Blood Clots are a Silent Killer

The medical facts of a silent killer and my personal experiences.

The following is the speech originally presented in 2007 and then posted here on this blog.  Republishing as part of: DVT AWARENESS MONTH.
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I. 200,000 Americans will die throughout the year from deep-vein thrombosis (DVT) and/or pulmonary embolism (PE); more than from drunk drivers, AIDS, breast cancer or homicide.

DVTs are treated in 2 milllion Americans each year. Of those patients developing a first-time diagnosis of DVT- 75% were not aware of the risk- factors prior to the event and were unaware that there are preventative measures.

I have had multiple episodes of DVT since 1975 and suffer from resultant chronic post-thrombotic syndrome (PTS). I have lost a kidney and the majority of functional vein capacity in one leg from below the knee to above the hip.

II. Risk Factors
A. Inherited or acquired predisposition to thrombophilia.

1. Thrombophilia is the tendency to clot or a blood-disorder. As a child I was fascinated with the Queen Victoria and her descendants- one in particular was Prince Alexei of Russia, a hemophiliac, whose mother's reliance on Rasputin to treat his bleeding helped bring about the end of Imperial Russia. Other than that- I had never heard of blood-disorders and to be honest- I found their murders much more fascinating.

It wasn’t until 1998 that there even existed a test to determine the most predominant clotting disorder,  Factor V Leiden. Before that time, many died of clots with their family not knowing why they had clotted.

I was diagnosed with Factor V Leiden heterozygous (one of two mutated genes) in Spring of 2007. The tests haven’t been performed yet to determine the presence of Proteins CNS and can only be drawn when I am off of blood-thinner, a risk in and of itself.

2. Five% of Caucasian Americans and 1% of African-Americans have FVL.

B. Cancer, Trauma, Advanced Age or Unhealthy Life Habits or Situations

Autoimmune disorders such as lupus, acute medical illness with restricted mobility, and certain heart or respiratory diseases can cause blood-clots or pulmonary embolism.

1. 60% of patients undergoing major surgery, such as hip replacement, who remain immobile in bed after operations without preventive treatment may develop clots

2. Age, smoking and obesity contribute greatly in the episodes of DVT.

3. Airline passengers on long-haul flights call it “economy class syndrome” and office workers that remain seated at their computers for extended periods of time without taking breaks (often called “desk jockeys”) account for 34% of DVT/PE.

C. Women’s Issues
Women are at a higher risk for DVT. Birth-control pills, Pregnancy and Hormone Replacement Therapy (HRT) are all contributing factors.

1. Healthy women taking oral contraceptives have a three- to fourfold increased risk of developing a DVT or PE compared with women who do not take birth control. Women with factor V Leiden who take OCPs have about a 35-fold increased risk of developing a DVT

2. PE is the leading cause of maternal death associated with childbirth. A woman’s risk of developing VTE is six times greater when she is pregnant.

My first known episode of DVT was at age 24 during childbirth, with repeating and devastating occurances in two additional pregnancies. While doing family genealogy it was discovered that one great-grandmother died not long after pregnancy. If you are researching family medical history- In the “old days” it was often called “milk leg”.

III. Symptoms

Often called the “Silent Killer” because as many as half of all DVT episodes
produce minimal symptoms. A number of other conditions display similar symptoms and mask the true culprit until the misdiagnosis can be corrected or results in death.

1. Leg pain, swelling (called edema), tenderness, discoloration or redness of the affected area and skin that is warm to the touch are the most significant of DVT presentations.

2. PE events are characterized by chest pain, shortness of breath, heart
racing or pounding, passing out or sudden death. These episodes can be a result of a fragment of clot breaking loose from the vein wall and traveling to the lung or a clot forming directly in the lung.

3. Symptoms frequently misdiagnosed include: charley horse, muscle sprain, twisted ankle, sore or achy muscles.

4. PTS or post-thrombotic syndrome occurs in 20-50% of patients after a dvt-event and usually is established within the first 2 years after the acute thrombotic episode. It is a disabling chronic condition consisting of leg pain, swelling, hardening or calcification of veins and skin and ulcers.

IV. Diagnosis

While there is a blood-test to determine if the blood is too thick- only x-rays or ultrasound are thorough in their conclusion.

1. Venous ultrasound is the least invasive of the tests.

2. Contrast Venograms are x-rays that display the clots by injecting radiographic material into a superficial vein.

3. EKG, Chest x-rays, arterial blood-gas and lung scintigraphy for PE’s.


V. Treatment
Treatment for DVT, PE and PTS are limited - all medications increase the risk of bleeding, allowing for bruising and are one of the hardest drugs to manage with interactive medications.

A. For clots caught early in development- clot busters (tPA) may be administered.
B. Blood thinners take a while to regulate and require rigid prothrombin monitoring. Foods rich in vitamin K (leafy green vegetables), soybean, green tea and a a variety of herbal supplements are to be avoided.
1. Heparin injections may be given through IV or injections.
2. Lovenox injections must be given subcutaneously (in the belly).
3. Coumadin or the generic , warfarin is commonly called rat-poison.
C. Leg elevation with compressive therapy and/or extremity pump.
D. Compression stockings or TED hose are the mainstay of therapy- many times the extremity must be custom fit which takes additional time, is expensive, and not covered by many insurance's companies including the Medicare system.

VI. Famous celebrities having DVT or PE.

A. Survivors
1. Vice-President Dick Cheney
2. former Vice-President Dan Quayle
3. HIllary Clinton, former first-lady and NY senator
4. Lainie Kazan, actress “My Big Fat Greek Wedding”
5. Terry Francona, Manager Boston Red Sox
6. Victoria Principal, actress “Dallas”
7. Ian Anderson, lead singer & flutist for “Jethro Tull”
8. Bonnie Bernstein, sports-journalist ABC-Sports and ESPN

B. Deaths due to blood-clots or related events.

1. David Bloom, NBC journalist, FVL
2. Shawntinice Polk, University of Arizona basketball player
3. Tammy Wynette, Country singing star
4. Harry Agganis, aka “the Golden Greek” Boston Red Sox
5. Dan Blocker, actor of “Bonanza” fame
6. Cesar Romero, actor played the Joker in TV-series “Batman” aka “The Latin Lover” and “Cisco Kid”

CONCLUSION: Deep Vein Thrombosis (DVT) is a common but elusive illness that can result in suffering and death if not recognized and treated effectively. You can prevent DVT- Don’t smoke! Exercise regularly! Be aware of subtle symptoms if sitting for long periods of time.


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SPEECH PRESENTED
HENDERSON STATE UNIVERISTY
ORAL COMMUNICATIONS
SUMMER II- July 16, 2007

Title: Deep Vein Thrombosis (DVT) OR "How Do People Die?"

GENERAL PURPOSE: To inform of the silent killer: DVT

SPECIFIC PURPOSE: To inform of the risk and management of DVT

CENTRAL IDEA: Causes of hyper coagulability leading to the risks of Deep-Vein Thrombosis (DVT) and/or Pulmonary Embolisms (PE) occurance, diagnosis and treatment, and to raise general public awareness.

SUPPORTING MATERIALS:
1. Factor V Leiden/thrombophilia Support Site: http://www.fvleiden.org/
2. DVT Prevention site: https://www.preventdvt.org/
3. Pulmonary Embolism (PE)
http://www.merck.com/mmhe/sec04/ch046/ch046a.html
4. Venous Thromboembolism: http://www.clevelandclinicmeded.com
5. National Library of Medicine and Health http://www.ncbi.nlm.nih.gov
6. http://ask.yahoo.com/20051128.html, National Vital Statistics Report, 2006
7. http://www.genome.gov/15015167

Factor V Leiden and the consequences....

Just what is Factor V Leiden (or FVL) and why am I writting about it now?

Visit the link above for "what" it is (in layman's terms). The reason I'm focusing on that today is because it explains some of what is going on with me. Not that I'm anxious to add yet another disease or illness to my ever-growing list.. but, had the test been around years ago and had I been tested- I might not be in quite the predicament I find myself in today.

For instance... I probably wouldn't have tried to bear children. I would have definetly found a different gyn to treat more agressively the female organs rather than believing the old rule of thumb "if it ain't broke-don't fix it" cuz it WAS broke and should have been out of there a long time ago.

I would have been on coumadin therapy for life after the first round of clots and the bum leg might not be in such bad shape.

I would have been a lot more astute about recognizing gall-bladder attacks for what they were. Yes- these may be related. Sister- go and get yourself checked NOW. If you need your g/b out- we'll do it together! Surely, the surgeon could offer a two-for-one special?? LOL!

I would have given more consideration to chasing dreams earlier in life rather than waiting til a more opportune time. Now that I have the time- I don't have the phsyical stamina or "shape" to chase them. Oh, well.

At least now- TODAY, I know. Finally. Definitevely. Without a doubt. I'm a FVL carrier/patient and hope that there aren't any other mutations to follow... problems with that mean that they cascade and cause certain other complications to other body parts. Joy.

Questions? Comments? Prayers? All of the above.

a Happy kind of Tired!

or... random thoughts from an exhausted scrap-mama that should be asleep right now!

Yesterday, I had the pleasure of joining several of the ARkansas Scrappers in Central Arkansas for a day trip of chit-chat, lunch and scrap-shopping! What FUN! And, now- I'm so keyed up I can't sleep! Being with friends is so invigorating! Putting my hands on new scrapbook papers has set the creative juices to flowing! Pictured above: Melissa (Mrs C), Ally & Rachel, Carol, Gladys, Sally, Wanda and Janet- thanks to Wanda for being our official photographer.

I've tossed and turned since around 2 o'clock with all kinds of ideas swirling! Ideas for themes for upcoming events: DAR (I'm the new Constitution Week co-ordinator); two State Swaps pages I've yet to finish; the Ferncliff retreat (can I even REMEMBER them now??); and of course- home decorating!

Oh, and before I forget it! I lost yet another 1.5 pounds this week-- and that was a surprise as I weighed-in at a totally different time of day (due to the parking nightmare thanks to Car Wars held at War Memorial Stadium). First of all- I've not been exercising much (cuz of the dratted leg/foot), and secondly because I ate prior to weigh; then there's always the fact that at different times of the day the body just fluctuates- so I was most pleasantly surprised to achieve this! The weight loss has slowed down in recent weeks; but, I'm still a LOSER and next will plan on breaking 75 pounds!! WHEW! What a relief!

Oh, and lunch was at one of the Hunan restaurants in NLR (and the little bit of veggies I snatched that weren't from the salad bar) were delicious! Mmmmhhhh! No fried foods- I just couldn't bring myself to do that yet. I've almost gotten this mind-set of an obsessed weight-conscious teenager.. I guess better late than never, right???

I had totally forgotten about FORTUNE COOKIES! Ahhh! Man- I miss junk carbs! Anyway-- friend, Gladys opened hers and decided I needed her fortune! Thanks, Gladys! It read: "You have a charming way with words and should write a book"! Well-- I love the word "charming" and I've read a few books.. does that apply?

Totally off the subject (but very near to my heart) is Sam and the other cats! Since Katrina has discovered "the great outdoors" and that she needn't be afraid of the DOOR to that wonderful world (or how to ask to get out and then back in again) she's gotten fiesty-er. She wallops poor old Samson when she comes back in- just pesters the bee-geebies outta him... poor Sam. But, he seems to have also accepted the newest outside-feline, "Tabby Tom", and when he comes in (which he LOVES to do!) he usually hunts up Sam and just hangs out with him! Odd cat-behavior for sure- but, I'm so glad that Sam seems to have "friends" in that weird cat kind of hierarchy.

Before I dozed off last night there was a special on TV about "Medical Mysteries" and one of the features was on these two young men that are both totally sightless but have developed "clicking" methods to allow them to triangulate (think sonar) sounds and judge what and where objects are. The really amazing thing was that they are so attuned to their surroundings that they could even determine the texture and type of building materials of new environments (such as a fence that was made of board fencing) rather than a brick structure from a distance of over six feet away. I mean to walk across a street and just by clicking the tongue and listening to the differences in how the sound returns and make path adjustments without falling down and tripping over obstacles is amazing! These two young men have never met, yet they both discovered the clicking methods on their own-- WOW!

I don't think Sam needs to "click".. but, he can sure identify a warm soft spot from a few yards away... he'd taken refuge earlier during the night (between me and Byron) when Katrina wanted to "rumble". He's followed me in here now and has claimed my lap and is purring almost loud enough that I need to turn up my iTunes.

Ah... this a happy kind of tired. Nat King Cole and Sam.

Is Life Nothing but a Numbers Game??

Somedays... perhaps!

Try this number on for size. One hundred eleven...

or- one hundred two *depending on the read-out you look at. Yup. You guessed correctly if you thought I was discussing the temperature! But, HERE? in ARKANSAS?? OUCH! That means with humidity factored in- it actually feels like 115 degrees out there!

*the higher figure was actually from the Weather Channel's site a few moments ago and the lower figure is because I could barely believe it and I ran to our handy-dandy outside thermometer that actually reads that figure and transmits it to me inside so I didn't have to go out the door again and actually feel it for myself! But- I have already today and I'm not going back out if I can help it! LOL!

If you guessed that I was meaning my weight-loss... well.. .that's another story.

Today's number from clinic is a ZERO.

No loss.. but, no gain either! This is the first time I've had a week with NO loss!

But, the encouraging number news is SIXTY-SIX. I'm still sixty-six pounds lighter than from where I started in January! So, all numbers aren't necessarily bad either in the great big scheme of things.

Here's another number for ya.... NINETY-SEVEN.

Yup! My grandmother, Mae, turns ninety-seven tomorrow! For someone that has seen an awful lot in her lifetime and relatively few personal illnesses- she's in remarkable shape! Except for today. She has a horrible sinus ailment that is causing fluid in her ears and she's having some vertigo. We had to cancel her "cousins" party in LR because of it- but, this afternoon she seems to be toughing it out (as is her typical character) and won't allow much help. We're all staying pretty close by in case she should get "tippy" and require anything.

Oh! Another number! TWENTY-FOUR!

That's the number of roses she received from a generous grand-daughter delivered by FedEx this morning from Hallmark Florists. And, MAN! They are GORGEOUS!

Another number coming up this week. TWENTY. Kid will turn two decades old on Monday.

That's all the numbers of interest I can think of right now.. must be the heat!

Six; Twenty-six point one

I'm melting, I'm melting!!

haha... no! It's NOT that hot here, YET! Though it was 80-something yesterday!!

I kinda like the numbers this week... and before you go thinking I'm meaning Racing Numbers... not those either! Though it is Oaklawn season and as "on top of the world" as I'm feeling I'm sure I'd be able to pick some good numbers!

I mean.... numbers accomplished.

For me- it's numbers shed. Lost. Left behind. Six pounds this week; Twenty-six total for six weeks.

My most serious EVER endeavor to deal with some serious health issues began on January 16, 2006. With the UAMS very successful Behaviour Modification program addressing weight loss, I'm making some strides towards a healthier lifestyle. I actually made the decision some months ago- but, the program dictated a start date in January. So... on January 10th, I weighed in a whopping 296 pounds. UGH. I've really had a struggle even admitting to that number. So there's a milestone in and of itself... that I can actually type that number (and not delete it!)

Turning a New Leaf

We humans hate change. I, myself- abhor changes. Most of them, anyway. I used to think I looked forward to changes- but, the older I become, the more I realize I prefer certain things certain ways and am unwilling to change them. That's not to say that I'd don't love a new operating system or a new hair-do.... I mean in the area of personal habits.

I DETEST the word: diet. Of all the dirty, filthy words in the English language- that ONE word is probably the word I resent hearing the most. I can watch an R-rated movie and nowadays (used to this wasn't the case) I don't even flinch when I hear the f-word. But-- the "D" word.... oh man! It sickens me, turns my guts and now it's a way of life I'm leading. How ironic.

I guess the first step to desensitizing myself to that word was saying it aloud and frequently in everyday conversation. Just like Elle's character using legal jargon in "Legally Blonde"! I still don't really appreciate the deeper meaning of the word calorie and how a calorie is the unit standardized to measure food energy. I mean.... a food item full of calories, such as a candy bar; should (and usually does) create a gigantic burst of energy. So if all things being equal in our little universe (recall the theory of for every action there's an equal and opposite reaction); then, WHY do our bodies STORE that energy rather than expending it immediately? Seems to me that if you "saved" it; it would lessen the amount of potential energy. But, NOOOO- if your body "saves" that energy it packs it into unwanted fat-packets and they do nothing but slow the rest of the energy levels down.

Oh, well-- that's all rhetoric and too bad that even the act of expending extra verbage doesn't do anything towards counting towards caloric output. So... it's off to the bike for me! I can hardly wait for the first two weeks to be over.. then, I can have some veggies again!

Admissions... and New Beginnings

Even when I was in junior high-- I hated the course of Health & Safety. Health and Science. Health and Anything. I abhor the obsessive talking of diet and the study of health. The time has come and now- I'm going to have to LIVE it. Eat, drink, breathe and LIVE healthy and a diet.

Last night I went to the Sign-up Seminar for the UAMS Weight-Loss Program. I had two really good escorts. My daddy and our family friend, Sandy. Sandy has been on the program since June and has successfully lost over fifty pounds. Yeah for Sandy!! Both are "in my boat" and both are supportive. Thanks- guys!

officially I begin the program in January.The more basic process of self-evaluation and introspective reflections begins now. I do look forward to being healthier. I really look forward to feeling better. I don't look forward to meal replacements. I hear they taste pretty mundane. Even the chocolate one. I don't look forward to admitting the truth leading up to my pathetic situation.

A Lie.. and the Truth....

For some time now... there has been elephant in my house- and I can no longer ignore or avoid acknowledging it. It used to be a silent creature that was just "danced" around... now, it is a real elephant and taking up too much floor space. It's not like the other critters in our house that are cute, cuddly and considered pets- oh no! It's ugly and pathetic and needy. Admitting it is both painful and a relief. It has a name, OBESITY. And.. it has a number. 296. YIKES! Did I just admit that, too?? Oh, geez. That's like the most heavily guarded secret in the Queen's court. I almost feel like I'm betraying myself by writhing this.

Two bad habits (more dirty little secrets) I'm having to give up are convenience foods and binging. That's the lie I've been living recently. Lies in the sense that what I'm doing (and eating) isn't going to "hurt" me. It has... and before I swallow (literally and figuratively) any more of it- I'm going to face it.

I am going to deal with it, though. And, I am going to choke down the awful truth- as bitter as it may be... it can't be any worse than the meal replacement stuff. The "stuff" is some powdered concoction of 800 calories of 125% of the RDA and can be made into liquid shakes, baked into chips, grilled (as in pancakes) and more. Oh, joy! *said sarcastically* Now, I get to go to cooking class.... grrr..... more of my favorite past-times... NOT!

What a vicious cycle...

pain = not being consistent
not cooking real food consistently = convenience foods
convenience foods = unsatisfied well-being
unsatisfied well-being = binging on more convenience foods
convenience foods & more binging= more pain

What a paradox. And, it's not really as simple as all those equations either. But- it's about as basic and concise as I'm able to grapple with today.

And, so-- I start fresh. Now. Today. In the present time. Like the lyrics from the Tracy Chapman song "New Beginnings".... Starting all over. Start breaking the cycle. Start breaking the chain. Starting all over. Make new symbols. Make new signs. Make a new language. Easier to redefine the world by starting all over.

And, calling my elephant "Obesity" is a great beginning.

Prayers requested. I'm a pretty weak and pathetic soul when it comes to facing myself and my elephant.

Harsh Realities

The cold hard truth of the matter is: I am obese and I need to loose 100+ pounds. In light of all the other medical complications- one kidney, blood clots and high blood pressure to name a few- the obese factor could be life-threatening.

How I got to this point and what happened is all relative. Pun intended.

My plan to address this predicament I've put myself in- is also dependent on the relatives- family that is.

Neither of those statements are made to point blame- but, rather to define how vital my dependence on them actually is.

Now, the options.

Traditional diet programs. Traditional in the sense that it's primarily an individual odyssey with me doing all the counting and the counseling on my own and finding the inner will for the necessary exercise. Considering that self-discipline and meal-planning aren't exactly my strong suit.

Planned weight-loss programs. This would include: Weight Watchers (which I had success with back in the 80's); Jenny Craig, Nutrasystems, etc. Might be an option if I commit to going to the once a week meetings and follow the guidelines- I don't know what effect their foods and or supplements might have on the kidney.

The Supervised Weight Loss Program like the one offered by UAMS that Governor Huckabee (see his book at the above link); and now his cousin, Sandy, is in that is so successful. This program is combined with weekly blood panels being drawn and monitored with counselors and classes. The success rate and the rapid loss that the majority of participants experience is impressive. The reality is it is hard on the kidneys. I could very well not be a candidate for this program.

I've got some tough choices ahead of me. And, some tough pounds. Prayers requested.