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Thread: Training while on rat poison

  1. #11
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    Quote Originally Posted by Mark Rippetoe View Post
    Looks good. Perhaps Dr. Prewitt has a more informed opinion, if he has time to post.
    This is their reply, edited of fluff :


    YYYY has no genetic problems that lead to clotting all of his bloods came
    back clear, the Dr said that clot was just one of those things.
    The clot is a axillary thrombosis and is small, it has now adhered to the
    vein wall and hopefully the warfarin will reduce it in size, but this will
    take a while. The Dr said that the risks of it moving now were very small
    more the opposite once the clot has adhered can be very stubborn to move.

    So I think he can start the 12 week training program. The Dr's do not want
    him doing any riding where he is at any risk of falling so hence the ergo.


    So I think we're ok to get him starting strength. Thanks for your council, Rip, it's much appreciated.

  2. #12
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    Quote Originally Posted by Mark Rippetoe View Post
    I am more concerned about the clot than I am the warfarin at this point. Is he still symptomatic?
    That's what I was thinking. Dave's been training hard while on warfarin for about 25 years, no problems on that end.

    Bloody noses take a long time to stop, though.

  3. #13
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    I came down with 4 DVTs in my left calf in June. I've been on a dose of coumadin since then and will be the rest of my life due to a genetic blood clotting disorder.

    A very good vascular surgeon whom is more than well respected told me nothing I do with a barbell is of concern while on coumadin as far as the blood clots are concerned. The real risk I have is from the bleeding associated with the possibility of trauma. A cut from a barbell on the noggin is manageable, the problem comes from the bleeding that you may not see. So falling and getting hit in the head may cause internal bleeding that may otherwise not have happened if not on thinners.

    The only thing it has stopped me from doing is rope climbing and max height box jumps.

    I DL, SQ, press, Oly lift heavy and hit the occasional hard METCONS with no real problems. As a matter of fact, since being on coumadin I have increased strength and my METCONs are getting faster....no idea why but it definitely has increased my performance.

    I will caveat all this with the fact that any blood clot above the knee seems like a bigger deal than what I had below the knee. Everything may change because of that, who knows.

    Hope this helps

  4. #14
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    Quote Originally Posted by Bleve View Post

    So I think we're ok to get him starting strength. Thanks for your council, Rip, it's much appreciated.
    Hmm. For this case, I am not so confident that we can easily suggest forging ahead with weight training.

    Axillary-Subclavian Vein Thrombosis (ASVT) is a problem that can actually be related to lifting. Seen in young men with low BMI who do repetitive upper arm/shoulder motions. Or activities that involve backward and downward rotation of the shoulder.

    These upper extremity motions can cause small tears in the inner layer of the subclavian vein that predispose to a clot. One can also have thoracic outlet syndrome due to a first rib, hypertrophied anterior scalene, or a congenital band that constricts the flow of the vein. This is a pretty unusual entity but certainly well-described.

    The clot is organized by now (meaning stuck down and contracting) and shouldn't be at risk to embolize to lungs, etc. The coumadin keeps the clot from migrating down the arm.

    Long-term, he may be at risk for arm swelling and recurrent thrombosis due to chronic obstruction. (Rip mentioned that problem earlier, I believe.)

    Sounds to me that the young man needs to be evaluated for a surgically-correctable cause of the thrombosis, e.g. thoracic outlet syndrome.

    In terms of training, I wouldn't recommend presses, and might be a bit worried to do squats due to arm position when fixing the bar in the low-bar position. Seems like the stretching of the vein due to this position may be problematic.

    A thoughtful consult with an experience peripheral vascular surgeon would be an appropriate next step. And with all due respect to those who I have posted their experiences with blood clots, I wouldn't extrapolate too much from DVT in the leg to this unfortunate situation.

    (Remember, I am not a vascular surgeon and don't have a significant experience with this unusual entity. I see this related to ports we put in for chemotherapy, and I have started to put catheters into the neck in part to avoid this problem.)

    Rip, we see a lot of interesting problems on the board, and we usually end up suggesting that folks proceed with training as appropriate. But this one makes me a bit uncomfortable.

    tprewitt

  5. #15
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    Noted. Thanks for this input. Not available elsewhere. Tell all your friends.

  6. #16
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    Quote Originally Posted by TPrewittMD View Post
    Hmm. For this case, I am not so confident that we can easily suggest forging ahead with weight training.

    Axillary-Subclavian Vein Thrombosis (ASVT) is a problem that can actually be related to lifting. Seen in young men with low BMI who do repetitive upper arm/shoulder motions. Or activities that involve backward and downward rotation of the shoulder.

    These upper extremity motions can cause small tears in the inner layer of the subclavian vein that predispose to a clot. One can also have thoracic outlet syndrome due to a first rib, hypertrophied anterior scalene, or a congenital band that constricts the flow of the vein. This is a pretty unusual entity but certainly well-described.

    The clot is organized by now (meaning stuck down and contracting) and shouldn't be at risk to embolize to lungs, etc. The coumadin keeps the clot from migrating down the arm.

    Long-term, he may be at risk for arm swelling and recurrent thrombosis due to chronic obstruction. (Rip mentioned that problem earlier, I believe.)

    Sounds to me that the young man needs to be evaluated for a surgically-correctable cause of the thrombosis, e.g. thoracic outlet syndrome.

    In terms of training, I wouldn't recommend presses, and might be a bit worried to do squats due to arm position when fixing the bar in the low-bar position. Seems like the stretching of the vein due to this position may be problematic.
    Understood. We'll avoid presses then, and I guess that would also include chins, pullups and the like? And be pretty careful with squats and maybe racking the bar with cleans?. I'd expect deadlifts would be ok though?




    A thoughtful consult with an experience peripheral vascular surgeon would be an appropriate next step. And with all due respect to those who I have posted their experiences with blood clots, I wouldn't extrapolate too much from DVT in the leg to this unfortunate situation.

    (Remember, I am not a vascular surgeon and don't have a significant experience with this unusual entity. I see this related to ports we put in for chemotherapy, and I have started to put catheters into the neck in part to avoid this problem.)
    I never thought about this, my partner has had a Hickmans catheter but we got her benchpressing (the rest, is a work in progress, but she does like deadlifting at least) - any likely complications for her?


    Rip, we see a lot of interesting problems on the board, and we usually end up suggesting that folks proceed with training as appropriate. But this one makes me a bit uncomfortable.

    tprewitt

  7. #17
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    UPDATE
    ---------------------------
    Rip, I ran this scenario by a vascular surgeon in our department who trained at a place with a big thoracic outlet surgery service. He said the following:

    1. Should treat with lytic therapy (i.ie. "clot busting" drugs) if the ASVT is diagnosed within 1 week of symptoms.
    2. Stent the vein if there is a stenosis after the vein is open.
    3. For a young athlete, he then keeps the patient on a heparin infusion and takes them to surgery for a first rib resection. He says that this is a highly effective treatment.
    4. The recurrence rate is quite high without surgery, something over 60-70%.
    5. He questioned the use of coumadin, saying this was likely unnecessary. He pointed out that the clot would only extend to the first venous collateral (correcting what I said), so no benefit from that standpoint. And since the coumadin doesn't dissolve the clot, it may not affect anything other than an increased complication rate.

    So, for this young cyclist, if he is early on in the course of this problem, he needs to see a vascular surgeon pronto. Also, coumadin may not provide a benefit yet expose him to risks.

    Just one long-distance opinion from an academic medical center in the US with no information other than as described by a third party on a discussion board.

    Maybe this will help someone else seek early intervention for the same problem.

  8. #18
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    Quote Originally Posted by TPrewittMD View Post
    UPDATE
    ---------------------------
    Rip, I ran this scenario by a vascular surgeon in our department who trained at a place with a big thoracic outlet surgery service. He said the following:

    1. Should treat with lytic therapy (i.ie. "clot busting" drugs) if the ASVT is diagnosed within 1 week of symptoms.
    2. Stent the vein if there is a stenosis after the vein is open.
    3. For a young athlete, he then keeps the patient on a heparin infusion and takes them to surgery for a first rib resection. He says that this is a highly effective treatment.
    4. The recurrence rate is quite high without surgery, something over 60-70%.
    5. He questioned the use of coumadin, saying this was likely unnecessary. He pointed out that the clot would only extend to the first venous collateral (correcting what I said), so no benefit from that standpoint. And since the coumadin doesn't dissolve the clot, it may not affect anything other than an increased complication rate.

    So, for this young cyclist, if he is early on in the course of this problem, he needs to see a vascular surgeon pronto. Also, coumadin may not provide a benefit yet expose him to risks.

    Just one long-distance opinion from an academic medical center in the US with no information other than as described by a third party on a discussion board.

    Maybe this will help someone else seek early intervention for the same problem.
    Thankyou very much for this. I'm now in a bit of a bind (not half as much as the young lad is though ...) - I guess I should pass this on to his dad, but I also don't want to be interfering with their medical stuff, and that's not my turf at all.

    Rip, what would you do? Keep him in the gym?

  9. #19
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    He and his dad need to decide that, after you've updated them with this new, quite important information that they obviously have not been provided with elsewhere.

  10. #20
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    Quote Originally Posted by Mark Rippetoe View Post
    He and his dad need to decide that, after you've updated them with this new, quite important information that they obviously have not been provided with elsewhere.
    I've informed them fully of all of this. They checked again with their specialist, and the doctor said 'go for it' WRT strength work so they want to do so. As such, I figure that's the best advice they can be given, and they want to proceed.

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