Feb. 2024 PEP Talk: Exercise, Anticoagulation and Weight Loss After a Blood Clot

so welcome everyone to tonight's uh National blood clot Alliance pep talk our topic this evening is exercise anti-coagulation and weight loss after blood clots uh tonight's clinical guest is Dr Jean Connors uh Dr Connors is a hematologist who received her medical degree from John Hopkins school of medicine she did her residency at Beth Israel deonis Medical Center and her fellowships at Bram and Women's Hospital where she current you currently practice at um she has been awarded top doctor by both Boston magazine and Castle connley I know you're a favorite amongst the clinical community and patient community and her specialty is hematology but her clinical interests are wide and varied but include coagulation coagulation disorders pregnancy thrombophilia cancer Associated thrombosis um she is and has been involved in several thrombosis trials one of which she may discuss with us tonight uh and with that we would love to welcome you uh to tonight's pep talk Dr Connor well thank you Leslie and and uh Todd thank you for having me on I on this important uh webinar I I think there's a lot to discuss and and I know we might not get to everything in an hour but but thank you uh for having me super thanks okay so um as a reminder tonight's event is for educational informational purposes only uh we are not here to give you medical advice we we ask that you speak directly to your doctor for medical advice as it pertains to you in this issue but we're hoping that we give you tools that will make you more educated about having that conversation with your personal clinician okay so before we start we do have some poll questions I'm going to turn it over to Todd so Todd if you could kick off the poll questions for everybody yeah when these questions pop up folks it's really important that you uh answer these because this this helps us with our Outreach and our education effort and and all of that stuff so just take a few minutes and I'm going to read them to you question number one did a health care provider speak to you about how to exercise uh post blood clot yes no or not available our second question did a health care provider speak to you about the possible risks related to anti-coagulation and exercise yes no or not available and our final question if a patient advocate has been provided to you to answer your questions about exercise anti-coagulation and weight loss would you have used that service yes no not available so if you guys could answer that real quick and then we'll uh go through the results and then we will have a a closeout poll too at the very end but if you guys can just answer these for right now as soon as these pop up our results I'll give those to you thanks everybody for being here this is a very important topic tonight I'm really excited can't wait for you to share your story okay here's the results did a healthcare providers speak to you about how to exercise post blood clot 14% said yes 83% said no 3% not available did a healthc care provider uh speak to you about the possible risks related to anti-coagulation and exercise 133% says yes 82% no 5% was not available and If a patient advocate had been provided to you to answer your questions about exercise anti-coagulation and weight loss would you have used that service overwhelmingly 8 7% yes 2% no 11% not available so thanks folks for answering those questions wow 87% that's amazing yep okay so um we're gonna kick it off uh if you have questions um please put them um on the side there is a chat function but we may not be able to get to all the chat function questions uh tonight because as um Dr Connor said who we're now going to change to Gan uh said uh we have a lot to cover in an hour so with that okay so Jee we're going to uh we're going to break tonight's discussion into three parts hence the name weight loss exercise and anti-coagulation and the first piece is going to be on weight loss itself so you know weight loss After experiencing the blood clot talk to us about why um carrying extra weight is a risk factor for blood clots um for those that are looking to lose we post their blood clot you know what is being recommended how do you talk to your patients about this um and then we want to talk about the gp1s can you explain to the audience what they are um and if they're currently being recommended to patients so we have a bunch of questions in here we'll keep going on this one for a little bit but we'll start with that yeah no well thanks Leslie and and I did forget to mention please call me Jean um and I am more than happy to make this a very fluid discussion because there's there's just so much information and it is kind of sad to see how many people don't get the kind of information that can help them live their everyday lives uh once they've had a blood clot so um so we'll start with you well so first of all a lot of people in the United States are overweight right I mean over 40 40% of us um adults in in some would even say 70% have a body mass index over 30 uh uh which is what we usually uh call but as overweight and then over 35 is even more um concerning um you know and and and it's a difficult topic because a lot of different things move together but but obesity um as it's defined by the BMI uh affects your risk for clots in a couple different ways and and one of them may just be that you move less frequently another is when you're sitting you know it may be harder for the blood to return to your body say your legs are cramped but but we also know and and this is where the GPL the glucagon like peptide one GP receptor agonists long name there um actually were started when were developed for people with diabetes who had problems with low blood blood sugars and regulating their blood sugars but they also had inflammation and that's one of the ways that blood clots can form is inflam inflammation so like just like having an infection like really severe covid can give you a blood clot or even like if you in the hospital with pneumonia or have other similar strong infections that can trigger a blood clot just due to the inflammation and so what happens when people are obese they tend to do become insulin resistant they develop um increased uh inflammatory markers and we can see this in people when we measure things like arthy sedimentation rate and C reactive protein so you know getting a little in the weeds here but but they the net effect and and then you increase the blood pressure um where usually when people are overweight that contributes because you have more wear and tear on your vessels they have higher pressure there's more shearing Force there's more activation of things um of cells and the blood vessels themselves and that makes them sticky and diabetes makes them fragile so you put that all together and you have like the perfect storm of combination of things to cause a blood clot and and so um obesity is one factor in many for some people but in and of itself is a risk factor and so one of the things I do in my day job is talk about inherited blood clotting disorders right and everybody's looking at people who've had a blood clot looking for you know why um and looking for inherited blood clotting disorders and and I will say that less than 10% of the people in the United States have an inherited blood clotting disorder um compared to at least 40% of the population um being overweight but when you look at one type of um blood clotting disorder the prothrombin gene mutation ptg or proin Gene g20210a um if you are heterozygous you have one normal proen Gene and one mutated or abnormal one your risk for getting a blood clot is the same as if you're obese right and so obesity has the same weight as these inherited blood clotting disorders uh and when and the risk for recurrent blood clots is high if you don't change your body mass index so and that's sort of the sort of the millu of the the first part of the question the second part is that these um glp1 drugs um were developed uh in patients who had diabetes and obesity and cardiovascular disease and we've known for a long time now 15 more years that inflammation plays a role in cardiovascular disease and we know that from some of the Statin trials I happen to work with a colleague uh who who really showed that uh statins not only lower your cholesterol but they also lower your inflammation and so that can help prevent coronary artery disease stroke uh and even deep vein thrombosis so statins have become one of my new best friends depending on on um what type of clot people have had and what their ongoing risks are but those cardiovascular risks were still an issue uh and primarily in diabetics and so the glp1 drugs were developed for diabetics it's kind of interesting because glucagon like peptide is like glucagon and glucagon is a hormone like insulin but it does the opposite of insulin so when your pancreas secretes insulin it drives down your blood sugar by driving the blood into your cells but if your blood sugar gets too low glucagon is released and that causes release of sugar from your liver and other stores so they're kind of like a balance and so it was thought that if you made something that bound to the glucagon receptor um you could get better blood sugar control what was found though is that not only did people have better blood sugar control and if you're familiar with diabetes there's something called hemoglobin A1c um which is hemoglobin which lives in your red cells that had basically has sugar attached to it it's glycosilated hemoglobin and so when you drive down your hemoglobin A1c that means your blood glucose levels are lower and there's not a lot of extra sugar sticking to your hemoglobin so they found that that not only did they drive down the A1C and patients did better and they had better what we call cardiovascular outcomes the people treated with these G um glucagon like peptide 1 GP one receptor antagonists um had less heart attacks less stroke less death when they had diabetes but they also lost weight and they also had a decreased appetite um and I've had patients on them so I have never prescribed these drugs but I've had patients for they've been prescribed um and they've lost weight when other things didn't work for them although they did not try bariatric surgery or gastric bypass but what they tell me is that you know it's like you late at night and you're like rumaging through the cabinets trying to find that snack or you're working on a project and you're mindlessly eating the bag of chips next to you that type of um food ER thoughts go away and so who knows there's a lot to learn about those but but that's sort of how obesity is a factor in risk for blood clots and not only risk for first blood clot but risk for recurrent clots um in in part of that is inflammation and part of that is hypertension um but also those new drugs are something that we have been very dramatic in causing weight loss so we have had um a lot lot of questions lately coming from patients asking about we refer to them as the as the glip ones the glp ones um also known as things like weavi and you know kind of their stage names um moic wovi monjo semaglutide or yeah yeah yeah yeah exactly but do they also cause muscle loss because um and you know losing weight is great but are you losing weight at the expense expense of losing muscle so that is great and there there's so these drugs have a lot of side effects before you even get to that point you know they can cause a lot of GI type distress in patients you know and they seemingly disperate diarrhea constipation nausea vomiting um but they can cause such rapid weight gain by limiting your blood sugar for when your body needs it that your body body starts catabolizing muscle that's it's a fancy way of saying it needs to get the energy from somewhere so it's going to start getting the gluc the you know the glycogen stored in muscles out of the muscle and then the muscles tend to waste because they don't have the energy they need to to keep themselves healthy and fit and that's um why there's a big concern about you'll see if you go on the web and look for one of these drugs that you may be able to sort of finagle uh getting a drug directly from say a compound pounding Pharmacy without the oversight of a physician and a nutritionist or a a a program to manage your weight loss uh and manage your diet I think people um you know from from what I understand people don't recognize that they need to eat more protein and they still need to keep their blood sugars you know um reasonably uh good you need to have a very balanced uh and strong diet uh on these medications okay that's great um the other question is people wanted to know um how do they interact with a Doak or Warr if they're taking an anti-coagulant so so that's a great question um there's really no interactions whatsoever um with with um the doax and there's really no interaction uh with Warren remember that there can sometimes be you know depending on what you read you you may have subtle interactions with warrin but um because people are adjusting the dose it may not be recognized and it may not be critical so if you are on one of these medications or contemplating the glip ones or the semaglutide the wois the OIC which by the way are the same thing but they are proved for different indications um or uh munaro um the you should continue to you know take your your anti-coagulant of course you should be getting a prescription uh at least in the United States from a physician who should be aware of all your other medications uh that you are on okay super um you know as we talk about we loss so uh you Todd and I certainly together I think lost enough way to create a person um you've been great about keeping yours off I have not been so great about keeping mine off is there when you talk about in you know inflammation somebody like me as an example I lose I regain part part of it I lose do I increase my risk of getting a blood clot um after my initial blood clotting because of inflammation am I reintroducing anything that could cause a negative surprise yeah no you know that that's a great question because before I even get to that specific question one when I give lectures to like medical people you know I I about particularly uh what we call inherited or acquired RIS rks for for clots and and and you know being overweight significantly overweight is an acquired risk I always say there's one risk that we cannot escape and we don't want to escape and that's age so I don't know if we've ever seen uh there are some great curves that the risk of clots are about the same and they're about the same and they're going along and then you hit 60 and it goes like that okay so um as you get over 50 and you get up to that areaa it's kind of hard to sort out the the differences there but I do think that you know I mean in in you know the I think you probably not had the ginormous extreme weight gain and weight loss and regain that that might put you at risk but um the heavier you are we know the more that um your inflammatory status is affected and and and it's not the same in everyone either so so you know we see people um you know and they have an elevated like a mildly elevated white blood cell count and and their BMI is 40 and you know we look for occult infections they have those inflammatory markers the said rate the ESR and the CRP are high and we can't find you know some people we find chronic sinus infections we find teeth infections we find chronic urinary tract infections and we treat those and some of the inflammation goes away but there's that innate um just the stiffer blood vessel problem um that that you know I think is in the hypertension and that the wear and tear um is increased really interesting and the role of inflammation are there any trials or research projects that are going on now with regard to inflammation and blood clots that that we should all know about um so that's a great question because uh there's some not so they're not directly um aimed at um blood clots alone there have been Trials of anti-inflammatory drugs like canakinumab um to prevent heart attacks and strokes and they've been um somewhat successful um in combination wi with other medications but there's there's we their talk about using statins to try to prevent uh the Canadian my Canadian friends are doing a a trial looking at preventing post thrombotic syndrome uh with statins uh and we're going to be looking into uh something along those lines if we get funding from NIH um but there's no um say post first blood clot looking at at any anti-inflammatory medications and certainly um it's hard to capture people at risk right so it it's hard to you know get everybody on board with looking out for the blood clot and I do know and I'm sure you've all heard stories of people who didn't even know what a blood clot was till they had one right right right so yeah that was me yeah right and and that's why I think it's great that they the work you're doing now is is so important because I have seen patients who whose family members have said hey you might have a blood clot you better go get that checked out uh and and that's so important okay so just in terms of weight loss itself so we do know that extra weight higher BMI um is a risk factor and inflammation plays a strong role there we're still trying to figure all of that out um in terms of the gp1s that we just talked about um people are asking about this they should speak to their doctor about it but they should understand that there is a component of them losing muscle uh and not just fat which is kind of where we all want to go with with losing fat um but it doesn't appear that they actually negatively interact with a Doak or Warf friend but again they should discuss that with their with their their doctor directly yes okay and then what do you recommend to people just in terms of somebody says hey Dr Connor I want to lose weight what should I do how do you respond to that yeah no that's I say great idea um and and no and it's serious because I do have these conversations with patients and maybe not the very first time I see them you know and I think when someone's first diagnosed it is you Todd and and llie you both know it's kind of like a whoa you know where' this come from oh my God it knocks you out it lays you flat um and and so when I see people in the first month or two of having had a blood clot because usually I can't see them on the first day but um it's just like what it is what you need to do all about your anti-coagulant and then at subsequent visits where it's or depending on their weight though at the first one maybe but then subsequent visits it's like okay let's start addressing your lifestyle issues let's start addressing you know your weight is a risk factor and I will tell you that I have had patients particularly before the doax which tells you how long I've been doing this um that that um I you know didn't like warrin they you know I thought they had what we called an unprovoked pulmonary embolis they tell me they were sitting there writing their book for like six hours and that was the cause and I'm like yeah no I don't think that's enough um and and um their body mass index was I remember this one guy in particular was over 40 and he did not want to be on Waring and he lost weight and he's got his BMI down to 27 and I said okay it's been but it's been three years right you know because if someone has an unprovoked pulmonary ulis we get very worried that they have a high risk of currents recurrent clots particularly in those first two years and so but at three years he was kind of like you know I know the risks my my body ni's out I'm like that's amazing right and so we took them off anti-coagulation so sometimes that's an incentive but but getting back to what I do I actually have no problems referring people to weight loss um uh clinics we have a weight loss clinic associated with our um our hospital and it it's comprised that they start with a nutritionist uh you know I I have to say that I was actually fortunate I grew up my mother was what they used to call a dietitian and now they call him nutritionist and so I never realized right you know the plain chicken and the no butter on the broccoli and no cheese on the broccoli and you know Ginger Snaps instead of Hostess Twinkies and potato chips um really really made a difference right and and so I forget that not you know not everybody is aware of healthy eating and substitutes right you know there was a great study maybe 12 years ago um you know eating fish is good for you right all those Omega-3s are great they help with your your again it's sort of anti-inflammatory stuff they help with your lipid profile um and people couldn't understand why people in the south in what was called the stroke belt were still having more Strokes despite the fact that they said they were eating a lot of fish but they were eating fried fish which took away the whole healthy you know healthy aspects of fish right so the first start is a nutritionist okay and looking at your diet and looking at making simple changes to your diet and your routine it does take some thought it does take some effort um to focus on your diet instead of having it be the last thing on your list and you know grab what whatever is in your like in my case the hospital cafeteria um or you know stopping by you know Dunkin Donuts here in New England right uh if you watch the Super Bowl you know how we feel about that um but but um uh you know so so that's the start and then and then there's a lot of different alternatives to just taking you know wovi OIC and and Muro right um I have a close friend who who joined Weight Watchers but it really didn't kick in until she retired uh recently um you know she again overweight borderline hypertension borderline diabetes she needed to lose weight for a lot of health reasons besides blood clots but when she retired she had the time to go to you know Whole Foods and to chop all those vegetables and to think about the healthy components so there are ways to do that without it consuming your whole life and that's why I would say start with a nutritionist I know Todd you have experience and Leslie you also have experienced losing weight maybe you can sort of share how you did that then I can come back to Medical um approaches yeah to why don't you jump in here and we going to move to exercise afterward yeah um and that's why this topic is so important to me I uh so so my mom died of a massive uh uh pulmonary embolism it was sudden death in front of me she was obese extremely obese that was just one of the factors right she she sat all day she smoked I mean it was a perfect storm and back in 1984 when you're a kid you don't have a lot of people telling you about blood clots and why this happened to her and I only found this out later on after my third blood clot and found out oh I've got an inherited blood clotting disorder on Factor 5 lien my mom was a factor five lien and so was my dad so I'm I'm homo zist so it that that learning process came to me late but I'm I'm sure glad it did but as far as weight loss I got to tell you and I tell people this in the support group the best decision I made there were two things I saw a nutritionist and I bought a digital food scale and I started tracking the grams of everything I ate now that sounds really intense and it sounds really timec consuming and it may be for a couple of weeks but then it starts getting easier you start getting more used to it but I knew exactly what I was putting into my body and I got you know I have to admit I was a Dr Pepper freak and and if you look at pop or soda depending on where you live you know the term um how much sugar is in that is just unbeliev able and it's just insane and when I stopped drinking pop that right there I started seeing the pounds melt off a little bit but if it wasn't for me tracking the calories and you know it I'm a very active person I love exercise we're definitely going to get into that um I mountain bike I bike I swim I do I love being active but that wasn't the you know that wasn't the main reason why I was losing weight I was watching what I was putting into my body and it took me uh almost 15 months but I lost almost 80 pounds and and it changed everything for me yes it I'm on a Doak I've been on zalto for 13 years but it made me feel better it made me feel more confident I I had to go out and buy all new clothes but that is not a bad problem when when you're trying to lose weight so I I totally back up what you said I think seeing a nutritionist that is the first thing I tell people in the support group when they ask about well I don't understand what to eat go see a nutritionist because they're going to help you they're going to understand your situation and and that's where I got a lot of my education um but going back to exercise um like I said it is so important to me introducing exercise after a blood clot you know this may be one of the most inquired topics we receive at the national blood clot okay support group emails phone calls I've heard it now for the past couple of years it happens all the time what is the best way to reintroduce exercise is there any medical guidance or even guidelines which regard to exercise post blood clot uh that you know is there a way there is I mean how can we prevent heart attacks and strokes and we have all these things happen but we want to exercise why is it that we see some people getting right back into exercise yet some people may take years to get back into exercise if ever what happens to one's lungs or legs or arms that often makes the comeback so hard yeah no so so these are these are great questions Todd and again again I think your experience with the pop is huge right um because um simple substitutions like that and you know water sparkling water I'm a big fan of diet sodas even they're bad though they're bad for you know your bone density right but but um so so I think that that's important I think you know let's let's move on to to exercise um I used to be I think I you know I um exercise quite a bit I grew up exercising I ran competitively I did triathlons competitively I swam competitively then I've had a bunch of significant injuries that have slowed me down um and I used to think though even you know with medical training and stuff I used to think wow if I can't go out and run five miles and it's not worth going out then it was like well if I can't go out and run two miles it's not worth going out and then you realize that every little bit counts right um with regard to exercise so so I I stress you know you may think that when you first diagnosed with a blood clot walking out to the mailbox or walking around the grocery store is not something but it is right and so and so I think so so you know every little bit counts now though we have to talk about differences in degrees of blood clots right so some people get what we call a calf vein blood clot they get a blood clot below their knee it hurts their leg can be swollen but they're not terribly compromised if they catch it early and you know within like a week they feel completely fine of after starting anti-coagulation um or maybe 10 days and they are not as slowed down by their blood clot um then you get people who have significant pulmonary embolis right they all of a sudden they're short of breath they can't breathe they're dizzy they're lightheaded they end up in the emergency room they end up in in the hospital and they might get thrombol liis they might just be on IV heprin for a couple days and then the next thing you know they've been in the hospital for five days or so and they get home and every time they try to go up the stairs they're short of breath from the pulmonary embolis and so that um leads to less exercise and they get a little debilitated right they they get like astronauts right astronauts up there have no gravity it's like sitting in bed for for however long they're up there and when they come back here they've got to regain the strength and the endurance that they had previously and and so I think that that's one thing you you can work with your physician you can work with a physical therapist we have cardiac rehab programs and I have sometimes sent people with strong pulmonary embolis symptoms to a cardiac rehab program so so what I do tell people and and I think this is important to the exercise thing is when you get a blood clot one of three things happens okay um you know after you start anti-coagulation um and after you've gone past a certain amount of time which we can discuss um but it either goes away completely it goes away partially or it doesn't go away at all and so if it goes away completely um then you really have less significant residual uh uh bad effects for lack of a better word right um sometimes your valves in your like the valves in your veins can be compromised and you might have a little swelling or a little post thrombotic syndrome but if you don't have residual clots in your legs you're doing pretty well and it's easier for you to get back on your feet without noticing symptoms if you've had pulmonary ambis and you have a lot of residual clot in your lungs that doesn't go away that does limit your pulmonary reserve and your cardiac reserve and so so I think I can't sit here and give a recipe for everyone what I can say is that um you know how you feel and Todd you you know as a as a consumate athlete right now I think you're on your bike every day um is that you know when you can push it and you know when you can't and so when people are starting back again every little step every step counts uh and you need to build up gradually if you've been uh out of commission for a long time we used to say when I used to run competitively for every week you take off it takes two weeks to get back to the same um Fitness level right so so you know and people can be you know I've seen some people have you know what I thought were big pulmonary embolist they've got chest pain they got a little you know dizziness tachicardia um and two weeks later they're great and then we have other people it's six weeks and they're still not quite feeling right they feel better but they're still kind of slowed down so for go ahead g go ahead yeah I could keep talking forever so please do I was just gonna say when so so after my pulmonary embolism I asked my pulmonologist about getting back on the bike and he thought that it was a great idea because it would help strengthen my lungs but he said be prepared to feel some discomfort from your scarring from from the damage that's taken place and that's not necessarily a bad thing he said you'll just have you'll know it back off and then repeat and I really believe I concur with him that that actually helped me strengthen my lungs was getting back into my activity but being very careful pacing myself one thing I wanted to ask you real quick while you were on this topic was if somebody's had a a DBT and the blood clot is absorbed but they still may have a little pts or they may have a little bit of vein damage is it still safe for them to do some leg exercises not just cycling but I'm talking about weight training leg presses calf raises things like that can they do that yeah no and this is a great point because I while you I I realize that I made exercise sound exercise is so important okay um because for a lot of reasons um and the taller you are the harder it is for your leg veins to fight gravity okay but even short people should exercise and what happens is the calf muscles and the leg muscles with walking um and the muscles Contracting help push the blood back up to your heart okay so like I mean I I I will be very you know the blood's in your heart and it pumps and it pushes it through your arteries and it pushes it through your veins but after it beats it stops and if you're standing up you've got these valves in your veins that that do this to prevent the blood flow from sloshing back down to your ankles but if you've got scarring because of a clot and the valve stay open then that's when even if the Clo's gone but maybe the vessel is the the valve is scarred you end up with swelling now if you increase the blood flow like with running or cycling or standing even on your feet all day say I don't know you're at some function where you're standing for 3 hours you may see swelling in your leg so what I do tell my patients with deep vein thrombosis is that compression socks are their friend okay um and I know you had a pep talk on on compression socks my biggest Bugaboo for people who have bad post thrombotic syndrome is to put them on before the swelling happens because the compression stocks put pressure against the blood vessel that's you know like a a drink a paper drinking straw and it prevents the fluid from leaking out but once the fluid's leaked out and you put the sock on it's not going to push it back into the blood vessels but if you don't have a lot of post thrombotic syndrome and you're going out for a walk you're walking your dog you're going out for a run by putting on a compression stocking you actually help prevent the swelling in your legs where you might have what we call Venus reflux or vascular reflux so so compression you know and let's face it you see all those marathon runners out there wearing knee high it's not a fashion statement it's a compression sock you know Michael Phelps used to sleep in a compression suit when he was uh training for the Olympics yeah so I I I think that that's big but then but they need to be properly fitted though right don't people need to be really careful on on that so so that's interesting because we used to say oh my God you would need 30 to 40 millimeter comp Mercury compression for post thrombotic syndrome and we're now re realizing just like exercise something is better than nothing and so what I tell a lot of patients who have mild symptoms or notice swelling when they go out and they're on or you know walking or running and they're on their legs for a long time get those 15 to 20 millimeter ones off Amazon you know six for $20 ask me how I know um and I look them up with my patient too no but but I I I I had a big leg injury and had a big surgery and it was really swollen for a long time and I love those compression sockets so um you know try that because that may give you the support you need and then you can work your way up um if you've had significant lymphadema if you have very severe postthrombotic syndrome you may need to go to a medical supply company get a prescription or even go to the supply company they can be pricey depending on the brand um most health insurance will pay for them if you have a doctor's um prescription so so if it's minor they don't need to go see a vascular specialist necess neily no I I and and you know yeah I mean the the idea behind the compression stock is to help when you are putting increased blood flow through your leg and you might get swelling uh and or you know people tell me after a long day at work their leg just feels kind of draggy and heavy and it's a little tight but it's not ginormous um you know those are people that can go the Amazon route and see if it helps and if it doesn't help enough then talk to your doctor about uh uh prescription strength uh compression stuff thanks Jean that's great okay question for you with regard to the exercising so you know using myself as the guinea pig again I started out walking in my apartment I graduated to walking down the hallway in my apartment building I started to walk around the block in where I lived and then I started to walk and walk and walk and I became incredibly obsessed with walking I was also obsessed with my spo2 and I want to talk about what that is what that means for people how they should think about it I was you know when I first started to walk I was in the low 90s and then I would actually get to the number 100 as I was walking literally like miles every single day what does that what is that spo2 what is the oxygenation in the blood how does it help people and should they be obsessed with it the way that I was we all got obsessed with it during covid okay all right during the first wave of Co I I bought my father one of those little $25 O2 sat meters off Amazon I bought one for myself um so so um percent oxygen saturation of your blood is really what we're looking at and your red cells carry oxygen and um no one is ever 100% unless they're hyperventilating or exercising but we all when I was a med student used to love to play with the O2 sat me that beep in your room all the time and see if we could get up to 100 okay so so anybody over if you're over 92 or so you're great um it's when you go below 90 that um we get a little concerned and and that you can see that with um with a new pulmonary embolis or residual a lot of residual blood clot in the lungs and so that's one of the things we evaluate when people come in to the emergency room or or are seen somewhere for possible pulmonary ulis you know what's their heart rate if it's high if they're you know over a hundred and that's usually not their resting we get worried and I'll tell you why that fits into the oxygen saturation if the oxygen saturation is low below 90 we worry and if the blood pressure is low as well or if they're laded and dizzy because they're not getting enough oxygen to the brain so what happens is your tissues need oxygen and if your heart um is pumping normally and you have an oxygen saturation above say 92% you deliver as much oxygen to your tissues as they need but as the amount of oxygen gets smaller in each you know unit of blood your heart has to work harder to deliver the same amount of oxygen and so that's when we get worried that's why people get tacac cardic they're not getting as much blood to the heart or they're not getting as much oxygen in the blood and then the heart has to work harder to get the same amount of oxygen out to the tissues and that becomes a stress on your heart and um this is very sad actually one of my husbands colleagues um died of a heart attack with the last snowstorm we had here totally unsuspected um so so I say that because he was exercising um and he had a different problem he didn't have have a blood clot but again that's stress on the heart you don't know you know we have a better idea of people's cardiovascular fitness and their coronary arteries but it is it's a long-term stress we don't want on the heart we want to make sure that the brain gets enough oxygen that the kidneys get enough oxygen so so that um you know there's kind of a relationship be between the oxygen saturation and as it dips you don't get enough your brain you don't get enough in your heart your heart has to work harder um so it's it's a kind of it becomes like a vicious cycle and we like to break that cycle because as it gets lower um people also tend to work harder to breathe right so your breathing rate goes up and you can only sustain that for a certain amount of time until you get tired now having said that you LLY when you first had your pulmonary embolis if you were walking around the streets of New York and your oxygen s saturation di to 85 for like 10 minutes no no long-term damage okay but but that's why we we pay attention to it okay good to know um all right I think um in the interest of time this is I'm having a blast I don't know about anybody else but I'm having a blast here listening to you and I said I could talk all night because go all night let's do it totally this is amazing okay let's move to anti-coagulation because uh this is one the topics also um and then we know that we have a lot of questions from people we see you guys in the chat we're going to try to get to everybody if we don't we'll try to follow up with with folks as well and and give you information but we know you're out there okay anti-coagulation so how should this impact one's decision with regard to which method of exercise they select one of the reasons why I started walking wasn't because I was like oh my God I love to walk so much it was because I was afraid to do anything else because I was on an anti-coagulant and so what how should it influence people's decision about what type of exercise maybe they start with but then eventually can move forward to um and talk to us about what is the risk of being injured on an anti-coagulant you know is there difference if somebody falls down and hurts their ankle versus fall down and H hits their head um as an example and um does it make a difference if you referenced the two you you U to show that I was listening to you you talked about a patient who had been obese was on the anti- quag for two years and came off of it because he dropped his BMI level does it make a difference if someone is on a full dose or maintenance dose in terms of selecting what type of exercise they want to do we have a lot more questions related to this well let's start there yeah I know these These are great questions um and and one of the reasons um that I like doing coagulation as a work and in dealing with patients as blood with who've had blood clots um because it's fascinating biology but also because every patient's an individual right um and so so um exercise is great as I said and it does to Todd's Point it it in you know keeping your lungs working keeping your heart in shape very important even if you've had a pulmonary ulis as you know Leslie walking around it can be anxiety provoking right like oh my God I'm going to get another oh my gosh I have a little chest pain is it another clot but let's talk about the risk when you're on full intensity anti-coagulation um I will say that the risk of bleeding with the directoral anti-coagulants for most people um is a bit lower than warrin so so we're already a bit ahead of the game if you're on one of those drugs if you need to be on warring because you have severe anti-fossil lipid syndrome or mechanical heart valve everything that I'm going to say applies to you as well um so in it's contact Sports and it's injury right it's risk of injury it's kind of like like let me tell you I'm for real I tell people to be careful with power tools right like don't chop your finger off in the basement or cut off your hand because you're going to bleed longer all right so Todd's laughing but you know those people right Todd that's right I know a lot I know a lot do have basement so so um so it what anti-coagulation does is usually it does not initiate bleeding okay it doesn't just cause spontaneous bleeding in most people unless you know you you know you get very very old and you have very fragile blood vessels in your brain but other than that what it does do is if you get a cut or if you get injured and you start bleeding or bruising you're going to have a bigger bleed or a bigger bruise on anti-coagulation than not and so that's what impacts the RIS RK of bleeding so that it coupled with your experience level and your expertise with a sport makes the difference like I had somebody again this was in the day of Warren who was in her 20s she was like 27 and she had had a big pulmonary embolis and she had inherited homozygous Factor 5 Liden and um she actually had a rare sistering beta synthetase deficiency but anyway it was like homozygous Factor 5 liting she was a rock climber now she said she would go to an indoor gym she would wear a helmet she' wear the harness and she had a friend belaying her right which means that she was roped in and she's like really I I need to do this for my mental health and I'm like yeah fine right go rock climb make sure your friend is paying attention to belaying you and doesn't like you know let you slept um if you land funny when you're coming down if you twist your ankle you may have a bigger bruise but you know that's that's not going to kill you um same is true for bicycl bicycling right I mean we want people to wear a helmet right um if you end up in a crash you're going to have bigger bruises so I think the harder part comes for um High Impact Sports um like uh skiing for example um where in there the frequency the frequency of the injuries is low but the severity can be very very high right uh and so for people on Direct oral anti-coagulants I will actually have them skip a dose I had a patient um just this win winter although it's not been a great winter here in New England for snow um who had a had cancer um and he finished his cancer treatments but he had had a blood clot and it wasn't time to stop anti-coagulation it was time for him we could put him on the reduced dose like we do with amplify extension he was on a PIX band two and a half milligrams twice a day or or the trade name is elois um but he he was um like a a ski patrol assistant a mountain greeter and this was a big part of his life and so he wanted to go out every Sunday and do this at his local mountain which he's been doing because they make snow um and and he um we have him skip the morning dose right we and sometimes we have him skip the dose the night before now he can't do that I have another patient who's um but how often does he do that right so this is the next thing so he does it every Sunday and that's okay right but because then he comes home and he takes it at night I have a patient um who likes to um travel a long distance with her family to go skiing homus Factor 5 Liden lots of clots right um I tell her she can in in some residual vein thrombosis you know take it while you're traveling the long distance right then when you get there you can skip the dose she was on the other on zalto 10 milligrams that she used to take at night I'm like skip it the night before go skiing but then you have to take it that night because if you go skiing five days in a row and you miss five days then I'm a little more concerned so when we look at the risk of recurrence we're talking like if you have an unprovoked clot and it's you know we've stopped you your risk of recurrence is about for everyone it's about 10% at a year if you stop anti-coagulation but that 10% is spread out over the day so as long as you don't have other added provoking factors like driving long distance in your car flying long distance in your plane you can skip a dose here and there and I will tell you there are some data and a colleague of mine named Stefan Maul has actually published uh a a a paper on this about professional sports players right NFL players basketball players who all of whom have had dvts or PE i' I've seen some um professional athletes I've seen a lot of um uh Olympic athletes and National level uh and international competitors in in different sports and we make the anti-coagulation work for them and we make it so that they can play their sport uh um effectively so lot of nuances in that question Leslie there there certainly are and it's definitely something to have a conversation with your your doctor directly about but we do get asked the question and frankly we do have professional athletes that we know are doing what's called intermittent dosing of their anti-coagulant um and so we want to address this with people that there is we just don't just don't people cannot just go out and do it on their own well don't we see people talking about that and it's like no don't do that don't do that no and and the stop start thing gets gets to be concerning because I'll tell I'll tell you two stories I mean one I had a a a Savvy person who worked for Pharma before the doxs were coming out and she loved to water ski in the summer right and so she preferred to stay on an ox aarin Lovenox during the summer so that she could skip the dose uh Sunday morning and go water skiing every Sunday morning so again you know that that's good what I do find is that I have some people on travel prophylaxis and I see a question in the chat which we'll get to and they get a little complacent and they forget like you know I don't know why people from Boston fly to Aruba and I'm like look you've had a blood clot before your risk is really high of getting another one take this one you before you get on the plane in both directions right then they kind of slack off and they forget and they go to Aruba and they come back and they've had a blood clot now Aruba is not that far really like I don't get it but that's a Boston thing so um the same is true if you start skipping doses on your own you tend to like slack off right and then did I take it did I not and that becomes an issue of of you know um like we have um Stefan published like a little calendar sheet for those those pro athletes I have patients make sure that you know they know when they're doing it and most people are concerned um they actually talk to us about it before they might have a big trip or or how to manage a trip or something like that I think Leslie to your point you know if your family's going away for a week skiing it's a little harder right to to skip the dose every single day or the doses so so that's what we try to avoid okay thank you and we'll have to get a hold of uh Dr Maul's um paper and share with everybody so they can see it um two things because we're hoping that in the not too distant future all of our concerns about anticoagulation and bleeding will go away possibly uh with some things that are in trial however before we get to that next discussion about Factor 11 specifically talk to women who are on an anti-coagulant um who are experiencing heavy menstrual bleeding what can they do they want to exercise um you know I went through this when I was first put on a do act um you experience heavy menstrual bleeding you want to be able to exercise but it's kind of tough uh to do that so what do you do about that what do you recommend to people well this again is it like you know I'm looking at the clock right and I could talk at least at least 15 minutes so I'll try to be very concise not not easy for me um in the first three months of having any uh clot event we don't like to interrupt anti-coagulation okay um I will say that I do think that um the way the doses between Reaver aaban and apixaban were designed so that once you get past the first three weeks of rever oxan 15 twice a day or the first week of epab um 10 twice a day the 20 milligrams once a day gives you a higher Peak intensity anti-coagulant effect with RAV aiban and that does tend I think to lead lead to more heavy menstrual bleeding than the apixaban five twice a day but we have had once you get past that first three months or and definitely first six months and you're on full dose we have um and I talked a colleague of mine and and dear friend Sask middle Dorp over in the Netherlands we tend to have the same approaches where we have women cut the dose in half for the first day of their period or even the first and the second day or skip it completely again you know being aware of the fact that they don't want to miss like a week in a row um the exercise part though because exercise does help and just like it helps muscles and helps blood flow um exercise can also help with um dysmenorrhea and menstrual cramps over time you can actually you know it can actually help in that um area so we advise women to talk to their um care providers about heavy menstrual bleeding on anti-coagulation and come up with strategies that work for them to to decrease the bleeding overall again maybe cutting down the dose cutting it in half stopping you know the first day um and then we encourage people to to exercise throughout again there's a balance as Todd referred to between pushing yourself and and and you know making yourself miserable right and so you wanna you do want to find that balance but sometimes you know pushing yourself get out to get out the door and then you overcome that that big hurdle and you're out there walking for longer than you thought and it's a win-win right yeah okay so let's talk about um Factor 11 what it is what's out there in trial land you're involved in this so you've got a front row seat to it and what this could possibly mean to those of us that are on an anti-coagulant that do want to do hardcore Sports at some point in time yeah no I I think that this is um It's been a major progression in in anti-coagulant choices right so Factor 11 is a blood clotting Factor um and interestingly it's people who are deficient in this factor that sort of spurred people on to develop drugs to Target Factor 11 because there are some people walking around out there you can't measure any Factor 11 in them um because they have um homozygous Factor 11 uh mutations and they do not have spontaneous bleeding they walk around every day they're doing just fine if they go to surgery they have some bleeding or if they have major trauma they have some bleeding but otherwise they're doing well and so the idea is that the coagulation system if you've ever looked at a coagulation Cascade right it has two different arms of how it gets activated if you have trauma you know someone you go to surgery and you have a scalpel cut or you get a big cut you know from breaking glass in your kitchen you release all this tissue factor and collagen and that drives coagulation and activates um thrombin and you can clot your blood and Factor 11 really isn't um part of that so so we call that necessary hemostasis you're clotting because you got a cut and you need to stop it Factor 11 comes into play with all of those inflammatory things you know there are a lot of um reactions that happen in the blood when people get infected covid was a big one yeah yeah Co was a big one right I mean nutrifil extracellular traps and polyphosphates and histones and DNA and increased cyto kindes and increased upregulation of adhesion molecules and Factor 11 is a contact activator and that starts thrombosis in a different way so the hope is that if we inhibit 11 we'll prevent all those nasty inflammatory related clots but still allow you to clot when you need to um because of the triggers through surgery or trauma and so that we can have less bleeding so there was a trial um I I you know full disclosure I'm on the steering committee for a drug called Abal asab or Abal asab um which is a factor 11 inhibitor and I'm on the steering committee for that drug for to treat cancer Associated clots but in the data safety monitoring board stopped this trial early in the fall of 2023 and it was um presented at the American Heart Association meeting um in Philadelphia where um aasm in patients with atrial fibrillation at intermediate to high risk for strokes from atrial fibrillation had left bleeding on that drug than people on rever oxan and that was huge news that was very very big because that's sort of we hope we haven't seen the final paper but we hope that that really proves the concept that you can have less bleeding and still prevent strokes and everyone's like there's a little bit of secrecy around the results although they were presented uh at American Heart Association it seems to be just as good at preventing Str Strokes in atrial fibrillation um as rever oxan but with less bleeding and so that's the hope that we'll have you know we'll allow people to go out there and Ski and and hit their head and and still not bleed uh or sprain their ankle so to be followed uh to be continued uh you know we're actually gonna be doing a mini pep on this topic um because more and more people are you know starting to catch on to factor 11 and you know hopefully as time goes on we'll start to get better and safer drugs uh and there are a lot of Trials open I mean the cancer VTE one is the only one for thrombosis right now um but they're soon to follow the other ones are in agrial fibrillation and stroke yeah and as we move forward if there are other trials specifically that come up for VTE obviously we want to be able to tell people if they want to participate in it okay I know we are like we have blown past the magic hour let's take some questions here and we'll kind of like rapid fire with you and then we are going to leave probably in the next 10 minutes or so I apologize to everybody we're going to get you to come back and continue with another P because this has been awesome okay great question sometimes you get injured when exercising muscle poles and similar is there a way to take anti-inflammatory drugs with DX like zalto something like ad or similar just to give you some relief what do you recommend to your patients yeah no absolutely and and so this is again one of those Nuance things where you're not going to find a lot of data about this right um and you know absolutely neox and sodium or Al uh ibuprofen or Motrin or Advil um all of those the generic the brand names they're all good um the issue is that um anti-coagulants affector clotting factors and aspirin and non-steroidal anti-inflammatory drugs like Motrin leave ibuprofen um affect your platelets so when you inhibit both you have a higher tendency to bleed now just like skipping a dose here or there for skiing taking a few doses of a non-steroidal anti-inflammatory drug in most people do not cause major bleeding if you take say the maximum strength ibuprofen which the prescription Stak that's 800 milligrams every 6 hours and you do that for two weeks straight you are going to find that you bruise more when you bump into the coffee table or the the door frame and if you take it on an empty stomach you may end up having you know some gastric bleeding so judiciously wisely a few doses here and there are important I see a lot of older patients who've had a blood clot and they have bad arthritis and my advice is to take it when your arthritis bothers you the most right so if it's when you're getting into bed and you can't sleep take a dose you know not on an empty stomach um or similarly if you have to get up and walk around and you're going to I don't know your grandchild's wedding or something take that dose so you can enjoy it okay it's it's it's risk versus benefit right because I have chronic pain I have to have four injections I can only have four um a year into my groin because of the chronic pain and so I talked to my Orthopedic Trauma surgeon and the hematologist and they said it risk veres benefit there's no problem with you taking a leave if you want but here's the protocol it's it's not like I can take it every day and every six hours or whatever you take it to get through to that next injection and it is worked it has worked beautifully absolutely let me just ask you a quick question because I really need to know this answer because my pulmonologist said this I don't know how true it is is it possible for exercise to somewhat speed up the process of absorption if you have a DVT and you're exercising is there any chance that exercise May in you know give that chance of of absorption a little little bump that is an excellent question and so just like I tell people that one of three things happen with you when you get a clot right it goes away completely it goes away partially it doesn't go away at all the second part of that discussion is there is not much you can do to hasten the process that we call fibrin yis right and and so we haven't really found I think um my experience is that the sooner you treat a clot the more likely it is to to um get dissolved by your body's own dissolving stuff which is called fibrinolysis I you know sometimes you see people and you realize you know they could have had this caught for a couple months here even even if you know not just weeks and then those might take longer to go away so Todd I don't really know if we have enough data to say whether that happens but what we do know is about strengthening your heart strengthening your pulmonary Reserve um all of that definitely helps if you have any residual vein thrombosis sort of getting around that that obstructive proc it's a it's a great question I'm going to look for answers if I find them I'll send them to you okay great great thank you Jean okay uh Julie k um I'm a competitive athlete senior doesn't matter Julie you're a competitive athlete that's amazing and part of my exercise and Healthcare routine has always included sauna and cold water swimming thoughts on these contraindicated once clock cleared um so that's a great question right because you know you get into the hot tub at some Resort and it says you know if you've had if you're pregnant or you had too much alcohol if you have medical conditions don't don't sit here and you're like huh and that's CU it vasodilates you so um sauna and and and cold I think that was the the combination together um is is not a problem for clots okay unless you've got such bad you know brand new pulmonary ulis that you're Shor of breath walking somewhere that's my gauge if you can't walk up the stairs then those extremes of temperatures may not be great for you um again today patients are much healthier than they were 50 years ago right we don't smoke we have cholesterol under control blood pressure under control it was the um undiagnosed coronary artery disease that doesn't respond well to some of those abrupt changes so keep doing that um I won't say it's good for you because we don't know but it certainly sounds good yeah yeah hey hey just just real quick so you see a lot of stories out there Fitness Watch saves somebody's life because they're because they're getting some readings right and and I can see where that that could definitely be true you were talking about you know we wear the thing on our finger we're checking our oxygen should we rely more on that or can we also rely on a fitness watch like the new Apple watch claims to to to track all this stuff um you know how confident should we be in that Fitness Watch to give us that information that we need hey I better go to the ER because my watch says this so that's a really good question and there's um there's degrees of accuracy how's that um I think step counters I think you know calorie counters where you know you know let's say they they may not be accurate are are one thing I think the heart rate monitoring part is interesting because I will actually tell you that I have you know the hematologist here has seen patients and in in in other settings who've who've had like um snle episodes or they have um some of them have actually had strokes and we've I've said show me your heart rate M monitoring you know um that because you can download it right even the Fitbit which is very inexpensive compared to that Apple watch you got an app on your phone and you can look at your heart rate and and I'm thinking of one patient in particular who was given the Fitbit as as part of a again I work in the cancer world as sort of a um you know a a keep EXT exercizing uh approach right and and and and monitoring that um and I'm looking at like his heart rate spiking at 140 at two in the morning when he's like asleep and ended up he had atrial fibrillation and and wasn't really aware and had had you know had had crashed a couple times and or just didn't feel right so sometimes people notice pounding in tacac cardia the one thing when the Apple watch first came out was that it tended to overall things things right so you know if it's not quite reading right its sensing abilities maybe overcalling something as a bad thing when it's more you know you're a little tartic from walking up the stairs but the watch wasn't quite on tight enough and you didn't get an accurate reading and you know don't panic and go to the emergency room so a little hard to tell because I've not seen the new Apple watch but I do think there is something to be said in general if you're the type of person who likes monitoring things um to to wearing one of those um even during exercise for example right when you know you can kind of see where your heart rate is and are you in the right zone now I know um I have a friend who who admits that she's a little OCD um about things and doesn't want to wear one of these watches because she feels she would be tied to it and always trying to get you know here we got the Garmin 4Runner here okay so yeah yeah me too me too um uh which I don't know how accurate the GPS is but that's another story but she said she would feel like oh my God I didn't complete my 10,000 steps today and I didn't get my heart rate in the Target Zone and she said it would make her feel worse about her life um right right the the anxiety level goes up you know really high for a lot they're checking it every five minutes even even with a thing on your finger if you're checking five minutes you're going to get some different readings and you're going to freak out yes so so that's so that's a great point that we're discussing right here because I think if you're trying to figure out why you don't feel quite right I think they can be helpful or if you know you're getting back into exercise and you have no idea what your target heart rate is and you're nervous about going above it then monitoring your heart rate um Can can be reassuring but if you're relying on on it for you know if you get too into it we won't say obsessed about it um it you know it can you know uh we had like a Fitbit challenge a couple years ago for like team building in our hospital and we had like little teams and I was wearing mine and I believe me I was getting my 15,000 steps and you know all of these things a day and we still lost to the neurologists and well the neurosurgeons who realized that if they put the little dongle thing remember little Fitbit they put it on their shoe and they would sit there swinging their leg in the meeting and they were like faking steps we're like oh my God right so those are the type of people you don't want to be like okay right right good to know um we're gonna take two more col questions and then we're actually gonna we have two more poll questions after this and then we'll let everybody go this has just been amazing I actually want to answer this question but I'm not because I'm not a doctor after three years on eloquest with unprovoked dbts and pees my hematologist has been wanting me to go off I am still 60 pounds overweight slightly elevated factor 8 she is not concerned about either of those is it safe to go off so that is a tough question um and again we're not giving direct medical advice but the general approach is if they were unprovoked the things that I assess are your age your weight um whether or not you have residual vein thrombosis because all of those things can contribute to our current clot uh and your personal preference and tolerance for risk okay because we do know that again as I said um half an hour ago or so the risk for recurrence from unprovoked events is highest in the first first two years but it doesn't go away so for all comers it's about 10% per year for year one and for year two and then it's about you know five to 7% for years three four and five so that when you get to five years depending on which study you're looking at you have a recurrence risk of 30 to 40% if you've had an unprovoked clot now one another factor that people talk about is whether you're deep vein thrombosis in the leg and I see you also have pees so that mixes it up is in your calf or more proximal I will say this that the European Society of Cardiology in 2019 came out with a statement that said anyone who's had a pulmonary embolis should remain on indefinite duration anti-coagulation so that's the European Society Cardiology some people feel if you had a provoked post gallbladder removal PE you could be safe to stop but but I I personally would be a little uncomfortable with all the scenarios that you've given me about stopping at this time I think that a reduced dose of uh a pixan or rever oxan may be a good compromise um I don't know if you've had any major bleeds these are other things we look at what's your kidney function what's your other medications but with unprovoked pulmonary embolis we get a little more concerned so as an unprovoked um PE patient I would encourage everybody to get a second opinion it's it's our right as patients to get a second opinion and I think they're very valuable I did that um you know shortly after my diagnosis and and it really helped me to have somebody else talk to to me about what the protocol should be for me and I was not thrilled at the thought of being on an anti-coagulant forever but um I also wanted to stay alive so you know that that that took priority um okay so I think we're actually going to stop tonight I'm really sorry everybody that we're just not going to be able to get to all the questions we're going to try to put something together we have a nbca launched a sports and wellness Institute um a few years ago and we're going to try put a lot of this material out there for people get answers to them to all of your questions so that you have access someplace um to go to get that information because uh the poll questions certainly demonstrated that people aren't getting the information that they that they need that's right okay Jean you have been unbelievably amazing um thank you so much we definitely want to have you come back this was just fantastic um Todd we're going to punch it back to you for um for the poll question questions we do want to in the chat I believe people have been U shown there's a link we want you to contact your Congress people um trying to to get funding out of Congress for blood clot education awareness Etc super important we need your help um and then if they if they don't think that that voice their voice counts and that letter counts they're wrong because it does count and and it needs to be done and we've got a lot of people sending in letters and we want all the states represented so that link is in the chat it's also in the support group I've been pushing it out there it's on our website it's on the stop the clot page you can find that link pleas please act on there okay and then we also have bibs uh for the five bike ride in May which Todd and I are both doing I'm scared because I'm not a bike rider um gonna have so much fun where are your helmet where I G wear my helmet um so if you're interested in participating we'd love to have people join us and then of course we um we'll be announcing we will have bibs for the New York City marathon in November that is like an nbca party so uh if you're interested by all means um you know reach out to us about that one as well and we're going to close this out with some poll questions yeah I do want to tell you that back bike ride in New York is something else when they shut down the streets of cars and it's just us cyclist out there it's a great time so I hope hopefully some of you guys can make it with us uh let's do the poll questions real quick and then we're going to let you go did tonight's pep talk increase your knowledge about exercise anti-coagulation and weight loss post blood clot yes or no number two after tonight's pep talk would you feel more confident speaking to your healthc care provider about exercise anti-coagulation and weight loss post blood clot yes no and would you be interested in participating in a national blood clot Alliance walking Club if it became available yes or no so we're going to get those results I'm G to read those to you as soon as they get piped in here and then we're going to cut you guys loose Gan I am so thrilled that you have been here I love you so much your information is is just outstanding yes uh okay here's the results so did tonight's pep talk increase your knowledge about exercise anti-coagulation and weight loss 98% said yes and after tonight's pep talk would you feel more confident about speaking to your health care provider about this 96% said yes and the final question would you be interested in participating in an nbca walking Club if available 83% said yes so we hope to see all of us walking together soon that would be awesome y I tried to yes for that last question and uh was unable to well you'll be walking oh thanks Todd thanks Leslie uh thanks everyone for joining us I I had a lot of fun with this so um happy to come back if you'll have me okay

Channel: stoptheclot

Views: 1,547

Keywords: Blood, Clot, DVT, PE, Deep, Vein, Thrombosis, Pulmonary, Embolism, Thrombophilia, blood, clotting, disorders

Id: -YoEH09diGw

Length: 80min 44sec (4844 seconds)

Published: Wed Feb 14 2024