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Runners Don’t Expect To Have Blood Clots
Every race is a reward after all the hard work it takes to get to the starting line. But one particular race—the 2017 Chicago Marathon—meant more to me than any race before it. The marathon was celebrating its 40th anniversary (four months after my own 40th birthday), and I was not only excited to be present, but profoundly grateful to be healthy. As I stepped across the start line, it was exactly one year to the weekend that I was released from the hospital for bilateral pulmonary embolisms (PE), also known as blood clots, in both of my lungs.
In June of 2016, I began training for the Marine Corps Marathon. Summertime training brings sunny days, but also heat, humidity and vacation. I logged miles while traveling in Hawaii, Colorado and South Carolina, staying true to my training plan and taking in breathtaking sights along the way. The problem was, my breathing couldn’t seem to keep up with my running. I struggled through every run, long and short, finding it difficult to catch my breath even while climbing stairs. But it was a hot summer, and other runners complained about how the heat was affecting them, too. I reasoned that everyone, including me, was struggling. If I’m honest, I also did what so many runners do: I told myself that I was out of shape. I convinced myself that I had to train harder and added spin classes and Pilates to my workout schedule to try to whip my body into better shape.
Something Wasn’t Adding Up
The Marine Corps Marathon was take place in October, so I signed up for the Philadelphia Rock ‘n’ Roll Half Marathon on September 18 as my fitness test. When that day arrived, despite 84 percent humidity, my training told me that I should be able to reach my goal of running sub-2 hours. I was on target for the first 10K, but when the moment came to pick up my pace, my body would not change gears. It felt like I was running through sludge, and I found it extremely difficult to breath.
Fortunately, I didn’t panic and instead re-adjusted my thinking to stay present and use the experience as mental training for the marathon. I finished the race in 2:17:10…almost 17 minutes slower than I had run a few months earlier and my slowest time in two years. My confidence was crushed. I told myself I wasn’t training enough and woke up the next morning for a spin class to push my body harder.
From Bad To Worse
After slogging through all those summer months of marathon training, I was anxious for the fall to arrive and offer a break from the heat—and a boost in speed and morale. But as October began and the temperatures started to drop, things still were not clicking for me. It was during an easy 4-mile tempo run that I finally thought something might be wrong. There was no humidity that evening, and still I felt like I was having something akin to a heart attack. I couldn’t inhale fully, I couldn’t catch my breath and I had a crushing pain in my chest.
When I finished my run and found my friends, I was so dizzy that I nearly fell over. They laid me on the ground and put my legs in the air, which helped get blood to my heart. The whole experience was scary enough that I called to make an appointment with my doctor. It was just three weeks before I was scheduled to run the marathon, so I requested that my blood be drawn, thinking my iron levels might be off.
Later that night, once my breathing calmed down, I convinced myself that I must have gotten scared in Central Park—maybe since all the lights were out?—and had a panic attack. I almost canceled the doctor’s appointment, thinking I’d found a logical reason for why my breathing was erratic.
A Doctor’s Concern Leads To An Unexpected Diagnosis
Thankfully, I kept the appointment, and after I described to the doctor what had happened in the park and explained that it must have been a panic attack, he began asking questions.
Doctor: Have you ever had a panic attack before?
Me: No, never!
Doctor: Have you done any long travel recently?
Doctor: Are you taking birth control?
Doctor: Was the episode in the park an isolated incident?
Me: Yes. Well…if I’m honest, I’ve been having a really difficult time breathing all summer during my runs. But it’s been really hot and everyone has been complaining.
Doctor: Any calf pain, soreness or swelling?
Me: (Eye roll.) I’m a runner. My calves are always sore, but nothing out of the ordinary.
The questions meant nothing to me, but apparently they were painting a possible picture for him—one that I’m grateful he considered, because not everyone would have looked for blood clots in an otherwise healthy runner.
I was at work late on a Friday afternoon when my doctor called with my blood work results. He explained that my iron levels and blood work all looked fine. Just as I was about to hang up, he explained that he had run an additional test on my blood (called a D-dimer) to check for blood clots in my lungs and that my levels had come back slightly elevated. He wanted me to immediately stop taking the birth control pills, as he planned to prescribe blood thinner medication and wanted to order a CT scan to see contrast on my lungs.
Not understanding the possible severity of what this all meant, I explained I had plans to run a half marathon that weekend. The doctor very firmly told me that I was not running until he saw the results of that test. I was convinced that I was fine, but I wanted to be cleared to run, so I made sure to get the test that day.
Toward the end of the test, I started to worry that something might be wrong. The nurses kept me strapped to the table for longer than I expected and reiterated to me multiple times that I could not leave until I spoke with a doctor. I was in the waiting room when my cell phone rang. I picked up, surprised to hear my doctor on the line. He explained that he had hoped he could treat me as an outpatient, but that the scan showed blood clots on both of my lungs and that he was admitting me to the hospital immediately.
A Strange Trip To The ER
It’s a weird experience to walk into a New York City ER, give your name and have the nurse say that they have been expecting you and lead you right in. That’s when it really hit me that this was something serious. As multiple doctors and nurses came by my hospital bed to treat me and ask questions, I detailed my activities, including a recent 20-mile run, and they all looked at me in shock. Did I understand how serious this was? Did I understand how lucky I was?
The National Blood Clot Alliance reports that, on average, one person dies every six minutes from a blood clot. According to research by Claire M. Hull, Ph.D. and Julia A. Harris, M.D., athletes are potentially at greater risk for missed or delayed diagnoses because they attribute the warning signs to similar sports-related aches and pains. Hull and Harris offer the example of a well-trained endurance athlete who is in strong cardiovascular condition but has unexplained shortness of breath. Because of her excellent fitness, this athlete’s doubled heart rate would not register as a warning sign for PE. Instead, a range of other reasonable diagnoses may be offered, including chest infection, allergies and exercise-induced asthma. In this case, the athlete might return to training unaware of the possible PE risk.
Fortunately, my doctor considered PE as a possibility for me. He later explained that it was the fact that I was in good shape from training with no history of lung disease but was presenting shortness of breath that made him think of a broader possibility for my symptoms. He also had my recent physical exam results, which were normal, as a comparison, and considered the fact that I was on an estrogen-based birth control pill—one of the risk factors for blood clots.
Blood Clot Risk Factors To Know
Including those I presented, the most common risk factors for blood clots include:
- Hospitalization for illness or surgery
- Major surgery, particularly of the pelvis, abdomen, hip or knee
- Severe trauma, such as a car accident
- Injury to a vein that may have been caused by a broken bone or severe muscle injury
- Hip or knee replacement surgery
- Cancer and cancer treatments
- Use of birth control methods that contain estrogen, such as the pill, patch or ring
- Pregnancy, which includes the six weeks after the baby is born
- Use of hormone therapy, which contains estrogen
- Family history of blood clots
- Confinement to bed
- Sitting too long, especially with legs crossed
- 55 years of age or older
- Long-term diseases such as heart and lung conditions, or diabetes
Knowing the risk factors and warning signs coupled with listening to your body can save your life. Pay attention to shortness of breath that feels different from pushing through a run on a hot day or being deconditioned, leg cramps that feel different from typical muscle cramps, or symptoms that persist long after running. Talk to your doctor if you have questions or concerns. Hopefully you are as fortunate as I am to have a doctor who does all of the diagnosing her or himself, regardless of the extent to which you talk their ears off about your own diagnosis theory.
Last weekend, at the starting line of the 2017 Chicago Marathon, I didn’t turn my watch on. The time no longer seemed important. I ran without music and took in every glorious stretch of the 26.2-mile experience. I reflected with gratitude on the friends, family and teammates who have supported me throughout my journey back to health. As I crossed the finish line, I smiled with joy and a deep appreciation for how far I’d come to get there. I am alive. I am stronger than I give myself credit for. I am healthy, and I am able to enjoy running again. Sometimes appreciating the journey it took to get to the finish line is the biggest accomplishment of all.