Awareness of deep vein thrombosis can save lives
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Chris Gathagan, athletic director, physical education teacher and basketball coach at St. Edmund's Academy in Squirrel Hill, was having "a very tough time breathing" and "a really tough time going upstairs" over the Labor Day weekend of 2006. He also had a lot of pain in his left leg that felt nothing like the discomfort he'd suffered because of arthritis or injury that required three knee surgeries.
Jocelyn Mazzoni woke up one morning in mid-March 2004 and found one leg swollen to two to three times the size of her other and hot to the touch. Ms. Mazzoni, then 19 and a student at John Carroll University near Cleveland, also didn't feel well. "I felt very light-headed, very weak," she said.
David Bloom, an NBC war correspondent embedded with the U.S. 3rd Infantry Division as it approached Baghdad in the war with Iraq, was suffering from leg cramps the night he called his wife, Melanie, in April 2003.
Different times; different places; different symptoms.
All three had deep vein thrombosis, which is a dangerous blood clot. DVT occurs most commonly in the lower leg or thigh but can occur in other large, deep veins.
In the cases of Mr. Gathagan and Mr. Bloom, a part of their clots broke off and traveled to the lung, a condition called pulmonary embolism.
Mr. Gathagan, who had pulmonary emboli affecting both of his lungs, was admitted to a hospital, treated with blood thinners and recovered. Mr. Bloom, only 39 and the father of three young children, died a few days after he told his wife about the leg cramps and before he could get help.
Ms. Mazzoni, who had multiple clots, also was put on blood thinners. However, she recently developed three new clots, one of which blocked the vena cava, and she said she had two stents surgically inserted to help keep blood flowing through what is the largest vein in the body.
Neither the three cases of DVT nor Mr. Bloom's death are unusual.
According to the Office of the Surgeon General, DVT and pulmonary embolism affect an estimated 350,000 to 600,000 Americans a year and contribute to at least 100,000 deaths. The Coalition to Prevent Deep-Vein Thrombosis paints an even more dire picture, saying DVT occurs each year in about 2 million Americans, some 600,000 of whom are hospitalized. According to Mr. Bloom's widow, now the full-time spokeswoman for the coalition, some 300,000 of those who develop pulmonary embolisms die.
"It takes more lives than breast cancer and AIDs combined," Mrs. Bloom said. "It's incredibly serious ... [yet] nobody has ever heard of it."
Mrs. Bloom and the coalition are trying to change that. She travels the United States to tell people her personal story and the facts of DVT. This year she's often accompanied by the DVT RV, which is equipped to give tests assessing people's risk of developing the clots.
Both will be in Pittsburgh Saturday for a day of DVT-related events at the Western Pennsylvania Hospital and the Pittsburgh Mills mall.
The leading force behind the event was West Penn hematologist Dr. Margaret Kennedy, medical director of the Anticoagulation Management Center at the hospital and associate director of the hospital's Hemostasis and Thrombosis Laboratory. She describes herself as "passionate about this disease."
"Any chance we have to teach the public not to ignore the symptoms is a chance to save a life," Dr. Kennedy said.
"This disease can be very tricky," she added in an e-mail interview. "There can be quite a few other things to give you leg discomfort, redness, or swollen ankle. If a patient complains of chest pain, an EKG gets done first -- even a 25-year-old woman coming to the emergency room is mostly suspected of a coronary event."
The West Penn event starts with a 9 a.m. continental breakfast; Ms. Bloom will speak at 10 a.m., and after that, Dr. Kennedy will lead further discussion of DVT. Attendees also will be afforded demonstrations of venous Doppler technology, which can be used to detect DVT.
From 9 a.m. to noon the DVT RV will be parked near the hospital's South Millvale Avenue entrance in Bloomfield and open to the public for computerized tests that will assess their risk of having or developing DVT. From 3 to 5 p.m., the van will be parked at Pittsburgh Mills.
"DVT is a disease of multiple risk factors," Dr. Kennedy said. They include genetic clotting disorders, oral contraceptives or hormone replacement therapy, pregnancy, obesity, cancer, and prolonged travel without moving around.
But, she added, "hospitalization and surgery are likely the most common [causes]. This is why raising awareness among the public is so important.
"I think if the surgeon general puts the cancer warning on the cigarette boxes, he should be putting the warning of blood clots on the main entrance to all the hospitals, because this is where they mostly happen."
Neither Mr. Gathagan, Ms. Mazzoni, nor Mr. Bloom had been hospitalized at the time they developed their clots.
Mr. Gathagan's case, Dr. Kennedy said, "is grouped as an idiopathic, a we-do-not-know-why. I suspect the fact he was somewhat overweight played a role. He was very good about following my advice of shedding some pounds. His testing did not show any familial predisposition."
On the other hand, Ms. Mazzoni, who has taken blood thinners since her first incidence of DVT, has protein S deficiency, and May-Thurner syndrome.
"Each one of us has a natural blood thinner in our blood -- protein S and C -- that provide a counterbalance to all the proteins in the blood that make the blood clot," Dr. Kennedy explained. "If you do not produce enough, you will likely develop a venous clot in your lifetime, particularly at the time of increased risk. Jocelyn was a cheerleader and had an intensive training session the night before she woke up with the swollen leg."
May-Thurner syndrome, named after the two doctors who first described it, is more common to women and always affects the left leg, Dr. Kennedy said. It is caused by a thick-walled artery running atop a thin-walled vein that pushes the vein against the pelvic bones on the left side. That stops the flow of blood back to the heart, and that causes blood to form a clot below the obstruction.
"In her case, blood thinning was not enough," the doctor said. She had her recurrence while taking anti-coagulants, thus forcing the placement of the stents in the pelvic vein and the use of thrombolytics, or "clot-busters."
Ms. Bloom said her husband's clot was caused by multiple risk factors. An autopsy showed he had an inherited blood coagulant disorder called factor V Leiden. He had spent hours cramped up on airplanes flying between New York and the Middle East and while embedded with the Army, slept curled up in the tank. He also was dehydrated, she said, "because they were running out of water.
"He called me in the middle of the night, whispering ... [and said] 'I'm sleeping on top of the tank. ... I've got these cramps," Ms. Bloom said. "It sounded so innocuous. I said, 'You should get back in the tank.'
"He died two days later."
The public is invited to the West Penn event. For more information, call 412-362-8677.</</span>p>
First Published May 20, 2009 12:00 am