At the end of a long day of studying Evidence in July 2010, I got up from my favorite study chair to go to bed. I had been comfortable on my cushy chair with my feet up on the ottoman, the soft blanket on my lap, cat snuggling with me as I read case after case and tried to draw out the rules. But when I stood up, I felt like my ribs had been kicked in and replaced with broken glass. I tried to take a deep breath, and it didn’t come easily. Sadly, but also fortunately, I recognized this sensation. I was experiencing my second pulmonary embolism. A trip to the Kaiser emergency room confirmed that multiple blood clots had broken off and made their way to both sides of my lungs. I was immediately hospitalized and stayed there for nearly a week.
“As a cause of sudden death, massive pulmonary embolism is second only to sudden cardiac death.” E-medicine.
So what are blood clots (also known as a thrombus) and pulmonary embolisms?
The source of pulmonary embolisms (P.E.) is almost always a DVT (deep vein thrombosis, or blood clot in a main vein in your body). DVT affects an estimated 2 million Americans each year. Up to 600,000 people are hospitalized and approximately 300,000 Americans die each year from DVT-related PE in the U.S.—that’s more than AIDS and breast cancer combined. There are so many reasons for blood clots to form that the medical profession has admittedly not even identified them all. The most common cause is inactivity, which is where the term “economy class syndrome” came from. If you’ve travelled internationally, you’ve probably been told to make sure to get up and move around on your long flight. Another common cause of clots is when patients are hospitalized for a long time or are immobilized for any other reason. Blood pools in the major blood vessels, and forms a clot. But even without those extreme environments, there are many other contributing factors. They include (but are not limited to):
• Birth control pills or any kind of hormone replacement therapy • Smoking • being overweight • Any kind of trauma to your body • Surgery • Cancer • Pregnancy • Prolonged inactivity
This last one is the one that can get us, as law students, in trouble. It’s so easy to get wrapped up in our studies – especially during final exams and while studying for the bar. Before you know it, a couple of hours may have passed without you moving from your chair. This is the kind of inactivity that puts you at risk of developing a blood clot.
How do you know if you have a DVT?
Symptoms of DVT are usually located in the patient’s leg. They may include:
• Pain • Swelling • Tenderness • Discoloration or redness of the affected area • Skin that is warm to the touch
Left untreated, the clot will either continue to grow, or break off into pieces. Once the blood clot travels through the bloodstream and lodges in the pulmonary arteries, you are at risk of losing oxygenated blood flow to your heart. That’s called a pulmonary embolism. Blood clots can also travel to your brain, causing a stroke. While often fatal, these don’t have to be if caught and treated quickly.
In my case, and in the case of the late David Bloom, the NBC embedded reporter during the Iraq war, we have a genetic mutation called Factor V Leiden, which makes us more prone to clotting. Again, there are many of these genetic mutations being discovered all the time. For both David and me, an additional contributing factor was necessary to cause a clot. For me, it was the long term use of birth control pills (hormones). For him, it was being immobile in a tank in the middle of the Iraqi desert. The night before David Bloom died; he talked to his wife Melody by satellite phone while on top of the tank. She could hear the whiz of bullets above, and asked him why he was outside the tank, putting himself in danger? He responded that he had been suffering from a bad muscle cramp in his calf and just couldn’t take it anymore. That muscle cramp turned out to be a DVT. It went untreated, traveled to his lungs, and caused a pulmonary embolism that killed him. Sadly, David Bloom died at age 39, and left behind his wife of 13 years and three beautiful daughters. So I feel incredibly fortunate to have survived a P.E. not just once, but twice. While law school is hard work, I’m grateful to be able to attend.
How can you prevent DVT’s and pulmonary emboli?
• Stay hydrated • Stay active • Know your family history. If someone in your family has experienced a DVT or pulmonary embolism, or stroke, get tested for genetic conditions that may have been the cause. Factor V Leiden is inherited from one or both parents. Knowing if you have it will give you the information you need to adjust your lifestyle • Quit smoking • Avoid hormones or birth control pills if you can
For more information about DVTs, please see http://www.preventdvt.org
March is DVT Awareness month, but I intentionally published this article early for the benefit of those studying for the February bar exam.
[Editor's Note: This article contained footnotes that could not be preserved. Please email firstname.lastname@example.org for an original copy of the article. The following sources were cited:
-Gerotziafas GT, Samama MM. Prophylaxis of venous thromboembolism medical patients. CurrOpin PulmMed. 2004; 10:356-365. -American Public Health Association. Presented at: Public Health Leadership Conference on Deep-Vein Thrombosis: February 26, 2003: Washington, D.C. White Paper.
-“Media Mix” article published 3/6/2006 by Peter Johnson, USA Today]