I took what I thought was a routine flight to visit my family in Florida in October 2009. My leg had been bothering me a little before the flight, due to chronic Achilles tendonitis. When I got off the plane in Florida, my leg seemed stiffer than usual. The flight was uneventful, and since it was late when I got back to the house, I went right to bed.
The next morning, a pain shot up my leg from the sole of my foot when I stood and put weight on my leg. I had never felt pain like this in my foot or leg. I knew there was something wrong. I am 25 and in good shape, so even in my wildest dreams, I did not think my symptoms could be due to a blood clot. I limped around for three days in Florida and iced my leg, wrapped it in Ace bandages, and worried about the swelling.
I had never had that kind of swelling before. I should have listened to my gut, and asked my father to take me to the doctor right then. However, I felt silly about my worry, because of my Achilles tendonitis and my young age.
Three days after flying to Florida I returned home to Dallas. The pain was so bad that my mother would not let me go home. Luckily, I was able to get an appointment with a podiatrist the day after I returned. During the visit, the doctor could see the effect of the clot on my leg. My leg was swollen from the knee down and none of the new symptoms fit with the tendonitis. Just to be safe, he sent me for an ultrasound of my leg. Not five minutes after the ultrasound, the doctor paged me, and I was soon hearing those scary words, “You need to go to the nearest ER and tell them you have a blood clot in your leg.”
When I got to the ER, they wanted to do a repeat ultrasound to confirm the results of the first, because of potential side effects of treatment with blood thinners. This second ultrasound showed some relatively good news, even though I did not realize it at the time. The blood clot was in one of the smaller peripheral veins nearer to the skin surface, not in a deep vein. This is a thrombophlebitis rather than a DVT, so I was fortunate that it could be treated with aspirin.
I found out I could go home, start taking aspirin, and see a hematologist the next day. After high doses of aspirin, six follow-up visits for ultrasounds, blood tests to see whether I had a genetic clotting disorder, and discontinuation of my birth control pills, the superficial blood clot dissolved.
Even though all the tests have shown that I do not have a clotting disorder that predisposes me to clots, my life has changed forever. I make sure to drink a lot of water whenever I take a flight, and get up and walk around every 30 minutes while I am in the air.
I can never take birth control pills again and was told that if I get pregnant I will have to take a blood thinner, because changes during pregnancy make the blood clot more easily. I am going to have surgery to treat my tendonitis and my hematologist and orthopedic surgeon are going to put me on an injectable blood thinner for two weeks while my leg is immobilized.
I now try to live an even healthier and fulfilling life, and consult as needed with my primary care physician and a hematologist. I know I am lucky that I had an expert doctor who did not delay at all in sending me for that ultrasound just because I was young.
If you can learn anything from my story, please know that no matter how young you are you can get a blood clot. If you notice symptoms suggestive of a blood clot, such as leg swelling and pain, go to the doctor immediately. If you are contemplating use of birth control pills, make sure to discuss your family history (especially related to blood clots) as well as the adverse effects of birth control with your doctor. Take your life into your own hands.
Important Take Home Messages
Seek medical help immediately for swelling and pain in your leg.
Let your doctor know your family history of blood clots, particularly in your parents, sisters, or brothers.
Birth control pills increase risk of blood clots due to the effect or dose of hormones, either estrogen or progestin.
Blood clots can happen in young people.
Immobility and orthopedic surgery increase risk of blood clots.
Do heel-toe exercises while sitting on an airplane and get up and move around at least every hour, and drink plenty of water during the flight. This is true for car, train, and bus travel as well, especially when longer than 4 hours.
Thrombophlebitis (superficial vein thrombosis, or a clot in veins near the surface of the skin) is treated with some form of injectable heparin (or other “anti-clot” injectable medication) or a “blood thinner” in pill form for at least 4 weeks.
“Blood thinner” pills (typically warfarin) may be given on the same days (“overlapped”) as the injectable “anti-clot” medication for 5 days.
Oral or topical NSAIDs (non-steroidal anti-inflammatory drugs) may control symptoms in clots very near the skin surface without “blood thinners.”
Aspirin is not recommended as treatment for thrombophlebitis. Sara got better, but this was likely independent of the aspirin treatment.