Pulmonary embolism

Grand Slam championship.

I see this photograph of Serena Williams — at the precise moment she won

the Australian Open in January — not as a testament to her prowess


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on a tennis court but as a symbol of life.

I am transfixed by the picture because, like me, Serena almost died

from a pulmonary embolism soon after a plane flight.

For me, the joy etched in the bright colors of her photograph is a testimony

to hope and survival, to the future of a life not yet fully lived.


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In the early-morning hours of Dec. 2, I awoke with a fierce pain in my right leg. In sheer agony, I stretched it, I rubbed it — nothing helped.

It felt dead. I took two Advil and returned to bed.

Hours later, I felt fine. But at 3 a.m. the next day, the pain returned. Viciously. This time, Advil accomplished nothing. Around 7, when I stumbled out of bed and into the living room, I noticed that our intrepid cat, Toby, had opened the front door and was lurking outside.

Kneeling to pick him up, I began a slow, scary blackout, collapsing in the foyer.

The sensation felt like nothing I’ve ever felt before, as though I were dying. Moments before completely fading to black, I stumbled to the couch.

My wife reached our amazing physician, Sarah Payberah, who said: “Get to the ER immediately. You may have a blood clot.”

Soon after arriving at Presbyterian Hospital of Plano, her suspicion was confirmed: I had a clot in my right leg. But there was worse news. The clot had traveled to my lungs, creating a pulmonary embolism.

It was large enough, doctors said, that it was impeding the heart’s ability to pump blood to the rest of my body.

Shocking statistics

Since then, I have learned about pulmonary embolisms and the clotting condition known as deep vein thrombosis. (Sounds like a blues band, does it not?) One of the first questions the doctors asked in intensive care was, “Have you recently completed international travel?”

The answer was yes. In mid-November, I flew from Dallas to London and back after writing stories for The Dallas Morning News and watching the Dallas Cowboys beat the Jacksonville Jaguars in Wembley Stadium. For eight hours en route to London, and 10 back to D/FW, I sat in a coach seat, reading and listening to music. Such prolonged flights, doctors said, may have triggered the problem.

As it turns out, I have plenty of company: Williams suffered her pulmonary embolism in 2011, months after winning Wimbledon. She had recently flown from New York to Los Angeles, where she was treated at a hospital.

Basketball superstar Chris Bosh suffered a pulmonary embolism after a road trip with his team, the Miami Heat. Bosh’s athletic future is on hold.

Jerome Kersey, once a star player for several teams in the National Basketball Association, had a pulmonary embolism in February. He was nowhere near as lucky as Williams, Bosh or me. Kersey’s embolism took his life. He was 52.

Actor Jimmy Stewart, painter Frida Kahlo and television journalist David Bloom all died from pulmonary embolisms. Trim and fit, the 39-year-old Bloom suffered his after riding across the Iraqi desert in a flatbed truck during the 2003 American invasion.

Statistics about deep vein thrombosis and pulmonary embolisms are shocking.

The precise number of people affected is unknown, though the Centers for Disease Control and Prevention reports that each year as many as 900,000 people in the U.S. “could be affected (1 to 2 per 1,000).”

Estimates suggest that 60,000 to 100,000 suffer fatal episodes of deep vein thrombosis (DVT) or pulmonary embolisms (PE) each year. Chillingly, the CDC adds:

10 to 30 percent of people will die within one month of diagnosis.

About 25 percent of people who have a pulmonary embolism die with no prior symptoms.

About one-third of people with deep vein thrombosis or a pulmonary embolism will have a recurrence within 10 years.

Almost anyone can suffer a deep vein thrombosis or pulmonary embolism, but certain conditions sharpen the risk.

They include, according to the CDC, injury to a vein caused by fractures, severe muscle injury or major surgery; slow blood flow, caused by confinement to a bed; limited movement (such as a cast on a leg); or sitting for too long, such as confinement in a seat on a plane or in a car.

Women may be at even greater risk, with the CDC listing increased estrogen — caused by birth control pills, hormone-replacement therapy after menopause or pregnancy — as potential triggers.

Other contributors include a family history of deep vein thombosis or pulmonary embolisms, age and obesity.

It was my good fortune to be treated in the emergency room by Dr. Christopher Blewett, a specialist in pulmonary and critical-care medicine. To break up the clot, he ordered an infusion of tPA (tissue plasminogen activator).

Used often with stroke victims, it’s applied through an IV in the arm. It lasted two hours, during which it attacked the clot, attempting to dissolve it. Blewett warned that tPA carried risks (stroke being one), but in my case, he deemed it imperative.

During treatment, it felt as though every member of the Cowboys offensive line was squeezing my leg as hard as they could. “It’s busting up the clot,” the nurse explained.

For the next four days, I was given other blood thinners intravenously or by injection and am now taking warfarin, a generic for Coumadin, once a day for a year. I cannot eat spinach or lettuce or other green vegetables, because the vitamin K works against the medication.

Extended car trips

Blewett, who I was blessed to have as my guardian angel during my time at Presbyterian, shared with me the story of a very active, fit patient who routinely took the stairs to his 12th-floor office each morning. He often took long car trips to see his college football team play on Saturdays.

Toward the end of last season, he felt different. Sent to Blewett for what he thought was bronchitis, he got an entirely different diagnosis: pulmonary embolism.

Robin Callan, 48, an interior designer who lives in Austin, also learned how car trips can be as risky as plane flights. Three years ago, Callan and her family drove from Austin to Destin, Fla., en route to Disney World.

At the hotel in Destin, Callan fell, requiring a trip to a hospital.

Doctors applied a boot that went from her toes to her kneecap. Unwisely, as it turns out, she kept her leg elevated during the 8-hour drive from Destin to Orlando. Even more intense pain forced her back to a hospital, where she got the bad news: pulmonary embolism.

‘It’s just so frightening’

Callan blames hers primarily on the car trip, as did her doctors. She admits, though, that weight may have helped. Inspired by her own near miss, she lost 100 pounds. She continues to struggle with something I, too, battle each day: Fear that it will happen again, and the next time, maybe we won’t be so lucky.

Blewett says it’s not at all unusual for survivors to endure a kind of post-traumatic stress syndrome, manifesting itself in an ever-growing fear of mortality. “It’s just so frightening,” Callan says. “Every time I get on a plane now … I have this to cope with as well.” So how does she deal with long flights or car trips?

“I pound water like nobody’s business.”

Dehydration, Blewett says, can be a factor in triggering a deep vein thrombosis. So I was apparently making a big mistake by sitting in a coach seat for eight hours en route to London and 10 hours back to North Texas while drinking coffee, not water.

“Now I take aspirin before any road trip,” Callan says, “and do exercises in my seat. I’m even nervous going to movies, anything where I sit for more than an hour.”

Dr. Gerardo Trillo, a hematologist and oncologist with Texas Oncology, says 20 to 30 percent of his patients come in with blood clots. Some work as airline pilots. He stops short of blaming their deep vein thrombosis or pulmonary embolism on air travel, noting that thousands of pilots live in an area where two major air carriers are based. Even so, he warns against the dangers of long car trips or spending hours in a cockpit or airline coach seat, which, as everyone knows, is far more cramped than it used to be.

Exercise and avoid salt

Sitting for hours and not drinking water causes stagnation of the blood, “which can lead

to clotting,” Trillo says. “And, of course, the clot can eventually travel to the lungs, causing a pulmonary embolism.”

He recommends “watching your diet several days before you travel” and taking aspirin.

He favors a low-fat, low-salt diet, noting that salt “can make you retain fluid, making it easier for the blood to clot.”

Exercise is fundamental, he says, whether you have had a pulmonary embolism or fear that you might. He recommends strengthening the lower extremities and says compression stockings are a must. I now wear them daily because they help move blood upward through the body.

“When you sit down, gravity is causing the blood to pool in the veins of your legs,” Blewett says. “So the compression stockings literally compress the skin and the muscles and make it easier for blood to flow back to the heart and harder for blood to pool in your extremities.”

CDC spokeswoman Michele G. Beckman defines venous thromboembolism, or VTE, as “blood clots occurring as deep vein thrombosis, pulmonary embolism, or both.”

Reduced blood flow “appears to play a major role in travel-related VTE,” Beckman says, “due to prolonged cramped sitting and immobility during long-distance travel.”

She estimates the incidence of travel-related VTE “to be around 0.3 to 0.5 percent, or 3 to 5 per thousand.”

She goes on to say that “specific incidence estimates are not available for other modes of transportation but these same mechanisms and risks would apply for any type of long-haul travel [greater than four hours] where a person is sitting for an extended period of time, e.g. car, bus, plane, train.”

Casey Norton, a spokesman for Fort Worth-based American Airlines, notes that a deep vein thrombosis triggered by prolonged sitting in a seat “is not unique to one airline.”

“We encourage all passengers to consult their personal physicians about the risks associated with DVT,” Norton says. “The cause of DVT is not clearly defined, and the prevention methods are uncertain. Passengers and their physicians may consider a series of exercises and movements during travel to decrease the risk.”

American Airlines is concerned enough about the risk to address it on its website.

It lists the following precautions as being helpful: wearing compression stockings and loose-fitting clothing. Passengers should “avoid crossing the legs at the ankles or knees.”

They should “drink adequate non-diuretic fluids,” meaning water, juice and milk.

The website advises changing leg positions, periodically moving and stretching “legs and feet while seated [by rotating the ankles and flexing and stretching the calf and thigh muscles].”

The aftereffects

Of course, these days, the airlines are in a dicey position. Safety and security demand that passengers stay seated, with seat belts fastened, as much as possible. Not everyone can sit in an aisle seat — the only kind I will ever sit in from now on.

So what happens after you incur a deep vein thrombosis or pulmonary embolism? In my case, it’s blood thinners for a year. For Callan, it was six months. It varies, depending on the patient.

Though my doctors don’t believe that age (I am 63) or weight caused my condition, I have lost 35 pounds, and now take a far more vigilant approach to travel.

As for the fear, well, it doesn’t hurt to look at that picture of Serena Williams. She, as much as anyone, reassures me that you can survive and flourish in the aftermath.

The match is not yet over for me or Serena.

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