Part III: Causes and Risk Factors
Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering. Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid. Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.
My Story
The excellent health I have always experienced was the proverbial blessing and curse in my experience with having a pulmonary embolism (PE). According to my doctors (and friends who are wanna be doctors and perhaps everything I’ve managed to find on the WWW), the fact that I was in physically good shape certainly aided in my survival, and I trust it continues to aid in my overall recovery. However, my history of having great health and being physically fit lulled me into a state of denial about the very real medical crisis that was unfolding in my own body. Because I was not very familiar with the symptoms of pulmonary embolism, I continued to attribute my growing problems to everything from stress to exhaustion – until my body sent me signals that couldn’t be denied.
When I say excellent health, it’s no exaggeration. I had never been hospitalized since my birth 48 years ago. I strove to keep myself in good shape, working out at the gym 6-7 days each week (if you’re there chances are I’ve seen you), taking stairs instead of elevators, walking instead of driving and keeping physically active. I never smoked, used drugs, or drank (except for the more than occasional Diet Coke – although tye attending ER physicians didn’t believe me — almost had to call friends to verify this fact), and used almost no medication in my lifetime. I even obtained an MPH and an MBA with a focus on Health Administration, so I certainly knew the general do’s and don’ts of promoting good health.
In retrospect, the one risk factor that stands out for me is related to my work in the travel industry. I spend hundreds of hours per year in overseas flights. The so-called “economy class syndrome” of cramped seating quarters is a major culprit in clot formation (see below). But I estimated that I upgraded at least 80% of my flights this past year with frequent flier miles, in order to take care of myself. (I’ve idly pondered the chances of finding an attorney who could get my miles back from the airlines!)
Lesson learned: Just because your health is good, it doesn’t mean that you’re not at risk for a PE. Understanding your own risk factors can help you better recognize your own degree of risk.
Causes of Pulmonary Embolism
The large majority of pulmonary embolisms are caused by a blood clot or as in my case a series of clots creating a sudden blockage of an artery in the lung. In most cases, the blood clot originated in the veins of the legs, broke loose, and traveled through the circulatory system to lodge in the lung. Individuals who form blood clots in the deep veins of their legs may have a condition known as deep vein thrombosis or DVT. Therefore, the single greatest cause of a PE is the presence of DVT.
However, a pulmonary embolism can be caused by a blockage created by something other than a blood clot, such as: fat from the marrow of a broken bone, tumors, air bubbles, and even amniotic fluid.
Risk Factors
Because the overwhelming majority of PE incidents are related to blood clots, particularly those in the deep veins of the legs, a look at risk factors should focus most on those elements most associated with such clots. Avariety of factors can influence one’s risk, ranging from ones that are completely outside an individual’s control to those associated with lifestyle choices.
The most significant risk factors associated with both DVT and pulmonary embolisms are:
- Prolonged immobility – Blood clots are more likely to form in the legs during periods of greater inactivity. If you have recently experienced extended bed rest or travel, you may be at greater risk. Many PE episodes occur during recuperation from illness or injury or after a long plane or car trip.
- Medications – Taking birth control pills or hormone replacement therapy medications increase the risk of clotting.
- Diseases or disorders – Cancer, heart failure, stroke, and severe infections are all associated with increased risks of abnormal clotting. Certain cancers, for example, can increase levels of substances in the blood stream that increase clotting, and chemotherapy itself can increase the risk.
- Surgery – Recent surgery involving the legs, hips, brain, or abdomen are associated with increased risk. Hip and knee replacement surgeries are particular culprits, as they may release tissue debris into the bloodstream during bone prepping.
- Family history/genetics – Some individuals inherit a tendency to form clots too quickly. Your family’s medical history is a significant factor in determining your own risk.
- History of recent pregnancy and childbirth—A baby’s weight pressing down in the pelvic veins can create pooling of the mother’s blood return and increase the incidence of clotting.
- Age–Older adults are at greater risk of forming blood clots, particularly above the age of 70. Valve malfunctions, dehydration, and age-related medical conditions are all contributing problems.
- Lifestyle issues – Individuals who smoke, are sedentary, or are obese have increased risk of pulmonary embolisms. High blood pressure is an associated risk factor.
In another upcoming article, we’ll take a look at how some of these risk factors can be reduced or even prevented, but for now, it’s important to know your risk factors as a predictive or diagnostic tool. The more you know your own risks, the more likely you’ll be to take appropriate action.
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