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Back to training after pulmonary embolism
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So I dislocated my shoulder snowboarding about 11 days ago, and then 8 days later started having rib/chest pain trouble breathing and after a battery of tests hospital doctor discovered I have two small PE's in each lung. Spent 24 hours in the hospital before heading home. Docs couldn't say for certain it was related to the dislocation injury but from my own research getting hurt traumatically at about 11k seems to be the culprit as I'm 33 and have been training hard for Wildflower in May and was feeling great and no prior history of these issues.

Other than wrapping my head around the blood thinners for 3-6 months I'm feeling okay, other than a bit fatigued but would appreciate insight from others on how it felt getting back to training after experiencing a PE? Thanks!
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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Saw your post on the FB running after PE Page. Sorry you had to join the club

This is partly a decision to be made with you and your family and doctor, but riding outside on thinners does present certain risks. I know you have WF coming up so that’s a decision to be made

FWIW I am a lifer on thinners since 2009 and continue to train and race. I do things but differently than before, keep my INR as low as possible, etc. but there are still risks. That said I had a pretty bad accident in 2015 but came thru ok all said.

As for fitness, I came off WF long a few weeks before my PE. It took them a while to diagnose so I had some lung damage. It took about a year to get back to full cardio shape. YMMV
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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On which blood thinners are you?
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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After finding and breaking up a clot extending from my calf to my groin, I've been on Xarelto for about three years now. It didn't take long to get my endurance back after returning to training--approximately 3 months or so.

I now do most of my training on the trainer (using TrainerRoad), and I shifted my emphasis from general road racing to time trials in an effort to avoid (or at least reduce the risk of) accidents/collisions. I'm probably being paranoid, but when I see how much I bleed from a shaving nick, I have erred on the side of caution.
Last edited by: AZSkeptic: Feb 8, 18 10:29
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Re: Back to training after pulmonary embolism [Thorax] [ In reply to ]
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Eliquis for now. Plan to review with hematologist at appt next week.
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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JKR12 wrote:
Eliquis for now. Plan to review with hematologist at appt next week.
Good stuff. You'll be OK. Follow your doctors advice.
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Re: Back to training after pulmonary embolism [ChrisM] [ In reply to ]
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Thank you for the concerns and well wishes.

Like most of course I love riding outside and living in SoCal certainly means it's enticing to be on the road year round as much as possible, but some of my first thoughts on training were exactly what you said as to the risks of a crash while taking blood thinners.

Glad to hear you made it through that accident in 2015 okay....at this point with my shoulder only at 2 weeks post dislocation I'm not even sure where I'd be for being able to swim by early May but was thinking of just going and doing the bike and run portion regardless because I already paid and didn't get the insurance (of course), but obviously this new diagnosis has thrown quite the wrench in the plans.

Appreciate the insight on your fitness. It sounds like I was pretty lucky and some good doctors discovered the PE's pretty early on, but I haven't tried much yet so I guess the real test will come with a hard trainer effort or when I'm cleared to run again.

Thanks again for all the great info and shared experience.
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Re: Back to training after pulmonary embolism [AZSkeptic] [ In reply to ]
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Appreciate the great insight. I guess lucky for me I really only ride for fitness/tri training as I was always too much of a wuss to get into road racing anyway...then again my snowboard injury happened at a ridiculous rate of speed and I used to race Boarder X but always had a lot more faith in my snow skills over road skills....go figure as my arm sits here in a sling!

Are you on the xarelto for life?
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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Yeah, I am in so cal too, and it makes it a little harder, but I've switched to trainer only during the week. Given my commute and sunlight hours though, not sure that's any different than what I would be doing anyway (and honestly my trainer work took me from a fair to middling cyclist to a knocking on AG FOP cyclist). Weekends I ride outside. I don't ride in big groups (although I broke that rule for a little while with a group in PV, but it was a little sketchy relying on other folks' bike skills), I don't ride certain roads (PCH between Temescal and Cross Creek), but other than that ride pretty normally. road, tri and mountain bike.

I did take a hit from the lung infarction, the docs took 6 weeks to diagnose the PEs and I was training (or trying to) so some damage was done. That said, mine were July 4, and I did a mile OW swim race in August and even got 3rd AG (not a huge field LOL), so fitness was there, but it really took a full year to feel "normal." I actually had another round in March of the next year, which is why I am a lifer. That was caught much earlier and no fitness issues resulted.

Since then I've done two IMs and 5 or 7 half irons, I forget. And a shitload of other races.
Last edited by: ChrisM: Feb 8, 18 13:56
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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JKR12 wrote:
Appreciate the great insight. I guess lucky for me I really only ride for fitness/tri training as I was always too much of a wuss to get into road racing anyway...then again my snowboard injury happened at a ridiculous rate of speed and I used to race Boarder X but always had a lot more faith in my snow skills over road skills....go figure as my arm sits here in a sling!

Are you on the xarelto for life?

Unfortunately, I am on it for life. My pulmonologist tried taking me off the medication for a short time, but another clot started to form.

I hope your recovery goes well and that you're back in the saddle soon. Best of luck.
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Re: Back to training after pulmonary embolism [AZSkeptic] [ In reply to ]
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I had a PE six years ago and been on coumadin/warfarin since then.

When I broke my leg, I switched to xarelto because the doc wanted to be absolutely certain about my clotting risk post-surgery, especially given the screws inserted into my tibia. My personal experience on xarelto was that I felt dizzy, but could be psychological! So I remain on warfarin; the monthly blood check is no problem as my wife is a nursing director at her hospital so it's convenient. I maintain my INR between 1.8-2.0.

Since being diagnosed with the PE, I have raced Kona twice and traveled for many ironmans. I do not feel it impacts my training in any way. I have told all my training buddies that I am on coumadin, so if anything happened and I couldn't speak, hopefully they will remember. I don't want to wear a medical bracelet, but it could be worth it for others who choose too.

Once you get going again, the day to day is fine. If you clotted pretty much out of nowhere, it is worth doing the genetic screening (which I did) and determining with your doctors if you should continue blood thinners. So on this, I wish to reiterate, they don't have any seriously negative consequences on your training/performance--you just have to be aware of the increased bleeding risk and how to mitigate that.

The other thing to be especially aware of is post race clot risk. Dehydration and strain on the body, then add in flying/long drives if it is a travel race are huge risk factors for blood clots. I would talk to your doctor in particular about this. Mine has me increase my medication, pay attention to hydration in a big way, and ideally, delay travel for a few days after the event.
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Re: Back to training after pulmonary embolism [Darren325] [ In reply to ]
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Thanks for all of the great advice and input. Particularly the info about post race monitoring and being sure to check hydration levels post race as well as travel.

Inspiring to hear you've done Kona twice! Certainly tells me that where there's a will there's a way.

I haven't learned about INR yet or monitoring, first specialist appointment with a hematologist is next week but I planned to go in there with a laundry list of questions for him.
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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Hello JKR12 and All,

If you elect to use Warfarin/Coumadin this is a device for home checking INR that my wife is going to get ... only requires a drop of blood.

http://www.coaguchek-usa.com/...uchek-xs-system.html

(these units are available on eBay and other resale locations if not covered by insurance.)

She elected to stay with Warfarin since an antidote to stop bleeding is readily available if she is in a crash or gets wounded and also Warfarin has been around for many years and has a track record ...

Currently she gets INR checked about every 2 weeks and shoots for about 2.0 with the recommended range 2.0 to 3.0.

If she gets a bruise it will last a few days but at 2.0 has no underskin bleeds and no other noticeable affects.

She is quite sensitive to diet changing the INR reading .... and also antibiotics and other meds affect it .... and regards diet as not a problem but just something to be aware of ... perhaps requiring a small change in Warfarin dosage.

There is information about Xarelto and Eliquis lawsuits on Google .... for instance:

https://www.fiercepharma.com/...iquis-bleeding-risks

"A judge in New York tossed liability claims against Pfizer and Bristol-Myers Squibb over bleeding risks for their blockbuster anticoagulant on Monday, ruling that the drugmakers and U.S. drug regulators clearly presented Eliquis’ risks to patients and doctors.

Plaintiffs Charlie and Ciara Utts brought the case against the companies last year, claiming that the big-selling Eliquis caused Charlie to experience severe gastrointestinal bleeding. Further, the plaintiffs said the drug’s label didn’t adequately warn of the risks.

But that’s not true, U.S. District Judge Denise Cote wrote in an opinion filed Monday.

Eliquis’ risks, plus the known lack of an antidote, “were clearly disclosed to the Food & Drug Administration when it approved the drug, and are prominently disclosed to medical practitioners and patients on the FDA-approved labeling for the drug,” Cote wrote in her 85-page opinion.

In their suit, the plaintiffs also contend the label is flawed because dosage recommendations aren’t individually tailored for patients and because it doesn't recommend constant monitoring, according to the judge. Cote said those claims “fare no better” under scrutiny."

Cheers, Neal

+1 mph Faster
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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You don’t need to monitor INR on eliquis or xarelto. Only warfarin.

I have the machine notes above and it makes life a bit easier.
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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I recently had a bloodclot in my left calf that went to my lungs a day after starting xarelto.

Stayed in the hospital over night after having rib/chest pain like you described.

I started training within 2 days of leaving the hospital and have put in 2 fifteen hour weeks since then. I just feel like I'm 3 weeks behind where I was. A little more for swimming.

I have been on xarelto for about 3 weeks now, going to the doctor again in a few weeks and am going to try to get off of it. I think it's screwing up my blood sugar. I get hypoglycemic if I don't eat for more than 5 hours so i have had to make my meals smaller and more frequent.

Anyone else have a blood sugar problem with xarelto?
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Re: Back to training after pulmonary embolism [jaretj] [ In reply to ]
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jaretj wrote:
Anyone else have a blood sugar problem with xarelto?
"Metabolic
Uncommon (0.1% to 1%): Hyperglycemia, increased amylase, increased LDH, increased lipase."

That's all I could find.
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Re: Back to training after pulmonary embolism [Thorax] [ In reply to ]
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Thanks, that's about all I could find for hypoglycemia
Last edited by: jaretj: Feb 11, 18 8:23
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Re: Back to training after pulmonary embolism [JKR12] [ In reply to ]
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I have had two PE’s about 13 months apart. He first had an infarction and was pretty bad. That one really screwed me up and the recovery sucked. Really couldn’t do much for a few months without feeling like I was going to pass out. The second was milder and I was able to keep training through it. After a little over a year I’m feeling normal again and my ftp is back to where I was before all of this. I am on xarelto for life and once I came to accept it, it’s not that bad. I don’t bruise any worse and cuts initially are bad but clot relatively quickly. I am back to road racing and all other activities. I initially didn’t want to do road, but figured got to live. My doctor said to not take the meds the day before an event and since it is a 24 hour med, I should be fine if I wreck. Some risk involved, but I am willing to accept it. Good luck with everything, it’s not a fun process but not he end of the world.
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