it...I went through the exact thing with my kid brother who was walking out of the ER after waiting too long for an examination. 30 minutes later he was admitted for a week with a similar clot.

Glad to see you're planning a return to the front bike.

[veespin]

Would you believe there are newsletters devoted to endurance athletes and blood clots?

Yes....but more of that later*.

I'm reaaly glad you're on the mend and you stared down The Grim Reaper (yes you did!!!)

Have you been given a preventive regimen that the rest of us need to know about??? Can't say I'm in the league to be brevetting like you (and I'd hesitate to try after your escapade!!) but it seems to me that your episode happened as a result of being Seriously Fit™.....which a good many of us are.

I decided to start taking a few supplements a while back......not with any religiosity but more of a "you never know" mentality. I've included fish oil capsules for the omega-3 fatty acid content and these are purported to have a modest anti-coagulation effect. Has this been mentioned??? Should I be guzzling aspirin???


*On the subject of "you don't know what you don't know".......a few years ago, I accompanied dh to some medical bash and we ended up on a table of gastroenterologists. Talk turned to my upcoming half marathon and the (apparent) problem of ischaemic colitis with endurance anthletes.....never heard of it in the terms that these dudes/dudettes were discussing it but since they weren't runners (and very obviously so not runners) I dismissed it as the sort of stuff you hear from folk who're embarrased in the company of someone who's doing what they know they ought to!!!

Anyhoo....imagine my surprise when, on the way back to the car after my race, I ended up doubled over in pain...as if I'd just had a colonoscopy with length of drainpipe!!! Husband carried me back to the car...with many "I told you so's"......and me on the toilet for the next few days with quite a serious bloody colitis.

And, yes, once I was alerted, I found more than a few references and web pages devoted to endurance athletes who'd even lost part of their colons to the mesenteric ischaemia associated with what we do for fun!!

Speedy recovery, Legs!

Vivienne

[Legspeed]

Have you been given a preventive regimen that the rest of us need to know about??? Can't say I'm in the league to be brevetting like you (and I'd hesitate to try after your escapade!!) but it seems to me that your episode happened as a result of being Seriously Fit™.....which a good many of us are.


I think it's important to clear one thing up, randonneuring had absolutely nothing to do with me getting a clot. As you correctly said, it was the training that resulted in me becoming Seriously Fit™. It was being inattentive to proper recovery that caused it.

Funny you mentioned fish oil. DW has been trying to get to take fish oil caps on a regular basis for about a year. I would take them for a while but invariably, I would burp up the taste of fish midmorning. Blech. So I would stop taking it.

We're sitting in ER after my sonogram, waiting for the doctor to come in. DW turns to me and says, "See! I TOLD you...you have sticky blood!"

Personally, I wouldn't recommend taking aspirin regularly. That's a good way to get an ulcer. My doctor and I haven't discussed any long term prophylaxis as I will be on prescription thinners for another six months. I would say, though, I now have a renewed motivation to take fish oil caps.

[like2bike]

I would say, though, I now have a renewed motivation to take fish oil caps.

Maybe if they use Orange Roughy in those fish oil caps--that might help you burp up an orange flavor. :lol: Sorry. Rough night. Get it? Rough? Roughy? Orange Roughy? OK I'm punchy.

[JFK]

I keep my caps refrigerated, and I take them with a meal. All of which attenuates the "repeating fish" syndrome.

As for regular (low dose) aspirin therapy, more and more research is making it look like a good thing. Ulcers aren't the issue, though GI bleeds might be. Obviously (I hope it's obvious) it's something one should take up with one's physician. Fish oil included, since it might affect other meds.

[veespin]

Have you been given a preventive regimen that the rest of us need to know about??? Can't say I'm in the league to be brevetting like you (and I'd hesitate to try after your escapade!!) but it seems to me that your episode happened as a result of being Seriously Fit™.....which a good many of us are.


Funny you mentioned fish oil. DW has been trying to get to take fish oil caps on a regular basis for about a year. I would take them for a while but invariably, I would burp up the taste of fish midmorning. Blech. So I would stop taking it.

We're sitting in ER after my sonogram, waiting for the doctor to come in. DW turns to me and says, "See! I TOLD you...you have sticky blood!"

Personally, I wouldn't recommend taking aspirin regularly. That's a good way to get an ulcer. My doctor and I haven't discussed any long term prophylaxis as I will be on prescription thinners for another six months. I would say, though, I now have a renewed motivation to take fish oil caps.

I've been doing a fair amount of sorting out the research on commonly recommended supplements for a while now.......nothing "fringe" but there does seem to be a reasonable amount of evidence to support the use of fish oil for omega 3 fatty acid content. The burps sure do make it burdensome, though, but there are a few companies that formulate the capsules so that it's much more tolerable.....Life Extension Foundation make a "burpless" capsule and I think also Carlson....I'll check for sure.

I have a few patients on anti coagulation therapy and most of them seem to be advised to go the aspirin route once active therapy is over. I often wonder if there was more money channeled into nutritional reseach whether fish oil might be recommended more frequently......if only for the lack of side effects (except the burp)

Vivienne

[Escandalosa]

If it's omega 3 you're looking for why not take flax seed pills instead of the fish oil pills. No fish burp :)

[veespin]

If it's omega 3 you're looking for why not take flax seed pills instead of the fish oil pills. No fish burp :)

No EPA or DHA, either.

The omega 3s in flax seed oil are short chain fatty acids ALA (alpha-linolenic acid) Less therapeutic activity than the long chain FAs found in marine cold water fish and not as well absorbed.

Flax seed is recommended by the folk who go in for this herbal stuff for the "anti-cancer" benefits associated with the lignans found in the flax seed itself. These are lost in the manufacture of flax seed oil.

Vivienne

[Escandalosa]

Man that stinks. I was just in Costco and holding fish oil pills and flax seed pills. I had no idea which to get so I got the flax seed. So you're saying I might as well be taking M&Ms?

[veespin]

Man that stinks. I was just in Costco and holding fish oil pills and flax seed pills. I had no idea which to get so I got the flax seed. So you're saying I might as well be taking M&Ms?

Not necessarily.....it depends on your rationale for taking the stuff.

Large doses of fish oil (>5gms a day) apparently reduces cholesterol effectively. The anti-platelet/anti-thrombotic and anti-inflammatory properties are due to the body' ability to convert the EPA (eico-something-penta-something-acid) to prostaglandins.

I think the flax seed oil is marketed to vegetarians but the ALA (an essential fatty acid, BTW, so it's not a total waste) isn't well converted to EPA, as far as I'm aware.

You see "Inflammation" is the buzz word these days.......and more of a problem the older you get.....hence my interest.

Everything has a price tag, though, and you need to balance trade offs. Are the anti-clotting properties always a good thing.....not necessarily. You want it just like Goldilock's porridge....not too little and not too much. I read somewhere that Eskimos whose diet is very heavy in marine cild water fish (and consequently EPA and DHA) have a greater incidence of haemorrhagic strokes than the average Westerner.!!!

You makes your choices and takes your chances.

Vivienne

[Todd S]

... or, you could just eat some fish a couple of times per week.

As a matter of fact, I happen to have some stuffed salmon ready to go on the grill right now. :)

[AC]

... or, you could just eat some fish a couple of times per week.

As a matter of fact, I happen to have some stuffed salmon ready to go on the grill right now. :)

Copy that...I eat salmon several times a week. I just like it.

[Escandalosa]

Unfortunately that's not an option. I seriously dislike salmon.

[veespin]

Unfortunately that's not an option. I seriously dislike salmon.

I eat it once or twice a week.....tops. I don't mind it but there's stuff I prefer to eat and I don't like the stink around the house.

It's interesting that when you start discussing supplements there's always a...."why don't you just eat......" crops up. Not totally unreasonable as a knee jerk but the whole rationale of supplementation is that you're supplying elements in addition to what's normally considered a nutritious eating plan and generally in greater quanities than would normally be possible to eat if you happen to like a varied diet.

That's what supplementation means. If you were adding to a diet that's deficient (like if you hate fish) then it should probably be called subsitution.

I guess it's a bit like exercise......40 minutes or so 4-6 times a week is good for general health improvement. And then there's what we do.

Vivienne.....PS, if you're going to use you flax oil, do it quickly. It goes rancid very quickly when the bottle's opened.

[AC]

Unfortunately that's not an option. I seriously dislike salmon.

And the salmon have mentioned to me on numerous occasions they are not fond of you either.

[Escandalosa]

Unfortunately that's not an option. I seriously dislike salmon.

And the salmon have mentioned to me on numerous occasions they are not fond of you either.

I knew those bastards were hating on me. Wait till I tell the bears.

[like2bike]

Starbucks all over my computer screen...thanks....

[AC]

Unfortunately that's not an option. I seriously dislike salmon.

And the salmon have mentioned to me on numerous occasions they are not fond of you either.

I knew those bastards were hating on me. Wait till I tell the bears.

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

[Escandalosa]

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

I've just told Chloe what you said. She's on her way to Jersey right now. If I were you, I would pack my bags and get out of town for a while.

[cfoam4me]

Starbucks all over my computer screen...thanks....
We seriously need waterproof screen savers. :D

[lizardbiker]

Starbucks all over my computer screen...thanks....
We seriously need waterproof screen savers. :D
I wonder if my patent for screen protectors that I developed at the "other" site transfers to this site...
btw - now I won't be able to sleep at night due to nightmares of cute doggies brutally tearing me apart.

[AC]

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

I've just told Chloe what you said. She's on her way to Jersey right now. If I were you, I would pack my bags and get out of town for a while.

I'll be right here..with my salmon body guards and posse. If Chloe leaves now, with traffic, she should get here in about 7 hours from Manhatten. My guess is my feet are bigger than your pet.

[Escandalosa]

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

I've just told Chloe what you said. She's on her way to Jersey right now. If I were you, I would pack my bags and get out of town for a while.

I'll be right here..with my salmon body guards and posse. If Chloe leaves now, with traffic, she should get here in about 7 hours from Manhatten. My guess is my feet are bigger than your pet.

You want a piece of me?

http://img.photobucket.com/albums/v26/Danimara74/Chloe1-24-04.jpg[/img]

[lizardbiker]

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

I've just told Chloe what you said. She's on her way to Jersey right now. If I were you, I would pack my bags and get out of town for a while.

I'll be right here..with my salmon body guards and posse. If Chloe leaves now, with traffic, she should get here in about 7 hours from Manhatten. My guess is my feet are bigger than your pet.

You want a piece of me?

http://img.photobucket.com/albums/v26/Danimara74/Chloe1-24-04.jpg[/img]

Ok - nightmares if I do get to sleep tonight. The attack of the sickeningly cute doggies!!

[veespin]

Well played, however remember, you are a fish alternative to a bear who might want sirloin that day. And your little dog too...heh...heh...heh...

I've just told Chloe what you said. She's on her way to Jersey right now. If I were you, I would pack my bags and get out of town for a while.

I'll be right here..with my salmon body guards and posse. If Chloe leaves now, with traffic, she should get here in about 7 hours from Manhatten. My guess is my feet are bigger than your pet.

You want a piece of me?

http://img.photobucket.com/albums/v26/Danimara74/Chloe1-24-04.jpg[/img]

Ok - nightmares if I do get to sleep tonight. The attack of the sickeningly cute doggies!!

Forget the Dog Breath™....what about the n-3 burps!?!

Vivienne

[veespin]

Forget the Dog Breath™....what about the n-3 burps!?!


Yes....my dogs do get omega-3 fatty acid supplements!

Vivienne

[AC]

Vicious ugly beast.

[Escandalosa]

Hilarious :D

[lizardbiker]

Hmmm - death match.... who to put my money on.... Dick Cheney or the cute puppy? Dang even odds! I'm going to risk it all on the puppy! Attack!!! Attack!!! Get him puppy!!!!

[Escandalosa]

Woooooooooooooo Hooooooooooooo!! I win. Chloe is eternal!

Suck it bitches! 8)

[AC]

OK...I had to go to Avatar Def Com 4

Prepare to get loxed.

[lizardbiker]

She lox me, she lox me not, she lox me, she lox me not...

Say, instead of a lox, it would be even better if you could (any Mony Python fans out there?) get...

A Herring!!

You can cut down the mightiest of trees with it - might be a good weapon against a cute attack dog...

[JFK]

Somebody get this thread a GPS....it has drifted mightily (so what else is new?) :wink:

[AC]

Sometimes a thread has to just swim upstream.

[like2bike]

If we were to have a contest on the best thread ever, this would be IT.

LMfreakin'AO

[joyofspin]

[quote="veespin"]

I eat it once or twice a week.....tops. I don't mind it but there's stuff I prefer to eat and I don't like the stink around the house.


Viv - easy no stink method - good old aluminum foil - make a pouch out of it salmon inside (of course) it usually comes out moist and no fish smell throughout the house - or you can go the easy way. Shoprite cooks the fish for you in the store - choices of marinades and cooking style. I do it all the time - place the order and shop - come back pick it up and take it home. Only have to reheat.

[Legspeed]

[quote=veespin]
I eat it once or twice a week.....tops.

Someone please remind me what we're talking about.

[kszspin]

Someone please remind me what we're talking about.

It was either a lactic acid/lactate debate or how many miles we actually ride in class. :roll:

[lizardbiker]

I thought it was about eating too much fish can give you herpes...

[JFK]

It was either a lactic acid/lactate debate or how many miles we actually ride in class. :roll:

I thought it was about eating too much fish can give you herpes...

This is why I love you all. :D Long live the internet! Long live thread drift!

okay, I'm going back to my stats dungeon now. Thanks for the break!

[megale3]

This is why I love you all. :D Long live the internet! Long live thread drift!

okay, I'm going back to my stats dungeon now. Thanks for the break!
Jen is that like Cardiac drift?? :P I know don't get you started.
M

[AC]

I change my avatars when the voices tell me...call it schitzavatarphrenia.