#452 Should I take Lovenox after an ankle fracture? - DOC

#452 Should I take Lovenox after an ankle fracture?

Today on the Doc On The Run podcast, we’re talking about whether or not you should take Lovenox after an ankle fracture.


Today’s episode actually comes from a question that is a real-world situation. That’s actually a great question, but it points out a couple of things I think are worth hearing. The question was, should I take Lovenox after an ankle fracture? And what happened is I got a message where said, I was out on a trail, run on vacation. I broke my ankle in France. So this is somebody who’s not insured and not a resident of France, but somebody they’re visiting and this kind of stuff happens a lot. The doctor gave me a prescription for Lovenox. So should I take it?

First of all, like this is a message that’s really interesting. Somebody basically says, okay, I broke my ankle. The doctor gave me a prescription. Should I take this thing or not? Is this appropriate for me?

Well, presumably when a doctor sees you, they actually evaluate you. They ask you what happened. They try to figure out what the injury was, in this case a broken ankle. And then based on all of your past medical history, your age, the risk factors for getting a blood clot, the risk factors for healing, the risk factors of actually developing a huge hematoma or bleeding under the skin from taking Lovenox, the doctor considers all of those things and then decides whether or not you should need it. But that doesn’t happen because the doctor only has three pieces of information. I was traveling, I was in France and I broke my ankle. It’s from all of this information that’s put together.

Now, I get patients all the time who do consultations. We do one hour consultations at a minimum. Yesterday, I spent two and a half hours with somebody because it was a complicated situation who’s had an injury who really needed to get this thing better. And she really wanted all the detail on what to do differently, what to change, what not to do, what to do with her shoes, which ones not to wear all that kind of stuff. And I spent two and a half hours figuring that out. So you can’t really expect that with literally only three pieces of information that any doctor, not me or anyone else would be able to make a decision that’s different than what the other doctor arrived at.

So the first thing is when I don’t know someone, I don’t know who they are, I don’t know what their history is and I don’t know what their unique circumstances are. Basically, I never even reply to them because I’m not going to tell somebody that they should not take a medication based on the fact that they’re in France and their ankle is broken. That doesn’t make any sense.

With these patients when I do remote consultations, where somebody calls me because they’re on vacation and they broken something or they got a stress fracture or they got an Achilles tendon issue or something else, those calls are always scheduled for an hour.

Why is that? You don’t want a halfway or one fourth way solution and I used to do calls that were really short. I only do this for people for follow-up now because people would book a 15 minute call and it would take them 15 minutes to even describe what was happening and what they’re training for. And then they say, what should I run? Or should I not? Well, I don’t know. We haven’t talked about anything yet. And so that’s really the thing is that you got to realize that if a doctor prescribed something for you and you think the doctor is doing the right thing and you trust the doctor well then obviously you should take the medication as prescribed exactly as prescribed.

If they say, well, how long should I take it? Well, what did the doctor say? It always says on the prescription, it has very clear directions on how many you’re supposed to get, what frequency you’re supposed to take them, how long you’re supposed to take them and whether or not you should get refills. It’s on the bottle. You have to do what makes sense.

What happens and why people call me is that they get in that circumstance, they go to see the doctor, they trust the doctor. They think the doctor has done the right thing. They’ve actually not only gotten the prescription, they went to the pharmacy, filled it and paid for their medication. But then they sort of, after the fact realized that but I forgot to ask this because I was in the emergency room and I didn’t really think about this and I don’t really know is this going to cause a problem with this other thing and I have a race in two months or the doctor told me to do this, but I didn’t even explain to the doctor that I was actually training for a 100 mile trail race and so we didn’t talk about any of that. And then they’re trying to sort out on their own, well, if I’m training for an ultra marathon, should I take Lovenox? If I’m flying back to the United States, do I need to take Lovenox then?

These are other questions, but they’re really trying to figure out what’s the right answer for all of these other things, just based on a small amount of information and you can’t really do that. We have all these basic presumptions that if a doctor prescribes something for you, we think the doctor made an evaluation, is properly trained and prepared to make that evaluation and then makes a recommendation to you based on all the information provided.

But it’s your job when you go to the doctor to provide them with more information. There is never a time when somebody comes on one of the group coaching calls that we do on Monday, Wednesday, and Friday, who comes on and says, “Okay, I’m this far into healing my plantar plate sprain and I’m getting ready to do my test run today. Should I do the run or not?” There is never a time when I just say yes or no. I always say, “Okay, what happened on Saturday? What happened on Sunday? What did you do on Friday? What does it feel like today? What is your pain journal say? How strong are you? Did you do the exercises we gave you to test your strength and your balance? Have you done those things? What happened when you did those?”

I don’t answer single questions like, should I run? It’s been three weeks. I’m worried about losing my fitness. Should I run? Well, short answer is if you’re worried about losing your fitness, you want to get your fitness back, you have to run. I don’t know whether or not it’s safe for you to run. If your doctor told you don’t run, maybe should not run. Unless you explain to the doctor that’s crucial that you’ve got to run because you qualified for the Boston Marathon. Are you qualified for Ironman Hawaii or something else? But you have to realize that doctors are only making decisions based on the information you provide.

So if you sign up for the group coaching and you come in on Monday, Wednesday, and Friday, and you have a question like, can I take off my fracture walking boot now? You are going to get questions based on those answers is the answer you’re going to get because it’s more tailored to your unique situation.

If you’re doing the 12 steps routine that I’ve given you, and you’re going through that, and you’re working your way toward figuring it out on your own, think about those things. So I can make those evaluations for you. If you’re really diligent about paying attention to the information that you have at your disposal right now, by going through that process in the 12 steps, you can make those decisions on your own.

If you need more help, you can join us in the group coaching calls every Monday and Wednesday and Friday for the next four weeks. But those are the options or of course, you can take the information that you get from the 12 steps and then working through that on your own, and then take it back to your doctor and give them some new information to see if you can get clearance to run. But that’s what you’ve really got to do. You’ve got to think about the prescription you’ve been given, whether or not it makes sense to you and whether or not you’ve actually given the person that gave you those directions, the full information.

If you think about all that stuff and you get some more information that changes things, you might be able to speed up your course of recovery and get back to running a whole lot faster.