My blood clot should have been obvious to me. Here’s what you need to know.
The possibility of a blood clot behind my knee, a Deep Vein Thrombosis (DVT), never entered my head. It was late June and I was in great shape for a Texas summer. I had run my first full marathon in January and a half-marathon as recently as March. Blood clots are for old people and I had only just turned forty-seven.
The first signs
I slack off on my running in the summer due to the heat, but this summer I was on temporary duty for the Air Force in San Antonio. I worked out a lot since I was only traveling home every other week, my mileage was down but steady.
It started as a pain in my right calf, but I thought it part of my normal suite of injuries. I have tendonitis in my right heel; the back of the heel is always tender and I walk funny early in the morning. My first quarter to a half-mile is sometimes awkward. I also had an Iliotibial (IT) Band injury from marathon training. I was mostly over it, but on some runs my right knee would still hum to me, letting me know not to push things.
When my calf started aching, in between the knee and the heel, I just assumed it was another running injury to ignore. I also noticed what should have been the tell-tale sign, general swelling in the calf. Like any good runner, I self-medicated with ibuprofen and pressed on.
I don’t go to doctors. I’m certainly not the type of person to run to a doctor with every little ache and pain. Half of my reluctance reflects arrogance about being tough and the other half insecurity. I don’t want a doctor to tell me I’m overreacting because I will feel dumb.
Finally, though, I reached my limit when I had to cut a run short after just a mile. I felt embarrassed at quitting. The next morning at the office I called the medical clinic and made an appointment. I was able to get in that day.
Seeing the doctors
I arrived at the base’s medical clinic and checked in. After a vitals check, a young Physician’s Assistant (PA) walked into the exam room to check on me. Now I was nervous. Now I might have someone twenty years younger than me telling me that I was imagining things. I hoped silently to myself that it was a muscle tear or something diagnosable.
I told her about my symptoms, trying to justify myself for wasting her time. We made small talk as she casually walked over to a drawer, pulled out a measuring tape, and sat down in front of me. She measured both of my calves and agreed that it was swollen, not just in my head. Whew, relief. Validation. But I was not prepared for what came next.
“I’m going to do a referral to send you over to SAMMC.”
The San Antonio Military Medical Center is one of the largest military hospitals in the world and was conveniently located ten miles down the road. I asked how long it will take until I could get an appointment, picturing days or weeks.
“I’m going to call over. They’ll be expecting you.”
Um, what? That’s not how medical appointments work.
“You probably won’t need surgery today, but they will probably give you a prescription. Don’t wait to take it until you get home, take a dose as soon as you get it from the pharmacy.”
Possible surgery today? What?
“And if you start to feel short of breath on the drive over to SAMMC, pull over and call 911. Don’t try to make it there on your own.”
Now I was beyond disturbed. She explained that if a blood clot breaks free, it could travel to my lungs and cause a pulmonary embolism, often resulting in death. Already feeling short of breath, I asked her if I would be OK even to drive over to SAMC by myself.
I had been afraid of being seen as a wimp who was making a big deal out of nothing. Now, the slightest change in tone, perhaps the tiniest bit of pity in her look, let me know the foolishness of not coming in earlier. She shrugged as she answered my question.
“You’ve been walking around on it for weeks, you’ll probably be fine.”
After having an ultrasound and seeing another provider, I received a prescription for Xarelto, a blood thinner. My dad, facing a blood clot in his 80s, resisted blood thinners because he didn’t want to end up on oxygen, which he saw as the last step before death. I learned instead that blood thinners do not thin the blood or affect oxygen transport.
Thinners make blood less sticky. My clot would no longer accumulate more particles, and thus particles would be less likely to break off and travel. If a piece of the clot traveled to my lungs, it would be less likely to stick and grow.
The reduced clotting action leads to an increased risk of internal bleeding, or uncontrolled bleeding after an accident or injury. Fortunately, I was only on the drug for ninety days. I could even run again after the swelling subsided.
Here are a few other tidbits I learned about blood clots:
- Clots can be provoked by forced restraint, surgery, or other factors. I had flown recently, so the docs attributed my DVT to that. Had it been unprovoked, meaning I just developed it for no reason, then I might have been on blood thinners forever.
- I now wear graduated, medical-grade compression stockings on flights and long car trips. This keeps blood from pooling in my calves and makes clots less likely to form. When traveling, I stand up to stretch regularly. If nothing else, just moving my foot around activates muscles that help force blood through my veins.
- The clot may never go away. It damages the walls of the vein, which rarely heals, so even on a Doppler ultrasound an old clot still looks like a clot. The blockage is still there. My body compensated and reroutes blood, but I may never be one hundred percent better. Four years later my right calf still swells when sitting for a while.
The obvious lesson here is to listen to your body. If I had approached the situation with a “What is this?” attitude instead of assuming it was some sort of pull, strain, or muscle damage I would have figured out the danger much earlier.
I also learned the symptoms of a clot. There will be swelling in one extremity. The area may be flushed, hot, or discolored, though it wasn’t in my case. Clots can affect just the foot, the calf, or the whole leg, so if you have unexplained swelling, seek medical attention immediately.
Brian E. Wish works as a quality engineer in the aerospace industry. He has spent 29 years active and reserve in the US Air Force, where he holds the rank of Colonel. He has a bachelor’s from the US Air Force Academy, a master’s from Bowie State, and a Ph.D. in Public and Urban Administration from UT Arlington. The opinions expressed here are his own. Learn more at brianewish.com.