Blood Clot from Long Drive
Elk
Got back Saturday from what I'm calling my first real elk hunt (OTC in Colorado). We went to this same spot in '13 but did not get to hunt but a few partial days due to the flooding. I told my wife before I left that this trip would probably either make me an elk hunter or convince me to put elk on the shelf for a while. Well, this time around I had a pounding headache for the first 3 days (altitude), trouble sleeping, nasal issues, and of course got my butt kicked by the mountains for 9 straight days. We still managed to hunt very hard and put on quite a few miles a day and got into elk on a few occasions.
Then, I'm back home for 3 days and developed what I thought was a cramp in my calf. After two days of it and the fact that stretching was doing nothing, my parents convinced me to go to the doctor. Sure enough, two blood clots in my calf so now I'm on blood thinner for 6 months. My Dad warned me about that risk before I went on our 25 hour straight through drive but I figured it was rare and for some reason thought it didn’t apply to me since I’m in good shape.
Doctor said the combination of the altitude thickening my blood and being in the truck so long was most likely the cause. My partner and I took turns driving about every 3-4 hours but apparently that was too long. Make sure you get out to stretch more often than that the next time you're heading out on a long distance hunt!
So a recap of my two elk efforts…..nearly a month of vacation time burned, the stress of leaving my wife and two boys twice, no tags punched, extreme headaches, terrible sleep, flooding, multiple hailstorms, blood clots, a string popping off a bow in the backcountry, and of course a lot of overall discomfort. And yes, I realize it could've been a lot worse.
But there was that one morning. The morning that has had me staring at Google Earth and my topo map, looking at all the good looking areas that were just a mile further. Re-reading my books and searching past Bowsite threads, refining my gear list and looking at others’ elk trophy photos. All in the past few days.
My wife asked what I was doing when she saw me scouring my map last night. I said I don't know. I can't explain it.
If you stayed for a month you are hooked foreever. a normal person can't stand it that long.
I really doubt that the altitude "thickened" your blood as it takes months for a body to adjust like that. What happens is that you are immobile for long periods of time so the blood doesn't flow like it would when you move. The constant muscle contractions of movement aid in blood flow. Gravity at it's finest here with the lowest parts of the body (legs, especially calves) suffering a severe bout of "venous stasis" (blood just sits and doesn't flow). The cause of your blood "thickening" is more likely due to dehydration which is exacerbated by 1) the high, dry altitude 2) increased exertion with decreased fluid intake which probably continued on your 25 hour drive. It is recommended that you drink at least 2 quarts of liquid (alcohol and coffee are not on that list) a day just to be at altitude and if you are active, increase that to as much as a gallon a day. Your urine is the barometer of how well hydrated you are. If it looks like the tap water you are drinking, PERFECT. If it looks like the beer or orange juice you had, then you need more liquid. That headache is also related to not enough fluid intake.
You did give some good advice but left out increasing fluid.
Sorry to hear about your malady, but it is more common than folks think.
Signed, Rikki, ER RN
My feet were all swollen up on the trip back this year. Thoughts from the RN and PA?
I suspect that the Dr. Was explaining that in layman's terms. The act of elevation, dehydration, etc. does "thicken" the blood compared to a persons normal state. This "thickened" blood makes it more predisposed to pool and clot on long drives or plane rides.
That's whyI (and everyone should check with their Dr. For their own specific situation first) take aspirin a few days before, during, and a few days after a long drive like that.
Gobbler, Retired Board Certified Emergency Physician
No I don't smoke. And I drank over 100 oz of water a day out there. Maybe that wasn't enough, but based on the pee test I was hydrated. I admit I didn't take it easy my first day of hunting.
I've talked to two people in the last day that know someone that had the same thing happen after long drives. I was fortunate mine was below the knee and fairly small. It's gonna make me nervous every long trip I take from now on though.
People who clot tend to be prone to clotting. You need to get out frequently and walk around a bit when you drive long distances. Same with plane flights. But don't get out. Just walk the isle :)
Sounds like you did everything right!
"My feet were all swollen up on the trip back this year. Thoughts from the RN and PA?"
Midwest-Go see a doctor. Tons of things can cause swollen feet. It can be as harmless as inflammation or as serious as a heart issue.
Headaches in high altitude are not always caused by lack of adequate water intake. The high altitude in itself can cause a wide variety of symptoms including nausea, headache, and dizziness. As was stated earlier, your lack of movement is what caused the blood to pool in your lower extremities. This is why we ask folks if they have been on any long flights that come to the ER with lower leg pain and swelling. The high altitude has nothing to do with the DVT ( deep vein thrombosis) or blood clot according to the ER doctor sitting 3 feet from me as I type. As was mentioned above, foot swelling from sitting a long time can be a result of congestive heart failure, a condition where the heart muscle is weakened. It cannot pump adequately to move blood from the lower extremities and it begins to build up fluid. If left untreated, this can commence to fluid build-up in the lungs.- Jason Thornton ER RN
I use the surgical knee socks whenever I fly or drive for long periods. I also take a couple aspirin before I leave. Blood clots in the calf area from long term sitting are more common than you think.
I drove a semi from NY to CA and back about 300 times and never had any problems and back in the day might sit behind the wheel all day and all night. Unload, reload and head back across.
I've heard about the socks and aspirin. I will be talking to the doc about using both the next time.
I second the aspirin before, during and after the trip.
Ed, watched a lot of doctor House and stayed at a holiday inn last night.
Thanks, Gobbler. I agree that it was probably the easiest way for an MD to explain things. For just the affects of altitude to have any change in someone's blood does take months, so I doubt that any change in H&H solely due to altitude happened in that short time. Working at high altitude (7000'-10,000') for the majority of my career, I have found that many of the doctors who live and work at low altitude do not take into consideration, or are truly unaware, of what happens at high altitude and what can be done before their clients come to altitude. Motrin has been shown to be the best OTC drugs for the S&S of altitudism and does have a mild "thinning" affect on the blood as well.
You don't want to mess around with DVT. Once you've had one, chances are you'll have more, or other issues, if you're not careful. I had a good friend (a pilot) who had one after a long international flight. He was grounded for months until successfully treated. About a year later, he developed a persistent cough after another long flight. Somehow his doc didn't link the two events, gave him antibiotics, and sent him home. By the time he realized he was in serious trouble and called 911, they were unable to revive him. What he had was a pulmonary embolism which would have been treatable if diagnosed early.
I would sure talk to my doc about an aspirin regimen after/if they take you off blood thinners. Use compression socks/leggings anytime you might be sitting for long periods. And don't sit for long periods without getting up often.
DVT and a PE damn near killed my pops on a long flight to Hawaii. This is no joke. Fortunately I am cursed with a peanut sized bladder which means lots of stops for me!
Sitting in a stand for many hours could possibly cause clots in the legs. Had a buddy who sat still for hours on end until he took his animal.
Then drove home (9 hours) and also had what he thought was cramps in his leg. Turned out to be a clot. He blamed the clot on sitting in his stand.
We take an aspirin every day in the mountains, learned that when Tred Barta had his spinal stroke, that and get out of your truck once in a while and walk around!
I manage ICU anticoagulation for a living. Young, fit people with DVT's are more common than you'd think. One thing is for sure, the length of time you spend sitting in one position has more to do with developing a DVT/PE than just about anything else though dehydration, smoking, etc play a role. A few years ago, there was a large study that compared the rates of DVT in people across many sub groups. One thing that stood out, as I recall, was that sedentary cubicle workers had similar DVT rates regardless of their afterwork habits. I.e., marathon runners carried the same risk as couch potatoes.
My friend and his wife drove to his home state for Christmas several years ago. Left two days before, drove the 7 hours and went to bed after the customary meet and greet. The next day she was feeling bad so, she stayed in bed while my bud got up to go visit with family. He went up to check on her about 10 AM. She was feeling really bad then. He called 911 and, she got up to get dressed when she dropped dead. Young school teacher that developed a clot from the ride. Left two boys and a husband. It is real and can happen to anyone. God Bless
My pop had knee surgery last year. The doc said the latest studies on the compression socks said they don't do a lot for the risk of clotting. They will help your swelling.
DON'T take this as the latest medical advice - talk to your doctor - as they may have come up with another study that says the opposite.
I injured my calf at 55 years old playing softball, simply by pushing off my right leg trying to get from third to home quickly on a ground ball . Felt like someone took out my calf with a .22 rifle and dropped me to the ground. Although ER said it didn't require surgery it was a big deal and couldn't put any weight on it. A few days later I had to go to Russia and flew for long hours of course to get there. I did that trip with a cane and in a wheel chair. Week later a return home. Was back home 2 days and my leg swelled up and got hot and red. Trip to my doc and an ultrasound showed a DVT below the knee. It took months to heal and I was on LOVENOX shots and blood thinners during the process. Was very scary and big deal. Now I always move my feet around and try to get up and walk anytime I am on a plane for even a few hours....or even in a movie theater. Better to be safe than sorry. I've known several folks who have died young from DVT and it isn't pretty.
See link
http://usatoday30.usatoday.com/news/health/spotlighthealth/2003-04-11-bloom_x.htm
