RICE & MICE: Blood clots, DVTs and PEs, oh my!

Anytime a highly conditioned athlete complains about shortness of breath after a normal “routine” workout there are eyebrows raised in the training room and action is taken.  

Less than 2 weeks ago the Colorado Avalanche announced that Tomas Fleischmann will be on the shelf for the remainder of the 2010-2011 season after blood clots, or pulmonary emboli, were discovered in both lungs.  

A deep vein thrombosis (DVT) is a blood clot that forms most commonly in the lower leg, though it can also occur in the upper extremities. A DVT can pose risk to the affected limb, but also, if not managed carefully, it can also pose risk to life. Sometimes a piece of the clot can break off and travel through the blood stream and cause problems in other areas of the body.

When the piece breaks off and travels, it is then called an embolus and if it gets stuck and cuts off blood supply it is called an embolism.  Emboli can lodge in blood vessels of the lungs or heart, as well as the carotid arteries or blood vessels of the brain resulting in a stroke.

The number of athletes and even endurance athletes that suffer from DVT’s isn’t quite as low as you would think.  There are several things that are thought to contribute to DVT’s forming in athletes:

First, athletes tend to have a lower resting heart rate. This combined with an extensive travel schedule for a hockey player means that blood may not flow quite as fast as needed. Blood that does not get pumped into circulation by movement of muscles on long flights, bus rides or train rides may form clots in the right circumstances.

Second, there is usually trauma that results in damage to the blood vessels. In most people, this can result from something as simple as high blood pressure or a bump to the leg. In hockey players, this can result from falls, collisions, body checks, and blocking shots. Most of us not-so-fondly remember when the news broke that  the Flyers Kimmo Timonen was lost to a blood clot in his foot during the playoffs in May 2008 after being hit by a puck in the second round against the Montreal Canadiens.

The final piece of the DVT puzzle is hypercoagulability, or increased tendency for the blood to clot. In layman’s terms it’s how “thick” the blood is. Again, in some people, certain health conditions can cause thick blood as well as things like cigarette smoking. In an athlete, dehydration can possibly play a role in how thick the blood is and can lead to clotting if the other factors are present.

Symptoms of a DVT include swelling, pain or tenderness over the area of the vein, redness, warmth and the pain can be similar to that of a pulled or strained muscle and can worsen with walking. If a DVT is suspected, tests that are commonly ordered include an ultrasound of the extremity as well as blood tests. Clots in the foot tend to resolve without much intervention, while clots in the larger veins of the leg usually are treated with blood “thinning” medications or anticoagulants for a period of time. Anticoagulant therapy can be either pill or injection form. Severe and acutely life or limb threatening blood clots may be treated surgically.

One of the biggest risk factors for blood clots is having a history of a previous blood clot, which is where we turn our attention back to Mr. Fleischmann.

Fleischmann was diagnosed with a DVT in June 2009 after returning home overseas after his then team, the Washington Capitals, were eliminated from the playoffs. His symptoms at the time were throbbing and pain in his lower leg, that he assumed was a muscle bruise or strain. The pain subsided with rest and increased when he started working out, so he had it checked out by a doctor and was diagnosed with a DVT and put on anticoagulant medication for a period of 3 months along with no working out and no contact. While on anticoagulation medicine, Fleischmannn was unable to participate in practices, due to the risk of uncontrollable bleeding caused by the contact that is normally expected in hockey.

Here is scary statistic number one: about 85% of air-travel blood clot victims are usually endurance-type athletes.

When Tomas mentioned his shortness of breath to training staff after a simple morning skate, they were very smart to have him see the team doctor. Taking into consideration his history of DVT thankfully the doctor didn’t miss a possibly life threatening issue. Symptoms of a pulmonary embolism (PE) are unexplained shortness of breath, problems breathing, chest pain, coughing, or coughing up blood. A person with a DVT may also have feelings of anxiety or dread, lightheadedness or fainting, rapid breathing, or sweating. A rapid or irregular heartbeat may also be caused by a PE. Sometimes there are no symptoms at all making it especially difficult to diagnose without specialized testing.

This time around there will be a longer duration of anticoagulant therapy; anywhere from 6 months to a year for most cases. Here is scary statistic number 2: 30% of PE (pulmonary embolism) cases are fatal. Hopefully, Fleischmann will have a relatively uncomplicated recovery and he will be able to return to hockey in the future.

Disclaimer: Information on found in RICE & MICE on flyersfaithful.com is not intended to be medical advice. Any information or materials posted on the web site are intended for general informational purposes only, and should not be construed as medical advice, medical opinion, diagnosis or treatment. Any information posted on the web site is NOT a substitute for medical attention. See your health-care professional for medical advice and treatment.