[magpie]

I'm asking on behalf of a friend, who is currently in hospital with newly diagnoses DVT, an enquiring mind and no Internet access. 

Is it likely that doing a lot more red-pointing than usual might cause you to end up with DVT?  From hanging in a harness for longer periods of time?  Or falling more often?  Or could it have made an existing condition worse?

[nik at work]

I was talking about this to the guru just the other day. Our feeling was that it probably did lead to an increased risk of DVT however this increase in risk would be offset by the relative fitness/ high activity level (when compared to couch potato man) of your average climber. As such I would expect no increase in the incidence of DVT in sport climbers when compared to figures for the general public, however I (in a feat of complete speculation) imagine that the incidence of DVT in non-red/headpointy climbers would probably be lower than that for the general public.
There is no official SCIENCE in this post, but I have compensated for this by instilling high levels of WISDOM.

GCW will be along shortly with referenced articles and the usual brew of GP mumbo-jumbo pseudo-science.

(I'm assuming the victim is our little lead figure loving chum?)

[SA Chris]

however I (in a feat of complete speculation) imagine that the incidence of DVT in non-red/headpointy climbers would probably be lower than that for the general public.

Except big-wallers. Hanging around in a harness for days on end while getting dehydrated can't be good for you. Or shitting in a bucket and carrying it around for that matter, but that's unlikely to cause DVT. Each to their own.

[robertostallioni]

I suggest he starts wearing socks.



Oh.

[magpie]

That's kind of what I thought, Nik. 

I'm assuming the victim is our little lead figure loving chum?

You assume correctly.  I reckon he's just looking for an excuse to do less gnarly sport and more easy trad. 

[Falling Down]

McDVT 

Give him our best and buy him a box of Chicken McNuggets from me.

(Seriously... hope he's OK)

[magpie]

I'm not sure it's sensible to raise his blood pressure with McD's chat at the moment, but I'll send him your regards. 

[GCW]

GCW will be along shortly with referenced articles and the usual brew of GP mumbo-jumbo pseudo-science.

Virchow's triad.

There's several studies that show increased risk of DVT if you sit in a harness a lot.  But only if you wear a Gimp mask while you do it.  BUt we don't know anyone like that, do we?   

Seriously, there's no proper SCIENCE but common sense says it would increase the risk, more so if you smoke, are overweight, have a history of DVT, eat at fast food restaurants, are pregnant etc

[magpie]

Cool, thank you.  Like you've said, I would imagine the chances of it being down to climbing are slim if you are otherwise fit and healthy, but I think he just wanted to know if there was any SCIENCE out there to back up the theory.

[fatdoc]

work hard.

play thin.

take an asprin once a week.

no other risk factors??

if not, dont lose any sleep..

[SA Chris]

Bummer. Send him regards. Maybe lycra leggings were a good thing after all.

[magpie]

dont lose any sleep..

Unless you happen to be the unlucky bastard who ends up with one anyway.

[fatdoc]

well yeah, obviously...

but you did ask

[Jaspersharpe]

Despite the sock / fast food hilarity, in all seriousness I hope he's ok soon.

[Falling Down]

How's he doing today Magpie?

[SA Chris]

Can you take him McGrapes and Lucozade?

[magpie]

but you did ask

 

He's still in hospital, FD, they are giving him all sorts of medication to try and sort him out so at least he's in the right place and being looked after.  He's in fairly good spirits, I spoke to him last night and passed on your good wishes, so he knows you're all thinking of him, and appreciates it.

I can't Chris get down this weekend, but I'm sure if you fancied the trip he'd appreciate it, the food's apparently not up to much, Chris. 

[SA Chris]

even further for me. Might be down in September, hopefully he won't still be there still!

[Duncan Disorderly]

Just got back from paying him a visit and can confirm the docs say it's more likely caused by too long sitting still painting toy soldiers and definitely NOT from an excess of redpointing (that gets me off the hook then )

Seriously tho he seems in good spirits.... Hopefully he'll be out soon.

:D

disclaimer... they didn't actually say anything of the sort I just want to admonish myself from any blame in this  (

[andy_e]

Do they have Quake multiplayer in hospital? Hope he's ok!

[magpie]

Glad you made it in to see him, Dunc, you and I both know he's only done this to make you feel bad about getting him on sport routes instead if his beloved trad.   
(or possibly cause I dragged him to Spain for a week and wouldn't go climbing with him)

[Eddies]

I did a working at heights course and they spoke about the risks of suspension trauma when sat hanging in a harness for long periods of time.
Apparently effects can be felt after as little time as 3mins but is only really a problem if the victims limbs are imobile, like if they have passed out.
http://en.wikipedia.org/wiki/Suspension_trauma

[saltbeef]

why is he being kept in? surely he can be anticoagulated as an out patient?

[magpie]

Probably, if you just need anticoagulating, but they are still waiting for other test results and stuff to come back.  He couldn't possibly just have a normal DVT with nothing else wrong, that would be far too dull and simple.   

[SA Chris]

Fiend, did you ever find out anything about cause?

[Bonjoy]

I've met a lot of sport climbers and a lot of roped access workers (many of whom are fat, unhealthy and smoke) and have never heard of anyone getting DVT before this occasion, if there is a increase in risk it must be very small and perhaps only relevant if you have a predisposition.

[slackline]

Being homozygous recessive for Factor V Leiden pre-disposes you to an increased risk of DVT (although penetrance is still incomplete, i.e. not everyone who is homozygous recessive will end up getting DVT).

There's a particular mutation that results in the protein the gene encodes, which breaks down clotting factors, being truncated and therefore not doing its job properly, so when you're body produces clotting factors they persist in the blood for longer than they should causing problems. 

Have you been cutting yourself Fiend?


(I know this one as my wife has been diagnosed as having this particular genotype).

[Houdini]

I thought deep vaginal tearing (full & profound penetrance) was restricted to the po.rn industry?

[Serpico]

Missed all this because I was away in French France, hope you're OK Fiend.
A.

[fatdoc]

Being homozygous recessive for Factor V Leiden pre-disposes you to an increased risk of DVT (although penetrance is still incomplete, i.e. not everyone who is homozygous recessive will end up getting DVT).

There's a particular mutation that results in the protein the gene encodes, which breaks down clotting factors, being truncated and therefore not doing its job properly, so when you're body produces clotting factors they persist in the blood for longer than they should causing problems.  

Have you been cutting yourself Fiend?
Christ, start writing medical texts... That's the best synpopsis of that disease I've ever read.



Respect.

(I know this one as my wife has been diagnosed as having this particular genotype).

[GCW]

Nice quoting FD.

There's a few things that give you hypercoagulable states (thrombophilia)- Factor V Leiden, Protein C or S deficiency, lupus anticoagulant, anti-cardiolipin antibody, anti-β2 glycoprotein 1 antibody, activated protein C resistance etc.

I reckon these are more common than many think, since they are only diagnosed when someone runs into trouble.

[magpie]

I'll nudge him in the direction of the thread so he can update you himself, but so far, still no idea what caused it. 

[Fiend]

Nice quoting FD.

There's a few things that give you hypercoagulable states (thrombophilia)- Factor V Leiden, Protein C or S deficiency, lupus anticoagulant, anti-cardiolipin antibody, anti-β2 glycoprotein 1 antibody, activated protein C resistance etc.

I reckon these are more common than many think, since they are only diagnosed when someone runs into trouble.

Thank you CGW I will mention those to the haematologist when I see him/her. Every test has come back normal, there is no obvious cause, it may be a combination of small, individually innocuous factors. Unfortunately there was a cock-up with samples taken just before I went on Warfarin and I didn't get fully tested for Thrombophilia, I will have to wait until I'm off the wfn.

The one mystery factor is still Citalopram which I started taking about 5 weeks before the clots appeared. There are no blood-related side effects listed on the BNF and the doctors think it is medically very unlikely, nevertheless my brother did some online research and found there were some case studies showing a link. Views on that would be welcome.

Thanks everyone else for your feedback, ideas, and well-wishes.

[webbo]

n.

The one mystery factor is still Citalopram which I started taking about 5 weeks before the clots appeared. There are no blood-related side effects listed on the BNF and the doctors think it is medically very unlikely, nevertheless my brother did some online research and found there were some case studies showing a link. Views on that would be welcome.

apart from the ridiculously obvious answer why were you taking this.i know g.ps prescribe anti depressants at the drop of a hat but anyone whole is still functioning at a reasonable level i.e. being able to go out climbing is no why depressed enough to warrent medication.the same applies if it was prescribed for anxiety.

[GCW]

I should think your haematologist will be able to advise you better than anyone here.

Webbo, SSRIs aren't always given out willy nilly.  Or at least shouldn't be.  It should be discussed with the patient and the decision made jointly.  Woo, look at me and my GP trainee hat!

[webbo]

just wait till they remove that trainee tag and the 50th bored badly treated housewife/unskilled bloke whos been made redundant comes in and you just found out about the 6/18 month waiting list to primary care counselling.it will be "were the fucks my prescription pad"

[GCW]

That's already the case as a trainee!
I have to say, access to mental health services in the NW is a fucking joke.  The waits are awesome, and I can quite agree that people get pills partly because of that.  Even though NICE say CBT is Da Bomb.

[tobym]

just wait till they remove that trainee tag and the 50th bored badly treated housewife/unskilled bloke whos been made redundant comes in and you just found out about the 6/18 month waiting list to primary care counselling.it will be "were the fucks my prescription pad"

I hate to agree, but that's a very familiar sounding sentiment

[Fiend]

I've been prone to depression and anxiety for all of my adult life if not before, any functionality I have is due to working to overcome that. I was first presented with the option of anti-ds about 12 years ago, I have resisted because I don't like mind-affecting chemicals. However still facing the same issues recently I decided to try them after a lot of discussion with friends family and health professionals. This is the truth and it's not something I am going to discuss in public.

I only mentioned Citalopram in the context of it being an unknown new factor in case it was revelant/useful to anyone who is helping out on here.

[webbo]

as a mental health professional of some 23 years standing.i have some experience on who and when anti depressants are going to be of some value.structured activity combined with talking therapies are usually the most effective.therefore i was a bit surprised that you had'nt been offered this option or maybe you have and you ended up with a know it all twat like myself.

gareth i'm sure nice are only saying cbt is gods gift because they way the nhs are using it is based on the american insurance model and its time limited unlike other psychotherapy which can take years.also its a bit one size fits all.in a year or two when everyone whos had their prescribed 10 sessions is back in the surgery complaining of the same problems.there will be a change of policy.

[Fiend]

All change. Got the results from the MRI Venogram today:

Extensive DVT is noted in the distal IVC, both iliac veins and extending into the femoral veins.

The IVC does not appear to be in continuity from the abdomen into the heart and appearances would be consistent with either severe stenosis-stricture of the upper segment of the IVC or more likely IVC hypoplasia-aplasia at this site.

There are extensive collaterals into the lumbar veins and the renal veins appear to drain into these lumbar collaterals. There does not appear to be any mass lesion producing a compression at this site.

There is no other significant abnormality.

Well that's okay, that one abnormality is plenty enough for me at the moment  ???

The rheumatology consultant (I got put into rheumatology as my initial symptons were joint based) thinks this is definitely the major cause, there are likely to have been minor contributing factors but this is the main one. He's referring me to a vascular specialist.

[GCW]

Certainly sounds like a significant factor, the Vascular boys will be more interested in that than their usual peripheral vascular diseases.

Steve, I'm sure you're right about CBT- the usual NICE BS, and I wouldn't expect owt else.  Being an ex-knuckle scraper the toughy feely shit is what I'm crap at

[Fiend]

I hope you appreciated that I copied over all the medical jargon just for you 

[tobym]

All change. Got the results from the MRI Venogram today:

Extensive DVT is noted in the distal IVC, both iliac veins and extending into the femoral veins.

The IVC does not appear to be in continuity from the abdomen into the heart and appearances would be consistent with either severe stenosis-stricture of the upper segment of the IVC or more likely IVC hypoplasia-aplasia at this site.

There are extensive collaterals into the lumbar veins and the renal veins appear to drain into these lumbar collaterals. There does not appear to be any mass lesion producing a compression at this site.

There is no other significant abnormality.

Fiend, thats a mightily impressive-sounding DVT, and almost certainly, at that level, unlikely to be due to any harness constriction. It's not something I've got much experience of, but I haven't done much vascular surgery, I would hope it is fixble though.

[Fiend]

That is a good point isn't it. How the fuck is a harness biting into my upper thighs going to cause a clot in the lower IVC vein....

[GCW]

Anything is fixable, but it's all about risk vs benefit.  With good collaterals it's something chronic and not acute.  IVC malformations aren't common but are congenital.  My limited understanding of this is that treatment is anticoagulation long term, rather than repair.

Hope all goes well Fiend.  If you don't object, I'm sure a few people would be interested to hear your progress.

[GCW]

That is a good point isn't it. How the fuck is a harness biting into my upper thighs going to cause a clot in the lower IVC vein....

You can get clot propagation proximally, but IVC malformations are known to significantly increase risk of DVT.

Bottom line is you'll probably never know.

[Fiend]

I'll keep people informed on here. I will be looking into the repair option quite seriously, a life-time of warfarin does not sit well with my current nor intended lifestyle.

[GCW]

a life-time of warfarin does not sit well with my current nor intended lifestyle.

Yeah, but your ass would bleed less if you ask Stallion to be more gentle 

[fatdoc]

Anything is fixable, but it's all about risk vs benefit.  With good collaterals it's something chronic and not acute.  IVC malformations aren't common but are congenital.  My limited understanding of this is that treatment is anticoagulation long term, rather than repair.

Hope all goes well Fiend.  If you don't object, I'm sure a few people would be interested to hear your progress.

I second this, and am compelled to say GCW you would have been wasted in ortho.

That post has the hallmarks of a damn fine Dr.
 

[GCW]

Maybe, but I miss hitting things with hammers....

[fatdoc]

I woul suggest you would of tired of the linear accelerator, and be interested not in each patient.. But of complication rates per thousand in the years to come.

Though only in ortho for a year I found nothing more challanging than putting up shelves in a hollow wall. When the patient hot sick / major trauma others sorted it.

Had fun mind... And that was back in the day where shos did AO repairs of ankles and primary knees..

My xray collection shows good reductions and m knees never had tibial component lift at the back... But ortho is a numbers game.. Not personal enoough.


Fiend, I apologise for the mini hijack...

[GCW]

I like it because it's very scientific, evidence based and technical operating.  I have a very mathematical mind so the working outmechanics was something I enjoyed.

And the hammers  (imagine that's a slap hammer battering in a tibial nail)

[Fiend]

Went to see the vascular specialist last night. The upshot being:

He is happy with my progress. He recommends doing as much exercise as comfort allows. He warned me to monitor any swelling etc in my legs (there hasn't been any). There is no change to my treatment for the clots. I will need to have more blood tests done when I'm off the warfarin to see if my blood is thrombophilic.

The "constriction" in my IVC is likely to be severe, with either negligible blood flow or completely sealed ???. This is all a bit weird to me because it's possible the vein effectively stops and reappears later on and does precisely fuck all . The collaterals are obviously doing a good job as I'm fairly physically fit otherwise.

Surgery is unlikely to be feasible as due to the severity of the constriction the vein would need to be reconstructed in that area and there is some risk of clotting or damage. The specialist reassured me that being on warfarin for life is not that inconvenient and there may be alternative drugs available soon.

He said he will check the images from the MRI scan with another team of consultants just to be sure. Other than that, I proceed as before.

Also, I led two F6bs yesterday . I didn't tell the specialist that tho

[GCW]

Also, I led two F6bs yesterday . I didn't tell the specialist that tho

He recommends doing as much exercise as comfort allows.

That's OK, then.
Thanks for the update.  Hope all goes well.  6 months on warfarin, or just the usual 3?

[Fiend]

6 (5 remaining). Then possibly for life  ???

[slackline]

Late, but glad you are out of hospital Fiend.

Any history/diagnosis of being homozygous recessive for Factor V Leiden (my wife is, hence the curiosity (beyond being a geeky geneticist))?