Doing phlebotomy can increase your platelet count!

maldorf · Jun 25, 2009

iprimate said:
Sorry bellicose but your post is a both confused and confusing.

The above is wrong.

Firstly, IV sticks are for all practical purposes are sterile procedures but further, and more importantly, megakaryopoiesis is inhibited after acute viral or bacterial infection. Platelets have an important role to play in the immune system but their production is not stimulated by infection but rather by inflammation.[1]

Secondly -- and most compellingly -- study I referenced found that the increased risk of thrombosis from phlebotomy had a weak relationship to platelet count. Phlebotomy produces an increased risk of thrombosis via some other -- as yet unknown -- mechanism.

Coronary heart disease due to atherosclerosis is the commonest cause of heart disease in the West. It accounts for about 70% of cases of heart failure. You appear to be alluding to vulnerable plaques and their role in coronary occlusion. A special type of athersclerotic plaque is implicated in myocardial infarction (MI) -- termed vulnerable plaque -- and we don't all have this sorts of plaque. We all have arterial plaques but not all plaques are vulnerable. Vulnerable plaque is distinguished by (a) a lipid rich core (also containing macrophages and microcalcifications); (b) a thin collagen rich fibrous cap; and (c) inflammation within the plaque. These vulnerable plaques are vulnerable to rupture (hence the name) and when they rupture, thrombosis follows (due to platelet aggregation) on the ruptured plaque and this leads to the arterial obstruction which can lead lead to MI. MI and thrombosis are not mutually exclusive as you imply but rather quite often mutually inclusive. MI happens most often as a consequence of atherothrombosis. So maldorf is correct in saying he had a thrombus i.e. blood clot.

You are confusing a thrombus with an embolism. A thrombus is a clot which is attached at its point of formation. An embolism is blood clot that detaches from its point of formation and travels to another site via the circulatory system to cause an occlusion.

These can cause an embolism or a thrombus.

Yes he did have a blood clot. The most common mechanism by which myocardial infarction occurs is atherothrombosis i.e. thrombosis superimposed upon a ruptured plaque leading to luminal obstruction.

You are comparing apples with oranges. Young guns die most often from cardiomyopathy cause by left ventricular hypertrophy (see my posts on the topic).

Who perform it isn't really the issue. The concern that maldorf has correctly identified is that phlebotomy increases the risk of thrombosis.

hey, Im glad youre around here! You know your stuff. Helps me to not be the only one here trying to bring these rarely known facts to the attention of readers on here. If you dont mind, what is your background?
I am not trying to brag here, just giving some background so you dont think im not ignorant as it seems at least one person here thinks I am. Me, I studied premed back at college and graduated with a bachelors in biology/zoology. then went on to earn a masters in education and teach high school bio/chem/sci. Also taught some undergrad anatomy labs at college as a TA. Sounds like you have a great level of education. Curious if youve been to med school or similar. I took some classes at med school as a grad student in exercise physiology which I also studied.

maldorf · Jun 25, 2009

Press said:
do you get dizzy from say doing hi reps but keeping the weight low? say do 250 squats but do like 20-30 reps. this may help keep you lean and add some muscle. i take it ur diet has probably changed alot as well. ima shoot ya a pm.

In the beginning i thougt i was safe with low weight and high reps but after i almost died with an arrythmia i learned otherwise. Pekker wood set me straight when he told me about not going to failure. thats the key on keep down stress on the heart. I was going to failure, did about 28 reps with 225 lbs. thats what did it. Now i am doing 295 lbs but only for 12 reps and i feel decent. I do feel like if i go any heavier it might cause problems. So its a matter of not going too heavy and not going to failure. Means not doing all of the things that cause muscle growth! woot!

maldorf · Jun 25, 2009

hemoglobin meters

I bought mine of ebay. Its a legitimate medical company. its called a HGB Pro by ITC europe. Made in germany. I thnk the cost of the meter and some strips was about $450. I do not recommend doing this on your own by rather that you go to a hematologist. The risks, especially after seeing these studies about increased risks of blood clots and how the docs dont even know why, makes me think that this really needs to be done by a qualified hematologist. The one im seeing now is a hematologist/oncologist. So he even deals mostly with cancer patients. If people insist on doing themselves then I would rather they use the meter, than nothing at all. Wow, just found one onlne much cheaper. here is a link if you are curious about it.

**broken link removed**

para · Jun 25, 2009

maldorf said:
I bought mine of ebay. Its a legitimate medical company. its called a HGB Pro by ITC europe. Made in germany. I thnk the cost of the meter and some strips was about $450. I do not recommend doing this on your own by rather that you go to a hematologist. The risks, especially after seeing these studies about increased risks of blood clots and how the docs dont even know why, makes me think that this really needs to be done by a qualified hematologist. The one im seeing now is a hematologist/oncologist. So he even deals mostly with cancer patients. If people insist on doing themselves then I would rather they use the meter, than nothing at all. Wow, just found one onlne much cheaper. here is a link if you are curious about it.

**broken link removed**

I got mine from www.cliawaived.com

STAT_site M HGB meter $169
Test strips 100 $109
Lancet $26
Draw tubes 11.95

I check mine weekly after doing a doube red blood cell. My HGB was 17.5 before the double red blood and now after about 6 weeks it still hangs around 13.9-14.5. It is a good tool to own, but if your in doubt go to the doctor.

HGB x 3 approx is your hematocrit.

maldorf · Jun 26, 2009

para said:
I got mine from www.cliawaived.com

STAT_site M HGB meter $169
Test strips 100 $109
Lancet $26
Draw tubes 11.95

I check mine weekly after doing a doube red blood cell. My HGB was 17.5 before the double red blood and now after about 6 weeks it still hangs around 13.9-14.5. It is a good tool to own, but if your in doubt go to the doctor.

HGB x 3 approx is your hematocrit.

Yeah, thats what I was doing before my heart attack. The heart attack must have not been due to the hemoglobin though, as I had it down to normal limits about 1 week or so before it happened.

para · Jun 26, 2009

maldorf said:
Yeah, thats what I was doing before my heart attack. The heart attack must have not been due to the hemoglobin though, as I had it down to normal limits about 1 week or so before it happened.

I read your posts seems like you may have a pre-disposition to high HCT levels and test makes that worse. Did you ever have them checked prior to AAS use or off for a long time? Your HCT with only 100-150mg a weeks still being over 50-53 seems high.

I play a sport and when the training intensity (cardio) is high my HCT drops quite a bit, I guess because the rate I am using red blood cells.

iprimate · Jun 26, 2009

maldorf said:
hey, Im glad youre around here! You know your stuff. Helps me to not be the only one here trying to bring these rarely known facts to the attention of readers on here. If you dont mind, what is your background?
I am not trying to brag here, just giving some background so you dont think im not ignorant as it seems at least one person here thinks I am. Me, I studied premed back at college and graduated with a bachelors in biology/zoology. then went on to earn a masters in education and teach high school bio/chem/sci. Also taught some undergrad anatomy labs at college as a TA. Sounds like you have a great level of education. Curious if youve been to med school or similar. I took some classes at med school as a grad student in exercise physiology which I also studied.

You have more formal education in the biological sciences than I do. No I didn't go to medical school. My higher education is actually in the social sciences but I read widely and I have some of the skills of a reference librarian. I'm probably not as knowledgeable as I seem, I'm just a good researcher.

iprimate · Jun 26, 2009

I found an important review article: **broken link removed**. This qualifies the results from the PVSG (Polycythemia Vera Study Group)-01 trial which reported the increased incidence of thrombosis amongst phlebotomised polycythemic patients:

The only randomized study comparing phlebotomy with myelosuppressive therapy was done by the PVSG more than twenty years ago (PVSG-01 trial).[4] Four hundred thirty-one patients were randomized to phlebotomy alone; radiophosphorus (32P) plus phlebotomy; or chlorambucil plus phlebotomy. The results of this trial and subsequent analysis of the long-term outcome of the patients originally enrolled[5] provided useful information on the value of phlebotomy and of ‘old’ myelosuppressive agents in the management of PV. Patients randomized to the phlebotomy arm showed a higher incidence of thrombosis in the first three years of treatment, which was most common in those with previous thrombotic events or advanced age. A number of factors might have played a role in the high thrombosis rate. These are the uncontrolled thrombocythemia and the fact that over the first few years of the study the target hematocrit marking adequate treatment was below 0.52. The target hematocrit was subsequently reduced to less than 0.45 when further evidence of the influence of hematocrit on blood flow and thrombosis was produced.[6] After the first three years,the rate of thrombosis in all three arms was the same. (Pearson et al. 2000 (1): 51. (2000))

So Pearson et al offers two explanation for the elevated incidence of thrombosis amongst the phlebotomised patients:

Residual elevated platelet count (thrombocythemia) -- the phlebotomy lowered the hematocrit but it did nothing for the elevated platelet count which itself increases the risk of thrombosis (this is an odd explanation given that no correlation was found between platelet count and thrombosis in PVSG);
Inadequate hematocrit target -- in the first few years of the study the phlebotomies were conducted with the aim of reducing hematocrit to below 0.52. This was later revised downwards to 0.45.

The PVSG-01 didn't appear to have a placebo or no-treatment arm which would have given us an indication of the absolute efficacy of phlebotomy in reducing the incidence of thrombosis. I am guessing that this was for ethical reasons since it is a long-term study that ran for almost 20 years,

Nevertheless, this should be reassuring to those that use phlebotomy to lower hematocrit.

The treatment algorithm in Pearson et al (2000) includes the addition of low-dose aspirin for prophylaxis from thrombosis but with numerous qualifications: "Laboratory tests of platelet function (e.g. bleeding time, platelet aggregation studies) have been generally unreliable in predicting the risk of bleeding and thrombosis, so the therapeutic decision rests primarily on clinical judgement...Aspirin is best
avoided in patients with prior hemorrhage, particularly of the gastrointestinal tract.".

maldorf · Jun 26, 2009

para said:
I read your posts seems like you may have a pre-disposition to high HCT levels and test makes that worse. Did you ever have them checked prior to AAS use or off for a long time? Your HCT with only 100-150mg a weeks still being over 50-53 seems high.

I play a sport and when the training intensity (cardio) is high my HCT drops quite a bit, I guess because the rate I am using red blood cells.

I had it tested every year before that as part of a physical and no doctor ever alerted me to it being abnormal, and so before using steroids it was never abnormal.
Never heard of cardio lowering HCT. That intersts me, I dont think that has ever been studied or reported. Good thing to research.

maldorf · Jun 26, 2009

iprimate said:
You have more formal education in the biological sciences than I do. No I didn't go to medical school. My higher education is actually in the social sciences but I read widely and I have some of the skills of a reference librarian. I'm probably not as knowledgeable as I seem, I'm just a good researcher.

Well, you come across pretty good. Unbiased in your approach, which I try to be now. Before all of this happend to me I used to be very biased against the info out there about the medical issues involved here, and pretty much thought of it all as being propaganda. I was very prejudiced in how I looked at this subject. Now I am much more objective, not subjective.

bellicose · Jun 26, 2009

anyone can quote studies....

iprimate · Jun 27, 2009

bellicose said:
anyone can quote studies....

Possibly, and it would be good if more did quote from relevant studies, reviews, clinical reports and textbooks instead of offering advice and answers based on hearsay, folklore, urban myth, TV medical dramas and reality programs, infomercials, self-referential WWW forums and apocryphal anecdotes.

However, some do have trouble quoting from studies (eg. Author L. Rea and some people on this forum) so I am unconvinced that "anyone" can quote studies. Your background knowledge of basic biological science, research methodology, descriptive and inferential statistics and scientific method will determine your comprehension of a research paper and your capacity to interpret its significance in relation to other research papers (some of which may be contradictory).

But I think your glib remark ("anyone can quote studies") is a wounded remark. Your post in this thread was replete with factual errors and it was delivered from a pretentious stance ("Some education for Maldorf"). You've obviously taken umbrage at my correction of your post (but you haven't actually refuted anything I wrote) and acting like a scolded child you are attempting to diminish my contribution to this thread.

I reference studies and textbooks because I care about giving out misleading information regarding matters of health. Why don't you care? Why are you willing to tap out a bunch of crap on a matter as serious as heart disease? Would it have killed you to look up the definition of thrombosis? By criticising my methodical approach are you asserting that their is virtue in your sloth and carelessness? Should I be more like you? Should I just spend my time on this forum posting unreferenced bullshit and factoids about matters I have read nothing about?

para · Jun 27, 2009

maldorf said:
I had it tested every year before that as part of a physical and no doctor ever alerted me to it being abnormal, and so before using steroids it was never abnormal.
Never heard of cardio lowering HCT. That intersts me, I dont think that has ever been studied or reported. Good thing to research.

It is common with endurance athletes to see a drop in HCT. That is one reason they take EPO, not to get there HCT levels sky high, but to keep them consistant, as they drop during the season.

maldorf · Jun 27, 2009

para said:
It is common with endurance athletes to see a drop in HCT. That is one reason they take EPO, not to get there HCT levels sky high, but to keep them consistant, as they drop during the season.

Next logical step then would be to try and increase your cardio/endurance training then to bring down your hematocrit. Anyone know how much it comes down on average?

dragonfire101 · Jun 27, 2009

When your bone marrow is overproducing rbcs like this, its a sign that something is really wrong. Just taking out the blood is only treating the symptom, and not the cause. Other things start going wrong then too and you open up a bad can of worms.

Sleep apnea will increase RBC considerably. That's my problem. I'm not getting enough oxygen at night and the bone marrow keeps producing RBC.

maldorf · Jun 27, 2009

dragonfire101 said:
Sleep apnea will increase RBC considerably. That's my problem. I'm not getting enough oxygen at night and the bone marrow keeps producing RBC.

Something that has been brought up on this board before and I should look into. How did you have any idea that you had sleep apnea? Would you wake up in the morning after sleeping a good 8 hours or more and yet feel exhausted? Just wondering what made you have it looked at. Did you have to go to a sleep clinic?

Conciliator · Jun 27, 2009

iprimate said:
Possibly, and it would be good if more did quote from relevant studies, reviews, clinical reports and textbooks instead of offering advice and answers based on hearsay, folklore, urban myth, TV medical dramas and reality programs, infomercials, self-referential WWW forums and apocryphal anecdotes.

However, some do have trouble quoting from studies (eg. Author L. Rea and some people on this forum) so I am unconvinced that "anyone" can quote studies. Your background knowledge of basic biological science, research methodology, descriptive and inferential statistics and scientific method will determine your comprehension of a research paper and your capacity to interpret its significance in relation to other research papers (some of which may be contradictory).

But I think your glib remark ("anyone can quote studies") is a wounded remark. Your post in this thread was replete with factual errors and it was delivered from a pretentious stance ("Some education for Maldorf"). You've obviously taken umbrage at my correction of your post (but you haven't actually refuted anything I wrote) and acting like a scolded child you are attempting to diminish my contribution to this thread.

I reference studies and textbooks because I care about giving out misleading information regarding matters of health. Why don't you care? Why are you willing to tap out a bunch of crap on a matter as serious as heart disease? Would it have killed you to look up the definition of thrombosis? By criticising my methodical approach are you asserting that their is virtue in your sloth and carelessness? Should I be more like you? Should I just spend my time on this forum posting unreferenced bullshit and factoids about matters I have read nothing about?

Priceless. This reminds of when I used to be criticized for posting quotes and references in the bodybuilding.com chat that I moderated. A few bros often attacked me for "cutting and pasting things I read on the internet" which is something "any child could do." When I called for reciprocation, they not once were able to produce any academic reference or quote. At best, I once got a supplement ad with an unreferenced claim. If we postulate as they did that posting research is something any child can do, then I guess it entails that they were intellectual infants, yet to graduate to the mediocrity of childhood.

Of course, once you demonstrate that neither a child nor a "bro" can quote research at will, things will go one of two directions. The first is a personal attack, for if you are so pedantic to actually save references and be able to provide them, you must have no real world experience, and thus have nothing worthwhile to say, even if that means quoting eminent scientists. Solicitations for physique photos will soon follow, as it's well established in brodom that LBM equates to specific technical knowledge on any imaginable research topic. Clearly, the larger someone is, the more likely it is that he will have primary knowledge of causal relationships, regardless of how microscopic they are. Don't point to an example where someone larger than the bro disagrees with him, as that will cause some short-circuting. A reductio ad absurdum that reasons that the largest man alive would then know everything will induce catatonia.

The second direction things will go is a facile, wholesale discounting of the world's academic work. You'll be told that all research is biased and unreliable. When you ask how several independent universities in different countries, with no apparent affiliations, all produced the same finding, the topic will quickly be changed. It will be stated that "you can find a study that shows anything." Of course, when pressed to produce a contradictory study, you will be furnished with an excuse, since not only is there a chance that the said study doesn't exist, the bro has no clue how to even begin looking for it. You needn't worry about explaining methodological or statistical shortcomings in contradictory research, as you'll never get that far.

In the end, if you post enough abstracts, you might be rewarded with the same priceless criticism I was once given: "your so one sided. all the studies you post come from the same stupid site."

bellicose · Jun 27, 2009

you can find a study to prove almost anything....real world medicine is a different story.

iprimate · Jun 27, 2009

bellicose said:
you can find a study to prove almost anything....real world medicine is a different story.

Bullshit. Find one for me that...

...demonstrates that cigarette smoking improves the health of your lungs...

...demonstrates that ingesting mercury raises your IQ...

...demonstrates that head trauma improves your short-term memory...

...demonstrates that an excess of "yellow bile" makes one short-tempered.

Or just find me one that contradicts what I posted about vulnerable plaques.

Again you don't know what you are talking about. There is a strong movement in medical practice towards Evidence Based Medicine (EBM) with many progressive medical schools aiming to produce graduates with skills in EBM. The goal of EBM is to increase the use of high-quality biomedical research in clinical decision making. EBM is the state-of-the-art in "real world" medicine.

You are a cliche. Read the second last paragraph of Conciliator's post:

It will be stated that "you can find a study that shows anything." Of course, when pressed to produce a contradictory study, you will be furnished with an excuse, since not only is there a chance that the said study doesn't exist, the bro has no clue how to even begin looking for it. You needn't worry about explaining methodological or statistical shortcomings in contradictory research, as you'll never get that far.

buschris · Jun 27, 2009

I believe that modern "progress" has caused more problems than it has solved. Most things that have killed folks in the past have been cured or eliminated, and technology itself causes many problems it seeks to "fix". Take for instance our food. Preservatives, methods of production and lax standards have caused heart disease, diabetis and cancer. These things used to be very rare but now are commonplace. Also the lack of exercise for a good portion of the populace has contributed to cardiovascular problems. Pasteurization was a good method to kill off bad bacteria, but now kills good bacteria and weakens our food. Homogenization also takes fat from milk and turns it into a deadly form of fat. So, with technology and progress, comes the bad side of life. Was it truly for the good of humankind, or is it a conspiracy of the medical industry?