[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.