- 10 Questions to Ask Your Doctor About Pulmonary Embolism
- The Anxiety of Survival: Living in the Wake of a Pulmonary Embolism
- Long-term limitations imposed on patients with pulmonary embolism
- Find a Healthcare Provider
- The Anticoagulation Forum
- The American Society of Hematology
- Treatment Centers Specializing in Thrombosis and Thrombophilia
- Amino Healthcare Professional Database
- The Society for Vascular Surgery
- National Society of Genetic Counselors
- Health Insurance Resources
- What are the symptoms of PE?
- David’s story:
- Recovery & Support for Pulmonary Embolism
- Monitoring During Pregnancy
- Cardiopulmonary Rehabilitation
- A perspective of a patient who developed Pulmonary Embolism and DVT: an interview
10 Questions to Ask Your Doctor About Pulmonary Embolism
A blood clot in an artery can be dangerous at any time, but particularly when it breaks away and lodges in your lungs, creating a pulmonary embolism.
So how does a pulmonary embolism happen, and what can you do to protect yourself? These 10 questions can get the conversation going between you and your doctor.
1. What causes a pulmonary embolism?
A pulmonary embolism is a blockage in an artery in your lungs, usually caused by a blood clot. Occasionally, tumor cells, parasites, air bubbles, amniotic fluid, or fat may be the culprit in a blockage, according to the National Institutes of Health (NIH).
2. How are the blood clots of deep vein thrombosis and pulmonary embolism related?
Deep vein thrombosis (DVT) is a blood clot inside one of your body’s deep veins, often in your pelvis, lower leg, or thigh, and sometimes in your arm, according to the Centers for Disease Control and Prevention (CDC). If a blood clot breaks off and travels to your lungs, it becomes a pulmonary embolism, the most serious complication of DVT.
3. How common is pulmonary embolism?
Blood clots are surprisingly common, and about 900,000 people in the United States develop DVT or a pulmonary embolism yearly, estimates the CDC.
4. Am I at risk for pulmonary embolism?
Because a pulmonary embolism can be fatal, it’s essential to discuss your risk with your doctor, says Jason S. Fritz, MD, FCCP, a pulmonologist at Penn Presbyterian Medical Center in Philadelphia. “There are preventative measures that can be taken to help mitigate that risk in appropriate circumstances,” he says.
Though anyone can develop pulmonary embolism, the CDC lists factors that increase your risk. These include your medical history, activities, and medications:
- A previous DVT, pulmonary embolism, or stroke
- Heart failure
- High blood pressure
- Long periods of sitting or lying still, such as on a long plane, train, or car ride
- Recent trauma or surgery
- A current cancer diagnosis
- Pregnancy, current or recent
- Taking oral contraceptives (especially if you smoke)
RELATED: Estrogen Products Can Spike Your Blood Clot Risk
5. How can I prevent a pulmonary embolism?
You can take steps to lower your risk of getting a pulmonary embolism, such as taking blood thinners, getting back on your feet as soon as possible after surgery, or wearing special compression stockings to reduce your risk for blood clots. If you are on a long trip, take frequent breaks to walk around and stretch your legs to improve circulation and avoid blood clots. Also, if you’ve already experienced a pulmonary embolism, look at what may have caused it, and get treatment for any conditions that may be increasing your risk.
6. How do I know if I have a pulmonary embolism?
This condition is often misdiagnosed because symptoms often aren’t particularly specific, says Shanon Makekau, MD, a pulmonologist with Kaiser Permanente in Hawaii. Usually, pulmonary embolism causes shortness of breath and chest pain. Sometimes, people develop a fever and cough up blood, or experience dizziness, lightheadedness, and heart palpitations. One of the most common symptoms of DVT is swelling in one leg. “These symptoms, particularly in high-risk patients, should prompt immediate evaluation and more definitive testing,” Dr. Makekau says.
7. Can a pulmonary embolism be cured?
A pulmonary embolism can be fatal if the blood clot completely blocks blood flow to the lungs, according to the CDC, and up to 30 percent of those who have an embolism die within the month. But if you spot the symptoms early and seek prompt medical care, pulmonary embolism is treatable. Anti-coagulant (blood-thinning) medications help prevent further blood clots, and a treatment called thrombolytic therapy helps dissolve an existing clot. Treatment may require hospitalization, depending on the severity of the clot, notes the NIH.
8. How long does blood-thinner treatment last?
“This is a very important question to discuss with your physician,” Dr. Fritz says, and the answer depends on your risk for a future clot. If the pulmonary embolism was caused by a trauma or surgery, blood thinner treatment may last a year or less. But if it was not caused by a temporary or reversible condition, or if you’ve had several DVTs or pulmonary emboli, you might need to continue treatment indefinitely because these types of blood clots are more likely to reoccur, he explains. It’s also important to discuss with your doctor the risks associated with blood thinner treatment, such as an increased likelihood of bleeding.
9. Will a pulmonary embolism come back?
It might. About 33 percent of people who have had a DVT or a pulmonary embolism will have another one within 10 years, according to the CDC.
10. If I have already been treated for a PE but don’t feel as good as before, should I be concerned?
Maybe, Fritz says. It can take several months to recover, especially if you have a heart or lung problem. But in some cases, the clot doesn’t fully dissolve, which can lead to pulmonary hypertension and a form of heart failure. These may cause shortness of breath, swelling, fatigue, dizziness, fainting, and chest pain when you exert yourself.
The Anxiety of Survival: Living in the Wake of a Pulmonary Embolism
By Jon Caswell
At age 49, Ellie Brady of Burlington, Vermont, was the picture of health. Patrick’s wife and Emma’s mother, she was training for a half marathon. On a nine-mile training run she got out of breath. ‘I must be getting old,’ she thought, but she was concerned enough that she visited two doctors during the following week, both of whom dismissed the symptom because she was a runner and obviously fit.
But as the week progressed so did her symptoms — back pain, chest pain, uncontrollable chills — until she could no longer ignore them. With intense pain in her right upper back radiating into her chest, she drove herself to the ER, where she was diagnosed with a pulmonary embolism (PE), which is a blood clot in the lungs. The pain in her back had been caused by a clot in her right lung.
A PE is a type of venous thromboembolism (VTE), which is what blood clots in veins (rather than arteries) are called. PEs don’t form in the lungs, rather the clot forms in the extremities, mostly the thigh, and travels through the veins and heart to the lungs. This blockage can permanently injure the affected lung, lowering the blood’s oxygen level and potentially damaging other organs by starving them of oxygen. In Ellie’s case, she did lose some lung tissue, but her other organs were not affected.
Ellie’s doctors did tests to determine what caused her PE.
Their investigation determined that she had three significant risk factors for VTE: 1) she had a genetic clotting disorder; 2) she was taking hormones for menopause; and 3) she was more sedentary as the result of a new job.
“We were shocked and surprised,” Ellie said. “My friends and family couldn’t believe it because I don’t drink or smoke, I eat well and exercise regularly.”
Running is a big part of Ellie’s life so her first question for the medical team was “when can I run again? Of course, their goal was to keep me alive. This is when they told me the statistics and explained how lucky I was just to be alive,” she said. “It started off with ‘when can I run again’ and turned into ‘will I die?’” she remembered. The National Heart, Lung, and Blood Institute estimates that a third of patients left untreated will die. The majority of people who die from a PE do so within a few hours of it happening.
Although her clotting disorder, called Factor V Leiden, was news to her, she felt relief with the diagnosis. “Once I knew my risk factors, I felt like I had gained some control,” she said. “There were things I could do about it. I’ll always have the blood mutation, but I stopped taking hormones and switched my job.”
Ellie hiking with husband Patrick
with daughter Emma at the Boston Marathon
But that was the easy stuff. “Emotionally I was a mess,” she said. Every chest pain stimulated a doctor or ER visit, where another PE was ruled out. She was convinced any leg pains were another clot breaking free to travel through her heart to her lungs. “After multiple trips to the ER, my primary doctor discussed anxiety attacks with me. I had never experienced them before,” she said. “I went to therapy and had a wonderful experience. I would highly recommend it to anyone. My family dealt with their stress by supporting and encouraging me. We are a good team!”
She was released from the hospital on blood thinners, which she was supposed to take for six months. Because of her diet, she did not want to take warfarin, so she was prescribed rivaroxaban (Xarelto®), which she could not tolerate. “So, I gave myself Lovenox® (enoxaparin) injections twice a day for six months,” she said. “I hated them because they were so painful. But every time I gave myself an injection, I’d say, ‘I choose life.’”
Being on a blood thinner itself became a source of anxiety: “I was in constant fear that I would hit my head and have a brain bleed, but then I had severe anxiety when it was time to go off it — I was afraid I would throw another clot. That was anxiety central.” The Factor V was the cause of this dilemma, but her therapist and family helped her make up her mind. She asked Patrick how he felt about her going off the thinners. “He said, ‘It’s great, you don’t need them anymore.’ That’s all I needed to hear,” she said. Now she takes a baby aspirin every day and makes sure she stays hydrated.
After a few months, she began to feel better and started walking. At first it was around the block and close to home, but as her endurance improved she ventured farther and stayed out for hours. She asked about running and was told to listen to her body. “After running the last leg of the Vermont City Marathon in 2016, I ran a bunch of 5Ks, 10Ks, a half marathon,” she said. When we talked with her in May 2017, Ellie was in training for a marathon in August and an ultra-marathon in October. “After beating the clot, I’m feeling quite unstoppable.”
Ellie & some friends celebrate the finish of a race
After her diagnosis, her daughter, sister and mother were tested for Factor V, and all came back positive. “My mother had four miscarriages,” she said. “I’m not sure if Factor V had anything to do with that, but maybe. Her mother died from a stroke at a young age. I’m happy my sister and daughter have this information and can take preventative measures.”
There are other positive changes. “I don’t sweat the small stuff anymore. I wake up every morning and realize how lucky I am to be alive,” she said. “I tell my family how much they mean to me and I’m definitely more patient. I also value life more. I’ll take a spider outside instead of killing it. I take the time to watch a sunset or smell a flower. Before this happened, when I ran it was all about speed. Now I’m just happy to be able to do it. It’s not all positive, I still have anxiety about having another embolism, but yoga and exercise help with that.”
This information is provided as a resource to our readers. The tips, products or resources listed or linked to have not been reviewed or endorsed by the American Heart Association.
Long-term limitations imposed on patients with pulmonary embolism
“Our clinical experience told us that some patients who’d had a pulmonary embolism suffered from shortness of breath and chronic fatigue long after the PE had been treated and resolved,” explained Dr. Kahn, who is founder and director of the Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC) at the JGH, and an epidemiologist at the Lady Davis Institute at the JGH. “Our study revealed that 47% of participants showed a significant reduction in their physical stamina.”
One-hundred patients were followed over the course of a year following treatment for PE. They answered quality of life questionnaires and participated in a number of physiological tests to measure their cardiopulmonary functions. All of the participants were generally healthy when they experienced their PE, so it was surprising that nearly half performed below 80% of their predicted peak oxygen uptake (a standard measure for cardiopulmonary exercise testing) one year later. These patients also scored lower in variables used to measure quality of life.
“One of the tests we use is to see how far a patient can walk in six minutes, which is a basic measure of mobility and stamina. When someone is limited in performing this test, it is really something that is interfering with their normal day-to-day functioning,” said Dr. Kahn, a Professor of Medicine at McGill University, who is recognized as a world leader in research and treating patients with venous thromboembolism (VTE).
The underlying cause of the PE did not seem to be a predictor of whether a person may experience long-term repercussions. The study did reveal that men were three times more likely to have adverse effects, younger patients fared worse, as did more overweight patients and smokers.
Though further study is required, the outcome of this research suggests that patients with PE may benefit from some form of exercise rehabilitation as part of their recovery.
Find a Healthcare Provider
If you have any questions as you work with the resources below, please contact [email protected]
The Anticoagulation Forum
The Anticoagulation Forum, also known as the AC Forum, is the largest organization of anticoagulant service providers in North America. Their membership includes more than 9,500 physicians, nurses, and pharmacists representing more than 2,800 anticoagulation clinics nationwide. Members of the AC Forum care for more than 900,000 patients each year, and exist as specialized centers to assist people who use anticoagulation treatment or blood thinning medications.
The AC Forum offers an online search tool that may help you identify AC Forum Clinics in your local community. Any of these clinics can connect you to the type of specialized care you need.
To find an AC Forum clinic in your community, click on the following link, and then select your state from the dropdown menu: Find an AC Forum Clinic.
The American Society of Hematology
The American Society of Hematology, also known as ASH, has more than 17,000 members from nearly 100 countries, and is the world’s largest professional society serving both clinicians and scientists around the world who are working to conquer blood diseases. ASH may be able to help you find a hematologist in your community who specializes in blood clotting disorders and thrombosis and hemostasis.
To help you find a hematologist, click on the following link, and follow the instructions: Find a Hematologist. To best use this tool, fill in your City, State, and Postal Code, and then select the mile radius you would like to search from the dropdown box under “Zip Code.” At the final dropdown box called “Clinical Interests,” click on “Thrombosis and Hemostasis/Blood Clotting” or other specialty of your interest, and then click “Search.”
ASH also offers some helpful tips for talking with your healthcare professional: Talking with Your Doctor.
Treatment Centers Specializing in Thrombosis and Thrombophilia
Treatment Centers Specializing in Thrombosis and Thrombophilia exist as part of a network of specialized healthcare centers that work to prevent and reduce complications from certain blood disorders. These healthcare centers are funded by the U.S. Centers for Disease Control and Prevention, also known as the CDC, and include hemophilia treatment centers, or HTCs. Some, but not all of these HTCs provide care to patients with blood clotting disorders or thrombosis and thrombophilia.
To help you find a specialized treatment center, click the following link: Treatment Centers Specializing in Thrombosis or Thrombophilia and Hemophilia Treatment Centers
Amino Healthcare Professional Database
Amino’s free online database can help you find healthcare providers that meet your specific needs. Reflecting the experiences of more than 200 million people nationwide, the search tool helps you find a doctor based on how much experience they have treating patients like you, your personal preferences, and your financial and/or insurance needs.
To find a doctor using the Amino database click on the following link: Amino Healthcare Professional Database. To best use this tool, start by entering one of these search terms into the search box on the homepage: clotting disorders, hematologist oncologist, deep vein thrombosis (DVT), pulmonary embolism (PE), or thrombosis.
The Society for Vascular Surgery
The Society for Vascular Surgery has a useful tool to help you find a vascular surgeon, or to provide more information about venous disease.
To access this information, follow this link: Find a Vascular Surgeon
National Society of Genetic Counselors
Genetic counseling services, or genetic counselors, can help families at risk for inherited conditions investigate the problem present in the family, interpret information about the disorder, analyze inheritance patterns, interpret risks to family members, and review available management options. Genetic counseling may be valuable for those who have questions about hereditary thrombophilia(s) in their family. Specifically, genetic counseling may be helpful in answering questions about inheritance, genetic testing of family members, and insurance discrimination.
For more information about genetic counseling, visit the following link: National Society of Genetic Counselors.
Health Insurance Resources
If you are currently without healthcare coverage, this tool will point you in the direction of resources to fit your individual circumstances: National UNInsured Resource Directory & Financial Resource. This online directory can provide you with a list of resources that address medical debt crisis, financial assistance, charity assistance programs, and job retention related programs.
If you currently need additional healthcare coverage, this tool will point you in the direction of resources to fit your individual circumstances: National UNDERInsured Resource Directory & Financial Resource. This resource is uniquely tailored to meet your individual situation encompassing financial resources, disease specific resources, location based services, employment aid, and general care resources for patients that are not fully served by their current insurance. This resource also contains a list of sample questions that can be used when speaking to your providers or insurance representatives.
What are the symptoms of PE?
While the vast majority of pulmonary emboli are believed to originate in the deep veins of the body, fewer than 30 percent of individuals who experience PE have symptoms of DVT. Instead, the most common symptoms are shortness of breath and chest pain. In the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study, a large study conducted by the National Heart Lung and Blood Institute of the National Institute of Health, 73 percent of patients with PE experienced shortness of breath, 66 percent experienced chest pain, 37 percent experienced cough, and 13 percent coughed up blood. During physical examination, 70 percent had rapid breathing and 30 percent had a rapid heart rate. When doctors listened to the study participants with a stethoscope, half had abnormal sounds in their lungs and one fourth had abnormal sounds in their hearts. Fourteen percent had a fever.
In some cases, PE may occur very suddenly, without any warning. The symptoms of PE, when noted, are also very nonspecific. For example, shortness of breath and chest pain may occur with pneumonia, bronchitis, or other lung or heart problems. Chest pain may be caused by a number of problems, including muscle strain, heart problems, lung infections, stomach problems such as acid reflux or hiatal hernia, or even anxiety. Whenever a patient has symptoms such as shortness of breath or chest pain, especially when the person has other risk factors for DVT (such as recent surgery, admission to the hospital for a medical disease, or recent immobility), PE should be considered as a possibility.
At age 35, I was into my ninth year as an electrical engineer. My involvement with the medical profession was brief and infrequent. I had a broken arm at age 4, all the vaccinations required to go to school, the usual childhood diseases (measles, mumps, chickenpox, and so on), a couple of lacerations that needed stitches, a few ear infections, a bout with hepatitis while in college—and that was about it. In other words, I was healthy.
One morning, I arrived at the plant, climbed the stairs two at a time (as I usually did to go to my office and lab on the second floor), and found myself at the top of the stairs gasping for breath and almost passing out. Because I had never experienced anything like this before, I was frightened, but not enough to seek immediate medical attention. I waited. In 30 minutes, I was breathing normally. I did call the office of the family doctor who saw our children. The receptionist asked me what I needed and I told her I needed a physical exam. She gave me an appointment for three weeks hence.
Meanwhile, I tried some self-diagnosis. I thought that I would try to get the episode to reoccur by running on the treadmill. Fortunately, it didn’t reoccur, but over the next two weeks, I started to feel more tired by the end of the day. In the third week after the episode, I was feeling really awful, so my wife called the doctor, and he came to our house that night. His diagnosis was a viral infection. His advice was to tough it out.
Two days later, I was so weak that I had to crawl to get to the toilet. My wife called the doctor again, who again came to the house. He still thought it was a viral infection, but because I was scheduled for my physical exam the next day, he told me that when I came into the office, I should get, among other things, a chest x-ray. The chest x-ray revealed a case of pneumonia. I was so sick that the doctor’s partner admitted me to the hospital to start intravenous (IV) antibiotics.
On the second night in the hospital, I got up to go to the toilet and collapsed on the floor gasping for breath. The staff put me back in bed, and in about 30 minutes I wasn’t short of breath anymore. In the morning, the doctor’s partner ordered a CT scan, which revealed several blood clots in my lungs. I was immediately taken to the intensive care unit and started on IV heparin. Three weeks later, I was out of the hospital, pneumonia under control, arterial blood gases normal, and taking Coumadin®. Six months later, I was told to stop the Coumadin®, start an exercise program, and take an aspirin a day. I did this for 30 years without another episode.
Two years ago, I contracted a case of Rocky Mountain spotted fever from a tick bite. I spent almost a week in bed with high fevers. A couple of nights later, I awakened with severe cramps in my lower ribcage. Hoping the problem would go away, I didn’t wake my wife. I felt better the next morning. When I finally told my wife about the episode, she asked me if I thought it could be a PE. I said “no,” because the PE 30 years earlier was accompanied by acute shortness of breath, and this episode was not.
Three days later, we started a 10-day vacation that included several airplane rides, including a round trip between New York City and Rome. Upon return from vacation, I resumed my customary exercise on the treadmill. I noticed that my stamina was basically half of what it had been a month before. I chalked it up to a month away from the gym, but after two weeks with no improvement, I contacted my internist, who scheduled me for a stress test the next day.
That next morning, I noticed that I got winded climbing the stairs in our house. Just walking outside to get the paper made me feel light-headed. I was concerned enough to inform my wife, who was getting ready for work. Her approach was to head for the emergency room.
The diagnosis was a PE! I had been fooled. From my experience 30 years ago, I thought I knew what a PE felt like, but apparently different episodes can be accompanied by different symptoms. The symptoms I had 32 years ago were acute shortness of breath and loss of stamina. The symptoms I had 2 years ago were cramps in the lower ribcage and gradual loss of stamina, but no shortness of breath. By the time I reached the emergency room, an echocardiogram revealed that the right side of my heart was beginning to fail. I was immediately started on Lovenox® and admitted to intensive care unit for tissue plasminogen activator (TPA) to help dissolve the clot. Now, I take Coumadin® every day, but I am lucky to be alive.
Recovery & Support for Pulmonary Embolism
NYU Langone doctors almost always recommend that people with pulmonary embolism wear graduated compression stockings during daily activities. These are generally not worn when you sleep.
These prescription garments squeeze the calves and legs, encouraging healthy blood flow. Compression helps prevent blood from pooling in the legs and the development of deep vein thrombosis, which can lead to pulmonary embolism.
The use of compression garments is especially important in the prevention or minimization of symptoms of post-thrombotic syndrome, which occurs as a result of damaged veins. In this syndrome, the valves of the veins become scarred and incompetent, or “leaky,” due to deep vein thrombosis. This can lead to long-term symptoms of leg heaviness, swelling, and discoloration.
Your doctor may recommend pneumatic compression if you have a history of deep vein thrombosis and pulmonary embolism. Pneumatic compression cuffs are placed around the thighs, calves, or arms, either over or beneath your clothing. They inflate and deflate every few minutes to restore and maintain healthy blood flow.
The cuffs are connected to a portable compression machine through tubes that attach to various points on the cuffs. They are generally worn at the hospital, while you are immobile during recovery or rehabilitation.
Monitoring During Pregnancy
Women who are pregnant may experience pulmonary embolism as a result of increased pressure on the pelvis and veins in the legs. If this occurs, an NYU Langone vascular surgeon works closely with your obstetrician to determine the best treatment plan for you.
NYU Langone’s Rusk Rehabilitation offers cardiopulmonary rehabilitation. Our physiatrists, who are rehabilitation physicians, work closely with our cardiologists and pulmonologists to address your cardiopulmonary needs during recovery from pulmonary embolism.
The team physiatrist, who specializes in treating heart and lung conditions, works with you to identify your medical rehabilitation needs and treatment goals. Based on these objectives, the physiatrist and the cardiologist collaborate with the rehabilitation team to develop an individualized rehabilitation plan.
Cardiopulmonary rehabilitation typically includes a 12-week exercise and lifestyle program that begins after you’ve been released from the hospital. The program is designed to improve your breathing, increase your strength and exercise capacity, and allow you to perform daily activities.
Our experts work with you to reduce your symptoms of fatigue and improve your energy levels and endurance. An NYU Langone nutritionist can also help you to improve your diet.
Our doctors can provide guidance about quitting smoking. NYU Langone offers Tobacco Cessation Programs, as well as support services that can help you to reduce stress levels. In addition, you’re invited to participate in weekly educational seminars that provide information about all aspects of cardiopulmonary wellbeing.
Tennis Star Recovering From Life-Threatening Blood Clot
By Daniel J. DeNoon
WebMD Health News
Reviewed by Laura J. Martin, MD
March 2, 2011 — Tennis star Serena Williams is recovering from a pulmonary embolism and a hematoma resulting from her treatment, according to media reports.
What is a pulmonary embolism? How can something so scary happen to a world-class athlete? Do people fully recover from a pulmonary embolism?
To answer these and other questions, WebMD consulted Shirin Shafazand, MD, MPH, assistant professor of medicine in the division of pulmonary critical care at the University of Miami Miller School of Medicine.
Shafazand has not examined Williams and has not seen her medical records. She commented on publicly available details of Williams’ condition and on her extensive experience treating patients with pulmonary embolisms.
What happened to Serena Williams?
Shortly after winning her fourth Wimbledon title last July, Williams cut her foot on a shard of glass. The severe cut required surgery and 18 stitches. Although she played an exhibition match shortly thereafter, continuing problems with the foot has kept her out of competition since then.
According to a statement from her representative in People magazine, Williams was in New York last week undergoing further treatment for her foot injury. She flew back to Los Angeles and apparently suffered a pulmonary embolism during or shortly after the flight.
On Feb. 28, she “underwent emergency treatment” for a hematoma she suffered as a result of her treatment for pulmonary embolism.
Williams is reported to be recovering.
What is a pulmonary embolism?
A pulmonary embolism is a blood clot that blocks a major artery feeding the lungs.
These clots usually arise in the leg, usually in a deep vein. Doctors call such a clot a thrombosis. A clot arising in a deep leg vein is called a deep venous thrombosis or DVT. DVTs often arise after a period of inactivity and are particularly common after long airplane flights. A clot originating in a deep leg vein in some cases will break free and travel to the lungs, causing a pulmonary embolism.
Williams may have been relatively inactive because of the foot injury. The risk of DVT is increased with inactivity.
“Her injury could have led to a clot in the leg,” Shafazand suggests. “And New York to California is quite a long trip — and that could increase risk of the slowing down of blood flow in the leg, which could lead to a DVT.”
Some people with very small pulmonary embolisms never notice them. But larger clots block blood flow to significant portions of the lungs.
“A large pulmonary embolism cuts blood circulation to the lungs and decreases oxygen levels in the body. A patient can very quickly deteriorate and die,” Shafazand says. “And the heart, which is supposed to pump the blood through the arteries, can fail because it cannot stand the pressure buildup from the blockage.”
What are the symptoms of pulmonary embolism?
The most common symptoms are:
- Sudden shortness of breath
- Sharp chest pain that is worse when you cough or take a deep breath
- A cough that brings up pink, foamy mucus
Pulmonary embolism can also cause more general symptoms, such as feeling anxious or unwell, heavy sweating, feeling lightheaded or faint, or having a rapid heartbeat or palpitations. Such symptoms, particularly if sudden and severe, require immediate medical attention.
What is the treatment for pulmonary embolism?
Treatment for pulmonary embolism depends on the size of the clot blocking the lung artery and on the degree of blockage.
“When someone comes into the hospital with a suspected pulmonary embolism, we give oxygen. Then we start with blood thinner, heparin, to thin the blood enough to allow it to pass through the blockage,” Shafazand says. “Then we do some testing, a CT angiogram, to look for the pulmonary embolism. We may also look at the veins in the leg through Doppler ultrasound.”
If a severe pulmonary embolism is confirmed, more urgent treatment may be necessary.
“If the embolism is very severe and the patient is at risk of dying, with blood pressure dropping, there is a procedure called pulmonary embolectomy, where we go in through a vein and make attempt at removal of the clot. This is done rarely,” Shafazand says.
Another emergency treatment for pulmonary embolism — also rarely done — is to use the clot-busting drug tPA to open the clogged artery.
Did Williams undergo an embolectomy? That isn’t yet known, but it’s unlikely.
Williams did undergo a procedure. This may have been simply a diagnostic procedure to take a close look at her pulmonary embolism.
Another typical procedure in patients who have suffered a pulmonary embolism is to insert a filter into the major vein leading to the heart — an inferior vena cava (IVC) filter — to catch any future clots that come along.
Why did Serena Williams have a hematoma? What is a hematoma?
People magazine reports that Williams suffered a hematoma from her treatment for pulmonary embolism.
A hematoma is a bruise — a collection of blood beneath the skin from a leaky blood vessel.
“A hematoma could happen with any procedure where they have to enter vein or artery,” Shafazand says. “If it is a large enough hematoma, it would be drained and if the artery beneath it is still leaking, it would be repaired.”
Will Serena Williams ever play tennis again?
Pulmonary embolisms usually are not removed because the body eventually reabsorbs the clot over time. Some people fully recover, others do not.
“For most patients, the recommendation is they go on some form of anticoagulant for at least three to six months, Shafazand says. “For a subset of patients, their pulmonary embolism may lead to pulmonary hypertension — meaning there has been damage to the pulmonary arteries. In these cases, the blood pressure in the pulmonary artery is high and this has many implications down the road for the patient’s health.”
Spider & Varicose Veins: Causes, Before and After Treatment Images See Slideshow
A perspective of a patient who developed Pulmonary Embolism and DVT: an interview
By Varun Rangnekar, Sophomore, Johns Creek High School, Johns Creek, GA
This interview is a part of the ongoing projects by the Georgia Thrombosis Forum to know the perspective from a variety of community advocates: the patient, the pharmacist, the physician, and patient advocate, about what they think about thrombosis.
One of my projects that I am very passionate about is to find out details about thrombosis from the patient’s perspective. We were fortunate to have interviewed 2 more patients, Ms. Rose, who had hemorrhage in the brain after her second delivery, and Senator Renee Unterman of Georgia Legislature, who had DVT.
I read with great interest an article in e-thrombosis, “Is a Politician exempt from getting an attack of Deep Vein Thrombosis (DVT)?”. After reading this article, I felt that I needed to talk with this patient to get his side of the story of what went on in his life when he suffered from the attack of DVT and Pulmonary Embolism (PE).
Author’s note: The name of the patient has been blocked due to confidentiality, and the patient is referred to as Mr. Peter in this interview. My name in the interview has been referred to by the initial V.
Thank you Mr. Peter for giving me your valued time, this project means a lot to me. It is intended to teach me the critical understandings how to get firsthand information from a DVT / PE patient, and conduct a business-like interview. As you may know, you are a special case, not just because you suffered from the thrombotic disorder, but also you are the first patient we have come across who has suffered from 2 thrombotic conditions, DVT, and PE, simultaneously!
I am sorry to know that you suffered from DVT and PE. In order to have our thoughts flow without any interruption, we decided to make a list of medically related questions appropriate to your condition.
Varun (V): I hope you do not mind my asking your age, how old are you, Mr. Peter?
Peter ( P): I am 62
V : Has anybody from your family suffered from this thrombotic condition?
P: We have a big family, but nobody has ever had DVT, or Thrombosis
V: When did your condition start?
P: It started somewhere either in Mumbai-June 18, 2014, or on the flight from Mumbai to Dubai June 22, 2014, or in Dubai 22-24, 2014
In Dubai, it was a very hot, very dry day, and I drank a lot of water. I was sitting in a meeting that lasted a very long time. I developed fever and laid down. I noticed a swelling in my left ankle, but there was no pain in the calf muscle. I believed that it was due to sitting down for a long time in the meeting, so, I decided to go for a walk in the morning and then went on a treadmill. My physician later on told me that fever had nothing to do with DVT, but it was the first sign that something was wrong in the body.
In the flight I was not feeling well and could barely open my eyes, I was very tired. I now believe that the clot had already formed.
V: In the plane, where you could not have an access to a hospital, how did you cope with this condition?
P: The plane ride was tiresome and I struggled to keep my eyes open.
V: I understand that your condition started during an International flight. Could you please tell the details of the flight?
P: The flight was from Dubai to Washington, D.C. for duration of about 14.5 h.
V: Did someone accompany you on the flight?
P: No, I was flying alone.
V: Who diagnosed your condition?
P: I went to see my physician 2 weeks after I reached Atlanta.
V: What treatment was given to you on the plane for your condition?
P: On the plane, I did not get any treatment, since there was no physician on board. During the plane ride, I did not get up even once, because I was very tired. In my house, I walked all over, despite the clot. When I went on a treadmill at LA fitness, I had hard time breathing. So basically, I was doing everything in the wrong direction.
I think my habit of regular exercise saved me when I got clots in my lungs. I had thought that the clot would just go away, how wrong was I at that time!
V: Were you hospitalized for your condition and how long?
P: Yes, for five days
V: In the hospital were you mobilized or were you on complete bed rest immobilized?
P: Yes, I was mobilized, I was asked to walk around three times a day.
V: From my research, the patient with PE may suffer from some of the following symptoms:
- Sharp or stabbing chest pain
- Burning, aching, or dull, heavy sensation in the chest which usually gets worse with deep breathing
- You may bend over or hold your chest in response to the pain
- Bluish skin (cyanosis)
- Dizziness, lightheadedness, or fainting
- Fast breathing or wheezing
- Fast heart rate
- Feeling anxious
- Leg pain, redness, and swelling
- Low blood pressure
- Sudden cough, possibly coughing up blood or bloody mucus
Which of the above symptoms did you have ?
P: I felt the following symptoms…
- Shortness of breath that started suddenly
- Dizziness, lightheadedness,
- Felt anxious
- Leg pain, redness, and swelling
- Sudden cough, coughing up blood but then realized it was just from the gums
- Due to my fear of death, I had panic attacks. I also had low blood pressure
V: Please let me know which one of these, or any other not covered here, did you suffer from?
P: My calf muscle got tighter and I started to limp right before being admitted. My calf muscle was tender and when I pressed it, it felt still and hurt.
V: How was your PE diagnosed? Here are some of the tests that I understand that are commonly used:
- Chest X-ray
- EKG: this test measures your heart’s electrical activity.
- MRI: this scan uses radio waves and magnetic field to produce detailed images
- CT scan: this scan gives your doctor the ability to see cross-sectional images of your lungs
- Pulmonary angiography: this involves making a small incision so your doctor can guide a specialized catheter through your vein into the pulmonary arteries. A special dye is injected so that the vessels of the lung can be seen.
- Duplex venous ultrasound: this test uses ultrasound waves to visualize the flow of blood and to check for blood clots in your legs.
- Venography: this is one of the oldest specialized tests of veins in which a special dye is injected before X-ray of the leg veins are taken.
P: The following tests were performed:
- Chest X-ray
- CT scan
V:What treatment did you receive when you landed?
P: I received treatment about 2 weeks after landing. During my hospitalization I was given IV blood thinner followed by Xarelto.
V: I understand that you travel a lot in your profession. Could you give us some idea of your travel pattern ?
P: I used to go to India every 4-5 months. I used to almost travel every week to, NY, Chicago, Denver, and San Francisco.
V: Do you make a habit of walking every few hours while in the flight?
P: On the way home from Dubai, I felt so tired that I didn’t get up a single time. However, when I was on a trip to Chicago, at the airport I walked for 2 hours
V: What was the intensity of pain?
P: It was sharp, but not unbearable.
V: What was the frequency of pain?
P: The pain was continuous.
V: Did the pain radiate to other parts of the body?
P: No it did not, it was a localized pain.
V: Did the pain disturb your sleep?
P: No, it did not.
V: Could you walk despite the pain?
P: Yes, however, whenever I walked, it hurt my left calf. I thought that this pain was related to travel; however, when my wife noticed my fatigue for a couple days, she recommended me to visit a doctor.
V: Do you, or any member of your family suffer from diabetes?
P: Yes my mother, my son, and I suffer from diabetes.
V: Did you ever have fracture of the hip or leg?
P: No, I did not.
V: Did you have a major surgery, such as hip or knee replacement?
P: No, I did not.
V: Have you had any other episode of thrombosis in the past?
P: No, I did not.
V: Did you have a major trauma, or spinal cord injury?
P: No, I did not.
V: Has any of your physicians ever told you that you may have a genetic propensity for clot formation?
P: I will know soon after I visit my doctor.
V: Were you ever prescribed bed rest for an extended period of time? If yes, how long?
P: No, I was not.
V: Were you at any time immobile due to sitting in place for long periods of time?
P: For my conferences, I had to sit for prolonged periods of time.
V: Do you have varicose veins?
P: No, I do not.
V: How did you cope with this attack?
P: I experienced panic attacks due to my anxiety and searching too much information on Google.
V: Were there any complications of DVT?
P: Yes, my DVT led to PE.
V: What were the instructions the doctors gave you while getting discharged?
P: My doctor told me to take my medication on time, try to go back to my old lifestyle, and resume my normal daily activity.
V: What was your rehabilitation process like?
P: When I came home, I had to walk several times every 2 hours trying to regain my physical fitness. I wore compression socks and drank lots of water. The doctors recommended that I wear compression stockings.
V: Did you have to undergo lifestyle changes in your daily life after the attack of DVT?
P: Every day, I compare my legs 3 times a day. I try to increase my water in-take and I drink a lot of tea.
V: Were there family lifestyle changes?
P: My biggest contributor was my wife, she frequently called me and made sure that I took my medications and drank plenty of water.
V: How did your DVT experience impact you emotionally?
P: Besides panic attacks and anxiety, which I have mentioned earlier, I was OK.
V: Do you still have any lasting pain or stiffness in your leg?
P: I don’t have the same kind of pain, but sometimes I develop mild pain in the calf.
V: Are you on a long-term medication to prevent DVT?
P: Yes, I am taking the same dose of Xarelto as before.
V: What would you say to other patients who are coping with or have suffered with thrombosis in the past? Especially those who have had to go through things such as major surgeries. What advice would you give?
P: I recommend drinking lots of water, staying physically active, and taking your medication at specified times.
V: What motivates you to continue with full force in despite of your risks?
P: I am a firm believer in my capabilities, and I fight back. I do not yield to fear and I continue to improve my self-confidence. In my mind if you give up, the game is over, if we don’t practice to improve ourselves, then what’s the point of living?
V: Are you currently on any drugs or taking any special precautions to prevent this from happening again?
P: For my diabetes, I take Janumet. For my Blood Pressure, I take Olvance. For my Cholesterol, I take the generic equivalent for Lipitor. For my prevention of DVT and PE, I take Xarelto, wear compression socks, and exercise daily.
P: There is only one life you have, live it up, and don’t let this condition get in the way of what you want to do in life. Be a fighter and don’t give up.
Thank you very much Mr. Peter for your time, and I would like to thank you for giving me this privileged opportunity to talk with a PE / DVT survivor such as yourself. This information is very valuable, and will help me in my efforts to promote awareness of thrombosis in the community. The GTF plans to use this information for prevention as well as educating others who have been diagnosed with this condition.