April 5, 2008 (Anchorage, Alaska) – I just got out of the hospital for the second time in a five days. The back pain I encountered earlier last week turned out to be a massive blood clot in my left leg extending from my hip down past my knee, a condition called Deep Vein Thrombosis, DVT. I spent last Saturday and Sunday in the emergency room in Fairbanks where I received the initial diagnosis and started on blood thinners to prevent any more clots from forming. The doctors told me I would have to wait for the body to naturally take care of the clot. Fortunately, I was able to get out just in time to watch the men’s 50km classic race, and it was very uplifting to see my longtime coach Frode Lillefjell take third overall and win the National Championship.

Monday morning I flew back to Anchorage and mostly stayed at home with my leg up. My leg had swelled to almost twice the size of my other leg over the weekend. Thankfully the swelling went down a little after resting. (I think the blood thinners kicked in). On Tuesday I got an appointment to see a vascular surgeon. Upon reviewing my case he immediately suggested a surgical procedure called lytic therapy where they send a catheter up the vein starting behind the knee and go up into the clot and spray out a drug that disintegrates the clot (like Pac Man). The other alternative was to leave the clot and let the body take care of it, but because the clot was so extensive there was a good possibility that some of the clot would turn to scare tissue leaving me with an ineffective, painful leg for the rest of my life (which would have made skiing very difficult). So as you can imagine, I chose to go for the lytic therapy.

On Wednesday morning I headed to Providence hospital and checked in to the heart center. After checking my vitals, I was carted down to the radiology wing to the cath lab for the procedure. I was laid flat on a skinny bed, face down on my stomach. They gave me some sedatives and I only came about every once and a while to see the wire being pushed through the clot on a screen ahead of me. It seemed like only a few minutes but the procedure took four hours. When they were done I was taken up to the cardio intensive care unit. I was pretty sleepy, but I guess the doctors explained to Jeff and my parents that they were able to get about 70% of the clot out. The clot had actually been older than originally thought. Instead of being a week old like my symptoms, it appears the clot had been in there for a lot longer, perhaps all season.

I spent the night in the ICU still sedated and pretty sleepy. In the morning, I was taken back down to the cath lab for a second procedure to try and get out the remaining clot. I was on the table again for another two hours. This time they were able to clean out almost all of the clot and a balloon was used to widen parts of the vein that had been compressed.

Then I spent a few more hours in the ICU while they took the catheter out and made sure things were stable. Everything looked good, so I was discharged. When I first got up to walk, I thought the leg would feel much better. However, I found the leg actually hurt worse. I was given some crutches to walk around on.

A big lesson was learned here! The doctors seemed just as concerned with how the clot started as they were about how to deal with the clot itself.

At first it was hard to understand why someone my age, in such great health could develop such a blood clot. However, over the last week it’s been quite an education for me, learning about how clots form and what the contributing factors are. From what we can determine, the initial clot started months ago. Although we still don’t know what caused it, there are a few categories I fall into: May-Thurner syndrome, on birth control, and long periods of travel. Additionally, we are still waiting for blood tests to come back to determine whether I have any genetic predispositions for blood clots. These are some of the categories explained:

1) May-Thurner syndrome: a rare syndrome that happens in young, athletic women. May-Thurner syndrome is compression of the left iliac vein by the artery crossing over it, causing a narrowing of the vein.

2) Birth control: Women who use estrogen-containing birth control pills are at a 3- to 6-fold increased risk of developing blood clots. Since November, I have been using a product called NUVA RING. Currently there is a national class-action lawsuit against NUVA RING, as it has been linked to other instances of blood clots and DVT like I had.

3) Travel: This incident brings to light the need for more education for athletes about the risks with blood clots and DVT. We all spend so much time traveling, cramped on long flights. We often travel after competing which contributes to dehydration. We are healthy most of the time and we don’t respond to symptoms right away. This clotting has been in my iliac vein for a while, it just took a string of unfortunate circumstances (falling, sitting in a car and plane for hours without moving, and possible dehydration) to cause the clot to build up to a noticeable (and painful) point. I’m lucky I discovered the clot before anything really bad happened.

I hope we can all learn from this! Remember to get up and walk around every couple hours while traveling. Stay hydrated! And a note to all you female skiers taking estrogen containing birth control medications. Please talk with your doctor about the risks involved with blood clots!!

I hope to move on from this and get back to my normal self pretty soon.

Cheers,

Kikkan 🙂
USA XC Ski Racer
2002 & 2006 US Olympian
www.kikkan.com