Stretch your legs or suffer a really bad beat

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The column first appeared in Ante Up Magazine in November 2008.

Answer this one:

You’ve been playing at the same table for the past five hours without so much as a bathroom break. A player in middle position who has you covered opens for three times the big blind. You push with AA. He calls and shows small suited connectors. Your biggest danger now is:

A. He’ll make a straight and you’ll get felted.
B. He’ll make a flush you’ll get felted.
C. A blood clot will break off from behind your knee, travel to your lung and you’ll get permanently felted.

The truth is, though your aces may seem to get cracked more often than you believe they should, your real danger from a long poker session is a blood clot.
A blood clot normally is a good thing. When blood is exposed to air, from a cut or scrape, it clots. If it didn’t, even a small cut might turn into a pretty nasty mess. The real problem occurs when a clot forms in a vein, especially a vein deep within your leg (deep venous thrombosis). The clot can break off, travel through the chambers on the right side of your heart and lodge in your lung. This “pulmonary embolism” can strain the heart, damage lung cells and actually kill you.

So what causes blood to clot inside a leg vein? Mainly inactivity. Sitting for long hours with your legs hanging down below you causes the blood to thicken and sludge in various spots in your legs. Eventually a clot can form and, if it breaks off, you’re in trouble. Poker players who have a history of cancer, recent surgery or previous episodes of deep venous thrombosis or pulmonary embolism are particularly at risk.

Prevention is pretty easy. First, get into the habit of frequently contracting your leg muscles while playing. Every time the button passes you (about every 15 or 20 minutes) stretch your legs out straight. First point your toes hard then pull your toes up toward your knee hard. This exercise contracts your quadriceps and your calf muscles and squeezes the stagnant blood out of the veins that run through these muscles. Try not to play footsies under the table with the other players or you may experience a different kind of medical problem.

Next, every time there’s any kind of break in the action, get up and walk around. In tournaments, there’s usually a five-minute break every hour. In ring games, just skip a hand every so often, stand up and do a few leg exercises. Get up on your toes and rock back on your heels a few times to get the blood flowing again. Do a squat or two and you should be good to go until the next break.

If your ankles tend to swell after long sessions or you have varicose veins, you might want to take some extra precautions. Support hose are a great way to reduce swelling and compress the size of the leg veins leaving less room for stagnant blood to collect. Most medical supply stores carry support hose or you can find them online at places like FootSmart.com. I use them myself. They look just like normal socks and feel great.
Finally, don’t forget that miracle drug, aspirin. Even one baby aspirin (81 mg.) thins the blood significantly and makes it far more difficult for clots to form. If you’re already on a blood thinner like Coumadin or Plavix, or if you have a history of bleeding problems like bleeding ulcers, you should probably check with your physician before taking aspirin. For the rest of us, though, it’s a simple and effective way to reduce the risk of clots.
Any time you’re going to be sitting with your legs below you for long periods of time, whether it’s because you’re sitting at a poker boot camp lecture, crammed into an airplane seat on your way to the WSOP or even simply planning a long home-game session with your crew, make sure it’s the bad beat that felts you and not a clot.

Play healthy!

— An avid poker player, Frank Toscano, M.D. is also a Board Certified Emergency Physician with more than 28 years of front-line experience. He is now the medical director for Red Bamboo Medi Spa in Clearwater.