Blood Clots in Fit Legs
In 2011, Serena Williams, one of the greatest athletes in history, suffered a pulmonary embolism, was treated for that, then suffered a hematoma. Soon after winning Wimbledon for the fourth time, Serena cut her foot on a shard of glass, needing eighteen stitches to close the wound. Some combination of her injury and/or her resulting inactivity and/or a long flight from New York to Los Angeles led to a deep venous thrombosis (DVT), and some of the clotting material travelled through her bloodstream to a pulmonary artery, causing an embolism of her lung.
About a year ago, on a very cold morning, I biked down the hill, then tore a big muscle in my left thigh when I stepped up with my bike onto the light rail. My leg healed over the spring, and I commuted by bike almost every day all summer and fall and into the mild winter. It got cold a few weeks before the record setting snow fall, and I decided to begin walking down the hill to the station, walking back up in the evenings. I walk a lot, so I didn’t have any problems at first.
For a few days after the snowfall, I had to walk a lot further because light rail and buses stopped three miles from my office. Descending and climbing the hill was a chore because there was hardly any shoulder left for walking. Over Superbowl weekend, my old thigh injury began to ache. In a few days, my left calf began to feel tight. I assumed I was favoring the upper leg and had overused the calf, so I began taking the bus up and down the hill.
But after a week of limping between bus and light rail, I saw that my left calf was swollen. My right calf is 18 inches around, but the left one had increased to just over 20 inches. My wife reported my symptoms to my local physician, who urged me to get to the emergency room. The PA in the ER didn’t think I fit the profile of DVT, and neither did I, but an ultrasound exam found a clot just below and behind my left knee.
They prescribed the very expensive Xarelto, which wasn’t covered by my insurance plan, and I rested the leg at home for four days. For the last three days I have been driving a rental car to rest the leg as much as possible while still working to afford the bills that will soon be arriving for the ER visit. Next week I am to visit a vascular surgeon who will advise me on whether the clot should be removed surgically.
[Update 20160225: The vascular surgeon recommended that I continue on blood thinner for several months, wear a knee high compression sock during the day, and resume exercising. That’s good news.]
I have found several articles about endurance athletes getting DVT. It isn’t common, but it isn’t as uncommon as one might think, either. In, Hidden danger: DVT in endurance athletes, Active.com advises:
Some people are familiar with the potential for DVT to occur during or after a long airplane flight. This has been referred to “Economy Class Syndrome.”
Did you know that 85% of air travel thrombosis victims are athletic, usually endurance athletes?
Being a cyclist is no guarantee against clotting:
So what does this have to do with riding a bicycle? Bicycle riders typically are in good shape, watch what they eat, and take care of themselves. They are not generally overweight. If they have been riding for some time and cover 300 miles or more a month at a good pace, their resting heart rate is generally lower than the norm for their age.
Lower resting heart rate means slower blood flow throughout the body. This is especially true for those riders who participate in endurance events such as century rides, time trials, and other competitive events.
Slower blood flow — sound familiar?
Unfortunately, that slower blood flow that is great for your heart can work against you if you have mostly sedentary work, as I do. Most days I sit at the computer only getting up to go to the rest room or print room, or chat with a coworker. A little riding in the morning and an hour in the evening is better than nothing, but my life is still fairly sedentary.