How to spot a Blood Clot

My friend A was supposed to be running the Niagra Falls half marathon with her husband this weekend. It was his first half, her 2nd (she ran Disney with me last year), and she had been training so hard, really working at getting in under 2 hours. 2 days ago, she posted on facebook that she had a calf strain and was looking for recommendations to heal up quick for the race. Today, her husband posted that she was admitted to the hospital with a blood clots in her legs and lungs. WOW.

Since I work in a hospital as a physical therapist, I know all about these sorts of things. I need to be careful of exercise with a patient who has a suspected blood clot because they can lead to many serious problems if they travel. I want to post a little about the signs & symptoms that A had, and other things to look out for. My hope is that it will help you recognize it in yourself or a friend or family member to get them treatment as soon as possible.

I used Stop the Clot for a lot of my information here to relate this topic to athletes. The rest I know from my expensive years I spent in school at Springfield College.

There has been research done to show that DVT (deep vein thrombosis) & PE (pulmonary embolisms) often have delayed or mis-diagnosis in athletes. How many times have you shrugged off an injury? Most athletes, and some health care providers are looking for the typical elderly patient with multiple risk factors. Your young age, and affinity to endurance events may throw them off.

So what is a blood clot? Your body has a crazy system of "pipes" called arteries & veins that carry blood throughout your body, nourishing your cells, and allowing us to go about our every day routine. Think of a blood clot like a clogged pipe. If there is a blockage in one of these "pipes" the blood is unable to flow to that specific area, which can lead to pain & even cell death. The scariest part is that these blockages can break off and travel through these arteries and veins, leading to pulmonary embolisms & strokes, both of which could kill you.

Sounds serious doesn't it? Well it is! I am a HUGE advocate for preventing strokes in particular since that is the patient population I'm passionate about. I LOVE treating my stroke patients, but I wish just as much as they do that strokes didn't occur. In fact, I trained for my first half marathon in Kona, HI with Train to End Stroke and raised over $5,000 for the cause. A stroke is pretty much a blood clot that occurs in the brain.

The most common clot is called a DVT or deep vein thrombosis. A DVT is a clot that is formed in a vein (the "pipes" that bring blood to your heart) deep inside your body. A very common place for this clot to occur is in the calf. Symptoms may present as:

• Pain & swelling in one leg
• Changes in skin color in the leg (redness)
• Increased warmth in one leg
• Increased tenderness in one leg

A had pain, but didn't notice any swelling. She was of course, training for a race! If she had any mild swelling, she attributed it to running & thought the pain was a calf strain. She only called her doctor because she was nervous since her dad had a blood clot at his knee about a week ago, and the pain wasn't going away, even with rest. She went to the doctor, who sent her for an ultrasound, the diagnostic testing for a DVT. It came back positive, and A was sent to the ER.

If those blood clots move away from where they began in the leg, they can move up through the heart, then end up in the lung. Here, if it becomes lodged in a lung artery, it is called a PE or pulmonary embolism. Symptoms for this are:

• Sudden shortness of breath
• Sharp chest pains, especially with deep breaths
• Increased heart rate
• Unexplained cough, sometimes bloody mucous

When A got to the ER, they did a chest xray to see if she had any PEs, and she did. 2 in fact. I asked A if she had noticed any shortness of breath. She told me about her run this past weekend, only 5 miles since they were tapering. She said she felt short of breath the whole time. She had to stop a lot, and felt like she was struggling to breathe like someone with asthma. After her exercise it went away, so she didn't think it had anything to do with her calf.

Luckily A & her doctors caught it in time. There are plenty of other races in her future, now that she is ok & being treated. The doctors aren't quite sure what exactly was the cause of the clots. A is very active so it certainly wasn't that. She was on birth control pills, which do carry an increased risk of developing blood clots. Her dad also had a blood clot, and family history is a risk factor as well. Amy's treatment is bed rest & blood thinners. She is stuck in the hospital, will miss her race in Niagra Falls, but will be happy that she is alive and ok.

As far as athletes are concerned, I think this summary from Stop the clot really summed it up.

"Unfortunately, there are few studies investigating the influence that physical training has on blood clot formation and dissolution. So, the exact net effect of training on this equilibrium is unknown. It is known, for example, that blood levels of the clotting protein “factor VIII” increase with exercise and that the elevation persists during recovery. Theoretically, this could lead to an increased risk of blood clots in athletes. However, data also indicate that the fibrinolytic system that dissolves blood clots is overactive in people who exercise. With this over activity present, the athlete would be protected from having a blood clot. Yet, the net effect of these changes in the athlete is not known."

 While we may not know why exactly athletes are getting blood clots, or how to specifically prevent them to avoid ever having to worry, you now know all the warning signs. So next time you notice it's touch to breathe as you run or you notice your calf to be painful & warm, go to the ER. Get it taken care of before something more serious happens.