Blood, Sweat, and Tears

That’s tears, as in a torn ACL, which along with two life-threatening blood disorders still couldn’t keep Kristin Koetsier off the court.

By Guillermo Metz

Guillermo Metz is an Associate Editor at Training & Conditioning.

Training & Conditioning, 12.9, December 2002,

After a remarkable high school basketball career, Kristin Koetsier could have gone to about any school she wanted. Powerhouse programs such as Connecticut and Stanford were among those recruiting Koetsier, who was named 1999 Michigan Miss Basketball following her senior season.

Despite the attention from both coasts, Koetsier decided to stay near her family and attend Western Michigan University, an hour’s drive from her home in Grandview, Mich. But before she even started practicing with the Broncos, her life changed drastically. With no warning or apparent cause, she developed a rare blood disorder called idiopathic thrombocytopenic purpura (ITP).

“On July 4, 1999, I came down with really bad stomach pains,” Koetsier recalls. “I laid in bed for about a week, and it wasn’t going away, so my mom took me to the hospital. My blood counts were low, and they rushed me to the emergency room.

“I stayed in the emergency room for another three days and met with a hematologist. About a week later I met with the surgeon. About a week after that I had surgery to remove my spleen, and I recovered pretty quickly. It all happened so fast that I didn’t really have time to think about it. In fact, that was the easiest one to get through.”

Easy isn’t a word often associated with a serious blood disorder that requires removal of an organ, but Koetsier had two more major medical hurdles to overcome to get to where she is today, and they were even more stressful that the ITP. Koetsier suffered an ACL tear the following year and developed an even more rare and serious blood disorder, thrombotic thrombocytopenic purpura (TTP) after that.

Yet in 2001-02, Koetsier started 30 games for Western Michigan and led the team in scoring. And this fall, she was voted to the 2002-03 Preseason All-Mid-American Conference West Division team.

For her hard-won fight to overcome two debilitating, life-threatening diseases and come back from a torn ACL, Kristin Koetsier is the recipient of the 2002 College Female Comeback Athlete Award from Training & Conditioning. Also honored are members of her comeback team: Leah Jo Bundt, MS, ATC, and Mike Lahaie, MA, ATC, CSCS, Assistant Athletic Trainers at Western Michigan University; Ron Stewart, Head Women’s Basketball Coach at Western Michigan; K. Donald Shelbourne, MD, orthopedic surgeon with Methodist Sports Medicine Center in Indianapolis; and Michael Zakem, DO, hematologist with the Cancer and Hematology Centers of Western Michigan in Grand Rapids.

ITP is a blood condition where the spleen inexplicably starts attacking the patient’s platelets. In adults, the spleen makes some of the body’s blood cells, stores and discharges blood cells into circulation, and filters blood. For an unknown reason, Koetsier’s spleen was destroying healthy blood cells. After she had her spleen removed, her blood count slowly recovered, though she was severely anemic for months afterward and had to have her blood checked monthly.

“With the ITP, there really wasn’t any rehab involved, just letting my body heal,” says Koetsier. “When I got to school, I had six incisions in my stomach, so the athletic trainers and coaches at Western were hesitant to just let me go out and start practicing.”

“There were some guidelines we needed to be aware of,” says Lahaie. “For example, if she developed a fever over a certain temperature it was considered to be a medical emergency. Her physician dictated those to us. I also talked to our team physician here to learn about the condition and what to expect.

Koetsier had a remarkable freshman season, despite starting out extremely anemic and a bit out of shape from her ordeal over the summer. She was a freshman All-American, took home Mid-American Conference Freshman of the Year honors, set school and conference freshman scoring records, and helped the Broncos win the MAC West Division title.

That summer, she went home, looking forward to some hard-earned time off, but July turned out to be a bad month for her again. “July ninth,” she recalls. “I decided to go out and play a pickup game with some buddies of mine. I was doing an up-and-under move, which I’ve done five hundred billion times, and my knee just went. That was really hard to deal with.”

After finding out she’d torn her ACL, Koetsier and her family did some research, looking for just the right surgeon. “I had my surgery in Indianapolis, with Dr. Shelbourne,” she says. “His method for a quicker recovery is to take the patellar tendon from the opposite leg, so you’re not putting all your work in on just the one leg, trying to rehab the tendon and the ACL at once.”

She was hoping this would give her the chance to be back on the court by fall. “I had surgery at the end of July,” Koetsier says, “and I was working out right away. After about a month I was jogging a little—I was able to do cuts and stuff.”

By the time preseason practice started, her recovery was going well, but it wasn’t complete. “They told me to sit out some sprints because my knee was going to get swollen,” she says. “That was really frustrating because I didn’t want to be held back like that, even though I had to be.”

When the season got underway, she found herself under a microscope. “It was difficult because the mental aspect of an ACL injury is not what I expected,” she says. “I thought I could just go out there and play again, but obviously, other people saw that I wasn’t the same person.

“The press and everyone kept asking me how I was doing and how my knee was and if I was scared that I was going to hurt it again,” she continues. “All the hype around my injury just brought me down. I was thinking about my knee the whole time I was on the court.”

She played four games that season before making the tough decision to redshirt her sophomore year. “That was really hard,” Koetsier says. “The big thing was I didn’t want to let people down. But I realized that the best thing, for me, was to sit out. If I played, I didn’t want the coach frustrated, wondering why I wasn’t playing as well as I used to play. If I missed a layup I wanted him to be able to ask me why I missed it, not say, ‘I know your knee hurts ...’”

Even though it was extremely difficult for her to sit out that season, Koetsier feels, in the long run, it was the right decision. “I’m glad that I took the time and didn’t rush things,” she says. “That helped me out a lot. I was able to really develop my leg muscles back. Unfortunately, all that went away when I got the TTP.”

TTP, like ITP, is a blood disorder in which the body attacks its own platelets. TTP, however, is characterized by the formation of blood clots and obstruction of the small blood vessels of the brain. And the usual cure, a splenectomy, wasn’t available to Koetsier.

“The TTP was the scariest,” recalls Koetsier. “For a couple of weeks during the end of school, I was tired all the time, sleeping as much as I could. The weekend after school ended, I was weed-whacking with my father and a rock came up and hit me, and the bruise spread all the way down my arm. My eyes turned yellow. My folks freaked out and rushed me to the emergency room, and I ended up staying there for two weeks.

“They tried some different things, like steroids, which helped a little bit but didn’t fix it,” she continues. “It took them a while to figure out it was TTP. Then they tried plasmapheresis. I had a catheter in my chest and they took my blood out through one tube and it went into a machine that cleaned it and put in the donor plasma. The whole process takes about four hours. I don’t even know how many treatments I had.”

After two weeks, she was well enough to go home, but she still had the catheter in her chest, and she had to return to the hospital every morning to get blood treatments. She was also given a dose of vincristine, a chemotherapy drug, which helped keep her platelets stable, but made her fingertips numb and her hair fall out. Around the beginning of August, she was stable enough to have the catheter removed and discontinue the pheresis.

She was free of the TTP, but not exactly at the peak of health. “I was feeling very burned out,” she says. “I was very anemic and taking double doses of iron because I was so tired all the time. It was pretty hard to start off the school year like that.”

She had fully rehabbed her knee before coming down with TTP, but was coming off several months of inactivity. “Working out and training had always come easy to me,” Koetsier says, “so when I was last during sprints or any kind of conditioning, I wasn’t used to that. My confidence level dropped a ton.

“There were times, especially with the TTP, when I thought that I was never going to be able to play again. For the first two months, I was determined that I was going to play again, but that third month was probably the hardest. Then I started getting better.”

And she never looked back. She knew it would just be a matter of time before she was able to contribute to the team again. At the same time, the athletic trainers at Western Michigan had to keep a fairly close eye on her. “Her blood disorder affected her platelets, so if she did get overtaxed, that would affect her levels,” says Bundt, who took over with the women’s basketball team that year. “Periodically, we would do blood counts, to make sure her levels stayed within the normal range.

“The thing that was kind of frustrating for both of us,” she continues, “was determining if bruising was from the game or indicated a low blood count. Basketball players rarely come out of a practice without a new bruise.”

Through it all, however, Koetsier knew what she had to do. She continued to work out as hard as she could, while taking her condition very seriously.

“She was very good about it,” says Bundt. “I think that once she was diagnosed with the second blood disorder, it hit pretty close to home. And I think she felt that her life changed, and she knew she had to take extra special care of herself. She would come in to me quite often and run things by me, and she would tell me when symptoms started to seem a little bit worse and ask me to make an appointment for her to have blood work done early.”

Despite the rough start, Koetsier had another great season with the Broncos, averaging 15.0 points and 7.5 rebounds per game. She tied WMU all-time leading scorer Kina Brown as the fastest Bronco to score 1,000 career points, reaching that milestone in her 61st collegiate contest.

This past summer, she was awarded the V Foundation Comeback of the Year Award, selected by the V Foundation for Cancer Research and ESPN. She was also awarded the Honda Inspirational Award, which was given to her during the 26th Annual Collegiate Woman Athlete of the Year Banquet, held during the annual meeting of the National Association of Collegiate Directors of Athletics.

“She’s worked very hard,” says Lahaie. “She did the best she could to keep a positive spirit about her. When things weren’t going well with rehab, she thought about it and made the necessary changes, and when things were going well, she was very willing to work hard.

“Now, she is doing absolutely wonderful,” he continues. “She is full strength, full speed, full go. I think she’s looking forward to the upcoming season with as much enthusiasm as anybody could have. In this year’s preseason poll, the media chose the Broncos to finish second in the MAC West, and I’m sure that a large part of that is Kristin’s influence and how she’s going to be able to contribute to the team this year. She’s ready to go.”