Everyone's Health

Simply put, Ignorance can be deadly

A common condition can become a killer – quickly;
few people know enough about it to protect themselves

P. Kelley

Which of the following kills the most Americans?
A. Traffic fatalities
B. The AIDS virus
C. Breast cancer
D. Deep-vein thrombosis

The answer: Deep-vein thrombosis. It kills up to 300,000 Americans each year, more than traffic fatalities, AIDS and breast cancer combined.

It could be the deadliest condition you've never heard of.

A deep-vein thrombosis is a blood clot that typically forms in the leg. It can move through the body, and if it lodges in a pulmonary artery, a condition known as a pulmonary embolism, it can kill you. Quickly.

The risk factors for DVT are numerous – “global” is how one doctor describes them. That means all of us, at some point, face some risk.

Most symptoms – such as leg pain or shortness of breath – aren't specific to DVT. Sometimes, there are no symptoms. As a result, the diagnosis is too often missed.

Risk factors Major surgery Cancer and some heart or respiratory diseases  Advanced age  A prior clot  Family history of blood clots Illness that restricts mobility  Obesity  Hospitalization  Pregnancy Use of birth control pills or hormone replacement therapy  Trauma, such as a blow to the leg Restricted mobility as the result of travel Symptoms There are sometimes no symptoms at all, but symptoms of DVT or a pulmonary embolism can include: Tenderness or swelling of the leg Shortness of breath Sweating Rapid pulse Dizziness Coughing up blood Chest pain Prevention To help prevent DVT: Avoid dehydration. If you must be in a sitting position more than four hours, keep blood flowing to your legs by taking periodic walks. Or, while sitting, repeatedly lift your heels, keeping your toes on the ground. This contracts your calf muscles and boosts circulation. Talk to your doctor if a family member has had DVT. Be aware of the risk factors.

Becky Williford found all this out the hard way. Williford, president of Mecklenburg Medical Alliance and Endowment in Charlotte, N.C., was a healthy 49-year-old in 2003 when she saw her doctor for a tender place on her calf. He told her it appeared to be a varicose vein.

Months passed. Soreness and swelling remained. Then Williford began feeling short of breath. In church one Sunday, she became lightheaded and clammy when she stood. Two days later, simple walking made her gasp for air.

A CAT scan of her lungs revealed numerous blood clots, or pulmonary emboli. Any one could have killed her if it had blocked her main pulmonary artery, halting oxygenation of her blood.

Williford spent a week in the hospital, taking blood thinners and waiting for the clots to dissolve. She continues on blood thinner and realizes now she has a genetic clotting disorder. Her mother died of a blood clot at 67.

But you don't have to have a clotting disorder to get DVT. In women, increased hormone levels created by birth control pills, hormone replacement therapy and pregnancy can cause blood clots. DVT is the most common cause of death in pregnancy.

Anything that restricts mobility, including hospital stays, also increases the chances of a clot. “It's the most preventable cause of death in the hospital,” says Dr. Sandy Benjamin, medical director of laboratories at Carolinas Medical Center-Mercy.

To combat DVTs, Charlotte's Presbyterian Hospital began in September 2006 assessing risk factors for every patient admitted. Those at risk may be prescribed preventive treatments, such as a blood thinner or a leg-squeezing device that promotes circulation. In January, all Carolinas Healthcare System hospitals enacted a similar policy.

Data show such assessments work. Mercy launched mandatory assessments in 2003-04, and its number of patients developing deep-vein thrombosis dropped from the previous year's 121 to 38 in 2005-06. Pulmonary emboli have dropped from 66 to eight, and deaths have declined from six to two.

Car trips or airplane flights greater than four hours also raise the risk of clots. DVT has been dubbed “coach-class syndrome,” though Sam Bowers knows now that business-class travelers can get it, too.

Bowers, 64, lives in Charlotte and Georgetown, S.C., and for years had been a frequent business flier. He first noticed dizzy spells, but brushed them off. More than a year later, his calves became sore to the touch. Shortness of breath sent him to a doctor, who treated him with antibiotics for pneumonia.

One day, after nearly passing out in an airport concourse in Florida, he flagged down a police officer. Paramedics did an EKG, determined he wasn't having a heart attack and sent him on his way.

Finally, his internist sent him to a specialist who sent him to the emergency room. Like Williford, he had multiple clots in his lungs.

Bowers took blood thinners for several months. Now, he makes sure he regularly flexes his feet when he's driving, flying and even sitting. That helps prevent a clot by forcing blood upward and boosting circulation.

“It's something I continually do. I'm doing it right now,” he said.

The risk of getting a blood clot rises with age, but DVT can strike young people, too. McCord Rayburn, a 24-year-old law school student from Charlotte, was studying for exams in May when he noticed a pain behind his ribs.

Rayburn had been in a bike race the previous day and first guessed a pulled muscle or cracked rib. But when he became short of breath and coughed up blood, he suspected a DVT because his sister had survived a pulmonary embolism at age 27.

In an emergency room, a CAT scan confirmed his suspicions. “They told me you're lucky you're alive,” he says. “You can die so quickly from these things. If it winds up in the right spot, that's it.”

An inherited clotting disorder, dehydration from the bike race and hours of sitting while studying may have been contributing factors.

When Melanie Bloom received word in 2003 that her husband, David Bloom, had died of DVT, she first thought it must have been “a rare, freak thing.”

As she learned more, she was astounded by how common the condition was. David Bloom, it turns out, had multiple risk factors. As a correspondent in Iraq for NBC, he was immobile on long-haul flights. He was dehydrated and cooped up inside a tank. An autopsy revealed he also had a clotting disorder.

His wife has become a spokeswoman for the Coalition to Prevent DVT and now works to raise awareness.

Her message: Know what DVT is. Know if you have risk factors. “If you fall into risk categories and you have a leg pain, there's every reason in the world to go seek help from a physician.”

“I decided if just one person's life is saved by David's story,” Bloom says, “then his death won't be in vain.”

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