Todd Robertson: [00:00:00] When we look at athleticism and the rigorous physical fortitude of competitive athletes, we often see incredible strength and near invincibility.
Sage Canaday: I try to go out at my slow pace, and after about 20 or 30 seconds, I'd be breathing so hard and my heart rate would be so high, I'd have to do stop and just walk.
Todd Robertson: Even for the strongest among us, a clotting event can be the difference between a bright future and a life cut short.
Sage Canaday: I thought it was pneumonia still, because that's what they told me, but then I noticed that I was actually coughing up blood, which was quite scary.
Leslie Lake: Every six minutes, somebody in America dies of a blood clot.
Todd Robertson: We're here to change that statistic. Welcome to Taking a Breath, a Stop the Clot podcast.
Leslie Lake: An award winning podcast dedicated to bringing [00:01:00] awareness of the dangers of blood clots from the clotting disorders community to the world.
Todd Robertson: With the help of many notable blood clot survivors, we are here to give you the knowledge and the skills that you need to prevent this silent killer.
Leslie Lake: My name is Leslie Lake. I am the president of the National Blood Clot Alliance, and I am a blood clot survivor.
Todd Robertson: And my name is Todd Robertson. I'm the patient engagement liaison for the National Blood Clot Alliance, and I am a seven time blood clot survivor.
Leslie Lake: And we're here to stop the clot.
The life of a professional athlete is unlike any other. To be so in tune and aware of your body at all times, recognizing when to push forward, When to pull back and how to trust your intuition when things feel wrong. Our guest today is somebody who has experienced firsthand the indiscriminate nature of blood clots, even for those in professional physical [00:02:00] health.
Please join me in welcoming professional distance runner, running coach, and role model for runners the world over. This is Sage Canaday.
Sage Canaday: Hi there, my name is Sage Canaday, and I'm a professional distance runner and running coach. I'm 39 years old and I live in Colorado. So it was the spring of 2021. I was running like I usually do, training pretty much every day.
I run quite a bit for my profession and to train for these marathons and ultra distance marathon trail races mainly but also road marathons and so it was April and I had some slight back pain actually is the first symptom I noticed like lower back I didn't know if it was like around my kidneys I'm not a medical expert so I just kind of wrote it off as back pain spasms that sometimes you get if you wake up on the wrong side of the bed or you don't sleep right or Yeah, yeah.
Maybe it was from running. Sometimes if you do a hard hill [00:03:00] workout, or you run too far too fast, you get some aches and pains. So I kind of shook it off as just being normal back pain type of fatigue. Although usually my lower back doesn't hurt like that, but I had back pain for a couple days, and then What I really noticed was that my breathing was a bit labored all of a sudden, like, I have asthma and allergies and I've had breathing issues, mild breathing issues, but this was pretty severe.
Uh, I was really struggling to catch my breath for a couple days and then the pain in my back kind of wrapped around my ribcage. And it got a bit sharper and it got so bad that after about three days of this, I had trouble lying down to sleep at night. I would be in so much pain. I felt like a back spasm, but it had wrapped around my rib cage.
It started on one side and then it went over to the other side, the other right lung to left lung kind of, but. I always had this back pain, this chest pain, difficulty breathing. I felt, uh, quite light headed. We lived in an apartment complex, so I had [00:04:00] to walk up three flights of stairs. There wasn't an elevator, and I'd really struggle to walk up flights of stairs, especially if I was carrying groceries.
And I live at Colorado at altitude, but I'm a fit athlete. I do distance running as a profession, so to get out of breath walking up a flight of stairs, uh, was quite alarming, but I just shook it off and didn't go in right away. I was worried about paying a emergency room bill, so I kind of hesitated. That was a tough lesson.
I would say it was about five days when I first started showing these light headed symptoms, trouble breathing, a lot of pain, and I kind of just did a general consultation with the doctor's assistant. They put me in, they took my temperature, they tested me for COVID, they did an x ray on my lungs. And that was the first thing they looked at.
And they determined from the x ray that they thought I had pneumonia at the time. So they put me on antibiotics, uh, a cycle of [00:05:00] antibiotics for either 10 or 12 days. And then I had another x ray, but my symptoms didn't go away. So I think it was probably a misdiagnosis of pneumonia. They could see something was going on in my lungs that was wrong, but.
Just with the limited image quality of the x ray, they weren't able to diagnose it yet as a pulmonary embolism. Which I think it was, but I was suffering for another several weeks after that and the antibiotics just didn't kick in or do anything. I didn't even know what a pulmonary embolism was. I think I'd learned about it in health class, but I didn't think.
Being as active as I am, being at 35 at the time, Blood clot wasn't on my radar at all. I didn't have any symptoms of leg pain or like a DVT. And I hadn't been on any long plane flights or had surgery or had a major bone breaker injury. So the risk factors, it seemed like were really low for it to be something like that.
So I kept going on. They x rayed my lungs again and they thought it had cleared up, but it hadn't. And so then I'm [00:06:00] trying to do work. I'm trying to run up mountains and I absolutely cannot run. I couldn't even run on a flat sidewalk for a block, and I'm a professional runner, so I'd try to go out at my slow pace, and after about 20 or 30 seconds, I'd be breathing so hard and my heart rate would be so high, I'd have to do, stop and just walk, which as a professional runner, that's generally not what you want to be doing.
Running's hard, but it was exponentially harder, and I even started coughing up blood around that time, so I'd be like, trying to go up a mountain really hard, I'd be breathing, and I'd start coughing, like, I thought it was pneumonia still, because that's what they told me. But then I noticed that I was actually coughing up blood, which was quite scary.
So over the weeks, it just got worse with me trying to force myself to get back into running, but not being able to run. And as a professional athlete, you know, your body really well, you kind of have this like extra sense when something's off, you could get a cold or you could get pneumonia even. And be pretty sick.
I mean, that [00:07:00] could be very serious. Pneumonia, you could even be coughing up blood, potentially. But, I thought I would be able to bounce back faster. And it had been, at that point, it had been about four or five weeks since my initial back pain. And I was going out, I remember it very distinctly, I was going out for a run in Boulder.
On a bike path near my apartment and I absolutely couldn't run for more than a minute at a time. So I was doing a walk run combination, which we recommend for a lot of beginner runners, but I just couldn't get back to my apartment running. So I started walking and I was a couple blocks away and the chest, I felt this tremendous pressure on my chest.
And I was just thinking like, I, it feels like I'm going to have a heart attack because there was just all this pain across my chest and my breathing was so labored. And that evening I was laying down in bed and I was in a ton of pain and I think early the next morning I just woke up in the middle of the night and I told my girlfriend that she had to drive me to the emergency room.
I knew I couldn't make it through the day because the pain was so intense. It was a [00:08:00] holiday weekend. It was May. It was over the weekend. So the ER actually wasn't crowded though so that was a good sign and I walked right up to the desk. It was pretty early in the morning and they got me in really fast.
Got me into my private room. My girlfriend was there to support me. They initially, they did a blood test. I didn't know it was a D dimer test, but they, one of the tests they, they did was a D dimer. They did a complete blood cell count, I assume, too. They hooked me up to an IV to get a saline solution in case I was dehydrated.
I think that might be pretty standard procedure no matter what you have, but they want to make sure you're not dehydrated either. So I was on an IV drip, which is useful because later they would use that to administer medicine. They hooked me up to a, uh, Portable EKG. They were checking my pulse, they were checking my heart with the EKG.
And then the real distinctive test that caught it and diagnosed it correctly was they did a CT scan with contrast. So, if you haven't had a CT scan, it's kind of like an MRI machine, but it's also more like a bunch of x rays all at once. [00:09:00] So it's a more clear picture. of what's going on, and they did it with the contrast IVs.
So they used the IV port in my arm to inject this dye. At the same time, they take the pictures on the CT scan. And after those results came in, I actually didn't know what those results had come in yet, but I was actually going off to the bathroom in the hallway with my little IV port. And I heard a nurse say, you need to stop him.
We need to get him hooked up to the EKG right now. because it's serious. And so I was a little tipped off by that, but they quickly came in. They wanted to monitor my heart, uh, make sure everything was stable. And then they told me that I had not only just a pulmonary embolism, but a bilateral pulmonary embolism.
So it had gone into both lungs, both sides. And quite a few segments in the lungs, so it was, uh, kind of a medium sized type of, uh, pulmonary embolism with all the clots. They were pretty calm about it, because I wasn't in, like, severe pain at that time, and once they had the EKG on, and they could monitor my [00:10:00] heart and my blood pressure I'd been living with it for five weeks, probably, so it was kind of a sense of relief, actually, that, you know, I didn't have pneumonia, but then I had this life threatening, serious thing, pulmonary embolism.
And they quickly injected some sort of blood thinner right there on the spot, and they said, well, that'll kick in pretty fast. So that was kind of a relief, but the doctors were really nice. Several came in and started explaining the next steps. They wanted to monitor me overnight. in a hospital, but since I was in a certain ER ward, I was going to have to move to a different facility and there was kind of a big debate whether or not I should take an ambulance or I could have my girlfriend drive me.
Between the insurance costs and the liability there, I kind of wanted to go home and get a change of clothes and a book or something for the hospital stay, so they said I was stable enough that I could do that. You know, it was a quick drive to the hospital and definitely they wanted to make sure I was stable overnight.
So I was pretty fortunate that overnight [00:11:00] stay in the hospital is my first time staying overnight in a hospital, but it was uneventful, which is always good. So, you know, I, I, everyone was really nice. I was hooked up on a EKG. type of apparatus overnight with a little BP machine. And, you know, it's kind of scary cause they ask for like your will and your disclosures if, if anything happens and being in a hospital overnight, it's, they keep waking you up in the middle of the night to check your blood pressure and stuff like that.
So, you know, it's, it's not the easiest experience, but they were injecting me with a blood thinner. And then they taught me how to inject myself with a blood thinner and I had to take home this initial blood thinner, uh, solution, I guess, to give myself injections for, I think it was like five days. Don't quote me on that.
I'm not a medical professional, but then I switched to, uh, I was prescribed an oral blood thinner pill that then I would take for months after, but it was a relief because I knew the medicine. They said it was probably going to kick in pretty fast. I wouldn't say I [00:12:00] felt like I could breathe better right away.
That's kind of a longer process, but just the idea that the medicine's starting to break those clots down or your body's starting to break the clots down because of the blood thinner medicine. Everyone kind of responds differently to that, but. It seemed like things started getting that, you know, the pain started going away once I got home after several days.
And then after a week or two, it definitely felt like there was, my chest was getting lighter and it wasn't so hard to breathe. So the pain does go away pretty quick. I was responding well to the blood thinner medication and that's pretty much all I was on switching between those injections to the oral pills.
We were actually doing a film where it was about my return to competitive running, and I mainly do, now I do a lot of ultramarathons, which are over 26 miles in distance, and I do them on trails and mountains. So I had actually traveled out to Hawaii to do this sea to sky fastest known time trail, which you run from the ocean up to [00:13:00] the top of Maui, which is uh, Haleakala.
And it's over 10, 000 feet of climbing on a really gnarly trail, like it's a really obscure hiking trail. And then I ran back down, so you get all the volcano terrain, you get pretty hot and humid conditions, and I was able to set the record on that. I remember my friend was filming it for the film, and uh, we were pretty excited about that, because here I'd done this 30 mile run up and down Maui, up from the ocean to the top and back down again, and I, uh, survived in the heat and humidity, so that was a real positive moment for sure.
Todd Robertson: When it comes to physical health, There tends to be an assumption that, for blood clots, those in peak physical condition are out of harm's way. Though physical activity and health can help prevent the likelihood of a clotting event for some, it is not an all encompassing safety net. Here to discuss physical health and its relation to the likelihood of a clotting event, [00:14:00] this is Dr.
Caroline Cromwell from Mount Sinai Hospital in New York City.
Caroline Cromwell: That really seems to be just a surprising group of people, right? The last people you would think of are the ones who can outrun us, outrace us, who have all the muscles in the world. But at the same time, some of that is what puts a pretty small amount, small group of them, but a small amount at risk.
And we always have to think about it and hopefully they think about it and their trainers and people around them think about it. And even for the less It's not professional athlete, but people who are very athletic. And so some of the things that we think about that do put them in higher risk categories is travel, right?
So professional athletes may be traveling a lot, on the plane a lot, which is a risk factor for anybody. Your genetics, while we do a lot to try to protect ourselves from our genetics, we cannot protect ourselves fully. Athletes can get very dehydrated with all their training and all of their workouts, so that's something else that can contribute to the development of a blood clot.[00:15:00]
So a lot of times it's a perfect storm of things. Injuries to the body and surgeries as well, especially a lot of it can be kind of orthopedic surgeries, which are particularly known to put us at risk of having blood clots. And another counterproductive thing, right, is these are young, fit people. What we tend to do is, oh, you know, that's a little strange.
That's a little, you know, I overdid it. My calves hurt. You know, I feel a little this or that just from all of overworking their body all of the time. Um, when in reality, that might be the beginning of a blood clot. You know, I do just have to have a self think about how hard it is when these events do happen to everyone, but especially professional athletes where their entire identity is.
and then being told, you know, you might not be able to do it or having this surprise event happen and you have to take blood thinners. It can be just very sort of devastating or some being told this is career ending for them. You know, that's a big, that's a [00:16:00] big part of it too. Thinking about how that just affects your entire life.
Leslie Lake: I'm also bilateral. They don't know why I actually did get a blood clot. And I think for me, that was. The hardest thing for me to process because I'm an analyst research person by training. And so, you know, and I'm a math person. And so for me, one plus one is two and not three or four. And I really struggled with that initially because I wanted an answer.
Why did this happen to me? I know the recurrence rate. You know, it's not insignificant. How do I prevent another one from happening? So are you also unprovoked or did they give you a reason as to why they think it happened?
Sage Canaday: Mine is also unprovoked. Yeah. And I could relate to that being frustrated because you want clear cut answers and there's a lot of ambiguity.
So I could relate to that totally.
Leslie Lake: That's why I'm like, I'm six years out now. I definitely [00:17:00] did not have, at least for two years, I would say the same level of confidence that you have. I think I'm there now, but it took me a much longer time to, to get there. And it's just interesting to see the, or hear the variability from person to person in terms of their response to this.
Do you ever think about the fact that you're unprovoked and what that means?
Sage Canaday: Yeah, well, it led to me getting a lot of testing done over the last several years since we're coming up on actually four years in April, uh, or May of this year. It'll be four years since my P. E., but yeah, I got, you know, a lot of blood panels done.
I don't have a family history. Like I said, I didn't travel on a long airplane flight or have, I didn't even have evidence of a DVT. They did a lot of ultrasounds on my legs initially too. And I never had like any of that leg pain. I'm not sure if you had a DVT first or Okay.
Leslie Lake: I didn't have, cause they were like, when I finally got diagnosed, they were like, did you have, do you have leg pain?
And I was like, I [00:18:00] don't have any leg pain.
Sage Canaday: Yeah. Wow. Cause I know some people, it comes up as a DVT. Right. So they get that first and then it turns into a PE. But yeah, other people don't show
Leslie Lake: that we're both unprovoked and neither one of us had the dbt that we know of related to it. Well, you're at a higher elevation, so dehydration can play a role also.
But I'm assuming as a professional athlete, you stay well hydrated. I hadn't flown either. Um, I hadn't been on a long flight or anything like that. So it's interesting to listen to you. Even when you were talking about this CT scan with contrast, you took me back cause I had the same thing. And it's a very warm, weird feeling when you have that contrast go through your body.
It's a little bit on the creepy side. And this is a, I guess maybe a shout out to the relationship with your sponsor. We have a lot of professional athletes who don't want to talk about what happened to them, which I understand. But in your case, your sponsor is just way more cool, I think, than some of the other ones out there.
So, were they concerned? [00:19:00] Did they talk to you about, Hey, we want to see how we can help you physically or mentally or? Cause I think it's a, you have a great relationship with them.
Sage Canaday: Yeah, I've been really lucky. Uh, so title sponsor Hoka for their running shoes, but I also had other sponsors at the time. As a professional athlete, you're kind of under contract to perform and there's usually.
Some sort of clause where if you get injured or have a medical problem, theoretically, sometimes they could cut your pay or drop you if you don't perform for whatever reason. I was really nervous about that, but at the same time, I knew I had to be open and honest about it because I'm just open and honest with everything.
So they actually helped support a film that one of my best friends made that's online on YouTube. It's called starting over. And a lot of the sponsors helped chip in to support the making of that film. It's kind of. Shares my story. It's more about running after the fact, but yeah, I've been really lucky.
The other concern too is as you get older as a professional athlete and running, I'm getting close to 40 now, which isn't really old, but as a [00:20:00] fast runner, it's kind of on the older side, maybe for professional track runners, at least. That's also been a concern. So you could just You know, you're not always going to be competing against your times that you set when you're 25 or 20 in your late 20s, when you start to get in your late 30s or 40s, always as a pro athlete.
So that's been a hard transition to, but I'm, uh, Still happy to be here.
Leslie Lake: The most important thing. I watched the movie. It was really beautifully done.
Sage Canaday: Oh, thank you.
Leslie Lake: And you had a lot of heartache in that as well. Uh, not just with the P. E., but I think there was a fire where you folks lived. And I mean, what a tumultuous time.
And here you are setting records, running up and down mountains. So that's pretty cool, Sage.
Sage Canaday: Oh, well, thank you. Yeah, it was, uh, it was a tough year because it was the same year of my P. E. Had a house fire, so we lost all our material possessions right after. But yeah, that's more of the challenges that happen in life, so.
Leslie Lake: Has it changed the way, I mean, I know [00:21:00] you're a much sought after coach. Has it changed the way you train people, having had this happen to you? Or do you talk to clients, other runners about blood clots and making sure they stay hydrated or if they take long flights?
Sage Canaday: Oh, definitely. Yeah, I know it's a, it's a number one concern on my mind because before I wouldn't know the symptoms or the risks and you know, there's a lot of health issues that you could get from overuse injuries running or just being sore, but it's always something that's.
lingering in the back of my mind now as a safety precaution, um, to make sure that, you know, it, people could recognize the signs. And it's also given me more compassion though, as a coach, just with everything probably in life. Like I realize how traumatic a medical emergency or this type of thing could be for someone if they're hospitalized for, you know, it could be severe pneumonia, but.
a blood clot or a pulmonary embolism or any life threatening condition. I feel like it kind of [00:22:00] shifted my whole perspective, not only in running and coaching, but in, in life in general. And just, you know, realizing that people are going through different struggles and they still are, you kind of have some element of like, uh, PTSD after some of these things, like I'll wake up with a nightmare where I feel like there's something heavy on my chest and I can't breathe very well because you're always worried about that, that breathing.
Leslie Lake: I know exactly what you mean. Every now and then I'll get a muscle cramp on my leg and I think, Oh my God, I'm getting another one. And then I have to talk myself out of it. Nope. You're okay. You've done this. You've done that. For me. You're I'm still on my DOAC, the anticoagulant, because I am unprovoked.
They don't want me to come off of it. And I would dearly love to be off of it because it does impact things that you can do if you're on it. I just want to ask you a question. How do you get up those mountains on those skis? And ski down those little narrow, I watch your videos and I'm like, Oh my God, this is so cool.
Sage Canaday: Yeah. Uh, it's tedious. [00:23:00] I, I'm a, I didn't start skiing till about four years ago, actually. So I've been in Colorado for over 12 years and hadn't skied. So it's been a learning process, but I love to Alpine tour, which means you could go uphill. And I usually do it at the resort, but I've done it on some of our 14, 000 foot.
Mountains out here in the back country. Um, I took an avalanche class last year and, uh, yeah, it's just really fun to, to be able to propel yourself uphill, take the skins off and then ski down like a regular Alpine skier kind of, or back country skiing. So it's been a good break from the running and I still run a lot too, but it's, it's good exercise.
Leslie Lake: It's beautiful to watch. You know, as I think about, we have the Sports and Wellness Institute because we have so many people that don't know how to come back to exercise after they've had a blood clot and clinicians really don't talk to them about how to do that. Myself included. And so seeing you out there, you know, doing your thing is really, it's a motivator for people to get back into it.[00:24:00]
At some point in time, you need to start an NBCA running club for all the Survivors out there that want to start running again and say, Hey, you can do this, guys. You can do this. Here's how we're going to do it is there's tens of thousands of us that are out there. I just want to say, Sage, thank you for joining us here today.
Your story is so incredible. Also as a Unprovoked bilateral P. E. survivor, I feel a kind of a kinship with you and I'm thrilled you're okay and your story is so motivating and inspirational and will save a lot of lives and we look forward to hopefully maintaining a strong partnership with you
Sage Canaday: to raise awareness.
Oh sounds great. Thank you so much for having me on. Really appreciate all the support and yeah, keep up the great work.
Leslie Lake: We want to thank Sage one more time for sharing his experience with us today. A special thank you to the exquisite Dr. Caroline Cromwell for her insight and [00:25:00] expertise. Thank you for joining us on another episode of Taking a Breath. For more information on risk, prevention, and community, please visit stoptheclot.org
org.
Todd Robertson: We know the patient because we are the patient. Together, with listeners like you, we can collectively stop the clot.
Don Shafer: For more information, visit stoptheclot.org.
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