Cheney Is Just in Time

March is DVT Awareness Month. And, just in time, VP Cheney suffered DVT after his recent mega-trip (25,000 miles in 9 days).

DVT (Deep Vein Thrombosis) is a blood clot that generally forms in the leg, usually when someone is immobile for an extended period of time. It is sometimes called "economy class syndrome" because sitting on a plane for hours is one of the best ways to get it. And sitting in first class does not exempt you (Cheney was traveling on the luxurious Spirit of Strom Thurmond, and the even plusher Air Force Two).

There are lots of theories about why being on a plane is worse for DVT than, say, sitting in a movie theater. Dry air, low air pressure, a tendency to be cold have all been suggested. If you are sitting on a plane, definitely stay warm and stay hydrated. (I bring an electrolyte replacement drink like Gatorade.)

What causes DVT? Some doctor will no doubt correct my over-simplification, but it has to do with the fact that there is no direct pumping of blood back towards the heart (in the veins) from the legs, other than the natural pumping action that occurs when the legs and feet are moved. Given immobile legs and other conditions, a clot (thrombosis) can form in the deep veins of the leg. If you find yourself on a plane, make sure you get up and walk around at a regular interval (every 30 minutes or so). Flight attendants don't like it, but tell them your doctor told you to. (Dr. Insomniac here!) If you can't get up, make sure you do some leg exercises in your seat. And don't cross your legs.

If a mysteriously painful leg that may even become permanently debilitating weren't bad enough, it is much worse if the clot breaks loose (an embolus) and travels to the lungs where it lodges. This is called a pulmonary embolism (PE), and it can kill. No kidding, this is one of the top killers in our society.

Many DVTs and PEs occur in the hospital, when patients are immobile for an extended period of time. That's where mine happened. There are a couple of very simple things that can be done to prevent legs clots while you are hospitalized. One is an anti-coagulant called heparin. The other is a set of compression stockings that actively massage the legs and encourage good circulation. If you have prolonged bed rest, immobility, surgery, or fractures, make sure you tell your doctor you want these measures to be taken.

Six months after my incident, when I was taken off the anti-coagulants, I asked my doctor why these measures weren't taken in my case. I was totally immobile because of three fractured vertebrae, and would seem to fit the risk profile. However, he said it was not within the standard of care, and even then it still wasn't. Pretty scary.

One of the big issues with DVT is that it is often misdiagnosed. A patient may think he or she pulled a muscle or has a cramp or some other minor annoyance that will go away in a few days. However, if the DVT goes away, it may go someplace you don't want, namely your lungs. Even if your doctor doesn't suggest it, if you have such a pain in the leg and you've been on a plane trip (or extended car trip) recently (in the previous two weeks or so), you should demand to be tested.

Another misconception about DVT is that it only happens to older people or people with other medical conditions. In fact, although typically not listed among the risk factors, being an active athlete (for example a runner) makes you a higher risk. Nobody knows why, but it's been suggested that running a marathon, for example, may cause small injuries in your legs that may encourage clotting.

In fact, a too common scenario is the athlete traveling home from a race by plane or car, and suffering a DVT shortly thereafter. Of course, these would almost always be misdiagnosed, with potentially disastrous results. At least the VP was with medical experts who were trained to look for DVT in his circumstances. Most athletes have never even heard of DVT, much less suspected that they may be affected by something so trivial as flying home after a race.

In my circumstance, I had competed in a triathlon two days prior to ending up in the hospital, possibly predisposing me to DVT. This fact was on my medical chart, but unfortunately nobody put two and two together and take preventative measures.

Luckily for me, I was in the hospital when I had my PE, and they were able to diagnose it and treat me. What's the treatment? Actually, all they do is put you on anti-coagulants for several months, so that you don't form any more dangerous clots, while waiting for the one(s) you have to slowly dissolve.

So, if you are an athlete or are in one of the other (more publicized) risk groups, pay attention. If you fly, go on a long car trip, or are on extended bed rest, realize that DVT is a risk. Take reasonable preventative measures. And, if you have an unusual pain in the leg (or worse, if you have unexplained shortness of breath or one of the other PE symptoms), get it checked out sooner rather than later.

The clot you don't know about can kill you. The one you do know about will just make your life inconvenient for a few months.

Me, I now try to avoid flying. When I can't avoid it, I get a prescription for Lovenox, an anti-coagulant, and inject myself before getting on the plane. Very unpleasant, but worth it in my mind.