Long term anti-coagullation

I finished a 6 month course of Warfarin therapy in July and honestly felt better than I have done in years. Besides the fact that I'd torn my hamstring, my cardiovascular fitness was returning and a lot of minor aches and pains I've endured over the last few years seemed to have disappeared. I was ecstatic and couldn't wait to get back to 'normal' living.

6 weeks later and having enjoyed a few weekend parties - my contemporaries all seem to be turning 50 this year - I really started to feel like I was heading back down the same road that led me to hospitalisation. Without having anything too specific, I simply wasn't feeling the same way that I had done. The only empirical evidence I have for this is that my apple watch estimated VO2 max dropped from 43 ml/(kg-min) to 38 ml/(kg-min) over a few days and stayed down at that level, having not been so low since I was just out of hospital.

With a bit more digging into my family history it's become very clear that there is an issue on our male side. I knew that we had suffered too many sudden young deaths, but I hadn't appreciated that other 'healthy' relatives had also suffered strokes too, so the basis on which I'd had my 'end of therapy' review was probably void.

Back to the doctor and one week of using even just a prophylactic anti-coagulant, I'm already feeling better again and the VO2 max score is climbing steadily once more.

I don't want to be on long term medication, but this is the right decision. Perhaps I was starting to clot again or perhaps it was psychosomatic? Perhaps starting to enjoy alcohol again is detrimental to my overall health and actually I now suffer week long hangovers? Perhaps the fact that I had not taken care to make sure I was getting a 30 minute daily walk done was a factor? In the end, the risks are a little bit too severe for my liking - take a wee pill every day or drop dead suddenly with the possibility of just having a heart attack or a stroke as the lighter alternatives. I'm on long term anti-coagulants now and my ambitions to train in Tae-Kwon-Do or play some masters rugby are parked.

UKCC Level 2 - Scottish Rugby

Accepting that my future involvement in rugby is much more likely to be from the sidelines, I embarked upon the Scottish Rugby UKCC Level 2 course with some like minded fellows down at Kilmarnock RFC last weekend.

First impressions are that the SRU have made a considerable investment into the support for coaches and coach development. 2 very fine rugby 'educators' were on hand to take us through some rudimentary rugby concepts and to understand the SRU blueprint. We discussed coaching techniques and how the SRU see the game being played from a top level down. The emphasis very much on Mini-Rugby being fun for all and Youth rugby being a developmental game; not one for coaches and clubs to simply hunt for trophy glory but for the much greater ideal of player capture, development and retention.

I have to say that the volume of resource available is incredible, almost daunting, but the Scottish rugby portal on Hive hosts a wonderful array of coaching video and self-learning cards for coaches.

Further to what the SRU have been up to World rugby also have created a 'passport' site where coaches can manage their learning, with superb resources for First-Aid training, Concussion management, Protecting rugby from gambling problems, coaching, officiating and generally understanding the game better. The passport site allows a coach to self-learn and work towards certificates, some of which are mandatory homework for the UKCC Level 2.

I've spent at least 12 hours doing online homework for this and will be back down at Kilmarnock on Sunday for another practical coaching session, where I will need to demonstrate that I've found a way to address the critique I received for last Sunday's practical session. I don't expect to fail, but my goodness I'm impressed with the level of detail in the course and the level to which we're expected to understand Strength & Conditioning, psychology and player development. It's a long way from the 3 laps around the pitch warmup and endless passing drills I endured as a kid.

Very impressed.

Hamstrung by stupidity

Fuck Fuck Fuckity Fucking Fuck!!!!!!

Was really starting to feel great. Genuinely benefitting from a wonderful break in Sardinia, chilling with the family, catching plenty of rays, dipping into the pool daily and even getting up for some early morning Body Balance - very cool class that is a mix of Yoga, Pilates & Callanetics with a very chilled out set of background tracks to work to. Doing it from a shelter just after sunrise looking out to sea added to the tranquility.

All of this tranquility and peace may explain why when the lovely Rachel asked if one of the parents could join in the football to even up the teams I reluctantly stuck my hand up and took my place in goals... Of course it could have been the tranquility, but it wasn't was it! Bloody stupid ego of a man who should know better is much closer to the truth... 2 stunning saves later and I'm dreaming of a comeback... Here they come... Change of direction, attempt at acceleration, foot slipping on uneven surface... Twang!

Just like that, another 6 weeks of rehab and the echoes of a doctor's voice in the distance reminding me that after 6 months rest, I shouldn't expect my body to be as it was before I was ill...

Fuck Fuck Fuckity Fucking Fuck!!!

6 Months later

Nice review meeting with a hospital consultant this morning. Under normal circumstances I think we would have just stopped the Warfarin, shook hands and parted our ways, but with the sudden death of my brother last year and no post-mortem, there remains a concern that this could be some genetic condition at play.

Warfarin days are over though, so that's the good news.

Next stage is to return to hospital in 4 weeks time, to allow system to be cleared of Warfarin, and get some more blood tests (D-Dimer) which will further inform the decision as to whether I need to adapt a prophylactic medical regime or can return to unmedicated status - which is my preferred option, of course.

Still, that been 6 months sans-alcohol. I've not really missed it to be honest, and with my new found knowledge of Alcohol-free beers, could this become a lifestyle choice???

Regrets... I’ve had a few

5 months since being hospitalised with Multi-Focal Pulmonary Emboli I’m back into an exercise program. I left hospital bursting with vim & vigour and was somewhat surprised when the Doctor insisted that I take 3 weeks off work then a staged return to work. I really couldn’t believe I was that ill... Actually if you’d told me 2 months earlier I might have believed you, but by the time we realised what was wrong the blog clot was splitting and I’m eternally grateful that the fragments lodged in fairly benign places rather than taking the opportunities for mischief that they had.

It didn’t take long for it to sink in though that there had been a significant hit on my health. Everyday life was wearying - possibly a wee bit psychology involved in that too? Up in the morning and ready to take on the day very quickly dulled into tired afternoons. I tried to lose some weight and took to walking, which was wonderful. For some reason Spring came to Scotland exceedingly early this year, February was fabulous and I made the most of it. The outcome of which was that I quickly escalated my walks too much and ended up with a spot of Plantar Fasciitis.

Regret 1 - Should have invested in better shoes for walking.

For all that the heel pain of P.F. Makes the mornings a bit miserable, it’s actually fine once you’re up and about and just requires a bit of stretching and taking care of your feet - I had the time, so no problem.

Having previously played rugby for too many years, I have a few wee niggles here and there that will always be with me. I’m missing a ligament in my shoulder that means I need to keep it conditioned so that the muscles provide the necessary stability. Those muscles have a habit of atrophying more quickly than the others and if I don’t maintain it, I end up with an unstable and painful shoulder. It really doesn’t take much to maintain them either, but as I was in complete rest, I didn’t...

Regret 2 - Should have added a daily movement routine to my schedule. Just running the joints through a sequence of moves designed to ensure the stability was maintained. No need to view it or manage it as ‘exercise’; no need to get tired or stressed (physically) by it, just keep things ticking over by moving those joints, maybe even tai-chi style... think that's what I might recommend rather than anything even as stressful as Yoga.

Regret 3 - Whilst doing that sequence of joint mobility exercises should have introduced some moves to make me less right sided. See the above comment on tai-chi, damn! Should have thought of that, it always seemed a bit of a weird thing to be doing, but actually kicking myself now that I didn't do that.

The move I’m using just now to return my shoulder to form is a bit like Saturday night Fever dance move. The Physio calls it ‘drawing sword from scabbard’ but I’m definitely more John Travolta than Braveheart, so ‘Staying Alive’ it is. She’s given me one of those rubber bands to add resistance, but honestly, just doing the move on it’s own and twisting the hand at the end so that the palm faces upwards is enough.

See a video version of it here

Most of the problems I had with it in the first instance I’m sure are to do with the fact that my brain didn’t know which order the muscles should be firing in. Getting there though.

Regret 4 - See all of above but apply it to the left knee, which is only slightly less damaged than the left shoulder

Regret 5 - Should have learned to juggle

Regret 6 - Should have played more guitar

Regret 7 - Didn’t make enough use of my Busuu account to practise languages

Regret 8 - Should have played more guitar

But here we are. Nothing to be done about what I didn’t do. I’m now back on the machines at the gym (cross trainer is nice and easy, rowing machine a brute) and I’ve been in the pool getting a few lengths done, so we're well on the way to recovery.

In the interest of balance, I don't regret stopping the booze for the last 5 months. It was pretty easy for the first couple of months as I felt so shitty anyway. After that it just seemed to come down to reminding myself that I didn't drink when people offered - which is more difficult than you might imagine, but with the negative impact of a bang on the head when on Warfarin, the internal debate doesn't take long to reach a conclusion.

The Recovery - a wee bit of perspective

I was discharged from hospital on 27 January after 5 glorious days of complete rest.

If you ever find yourself in such a position or are in anyway the type of person who gets a bit restless or fretful, then I recommend that you read 'My Name is Doddie', the biography of Scottish rugby legend published last year as part of his efforts to raise money and awareness of the mind bogglingly awful condition that is Motor Neurone Disease. They way the big man is dealing with this cruel card he's been dealt would bring a tear to a glass eye.

In hospital, I put my feet up, read a little, watched Peaky Blinders on Netflix, moved around the room to have my meals with different views and went to the toilet occasionally. I had frequent checks on my blood pressure and oxygen levels, a bit of fussing over changes to the medications that had been used to treat my misdiagnosed heart attack and changed my compression socks daily. In the end, the hospital realised that if they didn't kick me out they might run into a tea shortage well before Brexit even started to take effect, so as soon as my INR finally reached the minimum acceptable level I was out on my ear.

In that time my resting heart rate dropped from 75 back down to 60. In the 5 days after leaving, it crawled back up to 65 and has stayed around that level pretty consistently since, up to 68 briefly and down to 63 occasionally - funny wee vagary of the Fitbit, you can often be relaxed with a HR below what it records as your Resting Heart rate, something to do with how you sleep I believe, but I often see it a few beats below 60.

There really isn't a lot of information out there about what you can expect in the next stage. Take it easy is the main thing, don't exercise too vigorously for a couple of weeks, but no way of knowing when you can get back in the saddle - and this is what you really want to know in the early stages.

Most recovery plans I've been offered aim to get the patient up to walking for 40 minutes a few times per week, whilst I'm looking to set my bar a wee bit higher than that and after 1 week was pretty much walking 40 minutes daily - albeit, I was feeling the effects of that initially -  getting up to 1 hour in the 2nd week and by the 3rd week easily able to get out for a good 2.5 hour hike every couple of days.

What you can't really account for is just how much rest you also need at this point. I left the hospital feeling revitalised and full of vim & vigour and feeling desperate to get out for a run or a bike ride, almost fantasising about doing circuits or lifting weights. Just a week of having a fairly easy time of it at home showed me that this condition isn't just as simple as take some medicine, feel better, get back to training. There's a real need to come to terms with the predicament that has just been survived. There's also a need to realise that the body has had a bit of a kicking and could still yet suffer unwanted long term consequences if you get the recovery wrong. On the other hand though, there is a tremendous amount of good to be gotten out of a period of more gentle exercise. The walking has been uplifting. The need to have a more stable diet has been beneficial too, although it has highlighted my terrible discipline when it comes to peanuts. I'm allowed alcohol if I want, but actually there are too many risks associated with head knocks, so I've just completely knocked the drinking on the head and I have barely missed it at all - I'm now a fizzy water with a wee dash of cordial guy. I can do press-ups no problem and I quite like doing them, but I think I need to spend some time working on my flexibility, so I'm going to avoid strenuous exercise for another few weeks and focus on yoga type stretching - I am a tree! I am the mountain! I am the soft breeze!

In the meantime, I'm really enjoying getting out for my walks. It's good to reacquaint myself with the city and the parks that I'm lucky enough to be surrounded by. The weather this year is freakish though and at the end of February, 1 year on from us enduring the 'beat from the East' it's now way too warm. The flowers are already out in force - not sure how the next deep frost will affect them, but in the meantime I'm enjoying this very early start to Spring and am much more aligned with my need to recover physically more slowly than my ego would like, but even that has taken a few weeks to accept.

Deep Vein Thrombosis - the signs

Having established that I'd probably suffered a DVT sometime last Autumn, it slowly dawned on me that my body had been screaming this at me, but I'd ignored it.

In October at some point I had what I assumed was a calf cramp. I haven't suffered such an incident since I was in my 20s. Back in those days I did occasionally wake up in excruciating pain during the night - these are known as nocturnal cramps and the NHS have a page here, back then they were probably caused by the effects of rugby training in the deep mud that passed for Anchor Playing fields in Paisley. I brushed this incident off without considering fully that it's about 25 years since I had my last cramp like that, even if it did take a few days to feel like my calf was recovering - I put that down to old age - and I certainly hadn't been putting any great stress on my calfs in recent weeks.

I also noticed that my ankle was slightly swollen, socks were leaving much more pronounced marks around my ankles at the end of the day and I did consider that I might need to see the dr. about why that might be happening, then of course the swelling disappeared of it's own accord, so I did nothing about it - it seemed harmless.

Both of these signs are pretty major indicators that there was a DVT causing a blockage in my leg. Hindsight is a wonderful thing!