A friendly warning to anyone suspected of prostate cancer, or any other form of cancer for that matter: Beware of the sudden blood clot, especially if you're an endurance athlete planning air travel.
Not to be an alarmist, but cancer can cause your blood platelets to become rather “sticky” and begin clotting. Should you, say, take those sticky platelets on a cramped airplane flight….you’re at risk, no matter your age or fitness level.
You’re at risk of your blood pooling and coagulating, in my case, in a deep vein in my calf. Hence the name, DVT, or Deep Vein Thrombosis. The risk is that if not treated, DVT can lead to pulmonary embolism in the lung, which can be fatal.
That’s what happened to the late NBC reporter David Bloom, in the beginning of the Iraq war. Cramped in tight quarters inside a tank for days on end, a clot formed in his leg, traveled to his lung, and sadly killed him.
DVT affects about 2 million Americans a year, and up to 300,000 of them die when a fragment breaks off, migrates to the lungs and blocks a pulmonary artery, according to the Coalition to Prevent DVT.
Alarmed doctors
I knew little about DVTs when first diagnosed. But I saw real alarm in the eyes of my doctors when the Clot was discovered in my left leg. More alarm than when I received the cancer diagnosis, only days earlier.
The prostate cancer, unattended to, might get me in two to eight years, which is bad enough; but the Clot....in the next 60 seconds.
For several weeks after a long, cramped plane ride home from a ski trip to Salt Lake City, I walked around -- unknowingly -- with the huge clot forming in my calf. It hurt at first, like a severe muscle cramp, for 10 days. But then it quieted down, and became more of an annoyance. The calf was swollen, the back of my knee looked bruised and fatty.
At the time, I was preoccupied with the cancer diagnosis, getting scans, the biopsy, doctors appointments – all the preliminary details for choosing and preparing for a cancer treatment.
So the pain and discomfort in my ugly, swollen leg – that could wait. A couple doctors saw the leg but misdiagnosed it. They thought it looked like a Baker’s Cyst, where fluids pool behind the knee, possibly from a torn meniscus.
Eventually I visited an orthopedic surgeon, who recommended an ultrasound on the leg. The ultrasound spotted the long clot – think eight inches of twined yarn – in a vein deep inside my left calf, mostly below my knee.
Immediately, my doctor "stablized" the clot with the drug heparin. Instead of hospitalizing me for 4-5 days, I gave myself daily injections in my stomach to help affix the clot to the vein wall.
All this while starting up the radiation for the cancer....
Flying marathoners at highest risk
To say the least, what I’ve learned since about DVTs is alarming, because I thought it was mainly a problem for older folks with serious blood circulation problems. Not so.
Airplane travel is a high risk factor. Among frequent business travelers, studies found 4.5 percent of them develop one or more clots per year – about 50 times as many clots as found in a non-flying population. Most of these clots dissolve naturally, but the few that don't are a huge public health problem.
About 85 percent of air travel thrombosis victims are athletic – mostly endurance athletes, like marathoners. People with slower resting blood flow are at greater risk of stagnant blood subject to clotting. Also athletes are more likely to have bruises and sore muscles that can trigger clotting.
Not surprisingly, clots often go misdiagnosed. Like mine, the clot often feels like a muscle cramp or a tight knot. So aggravating the injury and increasing the risk of permanent disability or death is higher among athletes than other groups.
A perfect storm
For me, the clot likely formed for several reasons – a perfect storm of circumstance: The cancer changing the coagulation properties in my blood. I’m an endurance athlete, albeit an aging one, with low heart rate (55-60 bpm), hence slow blood movement in my legs. And a long, cramped plane ride following a ski trip, where my legs were fairly beat up, possibly bruised.
Hydration level is also a factor in DVT. As dehydration occurs, the blood thickens. Thick blood moves slower through the veins.
Long treatment period
The trouble with the typical DVT is that after the serious threat has passed, it threatens to hang around forever. After three months of the standard heparin/warfarin treatment, my doctor is continuing the medication for another three months. The swelling is down, but it still has a way to go.
Dr. Richard Chang, a researcher at the National Health Institute, wrote to me that about 50 percent of patients have good clinical results, meaning no pain and no swelling, after 3-6 months of treatment. But the warfarin only thins the blood, it doesn’t dissolve the clot.
A natural tPA and plasinogen in the blood flows over the surface of the clot to dissolve it naturally. As long as the clot is only partially occluding the vein – as opposed to a full occlusion or blockage – blood will most likely slowly dissolve the clot in time.
“God or evolution – depending on your world view,” Dr. Chang wrote me, “arranged for clotting to be quick to prevent bleeding to death, and clot lysis (dissolving) to be relatively slow.”
His message: Be patient. Wear compression socks.
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