Yep. You guys on TRT need to pay attention to your H&H.
Member
How I discovered I had a DVT
Rip, I'm writing this lengthy chronology because I think it will be useful to other forum members who find themselves with unexplained pains in the lower leg. It tracks a changing set of pains in my calf, behind my knee, and in my foot, that ultimately led me to believe I had a DVT, and get confirmation with a Doppler imaging scan.
On May 7, after a 5 hour drive to some business meetings, I found myself with discomfort in my right leg. I had squatted 3x5@270 the night before, an attributed the discomfort to a combination of pushing intensity with the weights and sitting too long behind the wheel. I had stopped along the drive to walk around a rest stop, and I took an hour-long walk that evening after my meetings.
May 9 I drove back, with an achy leg. Later I deadlifted 315, along with other lifts. I found it difficult to walk downstairs after the workout, but the pain was so minor the next day that I didn't see need to mention it to my doctor during a physical on the 10th. (I had the physical to see why my blood pressure was on the rise in recent months - as high as 160/94, typically 150/85 in 3 recent months, and before that 125/80.
May 11 I called the doctor and begged for a referral because I was certain that I had torn my Achilles tendon (past experience with full rupture on left leg). I could not move my foot in flexion/dorsiflexion and was peg-legging my way around the house. I had a burning pain in the middle of my calf, which I believed to be the location of a partial tear.
May 14 I called and canceled the referral, because flexion had been mostly restored on the 13th and the now I had deep, achy pain behind my knee (I'll rate it a 5).
May 15 I had to repeat the drive for another business meeting.
May 17 I donated blood, on advice from my doctor, who informed me my hematocrit and hemoglobin were very high (150-200%) and immediate action was necessary. At the blood bank the elevated level was confirmed when they informed me I was a fraction below the threshold where a donation is allowable. The doctor also told me to hydrate and noted that TRT injections (.6 ml/week Cypionate) was probably thickening my blood, elevating red blood cells.
May 21 I squatted 3x5@235 in a backoff just to see if I was better. May 25 deadlifting 275, May 27 volume squats @200. Started to develop plantar fasciitis and swelling on top and inside of foot.
May 28 I started researching lower leg pain, including tendinopathy and plantar fasciitis. I came across this thread: Achilles tendinopathy and plantar fasciitis which should be REQUIRED READING for everybody on the forum. However, I didn't have all the symptoms the OP presented, and continued to think I only had PF.
May 28-June7 Sometimes severe PF, sometimes mild. Swelling off and on. Painful to walk.
June 8 Friday afternoon, still in pain, and after re-reading the post I called my doctor and said I had a strong hunch that I had a DVT. Went to an imaging center and Doppler imaging confirmed it -- below knee popliteal vein extending into the peroneal veins in the calf.
June 8, after driving 20 minutes I noticed a familiar ache in my right leg. Turns out the location was exactly where my leg rests against the console of my truck when I relax. I'm almost certain my DVT came from long periods of diminished circulation caused by pressure on this spot. That was complicated by thick blood coagulating above and below the pressure point. I'll bet the Doppler shows clotting that coincides with locations immediately above and immediately below the pressure point.
Here's a link to a great article from the American heart Association which informed and encouraged me: A Patient’s Guide to Recovery After Deep Vein Thrombosis or Pulmonary Embolism | Circulation
I'll post treatment progress as it happens, provided there is interest in this story.
TMPHBITEU
Yep. You guys on TRT need to pay attention to your H&H.
Member
Chances are you'll be on a blood thinner for quite a while, Best.
I had a DVT in pretty much the same spot. My experience tracks yours; although I wasn't lifting weights at the time, I was moving carpet for a tearout. Thought I pulled something; noticed my lower leg turn hot and red from the knee down and my foot turn into a sausage from excess fluid. Went to the doctor finguring I needed soemthing drained or a cortisone shot; instead, took the Doppler and was admitted into the hospital right away and put on heparin. Had a four-day stay. Was on Xarelto afterward for 6 months.
Rip's program has allowed me to come back from that and become a lot stronger. I have what's called a Factor V Leiden deficiency, which means the blood likes to clot. My thinking was moving blood clots less. Nothing moves blood better than strong muscles and volume. Started the SS LP, made conservative jumps, got off the thinner, and eventually no longer needed to wear a compression sock. Nowadays it's HLM. That leg used to feel heavy from the valve damage (not draining well). Squats, deads, and GHR fixed a lot of that.
Member
My sister-in-law couldn't understand why we were all laughing at her when she tried to tell us about a friend of hers that had a "deep throat thrombosis".
Member
Sounds worth pursuing.
Member
(A quick correction to my first post: I missed a decimal point when stating the H&H levels. Meant to say 15.0 – 20.0% above normal. Actual numbers: HGB 20.5, HCT 60.0. Both in the critical range).
6/11 Went to the ER at Medical City McKinney. I disliked the idea of going to an ER because my wife had a bad experience that cost us thousands needlessly. But an ER has the equipment necessary to perform, evaluate and act upon the results of numerous test outside the scope of a GP visit, and at an ER they see DVT’s regularly, so can act swiftly. This could have been a true emergency because a clot can dislodge and cause a pulmonary embolism.
In my case, the originating event took place almost a month ago, I was healthy in all other relevant respects (not obese, non-smoker, very active, no recent pregnancies or catheterizations), and so luckily I was pretty stable. It’s the onset days of DVT where the clot has highest chances of breaking off and moving about inside the body to cause damage. And DVT’s above the knee are more likely to break off than those below the knee, where mine fortunately was.
Hats off to the people I encountered: sharp, knowledgeable and attentive to a one. I was in and out in under 2 hours. My MD encouraged me to go right back to lifting. They prescribed Eliquis (my first designer drug that I can see on TV!), so the doctor advised working with lower weights for a short period until I knew how Eliquis would affect lifting (lightheadedness is a known complication). Sensible, temporary.
The doctor agreed with my speculation that high H&H, a long drive, and protracted pressure on the side of the calf conspired to form the DVT. The PA thought the pressure component was irrelevant. Neither could figure out how Plantar Fasciitis had anything to do with the matter, but I can say that I found the key Forum post mentioned earlier by searching on “plantar fasciitis”, and had I not read that post I never would have contacted a doctor!
Yes, the ER bill was high. Hospital alone was $3,500 and I haven’t seen the doctor bill yet. So I crushed my deductible with that and can now join the millions who don’t care what things cost because it’s OPM. A good example: my wife shopped the Eliquis prescription. First quote $400, final price $10. We didn’t care either way. Well, ok, we took the $10 price.
Last night my GP called and spent a long time discussing my condition. He compared my original blood test results to the results from the ER’s testing (there were surprises). And he provided me great advice including informing me that TRT was playing a significant role in this, and that I was dangerously dehydrated. More on the former topic later. Mostly I’m amazed and very pleased at his level of interest and concern. He’s a 60 year old athlete that looks 40. He’s all about health excellence. And you’ll enjoy this: his name is Dr. S. Strength. Dr. Steven Strength, that is. Seriously! You know we gotta get him involved here!
Next post will cover the Oncologist/Hematologist who will manage the blood thinners, lower my H&H, and further the discussion on the perils of TRT.
Member
Not seeing a lot of responses to this post but I’ll keep going for a while anyway.
Saw oncologist/hematologist yesterday. After looking at my blood report and doing a quick examination he informed me that my problem is Polycythemia, which is a disease state in which the hematocrit (the volume percentage of red blood cells in the blood) is elevated. OK, makes sense. TRT is one cause of polycythemia. And he believes polycythemia, in concert with my long drives with prolonged pressure on the outside upper leg, created what he called the ”perfect storm” to create the DVT. He put me on 2 Eliquis daily after the 7 day double dose period ends. He starts phlebotomy (bloodletting) the 18th, with the goal of reducing Hematocrit to 42. I think by removing the H&H rich blood, and absent the TRT stimulus, my marrow will backfill with normal blood and that, of course, will reduce the likelihood of another DVT. He said to continue lifting, other activities as normal.
He thinks the polycythemia is a likely cause of elevated BP, because the more viscous the blood, the more pressure it takes to circulate it. He was not as concerned about dehydration, but I told him I was going to consume 80 oz per day just in case.
I told him I understood his point about TRT clearly, but did not want to forego the benefits (still working at 65, job requires high energy and drive). He said at some point I could resume TRT but if I did I would need periodic phlebotomy to keep H&H in line. Problem solved, probably!
I worked out last night. Was achy all over, and I don’t think the Eliquis was the reason, hoping it’s just the layoff. 3x5 squats @185 required real mental fortitude to get through, and that was a warmup weight 3 weeks ago. Deadlifts felt great. I didn’t push it, settling for 2x5@225, again a warmup weight.
I’m interested in tracking my mood, ambition and recovery speed once the TRT is out of me. Hope I don’t turn into a tired, grumpy old man! Also curious if I’ll feel the effect of lower viscosity blood in any way. I now know how to prevent DVTs from happening while maintaining TRT and hope readers of this thread do now as well.
Member
Please do keep this going. I read it intently, as a good friend went on TRT twice and both times got DVTs, so he suspects the TRT. I advised trying to up his D3 instead and take up LP. Talks are ongoing. I gave him the rest of my D3 500iu bottle and invited him over for "lift nights". Discussions ongoing. I had been considering TRT myself.Originally Posted by Bestafter60
My lack of posts does not equal lack of interest!
Member
Thanks for the response, Fast. Your case seems different than mine in that I had no sudden onset event. Did you not have a long drive or airplane flight that preceded the carpet tearout exertion? It's the long period of immobility while confined to cramped quarters that typically sets these things up. Your Factor V condition set you up like my elevated H&H.
How did you feel on Xarelto? I'm 3 days into the initial double dose of Eliquis and can't say for sure I notice anything I can assign to it. Since I'm coming off TRT for the time being, it's going to be hard to tell what causes any changes I feel.
My leg is still slightly darker and slightly swollen at the foot. It never got alarmingly large. I may have a milder case than you had. I was pretty surprised when, after my first return session under the bar, the swelling had reduced. I was totally expecting the opposite! The swelling comes and goes.
How long has it been since yours resolved?
TMPHBITEU
Look 60, when you went on TRT you should have been advised to never let your H&H get very high. If you are taking an 81mg aspirin daily, keeping your H&H down to sane levels with either regular blood donation or therapeutic donation (requires a prescription -- get one) as needed, and stay hydrated like an intelligent Texan already knows to do, you should not have a problem with DVT unless you're just real unlucky with genetics. So let's not blame TRT unnecessarily, because doing so might well discourage guys who need it from trying it.
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