Kate, a 28-year-old development professional, was uploading snapshots of Mai Tais and Maui sunsets from her Hawaiian honeymoon when she noticed a pain in her calf that felt like a pulled muscle. At night, the pain was so intense that it woke her up, so she went to an orthopedic surgeon who ordered a scan.
The test didn’t show any issues, so she forgot about it, until seven months later, when the newlyweds hopped a plane to San Francisco. On the return layover, Kate exited the plane, felt dizzy, and passed out in the terminal. The alarmed couple rented a car and drove back home to North Carolina, where she saw a doctor again. He chalked it up to dehydration.
Then Kate started experiencing something new on her daily five-mile walks: “I was kind of short of breath. Since it was my first summer in North Carolina, I thought it was allergies or maybe that I was out of shape—so I would go extra hard on the elliptical machine.” She didn’t share her symptom with anyone and soon became preoccupied with packing for a family trip to Alaska and Seattle.
As she waved hello to Starbucks’ stomping grounds from the Space Needle, Kate was completely unaware of the killer in her right calf. A massive blood clot, or deep vein thrombosis (DVT), had formed in her lower right leg and was releasing smaller clots that were traveling to her lungs.
These blood clots in the lungs, called pulmonary emboli (PE), “can be life-threatening and in 10-15% of cases, cause sudden death,” says Dr. Jack Ansell, MD, hematologist and chairman of the Department of Medicine at Lenox Hill Hospital in New York and member of the National Blood Clot Alliance’s Medical Advisory Board. “The first sign of a PE can be death.”
As the trip progressed, Kate had an increasingly difficult time catching her breath. She couldn’t shake the feeling “that something was wrong,” but boarded the plane with a pack of M&M’s and told herself everything would be OK.
Mid-flight, she got up to use the bathroom and collapsed in the middle of the aisle. A group of firemen on board gave her oxygen, and upon landing, an ambulance whisked her to an Atlanta ER where she was diagnosed with dehydration and vasovagal reaction (a fainting episode). She immediately flew back to North Carolina and scheduled an urgent doctor visit. As she prepped for her appointment, she collapsed again after climbing the stairs.
“I called 911, and the [paramedics] didn’t think anything major had happened,” she recalls. “They said, ‘wait until your husband gets home and he can take you to the doctor.’”
Luckily for Kate, a mother’s instinct was on her side. Her mom (a nurse) suggested that a blood clot might explain Kate’s mystery malady. Her doctor ordered a V-Q scan (a specialized lung test), and found multiple PEs in both lungs. Kate—a healthy young woman whose only risk factors were a series of flights longer than five hours and the daily birth control pill she popped—was in danger of having a heart attack.
Although Dr. Ansell states that the actual frequency of DVTs is low in young people, he emphasizes that it’s essential to know about the risk. “This should not be called an epidemic, but about 100,000 people die each year as a result and there are upwards of 500,000-600,000 cases per year.”
Take a lesson from Kate’s story, and read on for what you need to know.
Acquaint Yourself With the Symptoms
Kate was lucky to escape with her life, but knowing the warning signs could have gotten her more immediate medical attention. Shortness of breath, chest pain (particularly with deep breathing), coughing up blood, persistent leg pain, or redness, swelling, or warmth in your lower legs (usually one-sided) can all be indications of a blood clot in the legs or lungs, and should never be ignored.
And, give yourself a break already. “Women tend to beat themselves up about losing weight,” she says. “But, if you’re short of breath, it may not mean you’re out of shape. Know the signs and symptoms—you are your own best advocate.”
Get to Know Your Meds (and Your Family History)
Using estrogen-based birth control (pills, patches, and rings) comes with a risk of blood clots, though it’s relatively small. “The overwhelming majority of women on birth control pills do not have problems,” says Ansell.
But, it’s important to note that smoking, being obese, or having a family history of clotting disorders while you’re taking estrogen can all increase the risk.
Check your family tree for clotting disorders before your next appointment for hormonal birth control—and communicate the findings with your doctor. The most common inherited disorder leading to blood clots is Factor V Leiden, which is typically suspected in “individuals who develop blood clots at a young age, who are white with European ancestry, have a family history of clots, or have blood clots in unusual sites,” says Ansell.
If you’re already on estrogen-based birth control, burn the list of DVT and PE symptoms into your brain. And if you feel strongly that something is amiss—trust your instincts and see your doctor.
Wiggle Your Way Across the Ocean
Those warnings you see in the back of airline magazines? They do warrant a few seconds of your attention. “Individuals who undertake long distance air travel (greater than five hours) and are relatively immobile have a slightly greater chance of developing a clot,” says Ansell. And, the possibility of travel-related DVT is amplified somewhat with pre-existing factors (like taking estrogen-containing birth control, pregnancy, or obesity)—however, it’s important to note that the overall risk of clotting with air travel still remains small.
Even so, if you’re traveling internationally or cross-country, it’s imperative to get out of your seat every hour and move. “Get in the habit of fidgeting when you’re sitting,” says Ansell. Point your toes downward and upward, make circles, and heck, even try spelling out the alphabet. The key is to keep the blood flowing.
And, although being well-hydrated (a.k.a. asking the kind flight attendant for ice water instead of extra ice for your vodka cranberry) is never a bad idea—there is no definitive evidence to show that dehydration increases DVT risk. Pushing fluids might, however, push you to get up more frequently to use the facilities, and reduce your risk that way.
While you don’t need to be overwhelmingly alarmed about your blood clot risk, you should definitely be aware. “The bad news is that we’re talking about 100,000 deaths per year from blood clots,” says Alan P. Brownstein, MPH, CEO of The National Blood Clot Alliance. “But the good news is that most of them can be prevented.”
Photo courtesy of sakhorn38.