DVT, recovery and getting back to training

I’ve felt “off” since late September but medical tests revealed nothing. I started getting breathless in December and eventually had some pain in my right calf. On Monday I was diagnosed with unprovoked DVT in my calf and part had broken off into my lung.
I’ve finished testing now and everything else is fine and I’m on Xarelto for a few months at least which will clear the clots.
Does anyone have any experience with returning to training from this issue? My doctor is great but doesn’t really get the drive to train so I was hoping someone else had encountered this and could share some knowledge.
I figure on taking another week or so off, I stopped training in late December when I got so breathless anyway so I’ll just go back to ramp test and base training when I feel ready.
Thanks for any insights.

Been there, done that…had a DVT and PE 10 years ago.

However, I was also dealing with an Achilles issue at the time, so my return to training was pretty slow…but that was driven 100% by the Achilles, not the DVT / PE.

As for returning to training, you should first and foremost consult your doc. If he has no opinion, or doesn’t seem to know, find another doc.

Second, you need to see if you can determine the cause of the clot. You said it was “unprovoked”…what does that mean? For me, I was in a walking boot for 8 weeks prior to my DVT…but that was only the trigger, not the cause. Turns out I have a condition called Factor V Leiden, which predisposes me to clots. I’m on thinners for life as a result.

If the doc gives you the all clear to train, my suggestion would be to go more towards a Traditional Base approach, not SS. Lower intensities, etc. Even though you are on thinners, you still don’t want a chunk of the clot to break off.

Long term, it is not an issue in the slightest…other than I rarely race on the road anymore. Going through a turn @ 30moh, elbow to elbow with other riders while on thinners kinda seems like a dumb idea. :stuck_out_tongue_winking_eye:

Good luck!!,

<obviously my personal experience, not a recommendation>
I had a blood clot in my leg about three years ago, after having too many long flights and not moving around/getting up enough. I spent the next year and 1/2 acting like I couldn’t hardly get off the couch, gaining weight, etc.

The doctor told me that I would develop new pathways for the blood to get back up, even though my leg continues to be a bit swollen all the time. I started training again, and have lost about 45 pounds in the last year - hopefully I’ll be out racing this summer!

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Thanks for your experience. Unprovoked is the term the doctors used when all of the standard causes for DVT were eliminated. I figured it was the “shit happens” answer. I don’t fly much and not for a few years, no long car journeys and I try not to sit for too long at work. I’m waiting for the genetic testing result but there doesn’t appear to be anything in my family history that indicates a problem.
Training wise, not sure what the “SS”, SSB refers to, SSB maybe? but I’ve been on Trainer road pretty much since day 1 so I was going to follow the much given advice and press reset when I feel up to it, ramp test, see how that feels (Was 289) and start on base and see how it works out.
I should be off thinners in 3-6 months so I’ll be back out in the summer on road and trail hopefully.
Thanks again.

Wow, that sounds rough. My ultrasound revealed a blocked vein but the doctors think that it will recover after the thinners have dissolved the clot in my calf. I’m trying to eat healthy and not like the pounds on but it’s tough when I can’t walk very well. Maybe I’ll go swimming?

I have known a few people who had spontaneous clots with no known triggers or causes. Yeah, sometimes schitt happens…

But definitely get the genetic testing results and see what the doc recommends as a result. I laughed when my doc wanted to do the testing “c’mon, it is clear that the walking boot was the cause of the clot!”

Boy, was I wrong. :scream:

Let us know how things progress for you…good that you are on Xarelto. Next-gen thinners are much easier to manage than Coumadin / warfarin. Unfortunately, my insurance does not cover the next-gen stuff so I am stuck on warfarin. :confounded:

ETA - if your ride outside on thinners, be careful!! A fall can have serious implications…most notably inter-cranial bleeds. Get a RoadID bracelet noting you are on Xarelto and make sure anyone you ride with knows you are on thinners.

I am a NP and agree with Road ID / Emerg Alert bracelet . . . but may want to also throw out old helmets (goes for everyone as they do get less protective over time). 1 step further - you may want to invest in the New Helmets that shear a direct hit. I think Bontrager has them and called WaveCel.

More reason overall to have TrainerRoad be your mainstay of training!

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Agreed…definitely look into a MIPS helmet or the WaveCell tech from Bontrager.

(Also, generally good advice for everyone now :sunglasses:)

Unfortunately looking to revive this thread, as I found out I have two DVTs in my left leg (thigh and calf). I’ve read through a bunch of experiences people have written down on this surprisingly common issue, but a couple specific questions popped to mind that I figured I’d ask:

  1. For now my primary care physician has said that returning to very moderate exercise is fine as long as it’s not painful (and to be very honest with myself there…hard as I really want to get back on the bike), how did you find your return to training? I’m slowly ramping it up, but expecting to stay basically in the 60% - 70% FTP range for the next 4 - 6 weeks. Did you have any issues with volume, or strictly intensity was a no-no?
  2. I’m seeing my HR a little higher than previously (~10 bpm or so) - did others see this as well? My breathing is fine - this isn’t anything like shortness of breath which I know is a huge warning sign, just the HR is a bit higher.
  3. What was the overall timeline for recovery to “pre diagnosis” or “normal” levels? I had been feeling off (modest pain & swelling) the two weeks before the official diagnosis, so have to think I was affected for a while, but not sure what the recovery timeline is like.
  4. Did you change your training at all after wards in response to the diagnosis? Maybe more/less volume, adding strength work, anything like that? Honestly not even sure what would help - seeing that tempo and sweet spot are great for building additional capillarization / plasma volume (per this resource) so might be something to focus on more long-term?
  5. More of a medical than training question - in the path to recovery, what did you rely on primary care doc for and what did you get from the hematologist? My sense is hematologist is there for treatment & diagnosis of the specific issue, and primary care is there for managing recovery and integrating back into any other health issues (and long-term monitoring) but not sure if that’s how you found it as well.

Thanks in advance on any thoughts here, or just general DVT experiences to share!

Sorry to hear about your diagnosis…but at least they caught it before it turned into a PE or worse. The good news is that it can be easily managed and should not present an issue, long term. But first, and this is critical, you need to determine the root cause of the clots. Make sure you are tested for genetic issues such as Factor V Leiden, which is what I have, etc.

As to your questions…

  1. I was also dealing with an Achilles injury, so my return to training was somewhat limited by that, but I could pretty much do what I wanted once I got my INR to a therapeutic level (between 2.0 and 3.0 for me).

2). Don’t really recall any specific issues with HR.

  1. Again, my return to “normal” was affected by my Achilles, but I would think you should get back to “normal” as you would from a similar break in training time. There is nothing detrimental about the DVT to affect performance from a training perspective.

  2. Nope…just started training again, although moderately.

  3. My primary care doc monitors my INR levels and adjusts my warfarin dosage if necessary. I consult with my hematologist once a year, who monitors my Factor V. I did have to consult with him late last year when I needed to get a hernia operated on and he determined my pre / post-op blood thinner regimen.

Good luck…feel free to ask any questions, glad to offer my insight. / experiences.

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Thanks for the quick and detailed response, really appreciate it!

Definitely agree that the timing definitely was good - seems I avoided most of the serious complications and the blood thinner is helping, which all things considered is a great outcome.

For the root cause determination - was that primarily with your hematologist? Unfortunately I’m 5 weeks out from that appointment (so little availability) but my sense is that’s adequate as this diagnosis is more about the long term management and recurrence of the issue.

just jumping in here in case others read in the future.

this is actually not recommended by current thrombosis guidelines ( American Society of Hematology 2019 VTE guideline). note that many doctors will still do it. length of treatment is guided by if it was provoked (surgery, immobilisation, travel, sickness, oestrogen treatments, catheters…) or unprovoked (no risk factors/chronic risk)

sounds good, you can start with little and it is okay to increase time/intensity towards sweet spot guided by your symptoms. don’t increase if you have pain/swelling/tightness in the affected leg after. in this case you may need more time. some people find that compression sockings help during day-to-day life to reduce symptoms (if any persist beyond the acute recovery phase).

after you have recovered, no need to do specific adjustments the future, unless a specific intensity zone gives you symptoms in the affected leg. any exercise will help! :slight_smile:

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Thanks so much for the detailed response @schmidt , I really appreciate it.

Is this the main metric you would rely on - pain / swelling in the leg after? I’m thinking that HR is one I should monitor closely as well (mostly to compare to “pre” levels) but maybe that’s overkill? Thanks.

Yes, it ws by my hematologist. I don’t think there is an issue with the timeframe since you are already on anticoagulants, so I don’t think there is an immediate danger.

I’ll defer to Schmidt’s statement re: guidelines, but since it is a simple blood test to determine potential genetic causes, I can’t really see a downside in getting tested.

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That’s a good one for sure.

Hard to interpret the HR differences because you may have some detraining etc. Tbh I wonder if it gives you any actionable info.

That is highly individual, some will be fine in the leg after a week and others will have months of residual symptoms and a part may even stay as long term problems.

Btw you haven’t written how long ago it was, definitely give it a week or two and you should not have substantial leg symptoms left when you start training

I fully understand this point and it was accepted practice for a long time, and only recently started changing and continues to be debated among doctors. So it’s certainly not wrong.

Not sure the discussion of specifics belongs on a bike forum but I’ll write it anyway. Some of the downsides are as follows. A full thrombophilia work-up with genetic tests and some others is easily a few hundred euros. The outcome of testing mostly does not change management or prognosis because the primary clot mechanism (provoked/unprovoked, chronic risk) is much more predictive than having a genetic risk factor or not.
In other words, if a person doesn’t have any genetic risk factors but has had an unprovoked clot, the body has already shown that it has the potential to have spontaneous clots. That’s what determines future risk. The other way around, if a person has a mild genetic risk factor but only showed a thrombosis after being in a full leg cast for 2 months and good recovery, there’s not a substantial risk for future clots unless one has a cast again or other substantial risks like a 6 hour flight etc.

Some argue that genetic testing is useful because it may help family members to be tested and receive better thromboprophylaxis when they have a cast etc. On the other hand, they should get that treatment anyway because they’ve had a first degree relative with a blood clot. (Including no estrogen anti-conception for girls)

There are cases where family members get tested without having had any health issue themselves and then have found a “mutation” (factor V Leiden for example is present in up to 10% of a European population). Following this “diagnosis”, one can get issues with insurance. There’s a case of a young woman who got tested for a family member and didn’t get accepted to police academy because of this. Then there is the effect of living life with the idea of somehow not being healthy. All without ever having had a problem as a person.

I think that’s rather negative co-notations for risk factors that have no impact on management and prognosis. It’s an ethical discussion too. But some people just want to know and some docs just like to do it.
It’s not wrong, there may be good reasons, but it’s certainly a complicated issue.

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The clot really worsened last weekend and then I went to the ER / started blood thinners a week ago today. Waited until the leg was significantly better until I got back on the bike, probably about 80% strength and reduced swelling, and then did rides like this:

image

Very mellow and then making sure to hydrate well and get in compression socks as soon as I’m done, likely planning this for at least the next week or until all symptoms are gone. I do like staying mobile for my sanity, so getting in these easy rides is good there, but I have no intention at all to push it to get back to vigorous / specific training.

These specifics were SUPER helpful for me - thanks for laying it out in such detail. I definitely agree that the risk of a “unrealized positive” could definitely outweigh the benefit - maybe there is some truth to “ignorance is bliss” after all…

Thanks again for your clearly well informed take on this complicated issue.

I didn’t go on the trainer for a solid 2 months after my DVT, and I’ll be honest… I was terrified something was going to happen the first times back. Sadly I still have to wear compression socks from time to time as my legs swell badly if I do anything over an hour and a half these days. Still, summer heat aside, that’s not really the end of the world.

If it makes you feel better, I made it to 4.9 w/kg a few years later so even with appalling circulation it’s possible to be a strong cyclist.

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looks good, probably hardly more effortful than taking a walk. it sounds like you give your body the time and when you get symptoms take it easy. you’ll do well :slight_smile:

:clap: great to hear - you’re really fit and have found a way to deal with some residual issues!

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Sadly that’s “was” really fit. I shattered my hip socket a couple of years back and have struggled to recover any sort of fitness since (not helped by a bad bout of COVID last year).

Still, I keep trying.

I had a PE in 2015 and recovered really well and after a month or so was back on the bike. My problem was the anti coagulant Pradaxa. I felt that it was not right for me. I had periods of low blood sugar and low potassium resulting in raised blood pressure and palpitions. The doctors were convinced I had a heart problem and prescribed calcium channel blockers for blood pressure and heart rate. They did not really work and I found out that they should not be taken with CCB’s. After a discussion with the cardiologist he changed the anti coagulant to Eliquis. It has transformed my life.

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