When to defer to a doctor

[donfrancisco]

Dear Coach,

Since my recent inquiry into how to deal with a trainee who may potentially have a patent foramen ovale was not sufficiently different from asking for online medical advice, I thought I'd reword my inquiry.

While I agree that a doctor's exercise recommendations should be regarded with a huge dose of skepticism, could you please weigh in on the circumstances under which it would be appropriate to defer to a trainee's, or one's own, doctor re. exercise?

Let us assume that trainees who lack a heart, which is something I often hear said of those like you and I who are on the right (and I mean correct) side of the political spectrum, should not engage in strenuous exercise like weightlifting. And let us put aside obvious cases like those who are paralyzed from the neck down. What kinds of medical conditions might preclude someone from engaging in strength training?

Best,

Francisco

[Mark Rippetoe]

To clarify: defer to the doctor's advice on how to exercise, or whether or not to exercise?

[Pluripotent]

20% of the population have a patent foramen ovale. Probably every SS coach has a client with a PFO, whether they know about it or not. This is generally not a debilitating issue, and is often found incidentally when doing scans for other things. It does put you at risk for paradoxical embolism, however first you have to have an embolism for it to become paradoxical. And people with PFO are at no increased risk for embolism.

[donfrancisco]

Whether or not to engage in strenuous exercise. I've yet to meet a physician in person who knew shit all about how to exercise.

[Mark Rippetoe]

Spontaneous Spinal Tear

[donfrancisco]

Why this link Coach?

Dear Pluripotent,
Thank you for that information. It helps to put PFO in context.

[donfrancisco]

Dear Pluripotent,

Unfortunately for my trainee, she has a PAI-1 genotype AND high homocysteine.
Both, to my understanding, greatly increase risk for embolic stroke.

So that's the problem: clotting propensity combined with PFO. Alas, she hasn't been confirmed with PFO so we are keeping our fingers crossed.

Thanks again for your input.

Best,

Francisco

[Brodie Butland]

Dear Pluripotent,

Unfortunately for my trainee, she has a PAI-1 genotype AND high homocysteine.
Both, to my understanding, greatly increase risk for embolic stroke.

So that's the problem: clotting propensity combined with PFO. Alas, she hasn't been confirmed with PFO so we are keeping our fingers crossed.

Thanks again for your input.

Best,

Francisco

Make sure your personal training insurance and waiver of liability form are up to date...

[Pluripotent]

Dear Pluripotent,

Unfortunately for my trainee, she has a PAI-1 genotype AND high homocysteine.
Both, to my understanding, greatly increase risk for embolic stroke.

So that's the problem: clotting propensity combined with PFO. Alas, she hasn't been confirmed with PFO so we are keeping our fingers crossed.

Thanks again for your input.

Best,

Francisco

I suppose the question is, why is she having these tests done in the first place? These are not strong clotting factor markers. Why are we looking for a PFO? Usually, hereditary hypercoagulability workup is done after a clot happens (and is often done inappropriately). Results can be difficult to interpret, and positive values for the weaker clotting factors are often over-interpreted. I don't know the specific situation, obviously so I would be unable to give advise other than to say find a good hematologist.

[donfrancisco]

Thanks for the legal reminder Pluripotent, as well as for the added medical info. Legally I'm covered and I will certainly suggest that she seek the expertise of a skilled hematologist as well as a second opinion.

Thanks for your input.