DRHOOK- Deep breaths: Keep moving to avoid lung clots

the handsome doctor John Hong of Charlottesville

"Scab" is such an interesting word. I remember the culture shock in third grade when we moved from the Big Apple to Nowhereland, Ohio– and the shock was more for them than us. They looked and talked to us like we were Martians. ("We come in peace, but if you aren't peaceful, I'm going to blow you head off.") 

One of my neighbors skinned her knee and had a scab. Like a Janet Jackson's wardrobe malfunction, the scab spontaneously fell off. She said, "Yikes, my pit fell off." I asked, "What is pit?" She and her friends laughed, "You're the son of two doctors, and you don't know what a pit is?" 

But then again, they called soda "pop" and college "unnecessary."

So what does a scab have to do with a blood clot in your lungs?

Platelets stop bleeding. The scab is made because platelets are like paramedics: first-responders to the accident site. 

We want scabs on our skin so we don't bleed to death, the fear of hemophiliacs. Blood clots in the veins, though, can travel up to the lungs to cause a pulmonary embolism (PE). Unlike school PE where you get your blood flowing, a human PE will stop the blood flow to areas of the lung. No blood to lung = no oxygen exchange.

Take a deep breath. Diagnosing a PE is not easy, because there's no classic presentation for it. The main symptom is shortness of breath because the lung isn't getting the same amount of blood it did before. However, many sufferers do not get short of breath. Some only get winded with exertion, and they might blame it on being out of shape, fatigue, or their cell phone bill. 

Less than half will feel like a knife is stabbing them– not in the back, but in the chest. Sharp or prickly pain depends on where the PE is. Increased heart rate and decreased blood pressure can really vary, but in a worst case scenario, a person can got into heart failure if the right ventricle can't pump blood through the lungs because of that big ole obstruction.

The majority of PEs come from blood clots in the deep veins of the pelvis and thighs. These clots tend to cause a leg to swell up, be a little warm and purple, and cause the leg to be tender. A Rockette with a deep vein clot (called thrombus) would stick out like an owl at a mouse picnic. 

Other things can cause a PE, such as an air bubble and fat embolism. We all hear about murderers injecting air into a person's vein, but that's so Agatha Christy. Fat embolism occurs after a bone is broken, such as from trauma or surgery. That is one reason breaking a hip can be deadly.

Smokers are more at risk for a PE, as well as those who have high blood pressure, cancer, chronic heart disease, recent surgery, and history of deep-vein thrombus. 

I keep saying it's important to stay active and keep moving. Well, blood clots can form in the leg after a traveler has been sitting a long time in an airplane or driving forever to see relatives. 

Those most at risk of death from PE tend to have lung or cardiovascular disease. For many, another PE can occur again, so anticoagulation is vital treatment. Many folks have small PEs that are never diagnosed until they get short of breath just from walking across the room. All those PEs cause pulmonary hypertension. 

I already have thin skin (though I moisturize as much as possible), but to have thin blood to treat a PE and prevent more would really tip me over. It would be the scabs– er, pits.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.