If you are planning a ride in France mere days from now, I am assuming you have made just about all the major preparations, both for the trip and the event itself. You are probably down to the little stuff, the stuff that if you don’t get taken care of, it may or may not make a big difference. That unchecked portion of the list might look something like this:
___ Add new selections to I-pod
___ Adjust GPS Track
___ Replace disposable razor in shave kit
___ Replace patch kit glue tube
___ Get two new pair of knee high compression socks
___ Refresh ibuprofen in on-bike meds kit
WHAT? Hey, wait a minute, what’s up with the compression socks? Is that just a hidden one liner to see if you are actually reading this?
Well, actually not; as goofy as this sounds YOU need to be wearing compression socks. Maybe not on the ride, but definitely for the trip over, … and back. Compression socks, really?
Imagine an injury that could take you out of this ride, even before the start: an injury that you could incur just by laying around; which could result in months or years of recovery; that might even result in permanent (as in the rest of your whole life) medical intervention. Scoot up a little closer to the monitor kiddo, you don’t want to miss this.
First, the compression socks or support hose are all about blood clots in your veins, particularly the veins of your lower legs. I can hear your guffaw all the away from here. What is the picture that comes to mind when I mention blood clots in the veins of the lower legs? The little old lady with the dowagers hump in support hose pushing the grocery cart slowly down the aisle at the super marché, right? What in the world could she possibly have to do with you and your splendid planning for an amazing bike ride across France and back? Well, her problem is Thrombophlebitis, or clotting of the superficial veins of the leg. Fairly common but not the injury you are at risk for.
The condition that lurks in your closet is Deep Vein Thrombosis, occasionally referred to as 'economy class syndrome'. To keep spell check happy I'll just refer to this a DVT. This demon is the 900 pound gorilla of blood clots and you very well may be the next victim.
Are you athletic? Do you participate in endurance activities? Do you have a trip (plane, train, car, bus) of over four hours planned? If so, YOU are at risk of DVT. As it turns out, the very work you have done to improve your fitness makes you MORE not less prone to this crippling, possibly deadly malaise. I don’t mean to be overly melodramatic, but deadly is an actual possibility and your improved fitness, won on those climbs and long rides through the night really does elevate (not bullet proof) your risk. What’s worse your fantastic fitness will often mislead medical professionals in their efforts to figure out what your problem is, should you come in to the chop shop complaining of symptoms.
What the heck IS DVT?
A DVT is a blood clot (thrombus) that develops in a deep vein, often in the lower leg. DVT can cause pain in the leg and can lead to life threatening complications. Seriously! Though they usually occur in the lower leg, DVT can occur elsewhere, such as in the arm. When blood clots outside a vessel it is a normal process which protects the body against loosing blood, but if the blood clots within a vessel (DVT) it can lead to very serious complications. In most cases of DVT the clots are small and do not cause symptoms. The body is able to gradually break the clot down and there are no long term effects. Larger clots may partially or totally block the blood flow in the vein.
You feel a sharp pain, or a dull pain in the calf or thigh that is noticeably worse when standing or walking (or cycling!) Your lower leg may be swollen and take on a reddish caste. A friend who first suffered DVT on a 300K on a tandem described it as akin to having a bad cramp in his calf, which never went away. In standard rando death march style he rode to the finish not realizing that he had a more serious problem. This is a typical scenario; most riders have never heard of DVT and think of themselves as immune to something like a blood clot. We’re healthy right? We don’t get stuff like that.
Another friend on a vacation trip to North Africa described similar symptoms. He‘d been on a ski trip (think long ride in the RV) a few weeks before. By the time he was on his vacation he had been feeling these lower leg pain symptoms for a few weeks and decided to cut the vacation short, fly home, and see what was up. His plane was diverted over the Mediterranean and he spent several weeks in ICU in an Italian hospital as the docs tried to stabilize the blood clots that had formed in his lungs!
This common secondary effect (clots in the lungs) is referred to as Pulmonary Embolism, (PE for short). A PE occurs when a clot breaks loose in a vein and later lodges in the lungs. Symptoms of PE include difficulty breathing, pain when breathing, shortness of breath and weakness or fainting. PE is potentially life threatening and needs to be attended to immediately. In addition to the life threatening aspect, it is a little known, but solidly proven fact of randonneuring that fully functional lungs are enormously helpful when riding brevets. Most often after DVT or PE is discovered you can count on a pretty serious lay off from riding hard (good bye hard won fitness!).
One of the big problems with DVT is that it can be difficult to diagnose. In some of the scenarios above the physicians involved did not immediate arrived at the idea that this fit specimen was suffering from DVT! They considered other underlying issues, often having to do with the misperception of the deleterious effects of over-training or being too fit. Remember the matriarch in the grocery store? Physicians have blind spots too. Your relative youth and fitness may actually throw physicians off the trail. It is on you to employ proven, practical, preventive measures, and to recognize symptoms if you can’t stay out of the cross fire.
There are many potential causes of DVT including but not limited to:
• Age – people over 40 are at greater risk of DVT
• A past or family history of DVT
• Recent surgery, especially to the hips or knees
But there is a growing body of evidence that other factors may play an important role in the development of this condition. One example is air travel or any long duration travel which includes decreased mobility. Generally the risk of developing DVT when traveling is very small unless one or more to the risk factors is present. Here is where we sharpen the focus; see if you can find any of these associated risk factors tucked away in your carry on.
Research published in 2003 suggests that up to 10% of all long distance air travelers showed signs of raised levels of clot-forming proteins in their blood. These people did not show physical signs of having blood clots, but raised protein levels indicate they may be at increased risk of forming clots.
If you are athletic and you travel it just gets worse. Listen up super-randonneur this may be about you. Approximately 85% of air travel thrombosis victims are athletic, usually endurance athletes such as marathoners and cyclists. 85%, that’s HUGE! Why doesn’t your improved fitness bullet proof you? Here is how it works:
You have dramatically improved your cardio vascular fitness over the last few years; you know this by your general sense of fitness as well as some of the standard metrics:
• Your blood pressure is lower
• Your resting heart rate is lower
• Your LT Heart rate is higher
• Your resting respirations are lower
People with slower resting hear rates (think slower blood flow) are at greater risk of stasis, stagnant blood subject to clotting. Also, they are more likely to have bruises or sore muscles which can trigger clotting. No other risk factor comes close to this. Although over age 60 is a risk factor, these athletic victims are younger, 82% of them are under 60 years of age. Is that you in the mirror? Are you athletic? Are you under age 60? Is there a long distance trip in your future? If so, listen up there are things you can and should do to reduce your risk.
So there you are, slumped over in your 24” of personal space, plugged into I tunes, your big ole heart lub-dubbing away, just enough to keep you conscious. Your circulation is down so blood is pooling in your lower legs.
This is easy, painless, and cheap. Even if you still have that ‘immortal teenager’ mentality you should do this, precisely because it is cheap and easy. Remember this: Preventing DVT=easy. Recovery=painful, expensive, and time consuming.
Step one; compression socks. Yes super Jock, and Jill you need to head to Kroger’s or Rite Aid and seek out those geeky socks that will compress your lower legs while you are ‘resting’. You can go over the top and buy those flesh colored ones if you want, but you know, black or white are OK too. Just for your info, SmartWool offers a decent pair you could also use for riding or whenever. Yes they are calf high but they sport that goofy little smartwool guy, which may save just a bit of the caché for you. Shoot, get a pair of madras Bermuda shorts while you’re at it, celebrate your inner Fredness.
That’s the expensive part, so far so good, but don’t stop there.
• Be active while you are confined. Moving your body will help keep the ticker working which in turn should keep the blood flowing. Literally, that’s what you want, to keep the blood circulating.
• Flex your legs, your toes, your butt, all your major muscles repeatedly, think 15 minute intervals.
• Stay hydrated while in flight, drink enough fluids that you have to get up and ‘go’ from time to time.
• Avoid alcohol
• Get up and walk the aisles, whatever you do don’t just sit there! Do whatever you can to frequently get your juices flowing.
• DON’T snuggle up with a blankee and fall asleep for the duration.
• DON’T just lay there zoning out as the MP3 drills into your cerebellum.
If you are a techno geek this might be a good excuse to wear your HRM for that 7 hour flight. Oh I’m sure the TSA guys will let you float right on through the check point, with your geeky knee highs, your seat post and pedals in your carry on and some sort of strap across your chest that communicates with your ‘watch’. OK, maybe bag on the HRM and chest strap.
Compression stockings? Avoiding alcohol? What’s next? Using Ensure for nourishment? (Oh right, you already do that). The point is this is a very real threat and though some of these preventive therapies may seem an inconvenience for your globetrotting rando life style, or perhaps a little embarrassing, they could save your ride, and possibly a lot more.
Just like riding long, in this case the one thing you can do that is most likely to protect you is to get your head right. Don’t think that because you put in 150 mile weeks year round, or that because you can get to the top of lung buster mountain in under 48 minutes that you are immune. In fact, it is precisely because you are so fit that you are at elevated risk. You are not immune, you are at risk!
This is not just world class athletes we are talking about. When I originally wrote this article four years ago I personally knew three riders in our club who had suffered this crippling affliction. In all three cases the rides were in their 30’s and 40’s, all were very fit and none of them had ever heard of DVT. The number has since gone up to 4 folks I personally know.
I was recently discussing this with a friend who is a planner and statistician and he gave me this advice: He warned me that the plural of anecdotes is not ‘data’, which means he was unconvinced. But he was the prototypical geek so anything less than a regression formula was unlikely to swing his vote.
It can’t be coincidence.