Will comeback be worth physical risk?

Serena Williams has had her share of good fortune, but the past eight months have been particularly brutal to her.

Wednesday, her representatives announced that the 13-time Grand Slam champion had suffered a pulmonary embolism (a blood clot in the lungs) and undergone emergency treatment Monday in Los Angeles for a hematoma she suffered as a result.

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A look at two other athletes who had similar episodes and were put on blood thinners, Colorado Avalanche forward Tomas Fleischmann and NASCAR driver Brian Vickers, indicates that Williams likely will be out six more months, potentially ending a 2011 season that never began.

Fleischmann suffered from a pulmonary embolism in January, and the Avalanche announced he would miss will miss the remainder of the 2010-11 season, which in hockey terms means at least six months.

Vickers had an issue similar to that of Williams, although his appears to have been more severe, and the driver was out eight months.

Given that Williams, who has been out since Wimbledon because of a foot injury and just had a walking boot removed from her leg, has yet to resume training, she will be unable to return at the French Open and is long shot for Wimbledon.

At maximum, she might be out another year. Under that dreaded scenario, if she returns to the court next March, she’ll be 30 and would not have played for a year and eight months.

But in a statement released through her representatives on Wednesday, Williams seemed to have higher hopes — either that or she’s just dreaming.

“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.”

An early summer comeback appears highly improbable. ESPN analyst Dr. Michael Kaplan said Williams could be out as long as a year. Williams will be put on blood thinners to reduce the clotting and should she fall on her head while on court, Kaplan said it could be “catastrophic.”

A recent study by Dr. Karen Valentine and Russell Hull, based on the only clinical trial ever performed with patients with pulmonary embolisms, suggested that patients do a minimum of three months of therapy with an anticoagulant (any agent used to prevent the formation of blood clots).

Other athletes have played while on blood thinners, such as hockey forward Jed Ortmeyer, who has a disorder that forces him to take them daily. But as Dr. Nicholas J. Morrissey told The New York Times in a 2009 article, Ortmeyer, who's currently with the Minnesota Wild’s AHL affiliate, is playing with fire. Getting cut or bruised, let alone suffering a head injury while on blood thinners, is a big no-no.

“His risk of having something happen is real,” Morrissey told the Times. “Because things that to you and I that are not a bother can be bothersome to someone who is on blood thinners.”

Return game

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Almost every piece of medical advice given on blood thinners cautions about playing contact sports. While tennis is not one, players do fall down, and Williams is among those who have taken tumbles. It’s her decision as to whether she wants to take that kind of a risk, but one would think that at least her mother, Oracene Price, who is very protective of her daughters, will tell her to back off until the risk is minimal. But Venus ignored her mother’s advice to not play the Australian Open in January while she was still a bit hurt and out of shape, and it’s possible that Serena will, too.

Given that neither Williams' doctors nor her handlers will release specific information about the size of her clot, it’s hard to say just how long it will be before she returns.

Williams has been one of the toughest players the sport has seen, both mentally and physically. She has come back to triumph before. But here’s a dose of cold and sad reality: She's never faced a life-threatening episode like this, or the extended recovery from  surgery she had after she cut up her left foot last July at a Munich restaurant. And she's never been off the court for so long. 

Players such as Kim Clijsters were able to come back and be successful after such long periods, but Clijsters' return was at age 26 and not after such a serious struggle with her health.

Frankly, Williams' chances of returning as a dominant player are somewhere between slim and none. While she cannot be counted out of winning a couple more majors, her hopes of winning a calendar-year Grand Slam are all but extinguished.

While we have to take Williams at her word that she does want to play, she may have to restate her goals. Last year, after she won Wimbledon again, I wrote that if she stayed healthy, she was playing well enough to win five more majors and tie Chris Evert and Martina Navratilova with 18 Slams. When I told her that and asked whether she still would say it was impossible like she said a few years back, she said no, she thought it was a possibility.

It really isn’t anymore, because she’s missed the past two majors and likely will miss another two.

She does have more realistic goals left: winning the calendar year Grand Slam in doubles with Venus (that would be a lot less taxing on her body) and a singles gold medal at the 2012 Olympics in London, where if she manages to win, she could happily end her career. That situation could get complicated as she definitely will miss the United States’ Fed Cup tie in April in Germany, and players must participate or show up at Fed Cup in order to receive Olympic eligibility. So, Williams will have to appeal to the Olympic Committee to be sanctioned to play.

So here’s her million-dollar dilemma: Williams has earned enough money and plenty of fame off the court (she’s become a top seller and a darling of the Home Shopping Network), and she could live comfortably without ever hitting another ball. Will she really want to put herself through the ringer again to get back on court when she doesn’t have to? Will she be willing to take the physical risks and the depressing losses that are sure to come in order to achieve victories again?

Only time will tell, because it won’t become clear until after Williams puts herself through the ringer again and sees if the rewards match the effort. My feeling is that she’ll give it a go, but I cannot imagine her playing much, if at all, past 2012. She’s established a nice life for herself outside tennis, and she already has one (injured) foot out the door.