Monday, March 7, 2011

Serena Williams and Pulmonary Embolism—Who's at Risk?

Serena Williams is recuperating at home under medical supervision from a health scare she described as “extremely hard, scary and disappointing” in a statement issued March 2. The tennis ace and 13-time Grand Slam champion underwent emergency treatment for a hematoma brought on by a pulmonary embolism (a blood clot in the lungs). Here’s a guide to this dangerous and surprisingly common condition.

What causes pulmonary embolism and how serious is it? Pulmonary embolism occurs when a blood clot lodges in the lungs, a potentially life-threatening situation. Typically the clot forms in blood vessels in the leg, pelvis, arms or heart. If the clot comes from the arms or legs, it’s described as deep venous thrombosis. The clot then floats through the bloodstream to the lungs, passing through vessels until it gets stuck in one of them, obstructing blood flow like a clogged pipe. According to the Centers for Disease Control, up to 200,000 Americans suffer pulmonary embolism (PE) each year, and nearly one-third of them die.
Learn more about pulmonary embolism.

Who is at risk? PE can strike at any age, but certain factors magnify the threat, including travel. Sitting for prolonged periods in a car or airplane slows blood flow in the legs, upping risk for clot formation. This may have been a culprit in Williams’ case since she reportedly developed the pulmonary embolism soon after a flight from New York to Los Angeles. Other risk factors include immobilization after a broken bone, stroke or other illnesses that leaves the person confined to bed, obesity, heart disease, cancer, smoking and injury or trauma to the legs. Recent surgery is another risk factor, which played a role in my own pulmonary embolism, and may been an issue for Williams, who had recently undergone treatment for a foot injury.  PE is more likely during pregnancy or in women who take birth control pills or use estrogen therapy for menopausal symptoms, particularly if they smoke or are overweight. 

What symptoms does pulmonary embolism cause? Warning signs vary but among the more common are chest pain (particularly if it starts suddenly and intensifies during a deep breath), coughing up blood, unexplained shortness of breath, dizziness or fainting, and anxiety or a sense of dread. These symptoms warrant an immediate call to 911 or trip to the hospital since PE is a potentially life-threatening emergency.
Check out this 3D video on how blood clots occur.

What’s the treatment? People with PE typically receive oxygen, often through tubing inserted into the nostrils or a mask. In severe cases, a ventilator may be required. Blood-thinning medications, such as heparin, are often  administered by IV. For patients who are critically ill or have large clots, doctors may turn to clot-buster drugs (thrombolytics) or perform surgical procedures, such as removing the clot via a thin tube snaked through the blood vessels to the lungs. If someone suffers PE more than once, as occurred in my case, doctors may advise blood tests to check for clotting disorders.

What can I do to prevent PE? On long flights, get up and walk around the cabin every hour. Also avoid crossing your legs for extended periods. During car trips, stop and stretch your legs at least every two hours with a short walk to help prevent clot formation. Before surgery, discuss blood clot prevention steps with your doctor. Depending on your risk, you may be treated with blood thinners before or after the operation. You may also be asked to wear compression stockings or be treated in the hospital with air-inflated cuffs that automatically massage your legs every few minutes, helping push blood through the vessels. For most people, one of the best ways to prevent clots after an operation is to resume physical activity, such as walking, as soon as possible after surgery.

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