What is a Pulmonary Embolism?

A blood clot formed in the deep veins of the body is called deep vein thrombosis – DVT. Though primarily it occurs in the leg, it can also occur in the veins of the abdomen, pelvis, arm, or around the brain. The clot travels through the blood and gets stuck in an artery in the lungs, thus blocking the flow of the blood to the lungs. This complicated condition that arises is called Pulmonary Embolism.

This blockage can be a serious threat if not treated as it can damage the lungs, reduce the oxygen levels in the blood. A low level of oxygen will adversely affect other organs in the body. Pulmonary Embolism can be lethal if the clot is big or in case there are multiple smaller clots in the artery.

The worst scenario is if the patient has developed one clot, then chances of another occurrence of clot rises. Hence it is necessary to prevent from developing further clots by ensuring the blood is flowing. If symptoms such as pain, tenderness, swelling, warmer-than-normal or red skin are visible, then immediately call the doctor.

How many days should the patient be on anticoagulant medication?

This is decided by the doctor after he checks with the patient various factors
Such as
1. What factors that resulted in the formation of the clot?
2. Location of the clot.
3. Is there a chance of recurrence of the clot if the medication is stopped?
4. Are there any chances of bleeding if the anticoagulant is continued further to prevent the formation of a clot?
5. Doctor also discusses with patients about the effect anticoagulant is having on his daily activity.

The doctor also has to take into account several factors prior to deciding the appropriate anticoagulant suitability for a particular patient by considering the above factors.

When do the clot and pain go? The symptoms generally improve within a few days of medication of anticoagulant and over a period of time these symptoms disappear. However, in some cases, there are issues that are long-term and with symptoms that may be mild to severe. Most patients with Pulmonary Embolism recover completely within months without any serious complications or side effects.

Nearly half of the patients have some kind of chronic discomfort ranging from mild to moderate which includes swelling and pain. This is due to the post-thrombotic syndrome. Post-thrombotic syndrome can be partly because of damage done during clot formation and partly it can be attributed to the obstruction formed by left-over-clot.

Graduated compression stockings is one the best solution recommended by the doctor for DVT and PE. These stockings help to comfort the leg and the patient feels much better. These stockings made of a special kind of elastic and are designed in such a way that they are tight at the ankle and the tightness gets reduced gradually as the stocking moves up the leg. These stockings available only against prescription from the doctor and are individually fitted. The doctor prescribes these stockings with the tightness recommended of 30mm to 40mm hg pressure.

In case of a prolonged state of PE or if the patient has not recovered completely as earlier, then it is necessary to get assessed for pulmonary hypertension. There is a chance of a few patients with pulmonary embolism resulting in long-term damage to the lungs known as pulmonary hypertension. In this state of pulmonary hypertension, the patient experiences shortness of breath, and his ability to exert gets reduced. If not treated by a doctor it can be a cause of heart failure.

How much physical activity is correct during DVT?

The patients are scared that due to the physical activity the clot may break off and then they will suffer pulmonary embolism. However, patients carrying out their normal activities will not develop PE. One should be cautious enough and try to do those physical tasks that are easily feasible and more importantly, seek doctor’s advice about the do’s and Don’ts related to the daily activities.

How to cope with mental fatigue due to this illness?

Once the patient is diagnosed with a state of DVT or PE, the patient tries to
figure out what has been the cause, why he has to endure this pain? As is the case with any illness, DVT or PE does cause physical as well as mental pain, shock, anxiety, and depression. However, it is normal for one to go through this gamut of emotions. But at the same time, one should seek a doctor’s help in controlling and arresting this state of negativity. There are support centers that help in giving that required stability and help to rejuvenate which is immensely essential to recover from this illness of PE.

Whenever a patient experiences the symptoms of DVT or PE, then immediately contact the doctor. Consulting a family general physician immediately is essential and then it can be decided together to seek further advanced guidance from the specialist.

These clots may develop if the blood is not flowing freely through the legs as there is no leg movement due to various reasons such as long drive, long flights, or even while taking bed rest after an illness or surgery. The clot can also develop because of blood that has a tendency to clot – this condition is called hypercoagulability. This condition can be a cause of medications such as birth control pills, post-surgery especially surgery involving the hip, knee, or related to the urinary system. Injury to the lower leg, smoking, damage to the blood vessel wall, are some of the other risk factors which can be a cause of blood clot.

The best option to prevent PE is to stop the formation of blood clots in the veins. The initial treatment for DVT and Pulmonary Embolism is anticoagulation with blood thinners. These blood thinners delay the time it takes for blood to clot and thus prevent the formation of clots. Anticoagulants also stop the increase in the size of existing clots. These anticoagulants do not dissolve the clot, but the body over a period of time dissolves the clot completely or sometimes only partially.

Some simple steps to prevent clot formation – A simple exercise like getting out of bed and just walking after a long stay in hospital post-surgery or any kind of illness will be able to maintain the blood flow in the legs and it will not be able to clot.

In case of a long flight, take a walk around every few hours, if not able to stand then one should flex ankles by pulling toes upward. In case stuck in a traffic jam or long drive then stopping a car periodically and stretching the legs gradually will be helpful.

Family physician or physiotherapist can also guide in suggesting stretching
exercises for legs to maintain the blood flow.
Some other significant precautionary measures are

• Maintain a healthy weight
• Smoking is strictly prohibited
• Getting a regular body check-up
• Consulting family physician in case of other health issues such as diabetes, heart disease, kidney disease or certain autoimmune diseases, or family history of blood clots.

Dr. Parthiv Shah is a well-known Pulmonologist in Borivali, Mumbai popular for his pulmonary services for patients suffering from lung diseases. He has done postgraduation in Pulmonology with an additional diploma in respiratory medicine from Europe. His qualification coupled with experience and skills has enabled him to successfully handle many complicated cases. His specialty is in the field of Lung and Trachea Bronchi related illnesses such as Asthma/Bronchitis, COPD, Lung Infection, Tuberculosis has benefitted many patients to get proper care, alleviate pain, and get cured.

Dr. Parthiv Shah’s skill in handling PE cases is exemplary and has been admired by his peers as well. His recommendation of yoga and asanas to patients suffering from Pulmonary Embolism, Asthma/Bronchitis, Lungs related illnesses has helped rejuvenate patients thus boosting their healing and recovery process.