Coming back from a PE

Triathlon Forum
1

It’s been 3 weeks since I got out of the hospital (had a pulmonary embolism and was there about 5 days). I heard different things from different doctors; their collective advice was to wait between 2-4 weeks to start training again. So up until Monday I was walking about 4 miles a day, figuring that might help me come back a little easier than just sitting on the couch. On Monday I ran the same 4 miles, and I can honestly say that I have not been this sore in 5 years. My legs feel worse than they did after the marathon, although it’s more of a sore hurt than a broken hurt.

My question is (and it’s a stupid one)…is this normal after a 4-week break? I haven’t taken off more than 2 weeks since I started running seriously, which was about 5 years ago. Does warfarin/coumadin have any lasting effects, as far as training goes? I’m supposed to be on it for the next 6 months. It’s a little discouraging to go from running 6 miles every day, no problem, to aching like hell after 2. It would help to know it’s temporary and that I don’t have to start back from square one.

And I know this is bad form, but re: the jackmott mailbag, jack has a lot of good advice. I should know, because I’m his girlfriend. I started triathlon training less than a year ago and knew nothing at all about biking or swimming. He set me up on my first road bike and later on my tri bike. I won my first two races because of him, and since then everything he’s modified on my bike has just made me faster. I’m just crossing my fingers that I can get back to that sort of progress before long. Right now the rear disc isn’t going to help me much.

2

It’s been 3 weeks since I got out of the hospital (had a pulmonary embolism and was there about 5 days). I heard different things from different doctors; their collective advice was to wait between 2-4 weeks to start training again. So up until Monday I was walking about 4 miles a day, figuring that might help me come back a little easier than just sitting on the couch. On Monday I ran the same 4 miles, and I can honestly say that I have not been this sore in 5 years. My legs feel worse than they did after the marathon, although it’s more of a sore hurt than a broken hurt.

My question is (and it’s a stupid one)…is this normal after a 4-week break? I haven’t taken off more than 2 weeks since I started running seriously, which was about 5 years ago. Does warfarin/coumadin have any lasting effects, as far as training goes? I’m supposed to be on it for the next 6 months. It’s a little discouraging to go from running 6 miles every day, no problem, to aching like hell after 2. It would help to know it’s temporary and that I don’t have to start back from square one.

And I know this is bad form, but re: the jackmott mailbag, jack has a lot of good advice. I should know, because I’m his girlfriend. I started triathlon training less than a year ago and knew nothing at all about biking or swimming. He set me up on my first road bike and later on my tri bike. I won my first two races because of him, and since then everything he’s modified on my bike has just made me faster. I’m just crossing my fingers that I can get back to that sort of progress before long. Right now the rear disc isn’t going to help me much.
Your legs are sore because jackmott beats you, aren’t they?

3

First off - I am glad you are OK and on the road to recovery. My GF went through this about two years back. She was on thinners for 6 months after as well. I don’t think the thinners held her back too much once she was running again, but there was a re-adjustment period after the initial treatment. Part of it is the time off, but part of it is the damage done by the PE that you need to work through.

Is the issue you are having cardio based or muscular, or perhaps better asked - are you out of breath or do your legs want to give up? She found some time was needed to overcome a higher level of discomfort in her breathing/chest initially, and she’d be a lot more “worn out” after exercise, but it wasn’t too long.

  • Mike
4

Thanks for replying! You sound like you’re the perfect person to talk to. How long was your girlfriend off before she started running again? And how long did it take until it began to feel pretty normal?

The first day I ran, I think my lung might have been protesting a bit. My back started hurting (referred pain, i guess)–similar to the way I’d felt in the hospital, but much, much more mild. It was more like a tightness than actual pain. During this morning’s run, my breathing felt normal, but I am noticing that, apart from the soreness, I’m feeling way more tired than I used to, and after a ridiculously short distance compared to what I’d been doing. I guess I can blame that on the busted lung? I was expecting that more than I was expecting the muscle soreness, though. It’s difficult to walk, even.

If you’ve got any advice on limits–as far as when to run through something and when to quit–I’d appreciate it. I’m fairly certain none of the doctors I spoke to were athletes, and they usually weren’t very helpful with specific, or even general, training questions. I don’t want to put myself back in the hospital or anything, but I’m impatient to really start going again.

And no, in response to the first post–jackmott doesn’t beat me. And see, this proves that he doesn’t respond to absolutely everything!

5

I went back to the source to confirm on this one and her recollection is that it was about 6-8 weeks before the fatigue and unusual soreness completely disappeared. She did slowly ramp back up her running in the process though.

Keep in mind that all situations are individual. She wasn’t hospitalized (save the evening in the ER when this was all diagnosed) so I don’t know what the severity of your situation is/was compared to hers. She did have multiple PEs though from a clot originating in her calf/knee (soccer injury suspected as cause).

As for when to back off I think it may be dependent on how much discomfort you feel like dealing with - but I am not a doctor. It’s tough when your GP or specialist is not athletic and gives you advice you think is geared towards couch potatoes but I’d ask pointed questions about risks and healing and seek specific answers. My concern (as I suspect yours is) would be delaying full recovery or recomplicating the situation. Like any injury I think you need to appreciate if 6 weeks of low intensity gets you back to 95% that’s better than 6 weeks at medium intensity where you feel like crap the whole time and are still only at 75% after.

Best of luck - just remember even if it takes 8 weeks to get fully back on the horse that’s nothing in the big picture of what you went through and the alternative outcomes.

  • Mike
6

Eesh…6-8 weeks. I guess it could be worse, though, and that’s not so bad in the long term. Sorry to ask you all the detailed medical questions, which are, of course, impossible or impractical to answer. Was hoping you guys had found a better source of medical wisdom than I have. Thanks again for your reply! It’s really good to hear someone else’s experience–it gives me a better idea of what to expect. At the very least, no matter how painful or discouraging, it feels great just to be able to run again.

7

I’ve been wondering how you were. No, not a stalker, I read jackmott’s post about you. And I went into the hospital last July 1 with multiple bilateral PEs. Also in for 5 days. This was just a few weeks after setting a PR at Wildflower long, so I was in decent shape before all this (took them 5 weeks to properly diagnose my shortness of breath)

My docs weren’t athletes either, but they advised me to just take it slow. Your lungs have just been through a major trauma, and at least mine suffered some damage, although I am told they will heal and not affect my performance.

Can’t say whether running is good or not. I was in the pool about 2 weeks out doing easy workouts, went to the normal 3K a bit later. Just now feel like I am starting to get some shape back, 3 months out. I actually did a 1.25 mile OW swim race mid August, abut 5 weeks out. I had to cancel two really cool races (alcatraz challenge and SOS) and just really wanted to race again, actually got 3d AG :slight_smile:

Cycling, I am on the trainer. Again, started out with a real ez 45 minute spin. Eventually added in intervals. On the trainer until Jan when I come off warfarin

Running, I started out just walking with my wife. And it was realllly slow. Started running about a month after, but I could only do 1/4 mile walk/1/4 mile run. Now I am back up to 5 miles straight, although nowhere near fast (not that I ever was)

The primary concern from my pulmonologist was that the lungs not being 100% might result in a little less 02 to the brain, and the danger was passing out.

Sounds like you are on the road to recovery.

8

I just had one, they said, and it was in my left lung. I never experienced shortness of breath–the pain under my ribs was what finally got me in to see a doctor. I actually wasn’t in a terrible amount of pain until they started making me lay down to do tests (I’d been avoiding that for a few days, was sleeping sitting up), and then that first night in the hospital was absolute hell. If I’d still been at home i would have been sure I was dying, although even at the hospital, I was fairly sure I was dying. They didn’t get the pain meds right until the next morning. (Yep, that one was definitely my favorite nurse.)

Mine happened right after the Austin Tri. It was only my second olympic distance, but I felt good about it and was planning to do a half-ironman this November. I thought all I had to really work on was my swim…but little did I know!

Anyway, it’s good to hear another story. I actually read that series of posts one of the last days I was at the hospital. They were really encouraging. Made me go ahead and jump on the bandwagon, create a screenname. I just haven’t felt like I had much to say until now.

Sorry to hear that this happened to you, too. I hope your training regimine goes well. Sounds like you’re well on the road to recovery, as well!

9

Yeah, I had the shortness of breath, then the pain started. Was pretty bad to make me go into the ER, but the first day in the hospital is was freaking brutal. They finally gave me a great drug, but it would always wear off about 15 minutes before they could give me another does… christ that hurt! I know what you mean about hell

Honestly, if you feel OK to run, and are only a bit sore, you’re WAY ahead of the game. I thought I was doing well, from stories I’ve read on the 'net. Lots of folks have continuing pain, and can’t exercise at all (although I think a lot of people get every side effect of every drug they take…)

I’ve read that warfarin can cause fatigue, weight gain, etc. I get pretty tired, but I think that’s more just working out more regularly after the layoff.

Did they give you a reason? Recent injury? Birth control (sorry, none of my business, just curious)? I had a series of blood tests with a UCLA hematologist to see if there was a genetic tendency to clot (there wasn’t)

BTW, including you, I know of 3 triathletes/runners that have gotten PEs just since July. My wife asked if it seemed like they were happening more, I just think it’s I am more attentive.

10

They weren’t really able to give me a conclusive answer. Honestly, I think in the end, since they didn’t have one, they just picked something. All of my blood tests came back negative for anything hereditary, too, and as far as I know no one in my family has ever had a problem with it. The last doctor I saw–a hematologist–said he thought it was the birth control, but then my current doctor said that was still very strange because, if so, it should have happened sooner. (I’d been using it for 2 years.)

None of the doctors thought there was any correlation with triathlons, and they always looked at me like I was crazy when I brought it up. To me, though, it still seems likely. Or at least, it was another factor, and those factors added up. I had the triathlon on Monday, then Tuesday night (after intentionally resting all day, something I don’t usually do) the problem started. I had also, the week before, gotten a lot of bruises from caving. Maybe birth control + caving + triathlon equals doom. Who knows, I guess.

I’m willing to buy the birth control answer for the most part, though. I’ve always been really leery of taking things, so I was never very comfortable with it. No medicine is a science–we’re smart enough to figure out a drug can do one thing, and then we use it, and then it does 20 other things we didn’t want it to. For that reason, I’m also in a big hurry to get off the rat poison, but when I mention stopping at 3 months vs. 6, they give me a “do-you-know-how-serious-this-is-you-could-have-died” discussion, which at this point I’m very tired of hearing. From what I’ve heard so far, seems like 6 months is more precaution than science. They think the same thing is accomplished in 3, but they like to be cautious. It’s definitely a gamble–stay on a drug that could make me bleed to death or stop taking it and possibly get another clot.

11

I think all triathletes should be made aware that PE seems to have a triathlon link. It seems that most of them can be traced to a clot that formed after a particularly hard race. Here is some advice from another PE sufferer:

  • After every race, put on those compression socks for the rest of the day
  • After every race drink and drink until you are going to burst a bladder…and do this before the awards ceremony (dehydration can contribute)
  • Do a lot of walking/stretching before getting in the car for the ride home…it helps to make it a rule to wait until after the awards ceremony as this gives you a lot more time to ‘flush’ the legs before sitting.
  • On the way home in the car, stop every hour and get out and walk for 5 minutes.

Women need to be especially alert because oral contraceptives are another risk factor.

And heaven forbid you are a woman on birth control, doing triathlons, who smokes.

In my case, I went undiagnosed for about 3 months, during which time I was still doing my best to race and train. I probably sustained more long-term damage than you did.
After they let me out of the hospital, I went back to swimming/cycling right away, but was told to hold off on the running (probably because I had enough clotting in my thigh to kill me if they broke loose). I got one emergency call that week from the nurse telling me not to do anything until further notice because my INR had come back at over 7 and I was at risk for bleeding internally.

Otherwise, I see no reason not to return to mild exercise right away. I think the best I ever felt was probably day 2 in the hospital…since then it’s been a continual up and down (1 year anniversary now). It’s a bit disconcerting that I will have good weeks and bad weeks still. But this is solely cardio performance, not muscular.
And in my case this is most likely due to permanent damage done to my lungs. I don’t know how much of my lungs are still working, but a lot of my lungs died from lack of blood flow. My body is trying to adapt (I have a 53% hematocrit), but I still suffer a lot when running and especially when swimming. The good news is I’m smoking fast on the bike. :slight_smile:

I may have lingering damage to my right ventrical from pulmonary hypertension…tomorrow I’m having a full panel of cardiac testing done just to be careful (I’ve been in a downturn).

As far as the coumadin is concerned, and assuming your INR will be around 3-3.5…I don’t see it having any impact on your cardiovascular performance. The only difference that drug should make is to decrease clotting…it shouldn’t change the blood’s ability to carry oxygen…and it shouldn’t have any other affect on other body tissue.

Your soreness is definitely caused by the time missed running. Ramp up gradually just for the sake of the legs. I wouldn’t do any zone 4-5 work for the next few weeks, but you can do all the zone 3 stuff you want until you reach that magical 3-4 week mark.

the main consideration, as far as I know, in regard to returning to activity is that the clots that are in your lungs and especially any remaining in your legs take time to dissolve and vigorous activity could contribute to lung damage in the case of clots remaining in the lungs, and another PE event in the case of clots in your legs that are dissolving.

12

Hey,

I had PE and clots in my legs in January last year; to be honest, after getting out of hospital, I was so shattered at the end of the day that it was a major effort to get upstairs to bed. When I did start training again (3 weeks after getting out of hospital?), I was given an upper bound of 20 mins or when it started to hurt, and I think it took a good month before I hit the 20 min mark. I’d guess that the pain you’re feeling is pretty normal for two reasons - one, you’ve just taken some time off, and two, one seems to bruise/stiffen a little worse on blood thinners.

As far as the blood thinners go (I’m still on them), I don’t notice any major effects now. To begin with I was tired and nauseous more or less all the time: when I mentioned this to my doctor, she told me that the meds are chemically identical to rat poison, so I shouldn’t expect to feel amazing. Having said that, they have become more tolerable over time, and I very slowly and painfully did get back to where I was before - in fact, in some respects I was faster than I was before the issue surfaced. PM me if you need more info: gordon dot henderson at post dot harvard dot edu.

Hope you recover well,

G.

13

Hi everyone…wow what a relief…I thought I was alone here…
Just recently came out of hospital…Monday 5th with 2 x PE’s on lungs. Wife says I dont do things by half.!!!
Looking to do Ironman Austria next year, having already entered!!
Currently on 7mg of Warfarin and injections of Fragmin 'til my blood is thin enough.
I’ve been told to rest for another week…(it’s bloody hard) and then gradually start to excercise again.
I think my saving grace was a consultant that understood what a triathlete was and what it means…we are not NORMAL!!
It would be great to hear more from you guys and thanks again and best wishes to you all>>>>>

14

girlinblue you have never gone more than 4 hours without running before, so you didn’t know it makes untrained people sore.

you have never been untrained!

I am much more familiar with this “being untrained” phenomenon, as you know :wink:

15

Welcome to the “club” :frowning: you are definitely not alone

do a google search on endurance athletes and PEs or DVTs. Actually, it’s a little scary how many people get them, and how little attention is given to them by professionals, who apparently believe there is no athlete/PE link. I think mine came from getting dehydrated at a warm half, drinking beer after (more dehydration) and then a 5+ hour car ride with 1 stop, added to probably microtrauma from the run? Symptoms arose 3 weeks later. I know correlation is not causation, but it’s the only thing that makes any sense. No genetic factors, and they never found (and I never felt) a DVT. My hematologist said that “wasn’t compelling,” but frankly I don’t think they know much about how they are caused, and just assume as they always have that some 8 hour plane ride had to have been involved, or have been immobilized. As girlinblue posted above, the “time” protocols" are realyl just guesses, and a lot of people end up on coumadin for life prohylactically.

I think jyeager above gives GREAT advice for a post race protocol. I’d even add (if you are off warfarin/coumadin daily fish oil, and maybe nattokinase (haven’t looked at this yet).

Living on coumadin isn’t that tough, at least for me. I am three months thru and INR a solid 2 for the last 1.5 months, eating healthy but basically leafy veggies as I always did. Honestly, the only modification I’ve made (other than taking a pill) is riding on the trainer and not outside.

16

I’ve gotten conflicting advice about biking on warfarin… One doctor, who was a hematologist, told me that it wasn’t so much that you have to worry about getting scrapes and cuts. Basically, you just don’t want to get internal injuries, and if you start feeling pain in your chest, etc, after falling, then you should go to the hospital again. I was actually going to start biking this weekend, but am going to avoid busy roads and probably go quite a bit slower than usual. Of course, again, I don’t know how much to trust the advice. I think when people hear “bike” a lot of times they still think little bells and pink streamers.

There’s definitely a lot of myths about what you can and can’t eat on warfarin. I’m a vegetarian, so half of their no-no list were some of my favorite things–spinach, chickpeas, red wine. The doctors told me I just needed to be reasonably consistent in what I eat, and my diet wouldn’t need to change. They’re still trying to get the balance right, but I haven’t been on more than 7.5mg so far. Oh, but they did tell me no alcohol. Or well, the hospital dietician said 1-2 was ok, and the hematologist told me absolutely no, I might get bleeding in my stomach.

I think you guys were right about the 20 minute cap… Since that first day, I haven’t been able to go farther than that.

17

I’ve got nothing practical to add to this thread, other than:

  1. Glad to hear that you’re on the mend, after Jack told us about your PE a few weeks ago.

  2. Speaking as a CT tech, all of you young, healthy people are sometimes tough as hell to get a good, diagnostic study on. Damned low heart rates. Makes it easy to miss the contrast bolus, because it’s not being pumped through the pulmonary trunk at the moment when it’s being scanned. I’ve been experimenting with a new scan protocol for use in younger patients, and have had some degree of success with it (i.e. can turn a horrible study into a merely crappy one). BTW, the working title for this new protocol, amongst the CT techs, is the “ass-saver protocol.”

18

Feeling better already…
Mine started (apparently)in my calf…went to the doctors and said I was concerned that it might be a DVT due to my job as an IT consultant across the UK!
As mentioned earlier…obviously didn’t pick it up due to my level of fitness (Ha ha)
Had massage and Physio…this went undetected for 6weeks. During that time I’d been told to rest the calf and just swim…when i finally got on the bike i was a bit puffed but the telling thing was the run…got to the corner of the road and was “blowing out of my ar@e”
Blood tests came back and my DeDimer was 2000+…DVT usually has a number between 800 to 1000.
Still 4 days in hospital and once they get the INR correct I think I’ll be okay…!!!
Hoping to have some tests in early Feb 2010 for protein deficiency…would obviously like to come off these but at the moment I seem okay (ish)
What I have bought is a Road ID bracelet
www.roadid.com
I’ve ordered one in yellow to go with the Warfarin info and have put contacts and the fact that I’m on Warfarin…
Big Love to y’all!

19

I was diagnosed with bilateral PE at the end of August with a clot in the main pulmonary artery. I had symptoms for a month of shortness of breath, left shoulder pain and back pain then the pain moved to right under the ribs. After 2 ER visits and being diagnosed as ‘misuse of muscles’ my doctor did a CT and found the PE. I was in the hospital for a few days getting warfin and then released and told if I wanted to exercise listen to my body. I’ll be attempting IM FL on 11/7 so I went right back in to training which was slow at first. This past week was the first I was able to run (7 weeks out), a very slow run but I got through a 45 minute run with no problem. The swim and bike were slow for a few weeks but no complaints now.

The phyisican does feel there is risk with training but as long as I am careful there shouldn’t be an issue. I have seen a hematologist and a pulmonary doctor which both are totally different on opinions and treatment. I will be on coumadin for 3 months then off with the risk of getting another clot. There is no solid answer as to why I got the clots since I did not have a DVT, the physicians feel the clot came from my pelvis. The physicians do feel travel is a key factor with this since I’ve done a number of events with long drives to/from.

Give yourself some time getting back to your running, try an interval then build up from there, I had to finally do a 1 minute slow run/1 minute slow walk until I was able to run at a slower pace for any length of time.

20

Cheers for that.
Did a 20 minute MTB ride today but taking it very easy!
Have decided to cancel IM Austria to resist the temptation to go nuts!!
have also taken stock of my lifestyle and have now got a local job teaching just 20 miles away.
Good luck and lets hope we can both move forward and grow stronger from the experience.