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Jennifer Pollan's Story: Miscarriages, Pneumonia & Blood Clots
Posted July, 2012
Editor's note from Henry I. Bussey, Pharm.D.: ClotCare is very grateful to Ms. Pollan for sharing her rather complex story. There are a few key points in her story that I wanted to highlight in order to be sure that the reader appreciates these factors:
- Recurrent miscarriages are an indication that an individual may have a clotting disorder. One of the antiphospholipid antibody syndromes (APA) – and especially Lupus anticoagulant – warrant particular consideration. Such patients may require clot-prevention measures with subsequent pregnancies and/or during times of increased clotting risk.
- Ms. Pollan's story indicates a number of additional clotting risks that likely contributed to her developing a PE. She indicates that she was overweight, had recurrent pneumonia, and was at bed rest for more than 3 days. Each of these factors can increase the risk of blood clots.
- A diagnosis of pneumonia, as well as apparent worsening chronic lung disease (see www.clotcare.org/copdandbloodclots.aspx, may actually be due to a pulmonary embolism.
- Just as people who develop blood clots in their legs (DVT) may develop circulatory problems in that leg, people with pulmonary embolism may also develop a condition known as pulmonary artery hypertension (PAH) which results from clots obstructing the flow of blood in the lungs. Such PAH can overload the right side of the heart and lead to heart failure because that portion of the heart has to pump against the increased pressure in the blood vessels in the lungs. Any sortness of breath or "lung problems" in these patients should be carefully evaluated and monitored.
My husband, Michael, and I had a very frightening and sobering holiday season during 2010. Right after Thanksgiving, for a week and a half, I thought I had pneumonia, confirmed by two chest x-rays. I'm overweight and out of shape, but I'd had pneumonia prior to this, and the fatigue, exhaustion and shortness of breath I experienced with this bout was much worse than ever before. I also wasn't coughing as much as I had with previous bouts of pneumonia. With this experience, I'd get out of bed, go about 10 feet to the bathroom and go back to bed. All I wanted to do was put my head on the pillow. It would take five minutes to get my breath. One morning, I headed upstairs to get ready for work. Before I got to the top of the stairs, I had to stop because I was out of breath. While I was standing on the stairs, hanging onto the railing, everything started to go black; my neck, shoulders and back started to burn; and I felt as if someone had their hands on either of my shoulders, trying to push me down. I knew I was going to pass out. I climbed the last two stairs to the living room and sat down on the floor. I sat there for a minute, waiting for whatever was going to happen. Thankfully, whatever it was passed after about a minute. Later that morning, I went to the doctor again and had the second chest x-ray. The P.A. who read the x-ray said I had either pneumonia or a pulmonary infarct (a pulmonary infarct is when, for some unknown reason, a piece of your lung just dies), but she really believed I had pneumonia. I paged my doctor the next evening, told him about the overwhelming fatigue, exhaustion and shortness of breath, as well as what had happened at my house the day before. I asked him if any of this was normal with pneumonia and he said no.
I saw my doctor first thing the next morning. I had so little energy and was so out of breath that my mother-in-law, who had both of her knees replaced, wheeled me around the doctor's office in a wheelchair because I didn't have enough energy to make it on my own two feet. My doctor listened to my lungs and said they sounded very clear. He had me walk up and down the hall while wearing a pulse ox finger clip. My oxygen saturation never went below the mid- to high-90% level. He ran some other tests and took blood. My white blood cell count was slightly elevated, which was not surprising, as I was sick. My doctor called the next morning and asked if I was any better than the day before. I told him no, I was no better, but I was also no worse. He then asked me to come back because he wanted to re-run one of the blood tests from the day before. He mentioned the slightly elevated white blood cell count. He also said that I had a build-up of acid in my body that he thought was due to my lungs and he wanted to re-run the test to determine if the level of acid had improved since the day before. So, I went back and gave more blood, then went home. When my doctor's nurse called a little while later, I could hear it in her voice. Something was wrong. It was also in the words she used to start the conversation: “So, Jennifer, here's the thing.” She said they needed me to come back again because the results of the d-Dimer test came back really high. I had never heard of the d-Dimer test and didn't know what it was for or what it did. She said they were sending me for a CT scan of my chest and that they were looking for a blood clot. She also said that I needed to be aware that if they found the clot, they would be sending me to the hospital. I told her I understood. Sometimes ignorance really is bliss, but I was aware of and understood the potentially fatal consequences of what she was telling me: I might have a PE. I wanted to panic and cry, but didn't have time. I got myself together and called my mom to take me to the doctor.
The radiologist read the CT scan while my mom and I were still there. He didn't want me going home or shopping, in case things were not good. I knew I was in trouble when he came out with this serious look on his face. He very calmly said, “Mrs. Pollan, we found a few clots.” Clots?! Plural?! I couldn’t believe it! Not two minutes later, my own doctor came downstairs to the CT waiting room. He said they were sending me immediately to the hospital. I wanted to know just exactly what I was up against. I looked at my mom and she looked at me. I asked my doctor the blunt question: What were the chances of this being fatal for me? He said that I'd obviously had at least one clot for some time and that my oxygen saturation was consistently very high, so the chances of this being fatal for me were very slim. I hung on to that statement like my life depended on it! My mom got up to get the car to take me next door to the hospital, but my doctor held up his hand and said, “No. Wait. I'm gonna wheel her through the tunnel myself.” I thought that was so sweet because they never give you the personal touch like that anymore, but it was also very telling about the gravity of the situation. He disappeared for a couple of minutes to make arrangements for me to be admitted to the hospital. While he was gone, the radiologist seemed to be lurking, watching me very closely. I asked him just how serious this was. He stammered a couple of times before answering that it was serious. I felt that he was trying very hard to not tell me something. When he returned, my doctor wheeled me through the tunnel to the hospital, directly to a room in the MICU ward. He immediately put me on blood thinners, which I will be on the rest of my life. I don't mind, especially if the blood thinners will prevent me from ever feeling like that again!
The CT showed a massive embolism in the main pulmonary artery and emboli in both of the left and right pulmonary arteries, meaning I had multiple clots in both lungs. One of the first things the pulmonologist asked when he came to see me in the hospital was if I’d ever been pregnant. I said yes, that I’d been pregnant three times, to which he replied, “Yeah, but no miscarriages.” He went on to talk about something else. I interrupted him and said that all three pregnancies had indeed ended in miscarriage and wondered why he was asking about my history of pregnancies. I very quickly figured it out. He ran a lupus panel on me. I tested positive for three antibodies: the antinuclear antibody, the antiphospholipid antibody and the lupus anticoagulant antibody. Having tested positive for the lupus anticoagulant antibody is the reason why I’ll be on blood thinners for the rest of my life. Previous to this event, after our second miscarriage, my OB/GYN sent my husband and me to a specialist, who ran chromosomal tests on both of us, as well as a lupus panel on me. Chromosomally, we’re both fine. However, I tested positive for the antinuclear antibody and the antiphospholipid antibody. Four years later, when I had pneumonia the first time and wasn’t getting over it the way the pulmonologist thought I should, he ran a second lupus panel. Even though he wasn’t a lupus doctor (rheumatologist), the pulmonologist said my body was acting like it thought I had lupus, so he ran the lupus panel. I again tested positive for the antinuclear and antiphospholipid antibodies. Either of these two antibodies can cause a blood clot in the placenta, preventing nutrition from getting across the cord to the baby, which can be fatal to the baby. My OB/GYN was not, however, ever able to prove beyond a shadow of a doubt that these antibodies caused our miscarriages. As it turns out, my blood clots too much, but I would never have known were it not for the miscarriages and this event with the clots. I never knew my blood clotted too much because my entire life, I’ve always bruised really easily, which is the exact opposite problem. I asked the pulmonologist how my blood could clot too much and yet, I bruised so easily. He said my blood was just funny that way and that as a result, I would be on the blood thinners for the rest of my life.
The pulmonologist never did tell me how many clots I had, just that my CT “was not subtle.” A sonogram showed many clots in the lower and upper parts of my left leg, but my leg never hurt. I thought blood clots in your leg hurt, but not necessarily. The pulmonologist took me off the antibiotics for the pneumonia, as he believed this event was never pneumonia, but a blood clot from the beginning. He said that several clots had broken away from the veins in my leg, traveled through the veins to my lungs and lodged themselves in the arteries in my lungs. If any one of those clots had been large enough, it could have caused my death. I am very fortunate and blessed to be alive. I’ve tried very hard to tell the Lord every day “thank you” for my life. Before the doctor released me from the hospital, I asked him if the fact that I’d had at least one clot for over a week before we found them, I was weak and fading, but I was still walking and talking, if all of this meant that my overall health was pretty good. He said what it meant was the portion of my lungs that was able to exchange oxygen was doing so very well because the portion of my lungs that had the clots was not able to exchange oxygen at all. He also said that if I’d been a smoker (I’ve NEVER been a smoker), I would not have survived the clots in my lungs.
My doctor said it would be several months before I was back to my old self. His last patient who’d had a massive PE prior to me took about six months to recover to the point that he was not out of breath after experiencing a little physical exertion. My doctor said he hoped to keep me to the same six months. At the time of writing this story, that was three months ago, so I’m about half way there.
I was in the hospital for six days and went home the week before Christmas. I’m doing better each day. I still get tired easily, but at least I can get up and down the stairs at my house now without stopping to catch my breath. About six weeks after the clot scare, I was at the clinic waiting for another chest x-ray. I saw the radiologist who read my CT scan that horrible day, so I went to speak to him. I said I knew he didn’t know who I was, but he said he knew exactly who I was and it was great to see that I was obviously feeling and doing better. He said he’d been tracking me through my own physician. He also said he was very worried about me that day and had tried very hard to cover it up. I chuckled and said I knew. I also told him he didn’t cover it up very well because when I asked how serious this was, he stammered a couple of times before answering me. I really appreciated his assistance and thanked him for helping to save my life that day.
As a direct result of this experience, I’ve learned to appreciate life more. I don’t take the ability to breathe for granted anymore. I firmly believe that if it were not for the many, many prayers that went up for me, the Lord sparing my life for some as-yet-unknown reason, and the swift assistance of my doctors once they found the clots, I would not be alive today. I’ve wanted to learn more about DVT and PEs. My preliminary research has been alarming. I keep finding reports that say DVT, in particular, kills more people in the United States annually than breast cancer and AIDS combined. Those are staggering numbers! I’d really like to get involved in the cause somehow. No one should ever have to feel the way I did! And they need to know the warning signs of DVT and PE.
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