Running on Blood Thinners

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(Robyn Dunn and a friend August, 2010)

When ultrarunner and Ironman athlete, Robyn Dunn, felt short of breath in the early miles of a 50K trail run on August 22, 2009, volunteers and friends blamed the heat or exercise-induced asthma. Little did the 31-year old know blood clots in her lungs were killing her lung tissue.

Below, the Los Angeles resident shares her year-long journey from that race to bedridden patient to trail running phenom, after deciding to compete in endurance races while taking blood thinners.

The Race

On August 22nd, 2009 I was reminded that I am mortal, and no, I am not an invincible superwoman. I was 50 yards into the Bulldog 50K trail run, a brutal race in the Santa Monica mountains that consists of two 15-mile loops, and I was completely out of breath. The conversation in my head looked something like this:

“Ok, what is going on here you wimp?  You are running downhill so you should not struggling already! Breathe, breathe, breathe….” 

How could I finish the 31 miles if I couldn’t complete the first mile? I had a tight feeling in my chest. I ran/walked the first two miles, feeling very frustrated that my lungs were not cooperating.

At mile three I spotted my super-tall friend Eric, a registered nurse. He suggested that I stop running because I might have asthma. He stuck by my side as we power-walked up buttock-sculpting climb that rises about 2000 feet in four miles. When we reached the top, I decided to run the steep downhill section.

When the ground leveled out at the bottom of the mountain, I tried to keep running but couldn’t. I stopped at the aid station at mile 12 frustrated and hyperventilating. 

Volunteer at aid station: “Are you ok?”

 Me: “Uh I can’t breathe very well.”

 “What is your racing background?”

 “Well I’ve done three Ironmans, two half Ironmans, five marathons, a 50K, lots of 100 mile+ bike rides including three double century bike rides, Mt. Baldy Run to the Top…” 

“Well, this is a hard race. You are sweating a lot. You must be dehydrated.”

“ I always sweat like this. Just looking at a wool sweater or thinking about Las Vegas heat in the summertime causes me perspire. There is something wrong with me.”

The volunteer had me sit in a chair to calm down as I contemplated pulling out of the race. Dropping out of a race would be a first for me. I had done the Auburn half Ironman in 103 degree heat, and the Silverman full iron-distance race in wind and rain. I shivered in a ditch with a friend for forty-five minutes to keep warm during a freezing-rain plagued double-century bike ride—we finished. However, my gut told me not to finish this 50K.

I dropped out of the race.

The Diagnosis

Three days later I visited my doctor to see if I had asthma. His diagnosis was not asthma, but pleuritis, inflammation of the lining of the lungs. He prescribed an anti-inflammatory and told me to take it easy.

Two days later my best friend insisted on taking me to the emergency room when I developed new symptoms: chest and back pain. In the ER, a CT scan of my lungs revealed—to my surprise and horror—bilateral pulmonary embolism. I had multiple blood clots in both lungs.

Huh?  A 31 year old, active, non-smoker? Blood clots?  The ER doc said the blood clots occurred from the birth control pills I had recently started taking; pulmonary embolism, deep vein thrombosis and strokes are all possible side effects of that contraceptive.

I was started on blood thinner medication immediately and admitted to the hospital. A few hours later, a large clot caused my left lung become more deprived of oxygen. The pain escalated. It was an excruciating, crushing pain that I will never forget. I lay awake that night clutching a stuffed animal sent from my parents and begging for pain medication.

For the next five days at the hospital, I didn’t sleep. I lay in a narcotic-induced stupor, watching re-runs of “The Golden Girls,” experiencing double vision and hallucinating about aliens that resembled giant blueberries with long arms and legs.

My dear parents drove from my hometown, Salt Lake City, to be my side. Caring friends and co-workers stopped by to visit. On the fifth day, my nurse told me I could be discharged.

A very good looking physician was the bearer of very bad news. He told me the pain I experienced in my left lung was due to tissue death.  I needed to take Warfarin, a blood thinning medication, for one year.

Warfarin is an anti-coagulant, meaning it slows down the clotting process in the blood. To ensure effectiveness of Warfarin, he explained I had to avoid or limit foods with a high level of Vitamin K.  I would have frequent blood tests to monitor the effectiveness of the medication.

He told me I needed to be careful and cautious about participating in activities that put me at risk for internal bleeding. He didn’t recommend I bike, ski or snowboard. If I were to fall or crash, I would most likely experience rapid internal bleeding.

Trying to make me laugh, my friend suggested I cover my body in bubble wrap so I could ride my bike. I can honestly say at that point, athletics was the furthest thing from my mind.  I couldn’t even talk without experiencing pain or becoming out of breath. For the next month, I rested and allowed my lungs to heal.

I returned to work on September 28th, 2009. Five days later, I was rushed by ambulance to a hospital while attending a friend’s wedding in Houston. I had more blood clots. There was one in my upper arm vein and a very large one in the subclavian vein leading to my heart. My mother flew to Houston to be with me.

I had two surgeries, spent two days in the ICU, and had a filter placed in a major vein to prevent possible clots from traveling to my lungs. I was released by the hospital one week later and flew back to Los Angeles. I felt horrible, defeated and very pessimistic about my future. Despite being on thinning medication, my blood was turning into blobs. However, my doctors were adamant that eventually my blood would normalize. I was put on a stronger dose of blood thinners to ensure that I would not get any more clots.

The Recovery

In mid-November, I felt well enough to begin running again. It was tortuous at first. I ran very slow and short distances. I eased back into it. My healthy lung tissue began to compensate for the scarred portions. I continued to be challenged physically and also mentally over the next several months.

I experienced extreme fatigue from the blood thinning medication and trauma that my body had been through.  I experienced sadness, some annoying kidney stones, a broken heart after parting ways with a dear friend, horrible migraines, and more sadness.

I missed training and racing with my triathlon buddies. The level of medication in my blood became difficult to maintain, requiring three blood tests a week for a while. I hated not feeling well and wanted to rebel and jump on my bike and ride far away into the Santa Monica Mountains. 

My friends and family urged me to stay smart, be patient. I kept pushing through, and just kept running. I felt well enough to race the Redondo Beach 10K on Superbowl Sunday in February. I finished with a respectable time of 45:06. One week later I had surgery to remove the filter in my vein that was placed during my second hospitalization. 

A few weeks later, I ran the Malibu Creek 25K with some triathlon buddies. I had just two goals, to finish and stay upright. Not only did I achieve both goals but I was the 2nd female finisher.

A few weeks after that, I began to take beach volleyball classes through a local Hermosa Beach organization. I wanted to challenge myself and learn a new sport. The sport and people I have met while playing revived me emotionally and physically.

I signed up for another race on April 4th: the 18K Sycamore Canyon trail run in Malibu. I chased my buddy Aaron the entire race. He was a great pacer, because I was the first female finisher.

On May 8th, I ran the Xterra 22k in Malibu. I didn’t place this time, but still pleased because my legs felt awesome during the race. My health had improved dramatically over the past month.

In one week, on August 27th 2010, I begin to go off blood thinning medication. I can start biking again, woo hoo! I still experience occasional pain in the lung that has scar tissue, and my left arm does not circulate very well due to damaged valves in the vein. Definitely not ideal, but I can live with it.

The Takeaway

To all you athletes out there with physical conditions that limit your activities, hold your head high. Turn to family and loved ones for support. Draw energy from the beautiful world that surrounds you. Slow down, and appreciate the rhythmic beating of your heart. Remember that you are an athlete with a mind powerful beyond measure. Wherever your mind goes, your body will follow. Never, ever give up.

–Robyn Dunn

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