Grizzly Adam's Montana Method Log

[mgil]

Holy shit, @GrizzlyAdam!!!

Glad to hear you were able to piece the diagnosis together on your own. I would have unloaded on that hospital to tell them what a bunch of dumb fucks they must have employed (clearly they aren’t all dumb) to have released you with a wrong diagnosis by the tending physician.

[GrizzlyAdam]

Wow, that is a grizzly story, indeed, especially how your doc had the correct diagnosis in the office and then you got sent home with antibiotics, geez. Take it easy, Adam.

Holy shit, @GrizzlyAdam!!!

Glad to hear you were able to piece the diagnosis together on your own. I would have unloaded on that hospital to tell them what a bunch of dumb fucks they must have employed (clearly they aren’t all dumb) to have released you with a wrong diagnosis by the tending physician.

Thanks, guys. Yeah, I was pretty mad. But mostly I played the calm one, because my wife was about ready to stab someone. And to be fair, several of the docs and nurses were apologetic, and told me there would be an investigation. There were a few folks, though, who tried to portray it as a “miscommunication”, and I shut that down real fast. The report was very clear to me, and I have no medical training. If I hadn’t read it, things might have gotten really bad.

[GrizzlyAdam]

Not training really training at the moment, so here's a picture of what I'm dealing with:

[GrizzlyAdam]

Saturday 6/2/2018

Bench: 205x5x3, 205x4x4 - light and easy. Had some swelling from leg drive, but no worse than I get walking around.

DB Rows: 50’s for 4 sets of 8 - did these chest-supported by sitting backward on an incline bench. Super light, but nice to get some blood flow in my back.

I definitely can’t train lower body at all, but the swelling in my leg has improved a bit. I’m seeing a clot specialist tomorrow, and can hopefully get some good feedback. I’m guessing it will be few more weeks before I can squat or DL. I can bench and do other lying/seated upper body stuff. And I’m going to (gently) try the Airdyne this week and see how that goes.

[slowmotion]

Damn! Yeah, your leg seems to be slightly swollen .... holy crap. Glad to hear you're not dead.

[GrizzlyAdam]

Damn! Yeah, your leg seems to be slightly swollen .... holy crap. Glad to hear you're not dead.

Thanks, Jan! I’m happy about that, too!

[iamsmu]

I’m seeing a clot specialist tomorrow, and can hopefully get some good feedback. I’m guessing it will be few more weeks before I can squat or DL.

What kind of "clot specialist"? You should see a hematologist and get the standard work up for the most common clotting disorders. I had an upper extremity DVT and had to figure out how to deal with it myself. I read everything I could find on pub med. . . . The ER folks were clueless. . . In any case, I finally saw a cardiologist at MGH that specializes in this stuff and he ran a bunch of additional work. . . . Go to the best research hospital in the region you can find. . . .

I would not consent to going on blood thinners for life unless I had I had a clotting disorder or threw two clots. But you should expect to be on it for months, if not a year.

I was on rat poison for a year. They exaggerate the danger. I fell a few times running, cut myself shaving, etc. without issue. I'm not sure that I'd want to be punched in the head on the stuff though.

It kind of unusual that someone your age would just now throw a clot if you have a disorder.

[GrizzlyAdam]

What kind of "clot specialist"? You should see a hematologist and get the standard work up for the most common clotting disorders. I had an upper extremity DVT and had to figure out how to deal with it myself. I read everything I could find on pub med. . . . The ER folks were clueless. . . In any case, I finally saw a cardiologist at MGH that specializes in this stuff and he ran a bunch of additional work. . . . Go to the best research hospital in the region you can find. . . .

I would not consent to going on blood thinners for life unless I had I had a clotting disorder or threw two clots. But you should expect to be on it for months, if not a year.

I was on rat poison for a year. They exaggerate the danger. I fell a few times running, cut myself shaving, etc. without issue. I'm not sure that I'd want to be punched in the head on the stuff though.

It kind of unusual that someone your age would just now throw a clot if you have a disorder.

I'm seeing a pulmonologist at the Pulmonary Embolism clinic at NYU. They have docs from a bunch of areas who research and treat pulmonary emboli. So they do kind of specialize in clots, but that was a weird way for me to phrase it.

I'm sorry you had to go through all that. I know first-hand how much it sucks. What did the cardiologist find, if you don't mind my asking?

The argument for indefinite blood thinners was that since they couldn't find a reason for my DVT, it is probably a genetic thing that won't get better. But I take your point about waiting to see the nature of the concern before committing to a lifetime of anticoagulants. If it's a clot every 10 years, maybe better for now to just deal with them as they arise.

[iamsmu]

I'm seeing a pulmonologist at the Pulmonary Embolism clinic at NYU. They have docs from a bunch of areas who research and treat pulmonary emboli. So they do kind of specialize in clots, but that was a weird way for me to phrase it.

Great! Sounds like you'll be in good hands.

I don't think they are going to have much data to back up their recommendations on exercise. Some might err on the very conservative side. Upper extremity clots are different, as they aren't as likely to result in PEs, but they might worry about it breaking up and causing more problems. . . . They might suggest a compression stocking and nothing vigorous until the swelling is gone. I dunno.

I was told not to do much of anything. An interventional radiologist chose not to intervene, leaving me with a completely occluded vein. He wanted to wrap me up in bubble wrap. The cardiologist, who specialized in my issue, said not to lift anything heavier than a milk carton until surgery . . . My surgeon said that I could do whatever, but that I should avoid lifting my hands above my head. (I'll explain below.) So they were all over the place with recommendations. I saw no reason not to exercise after the swelling went down, which took a couple months. Movement helped me develop lots of new or enlarged veins that are doing all the work at this point. . . .

I had a friend throw a clot that resulted in a bunch of PEs. He threw another a year later and ended up with a small clot in the main vein in his dick. I'm pretty sure that sucked. . . .

I'm sorry you had to go through all that. I know first-hand how much it sucks. What did the cardiologist find, if you don't mind my asking?

I said he was at MGH. I was wrong. He was at Brigham and Women's. He recommended me to a surgeon at MGH, since he didn't like the outcomes from the B&W surgeon. . . .

He ran a huge set of tests for rare clotting disorders. My hematologist just ran a few. One of the tests the cardio ordered used the venom from a special kind of viper. hahaha. That probably wasn't cheap. I had good insurance. . . .

I figured out what the problem was and then found the cardiologist to confirm it. It was anatomical. I wrote up a lot of details back in Egypt. In gist, my subclavian vein was getting smashed between my clavicle and my first rib when I raised my hands above my head. . . The solution: pluck out the rib. [I still have a rib on the left. My surgeon wasn't worried about it, though there is compression. tick, tick, tick. . . ]

I copied my threads from Egypt into my log here somewhere. [20 minutes later] Here Is the first post, there's another below it:

viewtopic.php?p=34021#p34021

Different issue though.

The argument for indefinite blood thinners was that since they couldn't find a reason for my DVT, it is probably a genetic thing that won't get better. But I take your point about waiting to see the nature of the concern before committing to a lifetime of anticoagulants. If it's a clot every 10 years, maybe better for now to just deal with them as they arise.

Ask them when clotting disorders typically show up? You just seem a little old to have your first symptom. But perhaps I'm wrong about that.

It is strange that you don't have any clear cause. Hell, you could have been dehydrated and sat around too much that week.

But leg clots can kill you pretty easily. You'd basically drown above water with a serious PE. Scary stuff. I might opt for the rat poison. I'm curious to see what your blood work might show.

[GrizzlyAdam]

Feet-up Bench: 200x8x2, 200x6x4 - not sure about RPE. Second set of 8 was probably @8. Rest started at 90 seconds, but by the end it was around 2.5 mins. Never took video of feet-up bench before (I do it with my legs in front of me on a chair) - more wiggling than I expected.

Clot Update: Saw the pulmonologist at NYU. He said that at this point they don't think it's worthwhile to do the huge set of tests, since it would be unlikely to change treatment. He did say that I'm not necessarily on blood thinners for life. I'm on them for a year at a treatment dose, then another 6-12 months at a preventative dose. After that, I can go off them unless/until there's another clot.

He thinks the PE's are almost certainly gone at this point (based on the time I've been on meds, my vitals, and listening to my lungs). The bigger concern right now is that my leg is still so damn engorged. It's better than in the photo above, but still a lot bigger than the right leg. He said to expect 50-60% improvement in the next two weeks, and if that doesn't happen to consult a vascular surgeon. They would do another ultrasound, and possibly use "clot-buster" drugs via a catheter. He said there's also a possible anatomical issue where the hip presses against the iliac vein, encouraging swelling. If I have that, they'll stent the vein.

I'm honestly pretty happy to hear that my leg should be better soon (not 100% - he said that could take months - but totally functional), and that if it isn't they will do something about it. He also said exercise is fine, including lifting weights, limited only by what the leg will tolerate. At this point, activity should actually help. "But no basketball, no martial arts, and no riding a bicycle in Manhattan." Duly noted.

[iamsmu]

Clot Update: Saw the pulmonologist at NYU. He said that at this point they don't think it's worthwhile to do the huge set of tests, since it would be unlikely to change treatment. He did say that I'm not necessarily on blood thinners for life. I'm on them for a year at a treatment dose, then another 6-12 months at a preventative dose. After that, I can go off them unless/until there's another clot.

He thinks the PE's are almost certainly gone at this point (based on the time I've been on meds, my vitals, and listening to my lungs). The bigger concern right now is that my leg is still so damn engorged. It's better than in the photo above, but still a lot bigger than the right leg. He said to expect 50-60% improvement in the next two weeks, and if that doesn't happen to consult a vascular surgeon. They would do another ultrasound, and possibly use "clot-buster" drugs via a catheter. He said there's also a possible anatomical issue where the hip presses against the iliac vein, encouraging swelling. If I have that, they'll stent the vein.

I'm honestly pretty happy to hear that my leg should be better soon (not 100% - he said that could take months - but totally functional), and that if it isn't they will do something about it. He also said exercise is fine, including lifting weights, limited only by what the leg will tolerate. At this point, activity should actually help. "But no basketball, no martial arts, and no riding a bicycle in Manhattan." Duly noted.

For upper extremity DVTs (I'm not sure about lower) the outcomes are significantly worse if thrombolysis isn't done within 2 weeks. Time here is critical. A damaged vein could lead to a life time of swelling and discoloration. (I have a purple hand. . . .)

Your people don't sound very aggressive. My surgeon was pissed that they didn't lyse (sp?) the clot. I read up on this stuff and found someone in a week. But he was too worried about the off chance of bleeding. . . . I told the Interventional Radiologist at MGH (when I went in for venoplasty some months later because my vein was trashed) that the local guys were worried about complications and didn't do thrombolysis. They laughed for a while.

I assume they aren't worried about cancer either? That was the first thing my hemo wanted to rule out.

Are you giving yourself Lovenox injections and taking Warfarin?

[iamsmu]

A quick suggestion. They want you to monitor you swelling. Do so as objectively as possible. Mark a spot some inches above you knees and measure at the line. Keep track of both sides. This will allow you to get a more accurate sense of how much the swelling has or hasn't gone down.

[GrizzlyAdam]

For upper extremity DVTs (I'm not sure about lower) the outcomes are significantly worse if thrombolysis isn't done within 2 weeks. Time here is critical. A damaged vein could lead to a life time of swelling and discoloration. (I have a purple hand. . . .)

Your people don't sound very aggressive. My surgeon was pissed that they didn't lyse (sp?) the clot. I read up on this stuff and found someone in a week. But he was too worried about the off chance of bleeding. . . . I told the Interventional Radiologist at MGH (when I went in for venoplasty some months later because my vein was trashed) that the local guys were worried about complications and didn't do thrombolysis. They laughed for a while.

Oh man. I'm so sorry about your hand. Do you have normal function? I could definitely see the lack of bloodflow having long-term consequences for my leg. The docs I saw when I was hospitalized didn't seem worried about it, though. They were pretty adamant about letting the clot dissolve on its own. The idea was that medical or surgical interventions to break it up carried significant risk of bleeding, and clots usually clear on their own in a reasonable time frame. Most of what I've read online supports that. But the guy I saw yesterday seemed to think it would be worth the risk if the swelling doesn't improve significantly in a couple of weeks.

I assume they aren't worried about cancer either? That was the first thing my hemo wanted to rule out.

No one has even mentioned cancer, though maybe they covered that with the blood tests they did while I was admitted? I know they checked for a bunch of stuff, but I didn't ask what. I assume cancer would have shown on the ultrasound or the CT scan, but I will ask about it.

Are you giving yourself Lovenox injections and taking Warfarin?

No, I was on a Heparin drip in the hospital. Now I'm on 30 mg/day of Xarelto (which will drop to 20 mg after three weeks).

A quick suggestion. They want you to monitor you swelling. Do so as objectively as possible. Mark a spot some inches above you knees and measure at the line. Keep track of both sides. This will allow you to get a more accurate sense of how much the swelling has or hasn't gone down.

This is a great idea! Especially since he gave me an actual percentage guideline. I will absolutely do this.

[TheFlush]

I had a DVT and PE a couple years ago, but I really never had the leg swelling that you have. I was not training at the time. It was the PE that was noticed first. I was working in the yard and couldn't catch my breath, even doing simple things. I felt like I was drowning while walking around. I could hear the fluid in my lungs with each breath (rales?) Being a man, I thought if I just lie down for a while I would be fine. My wife played Dr. Google and eventually convinced me to go to urgent care (it was a Sunday). X-rays made the doc think it was pneumonia at first, but as we talked I recalled having some pain in my right calf. He decided I needed to go to the hospital for additional testing that could not be done at UC. O2 levels were in the 80s instead of mid-upper 90s. Blood work and ultrasound confirmed the DVT. My lungs had started feeling better already. A couple days later they cut me loose with a Xarelto rx and a PC doc followup. PC doc ordered some labs to look for genetic factors, which were apparently inconclusive and he sent me to a hematologist. He had taken me off Xarelto and had me taking daily aspirin. Hematologist did labs which came back clean, but she put me back on Xarelto as a precaution since the cause of the DVT/PE was unknown. She thinks the risk of clots is greater the the bleeding risk from the blood thinner. I went along since it didn't cost anything at the time and is only $10/month right now. I am not happy with the billing from the hematologist because I get billed for both an office visit and a hospitalization charge (it is part of the cancer center) and it cost me over $200 every 6 months. I convinced her to let my PC doc order the labs and write the rx since she never really does anything other than schedule the next appointment. Next appointment with PC doc is next week, so I will discuss the possibility of ditching Xarelto with him or maybe getting a 2nd opinion from another hematologist. Neither my PC doc nor the hematologist have any problems with my weight training. I remember an appointment with the hematologist when I was also having knee pain (torn meniscus) and the nurse reminded me to keep my knees out on squats.

[GrizzlyAdam]

I felt like I was drowning while walking around. I could hear the fluid in my lungs with each breath

That is terrifying. I had five PE's, but they were small and I never really had any shortness of breath.

I will discuss the possibility of ditching Xarelto with him or maybe getting a 2nd opinion from another hematologist.

I'm definitely on Xarelto for the next several months. I've gotten different opinions about what to do after that. The doctors I saw while hospitalized said I would be on blood thinners for life, end of story. The pulmonologist I saw two weeks later said that I would be on blood thinners for two years (gradually reducing the dose), then go off them unless/until I have another clot. The most recent doc (vascular surgeon) said Xarelto for three months, then re-evaluate. Maybe continue for a year, maybe switch to Aspirin, maybe something else.

Neither my PC doc nor the hematologist have any problems with my weight training. I remember an appointment with the hematologist when I was also having knee pain (torn meniscus) and the nurse reminded me to keep my knees out on squats.

Every single doctor has said I'm fine to lift weights, but I have definitely never had a medical professional give me squat cues. That's pretty awesome.

[GrizzlyAdam]

Clot Update

Here's a bit of a timeline:

5/23- Massive leg swelling appears out of nowhere. An ultrasound performed at ER shows a blood clot in my common femoral vein. The attending physician misreads the report and sends me home with an Rx for Keflex.

5/24 - I read the report myself and go back to the hospital. In addition to the DVT, a CT scan shows multiple pulmonary emboli. I start blood thinners, which docs say I'll be on for the rest of my life. The docs advise that I will need to let the clot dissolve over time as surgery and clot dissolving drugs are too dangerous to justify in this case.

6/3 - @Hanley switches me to bench-only programming, which is kind of awesome. It took a medical emergency to bring me to peak bro-dom.

6/4 - I see a pulmonologist at the PE clinic at NYU. He says that the PE's are likely already dissolved (woohoo!), but he is concerned that the swelling in my leg is still so terrible. He advises me to consult a vascular surgeon if it isn't greatly improved in two weeks' time.

6/5 - @iamsmu expresses concern that my docs aren't being aggressive enough.

6/8 - The swelling is down by almost 20%, which seems like good progress

6/11 - After a moderately active weekend, swelling is back to original levels. I book an appointment with the surgeon.

6/14 - I meet with the vascular surgeon. They redo the ultrasound, and it shows that the clot is largely unchanged and the vein is still blocked (hence the swelling). He says that if they had sent me to him right away, it would have been no big deal to surgically break up the clot (think microscopic roto-rooter). At this point, though, it has hardened and all I can do is wait and let it dissolve on its own. (@iamsmu 1 - doctors 0)

Today - My mobility has definitely improved, and the swelling is not as bad as it was. The skin isn't pulled tight over my leg. But it's still red and swollen, and my activity is limited. I can walk around, cook for myself, etc. But I spent four minutes on the Airdyne and the pain was awful. Blood rushes into the leg, and can't get back on. It swells, and the pressure is very painful. I'm on a treatment dose of Xarelto for another three months at least, and I'm wearing compression stockings. It's just a matter of time, and possibly quite a lot of it.

Side note, the surgeon said that activity (including lifting) is encouraged, but that I'll just be limited by the pain.

Log update

Thursday 6/7/2018

Feet-up Bench: 220x4x4, 220x4x3 (90 secs rest) - last set of 4 was @7. Everything else was @6 or under. Hit the upright on the last triple.

Monday 6/11/2018

Feet-up bench: 225x4x3 @6,6,7; 225x3x5 all @6ish except last triple @7

Thursday 6/14/2018

Feet-up bench: 245x2x6 @6.5-7.5

Monday 6/18/2018

Feet-up bench: 230x4x3 @7-8, 230x3x5 @7-7.5

[iamsmu]

6/14 - I meet with the vascular surgeon. They redo the ultrasound, and it shows that the clot is largely unchanged and the vein is still blocked (hence the swelling). He says that if they had sent me to him right away, it would have been no big deal to surgically break up the clot (think microscopic roto-rooter). At this point, though, it has hardened and all I can do is wait and let it dissolve on its own. (@iamsmu 1 - doctors 0)

Damn it! I'm sorry to hear that. Pretty much the same thing here. Your guys were so conservative they didn't even want to bother with the bloodwork. . . .

Hopefully your vein recovers well. I don't know about the difference between big thigh veins and upper extremity veins. I bet you've got a better chance of a good recovery. I was in pain at rest for weeks. I had to keep my arm elevated as much as possible to keep the swelling down. I wore a compression sleeve for months. The fact that you even have the urge to workout is probably a good sign.

If things don't go all that well and the vein is permanently occluded or its capacity is significantly diminished, they might be able to help it out via angioplasty and stenting. Hopefully that's not necessary. But it's not a big deal. (I'm considering going in for another round of angioplasty. . . .) Gravity is working against blood flow there, but there are lots of big muscles to help move it along.

You'll probably start growing some collateral veins to help pick up the slack.

[GrizzlyAdam]

Damn it! I'm sorry to hear that. Pretty much the same thing here. Your guys were so conservative they didn't even want to bother with the bloodwork. . . .

Hopefully your vein recovers well. I don't know about the difference between big thigh veins and upper extremity veins. I bet you've got a better chance of a good recovery. I was in pain at rest for weeks. I had to keep my arm elevated as much as possible to keep the swelling down. I wore a compression sleeve for months. The fact that you even have the urge to workout is probably a good sign.

If things don't go all that well and the vein is permanently occluded or its capacity is significantly diminished, they might be able to help it out via angioplasty and stenting. Hopefully that's not necessary. But it's not a big deal. (I'm considering going in for another round of angioplasty. . . .) Gravity is working against blood flow there, but there are lots of big muscles to help move it along.

You'll probably start growing some collateral veins to help pick up the slack.

Thanks, dude. It's been pretty frustrating, and I still haven't had all this stuff explained to my satisfaction. The report from the original ultrasound (5/23) only said that the common femoral vein was occluded. The second ultrasound (6/14) mentioned that, as well as a couple of smaller acute DVT's and another chronic DVT. I was concerned that could mean I'm still clotting inappropriately, but the doc said those are probably from the 24 hour period between the first scan and starting blood thinners. I guess that makes sense...

I also can't really tell whether it's getting better. The swelling goes down pretty significantly if I spend a day doing nothing and keeping it elevated. But if I spend too much time on my feet, it goes right back to the way it was. What is getting better is my tolerance. I can do much more now without experiencing pain, which is making my life better.

As a side note, my wife got me a ticket to the Barbell Medicine seminar in NY at the end of July. Awesome gift, and I'm excited, though it would be nice if I were able to do the standing lifts again by then. We shall see. If nothing else, I can ask the docs about clots and training.

[GrizzlyAdam]

Catch-up time - I've been bad about logging. Hanley has me benching four times per week, which is going well, and he's started programming the Airdyne so I can increase activity without putting a lot of pressure on the leg.

Monday 6/25/2018

Feet-up bench: 245x3x2 @7-8, 245x2x4 @7.5 (2ish mins rest)
Bro work: DB curls and pull-ups with band
Airdyne: 10 mins at slow-moderate pace (2.5 miles) - leg was okay with this

Tuesday 6/26/2018

Feet-up bench: 205x6x3, x5x3, x4x2 (90 secs rest)

Friday 6/29/2018

Feet-up bench: 235x4x3, x3x3 (2 mins rest) - all around @7, maybe @8 on the last set
Bro work: DB rows

Saturday 6/30/2018

Feet-up bench: 195x5,6,7,7,7,7,5,5 - 60 to 90 secs between sets
Airdyne: 10 mins with HR between 130-140

Tuesday 7/3/2018

Feet-up bench: 250x3x3, 250x2x3 (3 mins rest) - all around @7
Bro work: DB rows
Airdyne: 12 mins with HR between 130-140

Wednesday 7/4/2018

Feet-up bench: 205x6x3, 210x6x2, 210x5x2 - 2 mins rest, all under @7

[GrizzlyAdam]

Feet-up bench: 240x4x3, 240x3x3 (2 mins rest) - between @7 and @8

Airdyne: 4 intervals 2min/2min