Wednesday, March 2, 2011

Serena Williams has pulmonary embolism and 'unexpected scare'

Serena Williams poses for a photo at an event in Los Angeles on Sept. 26, 2010. (Chris Pizzello / Associated Press)


By Diane Pucin and Eryn Brown, Los Angeles Times

Tennis star Serena Williams is recuperating at home after suffering an embolism and an additional 'unexpected scare' with a hematoma, according to a spokeswoman. Williams says, 'This has been extremely hard, scary, and disappointing.'

Serena Williams, who hasn't played a tennis tournament since winning her fourth Wimbledon title last July, underwent emergency medical treatment in Los Angeles this week, days after doctors discovered a blood clot in her lungs.

It was not immediately known what precipitated her condition, though by Wednesday afternoon it was confirmed by a spokeswoman that the 29-year-old superstar was recuperating at her home in L.A.

People magazine, the first to report the news, quoted that spokeswoman, Nicole Chabot, as saying that doctors last week discovered Williams was suffering from a pulmonary embolism.

Chabot also said Williams had been treated at Cedars-Sinai Hospital on Monday afternoon for "a hematoma suffered as a result of treatment for a more critical situation." A representative for Cedars-Sinai declined to comment, saying the hospital was not authorized to release any information.

Late Tuesday night, Williams posted a cryptic message on herTwitter account saying, "Tough day." Her tennis publicist Jill Smoller responded later, "This, too, shall pass." Smoller did not immediately respond to messages Wednesday morning seeking comment.

"Doctors are continuing to monitor her situation closely to avoid additional complications," Chabot told the magazine.

By midday Wednesday, however, it was confirmed that Williams had been released, with Chabot releasing this statement:

"Serena did indeed suffer from a pulmonary embolism last week, and the hematoma was another unexpected scare. Thankfully everything was caught in time. With continued doctor visits to monitor her situation, she is recuperating at home under strict medical supervision."

"Says Serena, 'Thank you everyone for all of your prayers, concerns, and support. This has been extremely hard, scary, and disappointing. I am doing better, I'm at home now and working with my doctors to keep everything under control. I know I will be ok, but am praying and hoping this will all be behind me soon. While I can't make any promises now on my return, I hope to be back by early summer. That said, my main goal is to make sure I get there safely.' "

Williams, who had been mostly seen wearing a walking boot since suffering a foot injury last summer after stepping on glass at a restaurant, was wearing high heels in photographs she posted on her Twitter page after attending Oscar parties on Sunday.

A pulmonary embolism is a blood clot, usually originating in a vein in the upper thigh, that breaks loose and travels to the lung. Classically, a person develops a pulmonary embolism when he or she has risk factors for the problem — including pregnancy, use of oral contraceptives, clotting problems and obesity — and remain sedentary for a period of time, allowing blood to stagnate in the leg and form a clot.

People who take long airplane trips and car rides are at risk for pulmonary embolism, as are people who suffer an injury that keeps their leg immobilized. Williams cut tendons in her right foot when she stepped on some broken glass in July. It is possible that clotting around the injury site contributed to the pulmonary embolism, said cardiologist Dr. Ralph Brindis, president of the American College of Cardiology.

Another possibility is that Williams' clot originated in her subclavian vein, which in muscular athletes can get compressed below the collarbone and first rib. But Brindis said he'd be "very surprised" if that were an issue in this case.

Typically, doctors treat pulmonary embolism by administering anticoagulant drugs such as Warfarin or Coumadin to prevent additional clotting. Williams may be on the medications for several months, doctors said.

In some cases, large emboli are also initially treated with clot-dissolving agents. Brindis said that such agents can cause bleeding in other parts of the body, which may be the explanation for treatment of a hematoma — an area of bleeding — mentioned in the statement by Williams' representative.

Dr. Mark Adelman, chief of vascular and endovascular surgery at NYU Langone Medical Center, said that Williams' lungs should heal completely. The length of time to heal the original clot, whether it was in her leg or in her arm, could vary depending on its size and other factors. Adelman estimated that for anywhere from six to 12 weeks her doctors would not want her to play tennis at all. After that, Williams might be able to play at a high level, but because the anticoagulants will put her at additional risk of bruises and bleeding, she'll want to avoid getting hit hard during play.

Last week, Williams had told the New York Post that she was aiming her comeback for the French Open in May. From the statement released Wednesday, though, it is clear she is now hoping to be ready for Wimbledon, which opens play June 20.

A Los Angeles native who has homes in Los Angeles and Florida, Williams won the French Open in 2002 and has earned 12 other Grand Slam titles over her career.

Pam Shriver, a former player and now a tennis commentator for ESPN, said that despite this latest setback, there is precedent for a player of Williams' age to make a successful comeback.

"If the desire is there, she's still young enough and talented enough," Shriver said. "You only have to look at some of the other comebacks from long injuries, layoffs, retirements. Look at the quality ofLindsay Davenport's comeback after she had a child in her early 30s, Kim Clijsters' comeback after her baby, Jennifer Capriati, Monica Seles after her stabbing. When you think about it, in recent history, there's been a lot of wonderful comebacks.

"I don't feel her age is the issue, but this is such a different situation, such an unusual set of circumstances. When you start talking about vital organs, I'm not a medical person, but this just seems like a horrible set of coincidences."

Mary Carillo, a tennis television commentator and former player, pointed to the strong play of Andre Agassi late in his career as an example that Williams can return to the top. "She can come back and dominate if she feels like it," Carillo said. "I happen to believe in her case as soon as she's able to focus and commit she could be back at the top."

Mary Joe Fernandez, the U.S. Federation Cup captain, called the reports "very scary." Fernandez said she had called and e-mailed Williams and Smoller but hadn't heard back. "You would think, from what I know, this will take awhile to recover from."