Just after completing my rehabilitation from the onset of transverse myelitis, another medical emergency struck. I was walking with a friend from my office to lunch one Monday afternoon when a sharp pain in my chest doubled me over. I recovered fairly quickly but it left me a little lightheaded and a little short of breath. We went on to lunch. After we ate, I began to notice that it hurt when I took in deep breaths and that I seemed to have sharp pains in my back. Based on these symptoms, I decided to go to the Emergency Room to be checked.
Because of my history of heart disease, the emergency physician first suspected more cardiovascular problems based on my symptoms. And, of course, since I had been diagnosed with Stage IV melanoma, there was the suspicion of a possible relationship to that diagnosis as well.
During the physical exam, the doctor inspected my legs for evidence of a deep vein clot — an area that’s tender, red and warm. He listened to my heart and lungs and checked my blood pressure and other vital signs. Blood was drawn for tests. An EKG and chest x-ray were performed. And finally I was sent to get a CT scan.
The results of the blood tests did not show anything significantly out of the normal ranges. The EKG looked OK and the chest x-ray did not show anything conclusive.
***But, the CT scan showed multiple small clots in both of my lungs. These clots are called pulmonary emboli. A pulmonary embolism is when one or more pulmonary arteries in your lungs become blocked.***
In most cases, a pulmonary embolism is caused by blood clots that travel to the lungs from the legs or rarely other parts of the body (deep vein thrombosis, or DVT). A later ultrasound would show that there were no clots in my legs, thus ruling out the most common cause. Although anyone can develop deep vein thrombosis and pulmonary embolism, factors such as immobility, cancer and surgery increase your risk.
Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clots (almost never single) and your overall health — especially the presence or absence of underlying lung disease or heart disease. High blood pressure and cardiovascular disease make clot formation more likely.
You’re at higher risk if you or any of your family members have had venous blood clots or pulmonary emboli in the past. This may be due to inherited disorders that affect blood clotting.
***In addition, certain cancers — especially pancreatic, ovarian and lung cancers, and many cancers with metastasis — can increase levels of substances that help blood clot, and chemotherapy further increases this risk.***
Women with a history of breast cancer who are taking tamoxifen or raloxifene also are at higher risk of blood clots.
Blood tests were also done to determine whether I might have had an inherited clotting disorder. While I did not have any of the most common clotting disorders, I would later learn that our family likely has a genetic link to a disorder involving excess factor viii in the blood.
Anticoagulants are prescribed when a pulmonary embolism is diagnosed. Normally, when an injury that causes bleeding occurs, the body sends out signals that cause the blood to clot at the wound. The clot naturally breaks down as the wound heals. A person who is prone to abnormal clotting has an imbalance between clot formation and clot breakdown. Anticoagulants prevent the production of certain proteins that are needed for blood to clot. Although anticoagulants can prevent new clots from forming and prevent existing clots from getting larger, they do not break up or dissolve existing blood clots.
***Heparin and warfarin are the two main types of anticoagulants used to treat pulmonary embolism. In the hospital, I was given heparin. Heparin is an anticoagulant given by injection to the stomach. It immediately affects the clotting system in your body. Low-molecular-weight heparin (LMWH) as initial treatment is usually preferred because it can be given as an injection once or twice a day, and it may be given at home, which allows you to leave the hospital earlier. I easily learned how to give myself the heparin injection and was able to be discharged from the hospital on the third day.***
At the appropriate point in my prescribed course of heparin, I was prescribed warfarin. It is an anticoagulant that is taken in pill form. It is usually started while you are still taking the heparin injections because it takes several days for warfarin to build up to a level that’s effective. When the warfarin is at a proper level, heparin is stopped and treatment with warfarin continues.
Typically, warfarin is given for at least 3 months after pulmonary embolism to reduce the risk of having another blood clot. Treatment with anticoagulants may continue throughout your life if the risk of having another pulmonary embolism remains high.
***My warfarin therapy continued for a period of about 6 months. I continue to be closely monitored for any signs of further clots.***