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Everything you wanted to know about blood clots, but definitely are afraid to ask

chris graham blood clotsYour body wants to make clots. It’s how you don’t bleed to death every time you get a scratch. The problem with blood clots is, sometimes, and we don’t know why, your body clots too much.

This happened to me a few weeks ago, and landed me in the hospital for an overnight stay, with a pulmonary embolism – basically, a blood clot in my lungs that was making it difficult for me to breathe.

For me, what was odd was that, while not an elite athlete, I am borderline elite in terms of cardiovascular health – having completed three marathons, running and biking daily, at a healthy weight, not a smoker, none of the other obvious risk factors at play.

I discussed my case recently with Andrew Mihalek, who oversees the pulmonary medicine curriculum at the UVA School of Medicine, spends his clinical time leading the development of an acute pulmonary embolus response team, and serves as one of the co-directors for the multidisciplinary UVA Pulmonary Hypertension Clinic.

First thing Dr. Mihalek said to me: my case actually isn’t all that rare.

“You may remember Chris Bosh. His career ended because of blood clots. You may remember Serena Williams, who had to pull herself out of Wimbledon because of blood clots. And so in this regard, you know, the unfortunate story of having that healthy athletes coming down with this is a truism,” Mihalek said.

The tricky thing about blood clots is that the symptoms that you may have are really going to come into two buckets, Mihalek said.

“If you start experiencing really profound shortness of breath, if you start experiencing really profound chest pain, particularly if you’re younger, if you start experiencing very profound swelling in one leg, in particular, or pain in your leg, in particular, I would think that the average person would see that as a red flag and end up finding themselves in the healthcare system in some way, shape or form,” Mihalek said.

Problem for me was: there was nothing profound in what I was dealing with.

My workouts weren’t as effective. I started getting winded walking up the steps, which was out of norm for a guy who runs marathons.

I thought I maybe had a cold, until it didn’t go away – for four weeks.

“It may just be as simple as having some muscle aches in your leg, which depending, particularly, if you had an accident or an injury, or are involved in sports, that is maybe an everyday occurrence,” Mihalek said. “You may have a fever from your blood clot, which, depending on where you’re at, in your life may or may not be significant, especially during this time of year, you know, to kind of allergies, where you’re kind of just like, I just feel out of it, like, but just kind of chalk it up to allergies.

“In that regard, it can be a very hard thing to balance, when to worry, and when to just kind of chalk it up to you being a human with a human body that has moving parts that are going to be creepy at times.”

That was me. I felt like going to the doctor would be plain dumb, that I’d say to the doc, hey, doc, I used to average 22 miles an hour on the Peloton, now I’m struggling to get to 17, and the getting winded going up the stairs thing is annoying, but that’s it. Anyway, how can you help?

Mihalek conceded that a doctor may have agreed with my self-deprecating symptom report.

“I’m a pulmonologist, so obviously I deal with like shortness of breath pretty much with every patient that comes into my clinic. I have 20 patients in the clinic, everybody’s got shortness of breath,” Mihalek said. “The one thing that it can be a little bit challenging, especially if you’re seeing your 20th patient of the day, is you’ve got to have to kind of remind yourself, what does this mean to the individual at hand? I’m just going to go out on a limb and say, 98-year-olds tend to have shortness of breath, and people in their 30s and 40s, they’re running marathons, when they start saying that they have shortness of breath, and they tell me that they’re running 10 miles, you know, it’s going to be really easy to blow both those patients off, and you’ve got to kind of get back into the weeds.

“The young guy, OK, so you’re short of breath during 10 miles. All right, to me, that sounds like, that sounds awesome, especially since I just saw the 98-year-old guy. But if you can spend some time and effort in talking to the patient and find out, well, this guy used to run 30 miles a day or something like something insane, that would be a pretty significant dropoff in that person’s performance.”

The key here: we need to learn how to communicate with our doctors.

Basically, don’t sell yourself short, like I was trying to do – even as I was being wheeled out of my primary care doctor’s office for an ambulance ride to the emergency room, pleading with whoever would listen that, seriously, I just had a cold.

“Shortness of breath is one thing, but I think conveying how that symptom just like any other symptom is actually impacting your life is probably more important,” Mihalek said. “Because the devil is in the details. And you may not get there unless you’re packaging this up in a way that it’s going to, you know, get somebody’s interest.”

That was … almost me.

I wasn’t on death’s door or anything – pulmonary embolisms certainly can be and often are deadly; the CDC estimates 100,000 deaths in the U.S. each year from PEs.

Even though I’d been experiencing symptoms for four weeks, my situation hadn’t gotten to a point, yet, where I was in danger.

I wasn’t far from being in a danger situation, though.

My saving grace, in the here and now, and probably for the duration, is blood thinners – which, contrary to the conventional wisdom, don’t break up the blood clot that can put you in so much danger.

“Mother Nature treats your blood clot, and the clearance of that blood clot can be variable depending on the individual, for the most part for all kinds of blood clots, whether that’s actually you know, one in the leg or one in the chest. We think that that healing occurs somewhere between like the three- and six-months mark, probably closer to three months,” Mihalek said.

The real thing that we’re worried about for somebody who gets a blood clot is actually the reoccurrence of that blood clot.

That’s where the blood thinners come into play.

I’ll be on blood thinners to the end so that I don’t end up with another clot.

Here’s Dr. Mihalek explaining why:

“It makes sense that if you had a reason to have a blood clot, let’s say you had surgery, and you’re flat on your back for weeks, well, that was probably the reason why you got that blood clot. Or let’s just say if you were on a prolonged airplane flight for more than three to four hours and you got a blood clot, that would also be potentially a reason why you got that blood clot.

“Every so often you find somebody who doesn’t actually have a risk factor, and the point would be that if you took away that risk factor, their chances of reoccurrence are much lower, but if you can’t find that risk factor, we kind of argue that the chances of that reoccurrence are a little bit higher because there’s something maybe it’s a genetic makeup or or just something about that individual that put them at risk for the blood clot.

“In those circumstances, what we’re saying is we want to give the body a chance to heal, and so what we do is we do put people on medications that reduce their clotting abilities.”

The current guidelines and recommendations, depending on the type of blood clot that you have, are generally between three and six months.

“At six months, the current recommendations are to have a conversation with your patient,” Mihalek said. “I will say during those conversations, and particularly based on my understanding of the reading, I am pushing patients to a 12-month anticoagulation profile. And after that, if there is no reason to believe that you had risk factors for blood clot, oftentimes, if you’re young, I am actually recommending a lifetime of anticoagulation.”

Story by Chris Graham

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