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Posted by Dr. Sushrut Jangi March 22, 2013 04:47 PM
Several people guessed the answer correctly - exitseven7 figured it out first.
A few days later, D found himself in a CAT scanner per his doctor's instructions.
"While I was in there, the technician did a test scan first." He starts laughing. "Turns out that was enough for her. She rushed right in after the test scan, and said 'You need to talk to your daughter.' I knew something was wrong. She told me to sit in a wheelchair and not to move. I couldn't believe it. Just an hour ago, I had been driving down the Mass Pike on my motorcycle!"
D's story is not uncommon - a man in perfect health whose life is suddenly altered by unexpected illness. Susan Sontag, the famous writer and critic, forecast the inevitability and randomness of how disease affects each of our lives: "Everyone who is born," she said, "holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Sooner or later each of use is obliged, at least for a spell, to identify ourselves as citizens of that other place."
Most of us, whether in youth or in older age, will find ourselves grappling with some form of illness and with that territory comes Sontag's unfamiliar kingdom: the waiting rooms of doctor's offices, the dark and the clatter of an MRI machine, the long and dim hallways of a hospital. Such a transition is as dramatic as arriving in a new and unknown country. We respond with a kind of culture shock.
A radiologist called D in the scanning room. "I said - what's up doctor?" D laughs. "But the doctor was totally serious with me. 'This is no joke,' he said to me. 'You're lucky to be alive right now. You've got lungs blocked by large blood clots. If you weren't in the shape you were in, you would have had a really big problem.'"
D had multiple pulmonary emboli - blood clots that usually form in the legs and travel up into the vessels of the lungs. If they are huge, they can interrupt blood flow and cause shock or respiratory failure. Smaller clots can cause breathing problems like D was experiencing; if they are not treated, the symptoms can progress. "I went straight to the hospital and they put me on oxygen immediately," D says. "They started me on a Coumadin," he says, naming the commonly prescribed blood thinner. "I might have to stay on it for life," he sighs.
Pulmonary emboli can happen to anyone. In D's case, they were most likely caused by the long, 12 hour truck ride home from West Virginia to Boston after his motorcycle excursion. "Usually," says Dr. Praveen Akuthota, a pulmonary doctor in Boston, "this happens with prolonged air travel, particularly on very long, trans-oceanic flights that last in the 6-8 hour range. But even just being seated for most of a 12 hour journey puts him at increased risk."
There are other known risk factors for clot formation: cancer, structural problems in the vessels, dehydration, smoking, and certain blood disorders. But immobility, by itself, can be enough. You shouldn't sit in one place too long, Dr. Akuthota says - whether you are at work, driving, or flying. Get up and walk around often. But even then, Akuthota goes on, even if you are mobile and active, you can still get a pulmonary embolus. He points to his chest. I could get one right now.
Thankfully, D's doctor picked up signs that something was critically wrong on the EKG - he had a pattern called right heart strain, which is seen when the heart is pumping harder than usual, sometimes indicative of a clot in the lungs. But things could have gone worse. People can go into cardiac arrest from a pulmonary embolus.
As long as the human body remains complex, medicine will be imperfect, illnesses will strike seemingly at random. There is nothing fair about any of this. But the same flawed mechanisms that bring us into disease sometimes bring us back out again.
D thinks back to the days he used to run marathons. "During the run," he says, "it was a mental game with myself. I had to keep telling myself I could do it, I can do this. I've trained and today's the day to put it all out there."
The words of a marathoner are the same sentiment I've heard from patients who have been affected by illness; these are the words every fighter carries close to his heart.
Stay tuned for a follow-up post which will address the current medical controversies, risks, and benefits of running marathons. The 117th Boston Marathon will be run next month, on Patriot's Day.
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About the authorSushrut Jangi is an internist at Beth Israel Deaconess Medical Center and an editorial fellow at The New England Journal of Medicine. More »
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