South Carolina, DVT, what can I not do??

Hello, I am a very active 46 year old male. Weight train 5 days per week, mountain bike 3-5 days at lunch, more cardio at home, all to support my Motocross racing.
I travel internationally, had flight to Brussells, arrived with calf swollen. I should note that I had swelling, but NO real pain, no redness, no real warmth I could really tell was different, and to this day, no real pain, etc. And because I only had swelling, which really did not stop me from doing anything...I kept doing....for near one month....Oh, and no breathing or chest issues, so I assume I have no PEs.......
In a nut shell, I kept with my normal routine for nearly a month. Normal calf is 15" diameter. When my swollen calf was at 18" and I could not get my pant leg pulled up, I thought it was time to ask someone. Asked a doc friend, he knew the symptoms well, went to ER that day. Diagnosed with DVT from knee to femural vein, does not appear to be in the ilio vein.

What I am hearing is not a good thing to have been walking around on this thing for a month.
As of today, been about one month on Coumadin. Did lovenox for first week. INR was 2.2 last check.
When I checked out of ER, docs told me to resume my "normal" life. We had a long discussion about what normal was for me. I am doing all my old activities except motocross, and not racing is killing me...oh how boring not to race.

I have some questions for the experienced forum members:

I walked around for a month before treatment, been on treatment for one month; and I am doing all my old pre clot activities, except racing; is it safe to assume that since I did not die from a PE....that maybe the clot has grown in the wall, and I am OK to do my pre clot activities? (I am doing the activities , and ain't dead yet..... )

From the data I have seen, since I have no preexisting issues, great health, blood checks negative for disorders; do you think 3 months Coumadin treatment will be all I need? What is the prevailing wisdom of the forum group?

I check my calf measurements daily. Good calf is 15. In the morning, bad calf is 16 and will go to 16 1/4 inch throughout the day. I wear compression stocking, which is no big deal. After I exercise, I recheck my calf, pull my stocking down, no bigger than 16 1/4. I should not that my good calf will go up by 1/4 inch as well after exercising...so they are both expanding about the same. How normal does this sound? How bad a clot do you think I have?

I am afraid of having PTS. I did a trial one day where I did not where the stocking. Calf went to 16 3/4, so seems like blood is not returning normally and works best with stockings. If I could resume full activities and all I have left over from this is to wear a stocking...I can live with that. I am worried I may have vein damage that will cause issues. I read that even with my one incident, that wearing stocking for 2 years is advised, even if I get clear bill of health; what is prevailing wisdom on wearing stocking for 2 years?

Do you think it sounds realistic, given the information I have presented, to be on Coumadin for 3 months, and when I get my ultrasound, get a clean bill of health, be able to stop Coumadin??

My last inr check was 2.2. One thing I noticed is I don't bleed any more that what I thought I normally bleed like. I got my finger pricked for cholesterol check last week and they had to squeeze the hell out of my finger to get the blood they need. I have very small marks when the take blood for INR vial, but is very small. I am wondering if the "bleeding" risk is being overblown, and or should I see more bleeding? Reason I am asking is I feel great...I am thinking of going out and doing some light motorcross practicing....how "sane" is this???

My calf is 1 inch bigger than normal. When wearing stockings, I can exercise to any level and my calf will go up by 1/4 inch, same as normal calf expansion. How normal is this? Given my descriptions, do you think it is realistic for my dvt calf to return to normal size, in say 3 months of treatment?

Thank you very much for any wisdom and experiences you can share with me.
Regards,
Erik
South Carolina

Hi Erik,
I was just recently diagnosed with DVT as well.

My Coag RN told me to go ahead and expect to be on the Coumadin/Warfarin for 6 months and if you get to go off early then it's just a bonus.

I don't think motor-cross is a good idea being that your INR means that you are clotting 2 times slower then the average person and your level fluctuates and changes a lot in the beginning. If it is something you really want to do I think you should get a medical alert bracelet that way they know to give you the antidote (Vit K) in an emergency bleeding situation.

I don't believe that they are over exaggerating the bleeding risk. I tiny pinprick and an actual cut or wound are two different things. If it takes you twice as long to clot as the average person then that is twice as much blood loss. I think you should talk to the nurse who checks your INR levels, they are very knowledgeable and give great advice. my Coag RN has answered all of my questions with a smile!

Good luck!

Hi Erik,

Welcome to LADVT, like I have told so many other members, I wish it was under other circumstances that we meet, but it is what it is...

Had you asked me the same question four years ago, I would had said drop any extreme sport (MTB and motocross) that's actually what I did when I was diagnosed with my first clot in 2007, but after my last clot this past july (2011) I say, do what you think is correct for YOU.
As long as you take the proper safety precautions, always wear a helmet and maybe not live with the motto of "if you don't fall, you are not trying hard enough" I know that one very well, remember, I have MTB in my blood also.

Have an EMERGENCY plan, if you do crash.
I have a MedicAlert bracelet that states that I 'm on Pradax (anticoag) I also have in my bag these "Quick Clot" Sport they are sterile Advance Clotting Sponges. Been told by other MTBers that it may help until the ambulance gets there...

I wear my socks SPECIALLY when I ride, it does help with the recovery and prevents my legs from hurting and swelling.
Other then that, live life as normal as you can...
Keep the adrenaline rushing and keep the rubber down.

Dero, thanks for the reply.
Do you believe that a clot ever dissolves completely? It sounds like it adheres and melds in to the vein wall and maybe forms scar tissue, if this is true, is this condition safe to continue with, without anticoag treatment?

Reason I am asking, is lets say in a few months, I get an ultrasound, and the clot is still in my leg vein to some degree, will it be safe to come off coumadin?
My symptoms are so mild now, I am wondering if I might not have some mild valve damage that keeps a constant leg swell of about 1" more than normal calf...and if the clot I may have is at some stagnant point that is what I will live with....

I am back to everything in my pre clot activity except racing; weight training, cardio, etc. My calf stays constant at 1" bigger than other, and I wear my stockings religiously....

I wonder if the danger is over....
I have no confirmed clotting disorders....and I got the dvt as a result of international plane flight....

Thanks.
Erik.

Hey Erik,

First off you have to understand that anticoags don't do anything to an existing clot, it only prevents other clot from forming.
Yes, a clot does adhere to the inner wall of the vein and does become scar tissue. Usually it takes about 6 weeks for this process (natural) to start happening, that is why hematologists will tell you to take it easy during that period. So being in your 8 week (if I read this right) I think you could actually start ramping up your activities without having to worry.
The only thing you have to watch WHILE being on anticoags is cutting yourself and we only know how that is easy to do on a ride (MTB).
As for the clot moving right now, I think you are out of that ZONE.
I would not worry and THAT, is my unprofessional guess, going by my own experience of having two clots and
other adrenalin junkies, like myself.

Dero, what type of calf swelling do you see as typical?

I wear compression stockings, 20-30s and 30-40s; not much difference in either as far as swelling effect.
My DVT calf is 1" bigger than normal calf on a daily basis, and with compression stockings on, my DVT calf will swell by about 1/4" during the day. My good calf goes up about 1/4" throughout the day as well.

Thanks.
Erik.