A Public Service Announcement: Endurance Athletes, Air Travel, and DVTs

I've flown internationally probably 100 times in the last 20 years. That may be a bit of an exaggeration, but I've been to around 35 countries, most of which I entered by plane travel, and many of those I've visited multiple times. Regardless of the number, I am not new to flying, and not new to flying half way around the world. But somehow I missed the memo on the risk of deep vein thrombosis (DVT) to me. I'm young (well, sort of), fit, and I guess, a bit naive.

If you want to read about my experience with DVT and then PE, please read the last 2 posts. As far as I know, this was my first experience with either. This was what is considered a provoked incident of DVT. That is, it was brought on by a long flight, and a couple of other factors (birth control, and I'd argue endurance athlete) that seem to increase the risk. It's fairly easy to look at the risk factors and see why it happened to me. I don't know if it's accurate to say that endurance athlete equals an increased risk, but if you do some googling of DVT and runners or endurance athletes and flying, you will quickly come across many different reports, stories, etc. that indicate that it is not uncommon in endurance athletes and a statistic on Airhealth.org states that 85% of air thrombosis victims are "athletic, usually endurance type athletes like marathoners."  I have no idea where this data comes form, but arguing the validity of the data isn't really the point of this post.  The point is to raise awareness that this seems not to be an uncommon problem amongst types like us, so to exercise caution when stagnant for long periods of time, like on long flights or long road trips. Kim, an ultrarunner from Ohio sent me the link to her blog where she talks about DVTs in runners and about two running friends with DVTs.  Some other blogs/articles that discuss DVT in athletes can be found here, but again, some quick googling will lead you to any number of related posts (past several words are hyperlinked to some examples).

I am typically a fairly active traveler. Assuming I'm on an airline I fly often, I always sit in an aisle seat so I can get up whenever I want (frequent flyer status often dictates what you're left with, but again, I fly overseas a lot so I generally have some level of elite status and get my preference), I carry on a water bottle, and fill it on the plane so that I can drink often and more than what those little plastic cups hold (also cuts back on use of plastic cups), I often wear compression socks (but not sleeves--try it or think about it and you'll understand why I don't, even though there are any number of websites recommending sleeves for travel, as well), I get up regularly (because I'm drinking a lot) and usually want to stretch my legs. However, I also tend to sleep easily on a plane, so it's not uncommon for me to fall asleep for long naps.

I've also done some really stupid things like when I flew to Nairobi the day after running the Pine to Palm 100.  Getting to Nairobi from Portland involves 2 or 3 flights, 2 of which are going to be 8+ hour flights. Definitely not fun after running a 100 miler, and looking back, probably a bit dangerous. But to date, I never have had another DVT incident that I can remember.

I've received a lot emails from ultra runners who have shared similar stories, great advice, how they dealt with DVT/PE, or tragic stories of friends who died from PE after DVT. Mine is definitely not an isolated incident, so I'd really just like to ask all of my ultra running friends to be careful out there.  Maybe everyone already knows about this seemingly increased risk to endurance athletes, but I didn't.  Had I known, I would have been more cautious. Again, I feel like I'm already fairly cautious, but not because I knew of the risk of DVT, more so because I get uncomfortable sitting still.

I can guarantee that I am going to become the traveler that everyone hates.  That person who is pacing the aisle, and getting up every 10 minutes to fidget. I encourage you all to do the same. I may need to leave a day earlier in the future on trips to destinations where multiple long flights are necessary, like any destination in Africa, either to have a rest day after two long flights, or a scheduled stopover in between long flights, because going forward, the thought of falling asleep for more than 30 minutes scares me. I will be that annoying chick with the alarm that is set to go off every 20 minutes.

And if you find yourself with DVT, there are a lot of scare campaigns out there associated with DVTs and PEs, being on blood thinners, and what you can and can't do with regards to aerobic activity. There is also no good data to support a doctor's advice to tell you to either jump back into it, or avoid activity, and because there is a risk of death associated with PE and no data to support either approach, many doctors seem to take the conservative approach and ask that you avoid activity for up to several weeks/months (that was my first doctor who scared the living bejesus out of me).

There's the issue of physical activity with DVTs and then there's the added fun of being on blood thinners (which is necessary to be active with DVTs). Luckily I'm not a mountain biker, because I definitely wouldn't be comfortable mountain biking on Warfarin, but am comfortable running. Heck, I never fall (obviously not true for anyone who knows me). While I do fall regularly, head trauma is the major concern with falling on thinners, and I can count the number of times on one finger when I've hit my head during a run. If I scrape my leg, I might bleed a little more, but assuming my INR level is where they want it to be (between 2 and 3), I won't bleed to death. There are warnings out there about using blood thinners that go so far to say "don't use toothpicks" and "use an electric razor." I've been assured, that unless I get my INR up to 7 or so, I'm not going to start spurting blood out of a hang nail.  I will have to be diligent about making sure my dosage is correct and that means twice a week visits to the anti-coagulation clinic at this point, although that will become less frequent in the coming week or two.

On a very positive note, I found a doctor I like, and one who works with athletes and has worked with other cases of DVT and athletes.  I'm back running (the past 3 days), and am easing my way back into it and hope to still be able to compete in Italy at Worlds on April 22nd. There's still not a 100% chance that is going to happen, but a few days ago, I would have told you I had about a 2% chance of competing, and now I'm optimistic that it's a possibility.