Cycling After Pulmonary Embolism
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  1. #1
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    Cycling After Pulmonary Embolism

    Just before Christmas I suffered a pulmonary embolism. One doctor told me it was just a hair under "enormous". I was told there was some lung damage.

    As I was being released I asked a number of medical types, "How hard can I or should I push myself?" The only answer I got was "listen to your body". I've ridden on the trainer, did a little snowshoeing, and did some hiking. I felt pretty tired after each, but don't know if it's from the lung problems or from the fact I had laid in a hospital bed for eight days.

    If anyone else has had this problem, and returned to cycling I'd sure like to hear from you.

    Thanks.

  2. #2
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    I haven't had a pulmonary embolism, but I do live with the lung disease cystic fibrosis. That said, I know only very little about pulmonary embolisms, only what wikipedia told me 5 minutes ago, so this is hardly medical advice. I've had episodes of hemoptysis, and generally live by the "listen to your body" advice, and might have a sense of what you're going through.

    I ran competitively in college, and now I ride with the local club team. I have some permanent lung damage as well, but have taken to heart that physical exercise will maximize what lung function I have.

    Since it sounds like your docs haven't told you not to engage in strenuous activity, I would take that as a good sign, but you may have to realign your personal goals about cycling.

    If you are someone who enjoys kicking ass and taking names in cat 1-2-3 crits, you may have to re-evaluate depending on the extent of your lung damage. But, assuming your lung function is even close to 70% of your "expected" values, you should be able to return to cycling in a highly functional capacity, even if it means you can't race at your previous level.

    This isn't an easy switch... based on my personal experience, it was hard to accept that I was no longer going to be a competitive runner. I had to shift from running to beat people, to competing to "fulfill my own potential". And while some may scoff and say that that's just making excuses for finishing off the podium, taking that attitude has enabled me to continue finding satisfaction in athletics. For example, I finished a half-iron triathlon last summer. Was I fast? No, but it was incredibly rewarding, and I'm probably one of fewer than 5 people with cystic fibrosis who have ever done it.

    I would highly recommend you get a Pulmonary Function Test (PFT) performed to measure your current lung function. If you need help interpreting this once performed, I would be happy to help you, just pm me. Make sure they give you your "percent predicted" values for each of the measures, not just your raw numbers.

    What does "listen to your body" mean? It means figuring out if the activity you are currently engaged in is "OK". I have found that a heart rate monitor is a great tool for this. I use it to gauge how my exercise session is going... how it compares to when I feel good or when I feel bad. For example, if you have a local route you've done 100 times, or just are generally in tune to what speeds over what terrain are "normal" for you, the heart rate monitor can help tell how close to normal or not you are that day. For me, if its a really bad day, and I feel like I'm dead, and the heart rate monitor has me at 90% of max while I'm toodling at 15 mph, I cut that day short. If you don't think you have a good enough baseline to judge yourself on, start keeping a log. Record your heart rate... average should be enough, your speed, and mileage, and start looking at it over time. You could even use this as an excuse to get a Garmin...

    I wouldn't use the "I feel tired afterwards" as a good enough indicator, especially given how recent your hospitalization was. I think information from the session itself is far more useful... an oximeter is another potential tool for this, but I don't use one, and it might be overkill for you.

    Best of luck with your continued recovery... just the fact that your back on the trainer and active so soon is a great sign. Feel free to PM with any other questions.

    Chris
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    Learn More about CF here: www.cff.org

  3. #3
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    hey, Drag! I haven't had a PE, but I did have a DVT a number of years ago.

    my two questions would be do you know what caused the PE and is there any risk of suffering another one?

    is there any chance the lung damage could still heal early on in the recovery process? if so, I might wait to add intensity back into your training.

    I know a number of other racers and recreational cyclists who have suffered DVT and/or PE and I haven't noticed a measurable change in their performance.

    good luck to you!

    Lorri
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  4. #4
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    Thanks for the Replies

    Thanks for the replies.

    Topher: I am no racer, just a recreational rider. I was just hoping to be able to keep up with my normal riding buddies in the club. I think your suggestion about the heart rate monitor is a good one, and gives me a reason to finally spring for one. I am to see the specialist (see below) tomorrow, and will ask about the PFT. I had one done when I went to see my doctor the morning I first coughed up blood. I was told it was normal.

    Velogirl: I had a DVT eight years ago. I was told at the time that I was more likely to have another in the future. They were right! The DVT was caused by a condition I have called Wegener's Granulomatosis -- an autoimmune disease of the small blood vessels. In fact my DVT was the impetus for a study that found that Wegener's patients have an elevated chance of suffering DVT's. I got two differing answers when I asked about the lung damage. One doctor said the damage was permanent, but the other said I could have some healing, or growth of aveoli elsewhere in the lung. Your note that others have had these problems and are still riding certainly gives me hope.

  5. #5
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    Last piece of advice -- be patient during the healing process. You may need to re-set your expectations for a while. I finally got frustrated riding with the racers so I took a little break and rode with the club riders instead. Your fitness will return, just be patient.

    Lorri
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  6. #6
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    A pulmonary embolus (along with the also mentioned cystic fibrosis, and a lot of other lung conditions) causes what is known as a right to left shunt. Meaning, some of the deoxygenated blood in the venous side of the circulatory system doesn't get oxygenated during its trip to the lungs, either because it is physically bypassing the lungs due to circulatory probs, or else there is a dearth of functioning alveoli in the affected lung region, and/or both.
    If you had a PE big enough to be termed almost 'enormous', you're very lucky to be doing as well as you report. With any luck, a lot of the damage will reverse over time, or else the body figures out a way around it. A ventilation/perfusion scan tells the story.
    Just ride, see how you do. You'll get better and better; give it time. The process that causes a PE or a DVT is the same that causes a lot of heart attacks and strokes: a clot forms, dislodges and circulates. Where it lands determines which of the above you'll have. Prevention centers around carefully titrated anticoagulant therapy.

  7. #7
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    Pulmonary emboli don't cause right to left shunting, they increase physiologic dead space and cause ventilation perfusion mismatching. Also, the etiology of pulmonary emboli and heart attacks is different-- PEs are usually caused by clots in the veins (typically in the lower extremities) breaking off and getting trapped in the pulmonary arteries, whereas myocardial infarction (heart attack) is caused by rupture of an unstable coronary arterial plaque with subsequent thrombus formation. I don't mean to be too nitpicky, but the distinction is important since it has large implications in terms of treatment and secondary prevention.

    DragFreight: I'm not sure what is meant by "lung damage." Perhaps your doctor meant you had a pulmonary infarction, meaning a small portion of lung tissue died. Even if this is the case, there is little chance that you will have a significant, permanent change in lung function. An "enormous" PE will cause significant changes in your cardiovascular function by presenting a large obstacle to pulmonary blood flow. Fortunately, this is a problem which usually resolves given enough time and proper anticoagulation therapy.

    At this point, your clot has probably mostly resolved, and you should be able to exercise safely. Specific symptoms to watch out for include feeling light-headed or faint (suggesting that your cardiac output is limited to the point where your brain is not getting enough perfusion), chest pain or pressure, and extreme shortness of breath. If you don't feel like you're getting back to normal in the next few weeks to months, I'd suggest getting further workup to look for chronic sequelae of your clot.

    take care

  8. #8
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    Drag, one other thought. Did your doc prescribe a course of anti-coagulant drugs (ie coumadin or warfarin)? If so, you will want to use caution against trauma. In other words, don't fall off your bike. Bleeding and/or bruising can be deadly when your INR is at the standard rate post-DVT or PE. My doc let me ride, but she said no mtn biking, no track, and no racing.
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  9. #9
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    I also had a DVT back in 2003, and in 2007 had a PE from a second clot. The second clot came from chemo-therapy canceling out the coumadin. As far as lung function, what everyone else is saying. Give it some time, and it should take care of itself. Mine did, and I feel just the same on the bike and during other exercises as I did before the cancer treatment. (Cancer treatment being a whole other thing). Just take the time to make sure you're healed first. That's the most important thing. As far as the bleeding/bruising, while my PT/NIR was in the recommended range, I had scrapes and bruises from mountain biking, and had no problems whatsoever. In fact, I would ride with my doctor once in a while, and he had no problem with me riding. He was extremely knowledgeable about all of this stuff (it was his specialty) and was using my case as a thesis for his schooling. But that's just my case, your mileage may vary. Just take care of yourself, and like everyone else is saying, listen to your body. You'll know when you're pushing yourself too much.
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  10. #10
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    In human terms, a PE is a blood clot that blocks blood flow to a portion of the lung tissue. This lung tissue sends air through it, but there is no blood flow to that tissue, so there is no CO2 going out and O2 coming into that specific tissue. That is what physiologic dead space means. But there is other functioning lung tissue unless it is a big clot in a big artery or arteriole, blocking blood flow to a larger area thus causing more non functioning tissue.

    The mechanism of damage IS the same as a stroke or heart attack. Just that the clot comes from the venous system instead of the arterial system. Same mechanism, same type of damage.

  11. #11
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    Thank you for all your replies. I am now taking warfarin, and have been told that because I'm a double dipper (my term); I'll be on it for life. I have received the warnings of watching out for bleeding or traumas (which I was doing anyways on account of the Wegener's). They doc did say I did have an infarction.

    I have been riding the trainer in the basement, and definitely can feel the effects. I don't feel any pain, but at first it was a struggle to go a half an hour. However, there has been definite improvement in the past few times.

    Thanks for the encouragement!

    Dave

  12. #12
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    Riding Again

    Just wanted to drop back and and report that due to your encouragement I continued to ride. Two weekends ago I was able to complete the Pan-Mass Challenge. For those who don't know it is a two day, 193 mile fund raising ride across, oddly enough, Massachusetts. It took a long time to feel good on the bike. I had particular trouble on hills, but in the past few weeks I finally felt good again. The PMC went very well and was able to keep up with those with whom I rode. In a couple of weeks I'll be doing out club's century.

    Thanks again for the encouragement, advice and good wishes! I probably wouldn't have done it without these replies.

    Dave

  13. #13
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    congratulations!
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  14. #14
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    Wink DVT forum

    Quote Originally Posted by DragFreight
    Just wanted to drop back and and report that due to your encouragement I continued to ride. Two weekends ago I was able to complete the Pan-Mass Challenge. For those who don't know it is a two day, 193 mile fund raising ride across, oddly enough, Massachusetts. It took a long time to feel good on the bike. I had particular trouble on hills, but in the past few weeks I finally felt good again. The PMC went very well and was able to keep up with those with whom I rode. In a couple of weeks I'll be doing out club's century.

    Thanks again for the encouragement, advice and good wishes! I probably wouldn't have done it without these replies.

    Dave
    Join the family...

    http://www.robprince.net/dvt/forum.asp?action=start

    also do a google on DVT athlete...

    I also use natto (nattokinase) ....

  15. #15
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    DVT and LOTOJA

    I've recently been diagnosed with a DVT. I hear differing view point on rather to race or not. I'm on Coumidin and Lovenox currently and have a 200 mile race on the sept 6. So which is the greater risk... trauma or the PE?

  16. #16
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    in my opinion, you would be a fool to race while on coumadin. life is long. you will have many other opportunities to race. why risk it now? seriously.
    Lorri Lee Lown, founder + coach, Velo Girls
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  17. #17
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    Quote Originally Posted by velogirl
    in my opinion, you would be a fool to race while on coumadin. life is long. you will have many other opportunities to race. why risk it now? seriously.

    Well put.

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