Tuesday, March 31, 2009

Vascular Center physicians keep marathoner in the race

Ana Gamboa Webelman
Many people might think running a marathon is an unattainable goal, but Ana Gamboa Webelman of Mexico City has accomplished this incredible feat 11 times. Running 26.2 miles is never easy, but the physical challenges Webelman has faced over the years have truly added to the trials and tribulations of her journey.

Webelman has suffered four venous thromboembolic events, or deep vein blood clots, during her lifetime. The clots threatened to end her days as a runner until Robert Schainfeld, DO, and Stephan Wicky, MD, physicians at the Massachusetts General Hospital Vascular Center, were able to diagnose and treat the underlying cause of the clots - May-Thurner syndrome.

May-Thurner syndrome happens when the left-side pelvic vein is compressed by a right-side pelvic artery against the lumbar vertebrae, which inhibits blood flow. At the site of the compression, a blood clot can form and potentially cause a pulmonary embolism, which occurs when the clot dislodges from its original site and travels to the arterial blood supply of the lungs causing difficulty breathing, chest pain and sometimes sudden death.

Schainfeld says that by the time Webelman came to Mass General for treatment for her fourth blood clot, "her artery had been pounding her vein against her lumbar vertebrae like a jackhammer for 44 years."

Webelman in the race

It was only after Webelman’s doctor in Mexico City found her second venous thrombosis that she took up running. Her doctor told her that exercise could possibly prevent further problems, and Webelman wanted to do everything prevent another thrombus from forming. However, she quickly discovered that she loved to run.

"I got completely hooked and addicted to it," she says.

Over the next 16 years Webelman ran 10 marathons until doctors discovered a third pulmonary embolism. Before this, doctors considered external factors to be the cause of Webelman’s blood clots. The first was thought to be provoked by childbirth and the second by a hysterectomy. But there was no apparent cause for the third clot.

"It came out of nowhere," says Webelman. "There was absolutely no logical reason for me to have it. I have never smoked. I eat very healthy, have a healthy weight and exercise every day. This couldn’t be happening to me."

Webelman was treated with blood thinning medications and after a year she felt better, except for slight discomfort in her pelvic region. Despite the pain, she managed to run her 11th marathon in June 2007. Three months later, the “slight discomfort” turned up as a fourth deep venous thrombosis.

After many tests, Webelman’s doctors in Mexico found hereditary defects in her body’s blood clotting process, which lead them to diagnose her with a genetic condition called thrombophilia. Doctors told her that there was nothing they could do, and she would have to take blood thinners for the rest of her life.

"They told me I was getting worse, and getting worse very fast," she says.

Getting back on track

After the fourth thrombosis, it was uncomfortable for Webelman to walk or stand for an extended period of time, and she was told she’d have to stop running.

"It was very sad for me," she says. "I didn’t feel like myself at all."

Luckily, Webelman’s friend, Stephanie Blumenthal, told her about her son’s elbow surgery at Massachusetts General Hospital. Blumenthal suggested that her friend fly to Boston to get another opinion. Relectant at first, Webelman didn’t want to travel such a long way only to be disappointed. But Blumenthal insisted, and Webelman finally spoke to Kathleen Carroll, NP, of the Mass General Vascular Center to make an appointment with Dr. Schainfeld.

Upon meeting Dr. Schainfeld, Webelman says she knew things were going to be different.

"He was so kind and considerate and even spoke a few words of Spanish," she says. "He listened carefully and patiently to all I had to say, and then looked at my [CAT scans]. When he told me there was something that could be done, I almost fell off my chair."

Schainfeld referred her to Dr. Wicky, who treated the May-Thurner syndrome. Dr. Wicky implanted two stents in Webleman’s left common iliac vein to open up the narrowing and relieve the obstruction. She would still need blood thinning medications, but doctors were hopeful the procedure would be successful enough that she could return to an active lifestyle.

A month after the procedure, Wicky gave Webelman the okay to start exercising again. Now Webelman is back in Mexico City, feeling strong, energetic and happy.

"Dr. Schainfeld and Dr. Wicky gave me my life back," says Webelman. "I will never forget that. I only met them three months ago, and yet they treated me like they knew me for a long time. I will never stop thanking them. They are truly great doctors and human beings."

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