Catch Up Time

After a rollercoaster ride of highs and lows over the past weeks I finally have some answers and felt now was a good time to sit down and write an update. The story begins the morning of the day after the BCU Coffs triathlon when I was completing my recovery swim at Sawtell pool. As you normally expect the day after a race, I had some sore and stiff muscles in both my upper and lower body, but nothing to be worried about. I particularly noticed my right arm as it felt unusually tight and sore while swimming and my forearm and bicep muscles were fatiguing rather quickly. I simply put it down to normal soreness and finished the planned session.

Over the coming days this tightness developed into swelling my whole right arm while swimming and gradually worsened with each swim session. I now felt that this was more than simply muscle soreness and visited my GP to get some answers. After doing some initial research I came to the conclusion that my symptoms matched a condition called Thoracic Outlet Syndrome (TOS), specifically the venous form of the condition (V-TOS). Put simply, TOS involves compression of the neurovascular structures (vein, artery and nerves) between your clavicle and first rib. In my case it appeared that the vein was either blocked or getting blocked while I was swimming, hence the swelling in my arm. An initial Doppler Ultrasound was completed to assess the vasculature around my upper and arm and shoulder, which came back negative for any blockages. This was re-assuring to me as blockages (clots/thrombosis) in your veins are quite serious conditions with potentially life threatening complications and generally require immediate attention. It did however leave me still unaware as to what was causing my arm to swell. I continued to the week leading up to the Mooloolaba triathlon but decided it would be best to limit my swimming in order to give my shoulder and arm a chance to recover from whatever was happening.

The Friday before the Mooloolaba triathlon I made the call to withdraw from the race as some residual swelling remained in my arm and I now was developing some pain around my shoulder. This swelling and pain worsened over the weekend and prompted me to return to the GP and request another Ultrasound to confirm that there was no blockage in the vein. My concerns were valid as this Ultrasound detected a thrombosis measuring approximately 50mm in my axillary and subclavian vein in my right arm. I was immediately started on anti-coagulant therapy by the GP and referred to a vascular surgeon to further investigate the cause and devise an appropriate treatment plan for the condition. One thing that was certain however, was that my current training and racing plans were put on immediate hold.

After consultation with the vascular surgeon I was informed that I would need to take anti-coagulant medication for 6 months, to ensure that the thrombosis resolves and that no further clots form and that surgery to remove the first rib and therefore increase space for the vein was an option. He also ordered further investigations to determine whether there is any other underlying causes for the thrombosis and assess the degree of blockage in the vein. Results from these scans confirmed that there was a thrombosis present but could not identify a reason for it developing. Based on these findings I felt that rather than jump into the surgical option I would trial a period of rest and anti-coagulant medication which will hopefully enable the clot to dissolve and allow me to return to normal sport.

As it stands now, I have been on the medication for almost 4 weeks and the swelling in my arm has significantly decreased. I have been resting from training for 4 weeks and plan to have another 4 weeks off completely from a formal program. As I am required to be on the anti-coagulant medication for 5 more months I will not be competing in this time but will however commence some training before this time.In the coming weeks I will post a blog explain the condition as it is an uncommon and unusual injury. Otherwise its feet up for a few more weeks and enjoy a nice 10 hours of sleep every night!

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Copyright (c) Daniel Stein 2014