Aging Disgracefully

I was extremely lucky. Within three hours I went from a situation referred to as hemodynamic instability (where your heart is about to fail from having to fight so hard against the situation created by the clots) to essentially normal (in fact, quite healthy) vital signs.* An ecstatic doctor came into my room to inform me "those embolisms are his-to-ry!". While others have reacted as well to tPA, I am certainly in the group that responds the best. As one internal medicine attending put it later "you are sort of a poster child for tPA". I was probably saved by several factors. My clots were likely new and sort of messy and disorganized (rendering them more vulnerable to tPA) and it would seem that I have a pretty strong heart and large pulmonary arterial system. I was released from the hospital about 48 hours after admission, which is apparently unusually quick.

In the weeks since, I have been on blood thinners that prevent new clots from forming, or old ones from getting any bigger. The search is on for a cause, as well as any baseline factors that may have pre-disposed me to getting these. The verdict so far seems to be that a "perfect storm" of factors likely created the embolisms. The most important proximate reason they occurred was long-haul air travel, followed immediately by a long car ride to and from Rochester, NY to pick up my in-laws. Additionally, just before leaving South Asia, I became very sick, which likely dehydrated me, exacerbating the situation. Finally, I was exhausted on the return flights, and slept like the dead for about 12 hours on the flight from Bangkok to London. (Usually I get up and walk around a lot during such flights.) Because I am big (6'2-3" tall) I have little room even in business class seats and hence essentially sat motionless for 12 hours, which is a good way to get yourself some huge clots that might embolize (travel to your lungs).

Curiously, I appear to have no genetic predisposition to these things (at least to the extent that they have been able to identify such pre-disposing genetic factors). So my experience should be a warning to all: long-haul travel, particularly air travel (where you are subjected to a low oxygen, dry atmosphere in the cabin), puts everyone at risk. The doctors at Duke told me that they think this phenomenon (serious leg and pelvis clots or embolisms after long-haul flights) is much more common that any of the statistics suggest. When I first arrived with my symptoms at the emergency room, they asked me a battery of questions, and later told me that from the moment they learned of my recent travel they were pretty sure that I had pulmonary embolisms.

Don't take the lesson of my experience lightly: I am a lucky bastard. Many, many people in my situation (yes, even young people) have died. I was saved by a number of factors (my type of clots and their vulnerability to tPA, a strong cardiovascular system, etc.). A few weeks after I left Duke hospital, an otherwise healthy 30 year old female resident at another hospital (she is, or rather was, a few degrees of separation from me; details withheld to protect privacy) died of an embolism that may have arisen due to minor recent surgery.

Do not make the incredibly idiotic decision that I did: to try to ignore or "ride out" symptoms that I knew were highly unusual for me. Get thee to a doctor: with embolisms, as with many other things, the sooner they get their hands on you the better the prognosis.

As if my wife had not gone through enough, we had to more or less immediately turn from my situation to her father's: he had come down here for a heart operation. Fortunately, after several bumps in the road, he is back at our house and recovering well.

So that is what has been going on with me.

*It took 2 hours to administer the tPA. As they began administering it, I knew that everything, and I mean everything, rested on the course of the next few hours. One of things they do just before adminsitering tPA is to get exact instructions from you about the lengths they should go to to revive you should your heart fail. (I later learned that, perhaps especially with someone my age, they will go to great lengths to try to re-start my heart, should it fail, to steal some time to give tPA a chance to work.) You could tell that the doctors, while not pressuring me at all, wanted permission to go to whatever lengths were necessary to save me. That is not a choice you are prepared to have put to you at age 33.

I tried to remain stoic. But I confess that the next 3 hours (from when tPA was administered to when the doctors essentially declared victory) were the longest of my life, and I have never before felt the degree of relief that I did when the doctors entered my room and their body language alone said it all: the embolisms had been no match for tPA.