Monthly Archives: September 2016

The deadly condition about venous thromboembolism

When he was 58 years old, Kevin Wilson, a paramedic in Durham, N.C., woke up one January morning in excruciating pain.

“I felt like my chest had imploded,” he recalled. “I told my wife, ‘I’m in trouble.’”

He called 911 and when the paramedics arrived, Wilson was in profound respiratory distress.

“I could talk in barely one-word phrases. I knew something catastrophic was happening,” he said.

When he arrived at the hospital, doctors discovered that Wilson had a massive saddle pulmonary embolism, a blood clot that blocks the main pulmonary artery from the heart where it divides into two main arteries that lead to the lungs. Since blood was completely cut off from one side of his heart, it became enlarged.

Wilson spent 12 hours in the resuscitation room, where the team of doctors and nurses pumped him full of blood thinners, monitored his oxygen levels and made sure the blood clot didn’t move.

Although he was stabilized, his condition remained uncertain.

“I really didn’t think I would make it through the night,” he said.

For the next three days, he had to stay in bed, immobile, even as tears streamed down his face.

“They were very concerned that if I moved, that I would dislodge the clot and it would kill me instantly,” he said.

What is venous thromboembolism?
Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT), when a blood clot forms in a deep vein, and pulmonary embolism (PE), when a blood clot breaks off and travels from the leg up to the lungs.

Each year, approximately 900,000 people are diagnosed with VTE, according to the Centers for Disease Control and Prevention (CDC). Between 60,000 and 100,000 people in the US die from VTE and between 10 to 30 percent die within a month of diagnosis.

Men and women have similar risks for a first episode of VTE. In fact, the prevalence of DVT in men was 14 percent, compared to9 percent for women, according to a study in the Journal of Thrombosis and Haemostasis.

Yet when compared to women who don’t have risk factors for VTE, which include pregnancy, oral contraception, and hormone replacement therapy, men are more than twice as likely to have a VTE, according to a study in the journal Circulation.

“The risk of recurrence [for] venous thromboembolism is higher in men. In terms of a yearly risk, it’s about two to maybe two and half times higher,” said Gary E. Raskob, PhD, chairman of ISTH’s World Thrombosis Day steering committee.

Although it’s not clear why, experts believe that it’s likely there is some genetic difference between men and women, Raskob said.

Know your risk
There are several risk factors men have for VTE’s. They include:

  • A height of 6 feet or taller
  • Obesity and a larger than normal waistline
  • Smoking
  • A sedentary lifestyle
  • Sitting for long periods of time or prolonged bed rest
  • Any condition that can increase clotting such as a serious infection or an autoimmune inflammatory disease
  • A family history of blood clots or heart attack
  • Physical trauma or surgery.
  • Age: men over 40 have a higher risk

Men who take testosterone replacement therapy have a 63 percent increased risk, according to a recent study in the journal BMJ.

And simply being admitted to the hospital can increase a man’s risk. In fact, 60 percent of VTEs occur during or within 90 days of a hospital stay, another study in the journal BMJ found.

Symptoms of venous thromboembolism
If you suspect you have VTE, it’s important to recognize the signs early on. You can have swelling, tenderness, redness warmth or pain in your leg or calf, chest pain, shortness of breath, rapid breathing, an irregular heart beat or heart palpitations, lightheadedness or fainting.

“If someone has a clot, [it’s] usually because there’s a blood flow blockage, and so the symptoms are usually pretty dramatic and pretty rapid in onset,” said Dr. Amy Doneen, medical director for the Heart Attack and Stroke Prevention Center in Spokane, Wash., and adjunct professor for Texas Tech Health Sciences Center. “It’s a medical emergency, so people do need to go in and get evaluated.”

Better seatbelts for seniors

Ohio researchers say today’s seat belts weren’t designed to protect the smaller, frailer seniors who account for tens of millions of drivers in the U.S alone.

“When seat belts were first designed four decades ago, safety dummies tested in car crash simulations resembled the average-size male driver of 40 years old and weighing approximately 170 pounds,” said John Bolte, an associate professor of health and rehabilitation sciences and director of Ohio State University’s Injury Biomechanics Research Center. This standard seat belt design can be less effective for older drivers, Bolte said, and cause fatal harm due to injuries sustained along the path of the belt.

“If someone doesn’t adjust the height of their shoulder belt, and if that belt is up around the neck, you will have severe neck injuries,” Bolte explained. “If it’s under your arm, it will lead to rib fractures.”

To reduce injury in drivers 65 and older, Bolte and colleagues at Ohio State’s Wexner Medical Center are collaborating with automakers to measure properties of the thorax and upper body in older drivers to better predict how crash-related impact affects them.

The project’s new simulations use smaller crash test dummies to better represent older, frailer drivers, in order to design better protection.

“Like most things, injuries can be more disabling in older drivers,” said Richard Marottoli, a professor of medicine and medical director of the Dorothy Adler Geriatric Assessment Center at Yale-New Haven Hospital. Pain from the injury “can affect respiration, and if you have any underlying lung problems, it can make those worse as well.”

Marottoli, who is not associated with the research project, said seat belt-related injury is a significant issue among older drivers.

According to the National Highway Traffic Safety Administration, close to 600 older adults are injured each day in car crashes. Common injuries, including cracked ribs and broken pelvises, can be life-threatening.

More than 36 million drivers in the U.S. are now ages 65 and older, according to the Centers for Disease Control. By 2030, the AAA predicts that number will surpass 60 million.

“In a decade or two, the needs of the aging driving population are going to effect changes required in infrastructure, in vehicles, and in laws to manage driver licensing,” said Jake Nelson, the AAA’s director of traffic safety advocacy and research. “The needs of this driving population will dictate automotive safety technology.”

Nelson says automakers are developing inflatable seat belts that will assist older adults by spreading the force of a crash over a larger surface area. The hope is that thoracic injuries will prove less severe and less likely.

“People need to wear their seat belts,” Bolte said. “There could be smarter belts, and they could reduce the injuries we are left with.”

In the next decade, he said, new technology may include a personalized car key fob to activate a customized safety system within each vehicle. The key fob could adjust a seat belt based on a driver’s individual physiology.

Early 30s can test their fertility

According to the Centers for Disease Control and Prevention (CDC), more women are waiting until later in life to start a family. As of 2014, the average age of first-time pregnancies reached a record high of 26.3. The report suggests a decline in women having babies in their teenage years and an increase in women giving birth in their 30s.

But what do these statistics mean for American women’s fertility? We got the following email from a viewer:

Dr. Manny,

I am 30 years old, and I am focused on my career. I hear a lot of conflicting information about when to start a family. Is this something I should be thinking about now, or do I have time?


Many women have similar concerns when it comes to starting a family. CDC data suggests 12 percent of women between ages 15 and 44 are infertile— and the condition can be expensive for those who want to have children. In vitro fertilization (IVF) is a popular alternative fertility option, but one cycle can cost up to $12,000.

Causes of infertility include:
Drinking alcohol in excess
High stress levels
Poor dieting

Dr. Kaylen Silverberg is board-certified in obstetrics, gynecology and reproductive endocrinology, and she is the co-founder of Los Angeles-based fertility lab Ovation Fertility. He recommended that women in their late 20s and early 30s get an annual evaluation of their ovarian reserve at their OB-GYN or a trusted fertility clinic by having their blood drawn on the third day of their menstrual cycle.

The test measures a woman’s Anti-Mullerian hormone (AMH,) as well as her estradiol and follicle-stimulating hormone (FDH). With this information, specialists can determine if a woman’s ovarian reserve is stable or starting to diminish.

“The major benefits of ovarian reserve testing are that you’ll know where you are in your reproductive lifespan,” Silverberg told “If in fact your numbers are starting to deteriorate already— suggesting that your ovarian reserve is starting to fall— we’ll know the rate at which it’s falling, and therefore fertility specialists or even gynecologists can recommend how fast you need to get moving.”

Country fall victim to synthetic marijuana

The nation’s homeless are proving to be especially susceptible to a new, dirt-cheap version of synthetic marijuana, which leaves users glassy-eyed, aimless, sprawled on streets and sidewalks oblivious to their surroundings or wandering into traffic.

Nearly 300 homeless people became ill last month in St. Louis due to the man-made hallucinogen that experts believe is far more dangerous and unpredictable than the real thing. Other outbreaks have occurred in New York City, Los Angeles and Austin, Texas.

“It was common for us to see reactions where they were violent, incoherent, sometimes catatonic on the ground,” Austin police Lt. Kurt Thomas said.

The homeless are easy targets in a confined area, experts say. The drug is cheap — as little as $1 or $2 for a joint — more difficult to detect in drug tests and is a fast escape from a harsh reality.

Things got so bad in St. Louis last month that the region’s largest provider of homeless services urged people to stop giving the homeless handouts, because they were worried the money would be used to buy the drug.

The Rev. Larry Rice saw the odd behaviors from several homeless people in the streets outside his New Life Evangelistic Center shelter in downtown St. Louis.

“They told me, ‘You get so low, you get such a sense of hopelessness. Somebody wants to sell this for a dollar and you take it,'” Rice said. “People are desperate out there.”

Synthetic marijuana has been around since the late 2000s, packaged under names like K2, Darkness and Mr. Happy. The Drug Enforcement Administration says it is usually a mixture of herbs and spices sprayed with a synthetic compound chemically similar to THC, the psychoactive ingredients in marijuana. It is typically manufactured in China and sold in places like head shops, but it’s also on the street and over the internet.

State legislatures have outlawed it based on its chemical makeup, but the makers tweak the formula enough that it escapes the provisions of the law. So far in St. Louis, only one charge has been filed — a homeless man accused of selling to others on the street.

“You factor in some of the despair or difficult circumstances that these folks are going through, and they often fall prey to the suppliers offering an outlet to deal with their unfortunate situation,” Thomas said.

The medical dangers are real with synthetic marijuana, which can be up to 100 times more potent than real marijuana, said Dr. Anthony Scalzo, director of toxicology for the Saint Louis University School of Medicine.

Users often experience rapid heartbeat, high blood pressure, anxiety and hallucinations, he said.

Research published last year in the New England Journal of Medicine indicated that 20 deaths from August 2011 through April 2015 were blamed on synthetic marijuana, though that doesn’t account for overdose deaths of undetermined or multiple causes. Scalzo said those who survive can suffer permanent kidney failure and brain damage.

“We have no idea how the body is going to react to the next wave of chemicals,” Scalzo said. “It’s like Russian roulette. You just don’t know what you’re getting.”

During one outbreak in Brooklyn in July, 130 people were hospitalized. Witnesses said many of users were shaking or leaning aimlessly against trees and fire hydrants.

In emergency room interviews, users said they would prefer to smoke real marijuana but took the synthetic drug to avoid detection in urine tests typically mandated for probation and parole issues and other reasons, according to Michelle Nolan of the New York City Health Department.

“For individuals still using a psychoactive substance, this afforded them, criminally speaking, fewer risks,” Nolan said.

Zika defect

Michelle Flandez had just given birth to her first son, but doctors in this U.S. territory whisked him away before she could see him.

Perplexed, she demanded him back and then slowly unwrapped the blanket that covered him.

“My husband and I looked at each other,” she recalled. “No one had warned us. No one had given us the opportunity to decide what to do.”

It was mid-October, and in her arms lay what health officials announced as the first known baby born in Puerto Rico with a rare birth defect that has been linked to the mosquito-borne Zika virus. Those with microcephaly have abnormally small heads and often suffer impeded brain growth and other problems.

The island, already struggling with a shortage of doctors and funds amid a worsening economic crisis, has more than 35,700 Zika cases, including nearly 3,000 involving pregnant women. Some 300 people overall have been hospitalized and five have died, including at least two who developed complications from a paralysis condition linked to Zika known as Guillain-Barre.

Since the birth of Flandez’s son, named Inti after an Inca sun god, four other babies have been born in Puerto Rico with birth defects linked to Zika, including microcephaly. The U.S. Centers for Disease Control and Prevention has projected a surge in cases next year. A study by the CDC estimates that up to 10,300 pregnant women in Puerto Rico could be infected with Zika and that between 100 and 270 babies could be born with microcephaly. The U.S. mainland, meanwhile, has reported more than 30 cases of birth defects linked to Zika.

While Flandez had symptoms of Zika early in her pregnancy, she said she was told that tests showed a false positive. Sonograms in August and September showed no problems.

Flandez ran a finger through the silky dark hair on Inti’s tiny head on Friday as she described the challenges of raising her 3-month-old son on an island in economic crisis. She called several pediatric neurologists after he was born and found just one who accepted Medicaid. The earliest appointment she could get was in October 2017.