One of my running friends said it best, “It would be nice to know how to tell the difference between muscle pain and the type of pain you felt. Or maybe the really scary thing was that you couldn’t tell?”

I’ve been thinking a lot about that. And yes, one of the really scary things was that I honestly had no idea the pain I was feeling in my calf and lung was anything to be that concerned about until it was almost too late. That being an acute blood clot known as deep vein thrombosis (DVT) and a pulmonary embolism (PE), which developed as a result of a complete autoimmune meltdown. Why you ask? Because my immune system mistakenly produces antibodies against certain normal proteins in my blood, also known as antiphospholipid syndrome. You can read more about my hospitalization and diagnoses here and here.

The truth of the matter is we are all runners, cyclists, walkers, lifters – athletes – and we have learned through racing, training and pushing our bodies to the limit that pain is not only acceptable, but sometimes just the way it is. I know, I’ve struggled with Patellofemoral Syndrome (a.k.a Runner’s Knee and yes, everything really is a syndrome nowadays) all but the first year I ran. Knee pain for me? Completely normal, something I’ve had to live with if I want to run. It hurts worse at times, feels better other times and with no apparent rhyme or reason can totally make or break my run. And, I’m not alone. Most runners I know and run with seem to struggle with some sortof ongoing pain, injury or bodily malfunction.

We see each other in the Physical Therapists’ waiting room and don’t recognize each other because we are dressed normally. “How was your run?” becomes “How’s your PT going?” or “How’s that knee holding up lately?” We live with pain. In fact, some people might even argue it’s what makes us real. I thought that at first, Yes! My first running injury. I’m a real runner now! Um, no. That got really old, really fast and yet; we still run, bike, swim and tear up the gym with pain. Push through. Get over it. What doesn’t kill you makes you stronger. You can run 26.2 miles with pain, what’s stopping you now? You’re fine. Walk if off. Rest, Ice, Compress and Elevate. You know all the right things to say to yourself.

Given all of this, it only makes sense that when we have real pain that we need to be really concerned about, we shrug it off. We’re runners, right? We live sometimes everyday of our lives with an ache here or a pulled muscle there. We run long on Saturday and hobble around on Sunday and Monday (and maybe even Tuesday if you’re like me) until we’re recovered. Why are you walking like that? Someone asks us at the office. I ran 22 miles on Saturday (meanwhile we’re thinking, I bet you didn’t). And we go about our day, proudly displaying our battle scars.

Looking back, now? Yes. I should have known something was wrong. Really wrong. I blamed in on my knee.

The pain was different.

First there was the leg pain. I had been complaining about leg pain for a couple of weeks or so. I distinctly remember telling Duane, not only did my knee hurt, but my calf hurt too. I told him this pain extended down into my ankle and bottom of my foot. The thing that was different is this pain was not as a result of running. I had it even when I didn’t run. In fact, when I ran, I noticed it less.

I have always had a discolored left leg:

June 2012

You can see the brown, which now looks like freckling, but before this incident, it turned almost purplish. In fact, the other thing that makes my situation complicated is that I have had more than one doctor look at my leg for the discoloration. It had been discolored ever since college, from what I can remember. I even had a biopsy on the skin about two years ago in which a dermatologist determined it was a pigmentation issue and not cancerous or anything like that. Even my gynecologist was fascinated by the color of my skin and listened to my blood flow. No one ever heard a disruption of blood flow. Hence, no one assumed it was a clot. I didn’t have varicose veins, either, further indicating a blood clot was out of the question.

DVT Causes:

• Slow blood blow (often due to lying or sitting still for an extended period of time – such as in the case of a long plane ride or car ride)
• Pooling of blood in the vain often due to immobility, medical conditions, or damage to valves in a vein or pressure on the valves, such as during pregnancy
• Injury to a blood vessel
• Clotting problems due to aging or a disease
• Catheters placed in a vein

Symptoms of a Deep-Vein Blood Clot (DVT):

• Swelling in one or both legs
• Pain or tenderness in one or both legs, which may occur only while standing or walking
• Warmth in the skin of the affected leg
• Red or discolored skin in the affected leg
• Visible surface veins
• Leg fatigue

DVT can partly or completely block blood flow, causing chronic pain and swelling. It may damage valves in blood vessels, making it difficult to get around.

Half of all DVT cases cause no symptoms.

• Swelling in one or both legs
• Pain or tenderness in one or both legs, which may occur only while standing or walking
• Warmth in the skin of the affected leg
• Red or discolored skin in the affected leg
• Visible surface veins
• Leg fatigue

What I Felt:

Excruciating pain that extended from the back of my knee down to my ankle whenever I put any amount of weight on it. I was nearly dragging my leg by the time my husband and I went to the hospital. I have said it previously and I will say it again because it is the only way I can describe it: It felt like someone had the soft, fleshy skin behind my knee in a vice and just kept on tightening. Runner’s Knee caused me to hobble, caused me to scoot down stairs, sidestep curbs and grimace when getting in and out of the car. Runner’s Knee never caused pain in the back of my leg. Also, the side of my calf was tender to the touch, but not overly warm, now I know that soreness was primary along the femoral vein. I did not notice any swelling, especially in my lower leg. My knee is always slightly swollen to being with. I will note, remember Goofy when I was limping at Mile 4 of the full marathon due to my severe kneepain? It wasn’t knee pain. It was this pain that caused me to slow to the point of being pulled from the course and after a three hour plane ride and countless hours on my feet after that, I’m not at all surprised in hindsight.

I just wonder how long this clot had been building. It is terrifying to think about.

Then there was the side pain. I texted Judi on Sunday when she asked how my knee was doing, “Sore but okay. The weird thing is my left side. Hurts when I breathe like I can’t catch my breath. Slept propped up. No idea what the hell happened. Started mid-day yesterday.”

(OKAY, LOOKING BACK, THIS IS NOT NORMAL!)

Symptoms of a Pulmonary Embolism:

• Shortness of breath that may occur suddenly
• Sudden, sharp chest pain that may become worse with deep breathing or coughing
• Rapid heart rate
• Rapid breathing
• Sweating
• Anxiety
• Coughing up blood or pink, foamy mucus
• Fainting, lightheadedness or dizziness
• Heart palpitations
• Signs of shock

Pulmonary embolism may be hard to diagnose because its symptoms may occur with or are similar to other conditions, such as a heart attack, a panic attack, or even pneumonia.

Also, some people with pulmonary embolism do not have symptoms.

My Symptoms:

• Shortness of breath that may occur suddenly
• Sudden, sharp chest pain that may become worse with deep breathing or coughing
• Rapid heart rate
• Rapid breathing
• Sweating
• Anxiety
• Coughing up blood or pink, foamy mucus
• Fainting, lightheadedness or dizziness
• Heart palpitations
• Signs of shock

What I Felt:

I honestly thought this was a really bad side stitch. Only, it got worse over time. A pretty good indicator that it was not a side stitch was that it did not happen while I was running. It happened much later in the day once my body had a chance to relax. As time went on, the pain became nearly unbearable and not only that, it became hard to breath. I could not lie down at all – the pain was excruciating.I never really felt chest pains, but I did feel like someone was jamming their thumb into my rib cage. My breathing became shallow and I could only say two or three words at a time. The best indicator? I could not draw in a deep breath – very similar to when you are trying to catch your breath during a hard or hot run, but it doesn’t go away with rest or pain meds. One of my doctors told me, there should have been a moment in time when I realized I couldn’t breathe (when the clot entered my lung and obstructed air flow); however, I think this happened when I was taking my nap and I didn’t know the event had occurred. If I had been up, walking around or running errands, I may have noticed it as it happened and thought differently about it. Although this was serious, I am convinced my symptoms did not feel more life-threatening because thankfully my heart was not affected by the trauma to my lung.

The pain in my leg/knee/calf combined with the new pain in my side should have been an indicator that something was wrong and I needed immediate medical attention because a PE is most commonly caused by a blood clot that breaks off from a leg or pelvis vein and travels to the lung, creating a big problem.

(Now we know? I should have put the two pains together.) 

So there you have it. If you at all think you are suffering from a blood clot in your leg or lung, please do not wait to get emergency medical attention. Most people who are going to die from a PE do so within 30 to 60 minutes of the event, which is why I am so lucky (since I took well over 24 hours to go to the hospital). PE causes or contributes up to 200,000 deaths annually in the U.S. alone. One in every 100 patients who develop DVT dies, due to a PE. Immediate medical intervention is essential to reduce the risk of death to less than 10 percent. I’m still here!

As runners and athletes, we all live with pain, some of it more severe than not. We will probably always have to deal with pain. Its part of what makes us who we are – we push and workout and run until sometimes we just can’t go anymore and in those moments, we do sometimes find victory whether it be setting a new PR, going a new distance or achieving a negative split. But, listen to your body. If something doesn’t seem right, doesn’t feel right or just as even the slightest tweak to it, seek medical attention. Even if it is putting a call in to your family doctor. After all, I am convinced that is what saved my life. I wouldn’t be here had my family not been persistent in checking in with me and eventually calling my physician who then called me and told me to go to the E.R.

Until the next mile marker,

In Case You Missed It….

• What the #$%! Happened. In June 2012, I was incredibly lucky to survive a pulmonary embolism (or blood clot in my lung) that broke off from a clot that had formed deep within a vein in my lower leg. Read my story here.
• What the #$%! Happened: The Aftermath. What caused this, what my treatment entails and what the future holds for running, my job and life.

• “That’s Why I Pray.” God is not finished with me yet – and that’s why I’m still here! Do you believe in the power of prayer to make a difference? Do you believe there is hope when all seems hopeless? Do you believe in better days? I do now more than ever! The lyrics and meaning of this song got me through some seemingly hopeless moments in the days after my discharge from the hospital.

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