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Cycling and Blood Clots?
2000
Words: Kirk Willett
Cycling and blood clots are generally not topics
that enter the same conversation. Cycling
brings to mind sport, physical fitness, and a
healthy lifestyle, where blood clots bring to
mind cardiovascular disease, stroke, and
generally poor health. Recently though,
cycling and blood clots have been used in my
conversations together every day.
My right leg has been a mystery to me ever
since I began racing. Even though it is my
dominant leg, and I tore the anterior cruciate
ligament in my left knee, my right leg was
always the weak one. It would always
fail before my left leg would even feel an
effort on the bike, and be weaker when beginning
strength training in the off-season. My
right leg would fill up with this incredible
burning pain, far worse than the normal lactic
acid burn, in time trials and on long climbs,
where my left leg would be fine.
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Year after year, I would ask every doctor I
had access to for input on this problem.
Most of them said I just had a cramping problem
or did not warm up enough. The others said
they were stumped and really had no explanation.
This includes the very cycling knowledgeable
physicians I had access to when with the
National Team and now have with the Mercury
Cycling Team. While the problem worsened
each year, I assumed that my right leg was just
my weak link. I have learned to manage my
cycling to accommodate it. I have gotten
extremely good at governing my efforts, knowing
how much pain I can tolerate in my right leg,
and focusing on my left leg. When races
forced me past the limit, my right leg fills
with pain and becomes useless. Unless
there is a rest quickly, I have to stop pedaling
and click out for a few minutes. This all
changed May 12th.
I had rested after fighting through the Tour of
the Gila, and went out that day to start a block
of endurance/tempo rides to prepare for the
six-hour duration of the First Union USPRO
Championships. About five-and-a-half hours
into the ride, the usual burning pain began to
build in my right leg at tempo pace. By
the time I got home, at six-and-a-half-hours, I
had the burning symptoms warming down. The
next day, I couldn’t even pedal or walk for more
than thirty seconds without the pain. My
leg also had a strange background ache. I
figured that I had just really over-done it the
day before, since it was the highest average
heart rate for the duration ride I had ever
done. I tried to ride again the next day,
but nothing changed. I figured another big
rest day was in order, and then on to Arlington,
Virginia for the Clarendon Cup and some help
from our team’s therapist. There was no
change as I lasted one lap. I returned
home that night and went straight to a doctor
the next morning.
I described my symptoms to the doctor and,
after talking for a bit, he tried to find a
pulse in my right leg. He found none!
There was no pulse in my foot, behind my knee,
or in my groin where on my left side I could see
it through my skin. He immediately set up
an appointment with a vascular surgeon for
further investigation. I reported to the
surgeon, and he scheduled me for an ultrasound
and an arteriolegram study that afternoon.
An arteriolegram is an interior vascular study
where a catheter is inserted into a blood vessel
and a guide-wire is maneuvered through the
vessel to the area of investigation. A
contrasting substance is released up-stream, and
then x-ray pictures are taken of the blood flow.
It shows exactly where there are any
obstructions or defects. It took about two
seconds for my problem to be identified. I
had a complete occlusion of my right iliac
artery. In other words, I had a big-old
clot plugging up the main pipe that goes into my
right leg. I also had quite a bit of
collateral development around the clot keeping
my leg infused with enough blood to keep it
alive. The extent of the collateral
development made it evident that I have had a
clot and obstruction there for many years.
They also found five more clots throughout my
leg. The next thing I knew, I was in a
midnight ambulance headed for the Oregon Health
Sciences University Hospital (OHSU) in Portland
to start intravenous anti-coagulant medication
and to be worked on by the nationally renowned
vascular surgery team headed by Dr. Taylor.
Bright and early, they did another
arteriolegram on me, and then later went into
the artery again to attempt to break-up the
clots. Most of the time, with clots of
this magnitude and age, they are not successful
in dissolving them. It was time I had some
luck though. They were able to break up
all but one clot down in my calf, which would
not be a long-term problem. They
were also able to identify why I had clotting to
begin with. This is when I first heard the
sport of cycling and the term blood clot used in
the same sentence.
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Over the next seven days at OHSU, I learned a
lot about the rare connection between cycling
and blood clots. My personal anatomy and
the bent over cycling position caused the
clotting. The constant bent-at-the-waist
position, in conjunction with the action of some
of the muscles that stabilize the rotation of my
right leg, have been pinching and twisting my
iliac artery against my inguinal ligament.
That ligament, for the most part, is the crease
in your groin. For whatever reason, my
right side is just different than the left and
not compatible with the amount and intensity of
cycling I was doing. When I am on the
bike, my artery is pinched off a bit. At
the top of my pedal stroke it is nearly
completely pinched off by the inguinal ligament.
After a few years of riding and racing, probably
in the late ‘80’s, clotting began to form near
the obstructed area. Gradually, and in
spurts, the clot grew until it plugged the whole
artery. The infamous “leg lock”, as my
Mercury teammates named it a couple of years
ago, is a personal, cycling related
biomechanical problem that has been with me my
whole life. Although a most uncomfortable
and frustrating experience, I finally had an
explanation for “leg lock” and a cure.
Dr. Taylor and his team sent me home, on
anti-coagulant medication and a cycling ban, for
six weeks of recuperation before surgery to fix
my artery. They at least needed to clear
out some scar tissue surrounding the artery, and
eliminate the pinching and twisting of the
artery caused by the interaction between it, the
inguinal ligament, and stabilizing muscles.
The arteriolegram did show some damage inside of
the artery, after the clot was dissolved, so
they also thought that an artificial bypass
might be needed. On June 30, I checked
into OHSU hospital to be repaired.
My second hospital stay started off extremely
well. They did another arteriolegram to
assess the interior damage and found a clean,
smooth tube. The internal vascular damage
they suspected turned out to be just clotting
that had dissolved. No Gore-Tex tubes for
me! When they went in, they relieved the
pinching and twisting of my artery by making an
incision in my inguinal ligament, clearing out
some scar and connective tissue, and in general
making an obstruction-free path for my artery.
Believe it or not, I am one of the luckier
people to have this problem. Most people
require a bypass and/or have the problem on both
sides. Although rare, it is not
unheard of in cyclists. It is extremely
hard to diagnose before major clotting.
Most undiagnosed riders with the vascular
problem decide right away that cycling is just
too painful, and quit due to the symptoms.
Cycling can be painful at times, but let me tell
you, a good lactic acid burn is nothing compared
to the pain this problem brings when pushed.
What would most doctors say when you tell them
that you feel a building and extended,
excruciating, burning pain when you go hard on
the bike? They would probably say, “Why
don’t you just slow down” and not “Hmmm, I bet
you have an obstructed artery.”
There are several cases in European riders, and
in a growing number of Americans riders as well,
who have gone through the same ordeal as myself.
Ironically, while I warmed up for this year’s
Redlands time trial stage, an ex-teammate of
mine, Harm Jansen from Holland, suggested that
my decline in time trial performance may be due
to a vascular problem in my groin. The
possibility was familiar to him from Europe.
I’ll be back on the bike in August, and when I
get off the anti-coagulant, be able to start
racing locally a few weeks later in preparation
for next year. After all, I have some new
equipment to try out!
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