AVOIDING BLOOD CLOTS
By "DocNurse" Norma Stephens Hannigan
Imagine – you are driving along, trying to deliver your load on time, and suddenly you feel short of breath. Not a big deal, you think, probably just getting a cold. Before long, there is a searing, sharp pain in your chest which gets worse when you try to take a deep breath, you are coughing up blood, sweating, starting to pass out, not knowing what is happening to you. What could it be? Should you pull over? Should you try to find an emergency room? Is it a heart attack?
The short answer is no – this is probably not a heart attack, but some of the symptoms are similar. These symptoms signal a serious lung problem. One of the most dangerous disorders that can affect a person is a pulmonary embolus (PE) – a blood clot in the lung. If there is a clot, it can cause difficulty in sending enough oxygen around to the rest of the body, resulting in death. About 200,000 people die from PE in the United States every year.
The difficulty doesn’t even start in the lungs. A blood clot can form anywhere in the body, but most commonly it starts in the legs. When a person has an injury or sits for a long period of time, the blood flow through the veins in the legs becomes sluggish and lazy and blood clots can form. Normally, the muscles in our lower legs help to push blood back up to the lungs to pick up fresh oxygen, avoiding this problem. But, in order to do that, they have to be moving. Instead, what may happen is that a clot forms in your leg – a clot sitting in the vein may break free and travel through your bloodstream, ending up getting stuck in your lung. This prevents you from getting enough oxygen and, in the worst case scenario, may end in death.
While blood clots (deep vein thrombosis or DVT) have been known about for a long time, especially in hospitalized patients, this is a health problem in the general public that we have only begun to hear about in the past five years or so. Health care providers began to realize that DVT is sometimes not diagnosed correctly or early enough to prevent complications, so since about 2003 public health groups have been encouraging a greater awareness of the danger of this potentially life-threatening disorder.
By now you are beginning to see the concern – as a truck driver, you are probably someone who sits for hours at a time in a cramped space moving your legs very little. Other risks that can increase your chances of getting DVT are obesity, dehydration, varicose veins, smoking and a family history of abnormal blood clotting. For women, birth control pills can increase your risk of DVT, especially if you smoke. DVT causes pain in a limb, often the leg. Sometimes this happens slowly over time, but it may happen very quickly. The limb may become red, warm to the touch and swollen. Pain is usually what brings a person to a health care provider. Sometimes the affected person might want to massage the limb to relieve the pain. This is the WRONG thing to do with DVT because the massage may cause the clot to break free and move to the lung.
The two most common tests to diagnose DVT done in the hospital are a blood test and a “Doppler” test. The Doppler flow study can tell your health care provider if there is blockage in the painful limb. Once it’s known that you have a DVT, you will be admitted to the hospital and blood thinners will be used to keep the clot from getting bigger (and may even make it smaller). Initially, the blood thinner is injected, but eventually, when you go home, it is most likely that you will take a pill for about six months. People with very high risk for blood clots may have to take blood thinners for the rest of their lives.
The best way to prevent DVT is to keep moving. As with all things health related, one always has to try to find the balance in things. You might be saying to yourself right now that you can’t be stopping all the time just to get out of your truck and walk around. The real question that you should be asking yourself is if the risk of arriving late is worse than the risk of developing a PE. Now, doesn’t that make it easier to decide what to do? The choice is clearer when you know what the potential bad outcome could be. Also, quit smoking! Not only will this reduce your risk of getting DVT, but it will also prevent several other illnesses as well.
The airline industry got on the bandwagon a while back to prevent “traveler’s thrombosis” – blood clots from traveling in cramped spaces like airplanes – so truckers can follow the same recommendations since they are traveling in similarly cramped spaces. People traveling on planes are now encouraged to get up and walk around periodically, drink plenty of water and wear elastic stockings. Yes, wear elastic stockings. The stockings help to push the blood back up to the heart before clots get a chance to form. Alright, maybe not the coolest or manliest thing in the world, but, again, what’s worse – ribbing from some of your buddies or ending up in the intensive care unit? You can buy elastic stockings in many pharmacies. Some stores also sell high socks that create more pressure on the lower leg as well.
There is another complication from DVT called Post-Thrombotic Syndrome (PTS). While not as severe as developing a PE, PTS is a chronic condition in which the limb swells and an ulcer (open sore) may be present – not a happy situation. These open sores do not heal very fast or easily and are always a big concern because not only are they painful, but they can also become infected.
So, what do you do if you think you are experiencing the symptoms of PE? Pull over, call 911 and stay calm. Don’t continue to drive – let someone else take over to get you to the care you need so that you can keep breathing easy and avoid a deadly blood clot in your lung. The life you save may be your own or someone else on the road around you.
~ Dr. Norma Stephens Hannigan, who recently graduated with a Doctor of Nursing Practice degree, teaches at Columbia University in New York and has treated many truck drivers at the various clinics she has worked over the years. She currently writes from her home in Newburgh, New York.