DBN, DVT & PE…. Not necessarily places I’d like to visit again!

Durban 70.3
Photo credit: Chris Hitchcock

A diary of events running up to Durban 70.3, the race itself, and hospitalisation that followed:

28th April…my second run since Ironman. A slightly sore calf…near the top. A dull pain. No heat or swelling. It just felt tight.

The pain got worse in the days that followed. I struggled to put the weight on my heel. The next thing I knew my back was out! I managed to hobble to the physio (Martlie at Liandi van der Westhuyzen’s practice) and was out of action for 10 days.

Fortunately my back came right reasonably quickly and I could resume training. My calf seemed to have benefitted from the rest too. Durban 70.3 was just going to be a fun race and I wasn’t training specifically for it. The main aim is IMSA 2018 so low heart rate/ base training and lots of swimming was on my program for May/June. I was swimming 6 day per week. Diligently braving the Tygervalley pool at 5:30am.

On the Tuesday evening (13th) before Durban I had an hour low heart rate run on my program and Nicola was going to join me. We set off and within 100m I was gasping for breath, and not just the usual out of breath as you start your run. I was grateful for the robots stopping us and I could try compose myself. We continued slowly, very slowly. My heart rate alert was beeping but also the fact I couldn’t get air into my lungs resulted in this run being a walk/very slow jog. 10kms of feeling like shit. Not knowing what was wrong. Barely able to speak due to having no breath but also worrying what on earth was wrong. I felt bad for being such crap company for poor Nicola (who’s recovery advisor on her watch at the end said that she needed no recovery!!) I messaged Dave that something was up. I couldn’t breath and was lacking energy. But I didn’t feel sick. No snotty nose. No temperature. Could it be chlorine poisoning from all the swimming? I always sneeze after swimming at Tygervalley. I think they put in extra chlorine since it’s a very busy pool. And maybe they are putting more in due to not being able to back wash it due to the water shortage? Jokingly I briefly mentioned maybe I’ve a blood clot? I had read an article in the Ironman magazine about Helen Ellison who had suffered from DVT and one of her symptoms was being unable to breathe. I told Dave I’d do some research (Google, and ask some swimming friends) and also asked him to make sure I was alive in the morning. (Looking back I now realise that this was not a joke!!)

I tried swimming the next morning. I was even more slow than usual and gave up after 2km. I went out for a spin on my bike in the afternoon. To check everything was in order before I boxed it and also to see how I felt. I felt ok….I think. But it was just an easy spin and my heart rate seemed normal.

I ditched my swim on Thursday morning. I needed to get the chlorine out of my system…so I thought…!! I had another hour easy run planned for the evening and Dave said I was to join him. Easy jog on a flat route. It was flat. It wasn’t easy. I was gasping for air at 6:30min/km pace. I told Dave to keep talking and I was listening, but I couldn’t talk back. I just couldn’t get air in to my lungs. My lungs felt sore. I told Dave I would be fine by Sunday and I would just listen to my body and go at whatever pace I was able to… It would be time on my legs and a good, but expensive!, training day!

I flew up to Durban on Friday and tried to do very little except registering, walking round the expo and walking back to my hotel.

Saturday morning… I went for a 45 minute spin on my bike. Everything seemed ok except my bars which I clearly had torqued correctly! Then I went for a 20min run…jog…leg stretch. I still couldn’t breath. Tomorrow would be interesting. But hey, I could walk 21km if need be…

We were to meet on the beach at 10am for a Wingman group photo and then a quick swim. Time to see how my lungs and body would cope with swimming…A small group of us swam out a few hundred metres. Thankfully the waves were tiny so I managed to have enough breath to duck under as they broke. We regrouped, took some GoPro pics and headed back towards the shore. All of a sudden I started to panic that I wouldn’t be able to duck under the breakers. And what would happen if I got hit by a breaker unaware and didn’t have enough breath. Sam and Marinda were to my left. I could feel myself drifting towards them. The others were ahead. The backline was getting nearer. Fear engulfed me. Fear of drowning and fear about what on earth was wrong with me. And the more I panicked the less I could breath. What was Sam going to think if I shouted for help?? But her name came out my mouth before I could question myself any more. She could see the anxiety in my face and told me to keep calm (Fortunately Sam is a good friend, an amazing ice swimmer and knew I wasn’t 100% so I think, and hope, she understood the situation and knew it wasn’t normal for me!) Tears filled my goggles and the more upset I was getting the more I was gasping for air! Suddenly Dave popped up next to us and became Super(supa)dave and held on to me asking if I was ok??! Evidently not! Poor Dave was now thinking – ‘OMG one of my best athletes, who has done several halfs and fulls, including World Champs! is having a panic attack in possibly the calmest sea conditions ever?!?’ (Yes it has taken guts to share this but shows we all have weak moments!!) We swam slowly back to shore (apparently I set off in the wrong direction…I don’t remember this and still don’t believe I did…?!!) Sam however wouldn’t let me leave the situation like this. And to be fair I would have been exactly the same if I was her. She made me swim back out with her to make sure I was comfortable and confident that I could easily duck under the waves and had plenty of breath.

I told Dave I would be fine tomorrow. I would take it slow and keep my heart rate down. I’d got to Durban and wanted to participate. If at any problem I wasn’t ok I would stop.

Racking was done and an early night was on the cards. But first a bath in bicarbonate of soda – apparently good if one has chlorine poisoning! Yes at this point I still thought my problem was from chlorine poisoning!

Dave messaged asking again if I was ok. I replied yes and I would be fine…

Looking back there were so many signals but one brushes them off thinking they are a result of something else. I was highly emotional all week – floods of tears on so many occasions when normally I’d tell myself to HTFU.

‘Race’ day…

Thankfully the sea was as flat as a pancake! I took the swim very easy. I broke it up into sections and told myself I could rest at each sighting buoy if I needed to. My watch strap started flapping; I stopped and fastened it. I tried to keep away from the washing machine effect at the turn around buoys. I did wonder that if I did get into difficulty and put my hand up would anyone actually see me amongst the flailing arms?? Memories/nightmares! from Durban 70.3 2015 came flooding back as I headed back towards the shore. Fortunately no massive waves to somersault me upside down this year. The gentle tide pushed us to the sand.

It was a fairly long run up through the sand to T1. I tried to run but found myself walking pretty quickly. Voices in my head were telling me just to chill and who cares if I’m walking.

Being number 4 (a very undeserved race number on this occasion) meant my bike was waaaaaay at the end of the 1km transition area. Lucky me!

The 2km ‘neutral’ zone along the promenade was a joke. A free for all. But it was least of my worries.

I was planning to ride to my heart rate. I knew it was higher than it should be and my breathing wasn’t great. After about an hour my HR monitor decided to stop working so I would have to go on feel… I felt pretty rubbish to be honest! I ploughed on, legs heavy and body lacking energy…not helped by the fact my back brakes were binding (I did stop and try to sort but couldn’t)

Not long after the 42km turn around my left leg caught my eye. My calf was massive! ‘Shit! What’s wrong with it?’ ‘Should I stop?’ ‘Its not that sore…it just feels tight.’ My head was completely not in the race. Not far from the end of the first big loop I caught up to Debbie – she shouted as I passed asking if I was ok? ‘No not really, my leg is swollen.’ And she replied yes it was!

I was still not really sure what to do at this point. Where was the medic tent on the route? I could get to T2 and see someone there or should I stop now? I decided to continue. It would have been a long walk otherwise!!

I got to T2. I could run on my leg. It didn’t feel that sore. Just a bit weird. Heavy and tight. I changed into my trainers, hesitated as I passed the massage/medical tent, and thought ‘nah, I’ll be fine. I‘ll see how it goes…’

My 21km was the slowest 21km I have ever run. I couldn’t run any faster. My lungs wouldn’t let me. I walked at the water stations and made sure I kept hydrated. We were very lucky with the weather and it wasn’t unbearably hot.
I made sure I smiled as much as I could. After all I wasn’t racing and was doing this for fun. I was happy to reach the finish line but also a bit sad; people expect me to do well and I’d let them down (even though I’d tried to lay low for this race) and I wasn’t feeling great. And what’s wrong with my chest and now my leg?!

Result:
Swim: 00:37:10
T1: 00:06:04
Bike: 02:55:57
T2: 00:03:10
Run: 02:01:57
Total: 5:44:18
Position: 16th (40-44)

I bumped into Britt after the race (Britt had a blood clot in her leg last year) and mentioned my leg to her. She told me to definitely get it checked out asap. And Robyn (physio) was also concerned by it. Now I was beginning to worry even more. I then bumped into Annchen who asked if I was ok. When someone asks you if you are ok and you are not, it seems to trigger tears! She suggested I go to the medical tent just for a check up and reassurance if nothing else. So I did.

Heart rate, blood pressure, blood sugars etc were all normal. Yes my leg looked a little bit swollen but they didn’t have an ultrasound machine there. They gave me Aspirin to take to help thin the blood and told me to go for an ultrasound as soon as I got back to Cape Town. So I’m ok, I thought. It can’t be that bad. They didn’t seem too worried about it. So I’m not going to die…

Probably going to the after party wasn’t one of my best ideas. But I still didn’t think there was anything seriously wrong with me. And alcohol is a blood thinner, right?! I’m not sure if taking a dip in the sea at midnight was a great idea either! Sand…everywhere!….for days!

I flew home on Monday lunchtime; I tool my Aspirin, compression sleeves on my calves, and tried to keep my legs and feet moving. I was feeling slightly nervous. Thoughts were rushing around my head. ‘What happens if you have a blood clot and you fly?’ ‘I wonder if there a doctor on the plane?’ ‘Who do I know on the plane?’ ‘What happens if I die??’ But I kept reminding myself that I had just raced a half ironman so surely I must be fine…

I landed, ubered home, jumped straight into my car and went to the radiology dept at the medi clinic. But with no referral letter they wouldn’t do an ultrasound. But what if I die, I asked jokingly, little did I know how close to the truth it was! I didn’t really think I could go to ER. I wasn’t dying was I? So I booked a doctors appointment for the following morning and I’d take it from there.

The doctor listened to my long story of my calf and chest. Yes chlorine could have affected my chest but it wouldn’t explain my leg. Bloods were taken and marked urgent. It was a 97% reliable test which would indicate blood clots or not.

Within 2 hrs the doctor called to say my results were back. The d-dimer test result was to be under 550ng/ml if no blood clots were present. My result was 2443…

An ultrasound appointment had been booked at the Medi Clinic for 15:30. A tearful Jenny (I don’t think I’ve cried so much in a week! Shock…and feeling sorry for myself!) was very relieved when Lisa said she’d come with me. Arriving at the medi clinic I was immediately put in a wheelchair. I was extremely high risk and wasn’t allowed to move! If I had a blood clot in my leg it could fragment at any time and could end up in my heart or brain…

An ultrasound on my leg confirmed a blood clot. It ran from mid calf to mid thigh.

Ultrasound report:
COLOUR DUPLEX DOPPLER DEEP VENOUS SYSTEM LEFT LEG
There is evidence of a deep vein thrombosis of the peroneal veins, the popliteal vein and the mid and distal femoral vein. Also evidence for thrombosis of the intramuscular veins of the medial gastrocnemius muscle.
The posterior tibial veins, anterior tibial veins and the proximal femoral vein and common femoral vein are patent.
No clear evidence for a superficial thrombophlebitis.
CONCLUSION
Extensive deep vein thrombosis of the left leg as described above. As discussed with the clinician a spiral CT examination of the chest will be done for exclusion of pulmonary embolism.

Because I had experienced chest pain, they sent me in for a CT scan of my chest. A very strange experience when they inject you with iodine. A warm sensation rushes through your body and you feel like you have wet yourself! The results concluded that I had bilateral pulmonary embolism – blood clots scattered all over my lungs.

CT report:
CT CHEST
The pulmonary trunk appears slightly prominent but the diameter does not exceed the diameter of the ascending aorta at the same level and currently therefore not convincing evidence for pulmonary arterial hypertension.
No visible embolism of the pulmonary trunk. There is no clear evidence for a pulmonary embolus of the left main pulmonary artery. There is however evidence of pulmonary embolism involving the pulmonary arteries to the lingula segment of the left upper lobe as well as the left lower lobe, the right lower lobe and the right middle lobe. On the right the thrombus extends into the distal right main pulmonary artery. Also evidence for pulmonary embolism in the right upper lobe pulmonary artery.
A small non specific intrapulmonary nodule is visible in the right lung. The largest one is pleural based and is in the right middle lobe. It measures 4.2 mm in length.
There is no visible pleural or pericardial effusion.
There is no visible focal abnormality of the liver. The remainder of the visualised upper abdominal organs appear within normal limits. The visible skeleton appears within normal limits with no clear evidence for a destructive process of bone.
CONCLUSION
Bilateral pulmonary embolism as described above.

The doctor told me he had no idea how I was alive. To have done Durban 70.3 plus two flights and not to have died from a clot in my heart or going to my brain, it was a miracle. My very strong heart and lungs had saved me. I was admitted to hospital for 5 days. Normally DVT and PE patients would be in ICU but apparently I was clearly too tough so a normal ward would be fine!

I had a heart sonar the following morning (Wednesday) which showed there were no clots near it and no damage.
My time in hospital went very quickly. I was either sleeping or being entertained by visitors. Lisa was amazing! I’m massively indebted for all her love, support, care and time. Not easy for my family being so far away and my sister was ready to jump on a plane – I think she just wanted a holiday!!

I slept a lot – my body had obviously taken huge strain. Emotionally I was fine except it did hit me on the Thursday evening how very lucky I had been. I guess if you don’t know how close you are to death you don’t get frightened by it. I was pretty oblivious to it all, apart from not being able to breathe and a swollen leg!

Since leaving the hospital on the Sunday I’ve had a check up with Dr Laura Redman, a vascular surgeon. The blood clot in my upper leg is still there but should slowly disintegrate with the blood thinners (Xarelto) that I’m now on for 6 months. And in future whenever I fly I’ll be taking blood thinners as a precaution. I’m allowed to walk for the next 6-8 weeks while my lungs repair and then training can commence. I’ve got a bit of a chest infection from dead bits of lung but apart from that I feel fine! I have to be careful while I’m on the blood thinners that if I cut myself I could bleed out or if I hit my head a brain bleed would kill me! So no mtbing for me for a while!

The cause? Probably the contraceptive pill and dehydration.

People have since asked me what are the symptoms. My symptoms were a dull pain in my leg and swelling. And chest pain and being unable to get air into my lungs. I had a sports massage on the Tuesday morning which possibly caused the blood clot to fragment, hence my breathing was initially affected on the Tuesday evening.

Apparently other symptoms include:
DVT: heat and tenderness of the leg, darkening of the skin
PE: dizziness, sweating, chest pain, rapid breathing, coughing up blood, rapid heart rate

So, I’m very happy to still be alive. Clearly it wasn’t my time yet! Thank you to family and friends for all your love and support. And yes I will be patient and know it’s a slow road back to recovery. But I will come back stronger! And if I can shuffle a 5:44 70.3 with a clogged up leg, collapsed lungs and millimetres from death then I’m hoping I can cruise a sub 5 when I’m back in action!?! 😉

4 thoughts on “DBN, DVT & PE…. Not necessarily places I’d like to visit again!”

  1. Seeing it all written down like that makes it worse. Please don’t put yourself in that situation again- I don’t think my heart could stand it!I cannot believe you managed the race at all feeling like that.
    Amazing support from all your friends throughout, massive thanks to them.
    You will be back, stronger than ever. xxx

  2. Wow!! You are incredible! I’m 25 and I went into hospital in December with an extensive DVT in left thigh/groin! I cried and cried at having to give up my sport! Your posts make me feel motivated and determined! Considering another half marathon and eagerly awaiting my return to women’s rugby!

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