{
  "version": 3,
  "sources": ["ssg:https://framerusercontent.com/modules/iai2thZTrYVwcwUEazBR/kgjZYpA8tkIdD0Y9P09O/p_wfmNz_K-2.js"],
  "sourcesContent": ["import{jsx as e,jsxs as t}from\"react/jsx-runtime\";import{Link as o}from\"framer\";import{motion as a}from\"framer-motion\";import*as n from\"react\";export const richText=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"h3\",{children:\"Stone Age to Space Age:  Experiences of a Thrombophilia Patient\"}),/*#__PURE__*/e(\"p\",{children:\"September 1, 2009\"}),/*#__PURE__*/e(\"p\",{children:\"People die from clotting events.  This was true in the \u201Cstone age\u201D, before Factor V Leiden (FVL) and other clotting disorders were identified, and it is still true today. In the past, however, clotting was simply chalked up to complications in the hospital, complications in pregnancy, or simply being prone to episodes of phlebitis (like Richard Nixon).  No one really questioned the disorder or looked to identify an underlying cause.  I know in my own family that my aunt died giving birth to my cousin after experiencing a clot.  \"}),/*#__PURE__*/t(\"p\",{children:[\"She probably had FVL, which was passed from my grandfather to both my father and aunt, and then from my father to me.  It was simply accepted that older folks had strokes and heart attacks.  It was just part of growing old.  My grandfather had several heart attacks before he died from one.  He may have had, and probably did have, heart disease, but given what we now know about my family history he may also have had FVL.  Perhaps in this day and age, he would have been put on \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/thrombosis-and-blood-clots/procedure-playbook-blood-thinners-surgery-guide\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"Coumadin or Plavix\"})}),\" and survived longer.  Perhaps also now my aunt would have been diagnosed and her clotting disorder managed during her pregnancy \u2013an example of the differences between then vs. now.\"]}),/*#__PURE__*/e(\"p\",{children:\"There were no questions asked when I went to get my first prescription of birth control pills in the late 1970\u2019s.  I was on them for 8 months before I got my first superficial clot; it came a ten-day stay at Stanford Hospital on \u201Cblood thinners.\u201D  All the nurse said was that \u201CSome folks clot, we don\u2019t know why,\u201D and \u201CStop crossing your legs.\u201D  No booties were given to me; no compression hose; no leg warming apparatus \u2013 another comparison between then and now.\"}),/*#__PURE__*/e(\"p\",{children:\"In 1994, the test for Factor V Leiden came out.  A simple blood test can now tell if you have the FVL gene, and if you are heterozygous or homozygous.  In late 1994, out of the blue, I had a hemorrhagic stroke.  While at Stanford, a complete blood panel was worked up to figure out why a 34 year old would have this type of stroke (I probably had an ateriovenous malformation [AVM] that burst; even discussions at Medical Grand Rounds could not prove or disprove the reason for my stroke).  \"}),/*#__PURE__*/e(\"p\",{children:\"I was told 50% of folks never wake up from the type of event I had.  It turned out that I am heterozygous for FVL.  Later, I would find out that I have other clotting disorders in the mix: I am also heterozygous for factor II and I have homocystienemia.\"}),/*#__PURE__*/e(\"p\",{children:\"A year later, I landed back in the hospital again because of my clotting disorders.\"}),/*#__PURE__*/e(\"p\",{children:\"Following minor surgery, I got a DVT from ankle to pelvis.  I was put in compression hose and leg warmers and was told I would be taking Coumadin for life.  If either event had happened in my aunt\u2019s time, I would probably not be here.\"}),/*#__PURE__*/e(\"p\",{children:\"When I got out of Stanford Hospital I asked myself \u201CWhat does this mean? What is FVL?\u201D  I had never heard of it prior to my stroke.  I certainly knew what hemophilia was.  My husband has hemophilia, a disorder that has been around forever, even appearing in history books.  I went to the Stanford medical library and could not find a single article on FVL. I searched the web in the absence of Google or other search engines \u2013 Yahoo had only recently started.  \"}),/*#__PURE__*/e(\"p\",{children:\"I found one medical article and it was a doctor\u2019s study (in doctor speak), which was very difficult to comprehend, let alone after having had a stroke.  It made little sense to me.  From my husband, I knew that hemophilia support groups were available, so at my next checkup I asked what was available to me.  \"}),/*#__PURE__*/e(\"p\",{children:\"Nothing.  \"}),/*#__PURE__*/e(\"p\",{children:\"The only thing that existed was a stroke support group.  I thought, \u201COkay, I\u2019ll try it.\u201D  I tried one session, but everyone there was much older than I and had suffered a \u201Cregular stroke\u201D associated with old age.  Their issues were much different than mine.  None of them had a clotting disorder (or at least none of them knew that they did).\"}),/*#__PURE__*/e(\"p\",{children:\"I contacted the local hemophilia organization and asked if there were any resources for me.  Again nothing.  I said to my husband as we left Stanford after one of my many checkups, \u201CI can\u2019t be the only one with this.  Why isn\u2019t there something for us clotters to read or meet or attend \u2013 similar to what the hemophilia group offers.\u201D  It has symposiums and support groups, educational materials, children\u2019s camps, and more.  \"}),/*#__PURE__*/e(\"p\",{children:\"After repeatedly searching on the Internet, I found a woman in Wisconsin that offered a bulletin board message board website.  It was difficult to follow the conversation threads, but at least there was someone out there just like me!  We kept in touch for a while but I lost interest because I did not feel it was an effective tool for people with clotting disorders.\"}),/*#__PURE__*/e(\"p\",{children:\"I am a Silicon Valley worker, so I thought I would just make my own FVL web page and put it up on the web.  I also knew that my husband had participated for several years on an email-based discussion list for persons with hemophilia.  This site was heavily used to discuss pertinent issues within that community.  \"}),/*#__PURE__*/e(\"p\",{children:\"Thanks to my husband, I got in touch with the fellow who ran the hemophilia list.  He helped me create the www.FVLeiden.org website as well as an email discussion list.  I intended the website to serve as a vehicle for providing information while at the same time informing people about and enrolling them in the email list.  \"}),/*#__PURE__*/e(\"p\",{children:\"I told my husband that if after two weeks no one signed up for the discussion list I would take down.  The site and list serve caught on quickly and grew steadily.  With over 1,400 participants from all over the world, 2009 is the 10th anniversary of www.FVLeiden.org.  \"}),/*#__PURE__*/e(\"p\",{children:\"The topics discussed are exactly what individuals with clotting disorders want to discuss.  It is an open, un-moderated email forum; those of us who have been through whatever topic is being discussed lend our ideas and support.  I also continually expand the website with up-to-date information relevant to persons with clotting disorders.  At its inception, my site was just about the only thing on the Internet with such a compendium of information.  \"}),/*#__PURE__*/e(\"p\",{children:\"Today, of course, when a person is diagnosed with FVLeiden or another form of thrombophilia there are pages and pages of information from other web sources and in medical libraries.\"}),/*#__PURE__*/e(\"p\",{children:\"Because of my work with www.FVLeiden.org, I was asked to participate in a clinical trial for one of the first home INR home testing meters.  My fellow study participants and I went to Stanford once a week to poke ourselves.  It was great to sit around the table with others who needed such a device.  \"}),/*#__PURE__*/e(\"p\",{children:\"I was the youngest person there; everyone else was elderly with had heart conditions (hence they were on Coumadin).  For our involvement in the trial, each of us was given a meter of our own at the end of the trial for participating.  This machine gave me the freedom not be tied to an anticoagulation lab.  I could test my INR at any time, any place.  It gave me the freedom to travel and move anywhere I wanted to live.  I consider it the biggest advance in thrombophilia thus far.\"}),/*#__PURE__*/e(\"p\",{children:\"The home INR meters have improved since then.  I now own a different one, smaller and more compact.  I do not have to refrigerate the strips or calibrate the machine as I did with the predecessors I owned.  The same types of advancements have occurred with compression hose.  When I was first in the hospital, I was given what I would consider granny compression hose \u2013 ugly thick white stockings that took me a half hour to pull on or off.  \"}),/*#__PURE__*/e(\"p\",{children:\"A prescription was needed to purchase the stockings and I had to go to a medical supply store to purchase them.  Now there are multiple websites to purchase nice, fashionable stockings.  They come in a variety of colors, sizes, thicknesses and a prescription is not needed.  What a difference from 15 years ago when I was given my first stockings to take home!\"}),/*#__PURE__*/t(\"p\",{children:[/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/ask-the-experts/patients-are-asking-what-s-the-right-anticoagulant-for-me\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"Genetic testing\"})}),\" has started to focus on thrombophilia as well.  When I was in my early twenties and got married the only testing available was for Tay-Sachs.  However thrombophilia testing was not available at that time.  Now there are websites advertising multiple genetic tests for thrombophilia.\"]}),/*#__PURE__*/e(\"p\",{children:\"The media has started to focus on DVT awareness too.  A few airlines show videos on long flights that show exercises to prevent passengers from being stationary for too long.  Articles are popping up in magazines about the risk of clots after long car trips or plane flights.  When I travel for more than 3 hours on a plane, I walk the length of the plane several times.  I used to get all kinds of looks while doing this, now people understand why someone will get out of their seat and move about the plane.  There has been mention of thrombophilia on network news and in doctor related TV shows (House and ER, for example).  They do not usually go into great detail, but at least there is mention of it to a large audience.\"}),/*#__PURE__*/e(\"p\",{children:\"It seems to me that the last fifteen years there has been a time of huge advancement in awareness and treatment of thrombophilia.  When I was first diagnosed, I truly felt alone.  Now there are many thousands of people around the country and the world with whom to share information and experiences, and thanks to the Internet, this is happening every day.  I still feel that there is a void in terms of a national entity that truly speaks for people like me; but I am still hopeful that this will change and I am constantly looking for ways to help make it happen.  As The Grateful Dead said, \u201CWhat a long, strange trip it\u2019s been.\u201D\"})]});export const richText1=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"People die from clotting events. This was true in the 'stone age,' before Factor V Leiden (FVL) and other clotting disorders were identified, and it is still true today.\"})});export const richText2=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"In the winter of 2007, Melissa Hogan woke up with a swollen leg and ankle. As a healthy 24-year-old, she had no idea what was causing the swelling. At her doctor\u2019s office a few days later, an ultrasound confirmed a superficial blood clot in her leg. She was told to take some aspirin and come back if things got worse. Eventually, things did get worse. Melissa has had four recurrent blood clots since that day 13 years ago.'}),/*#__PURE__*/e(\"p\",{children:\"What do you remember about your first clot?\"}),/*#__PURE__*/e(\"p\",{children:\"What I vividly remember is that I started taking birth control 5-6 months before the clot developed. My doctor casually mentioned that oral contraception can cause blood clots, but I thought nothing of it. I stopped taking birth control after that first clot.\"}),/*#__PURE__*/t(\"p\",{children:[\"Did you have any other \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/hormone-therapy/blood-clot-risk-factors-explained\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"risk factors\"})}),\" for blood clots?\"]}),/*#__PURE__*/e(\"p\",{children:\"I had a risk factor that I didn\u2019t know about at the time. I have a fraternal twin sister and after returning from a trip to Europe, she started having swelling and leg pain \u2013 symptoms similar to the ones I had two years before. She\u2019s a runner and thought she had injured herself on a run. She ignored her symptoms for the longest time but finally went to the doctor. Lo and behold, she had deep vein thrombosis (DVT). A week later, she had trouble breathing and was diagnosed with a pulmonary embolism (PE).\"}),/*#__PURE__*/e(\"p\",{children:\"She had a full workup and discovered that she was positive for Factor V Leiden, a genetic condition that increases the risk for blood clots. My PCP recommended that I get tested, and my test also came back positive for Factor V. So, by my late 20s, I knew I had a predisposition to clots.\"}),/*#__PURE__*/e(\"p\",{children:\"How did you feel after getting the results from your testing?\"}),/*#__PURE__*/e(\"p\",{children:\"I wasn\u2019t overly concerned. My doctor told me to be aware of anything unusual going on in my body, but I was encouraged to stay active and live my life normally. The next few years were uneventful, until I broke my foot in 2014.\"}),/*#__PURE__*/t(\"p\",{children:[\"Did you need \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/clinical-resources/clot-chronicles-protecting-patients-after-hip-and-knee-surgery\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"surgery \"})}),\"on your foot?\"]}),/*#__PURE__*/e(\"p\",{children:\"No, but I was in a boot and on crutches for several weeks. After three weeks of being in the boot, my leg blew up like a balloon. It was really painful, like crying-in-the-shower painful.\"}),/*#__PURE__*/e(\"p\",{children:\"I had a friend drive me to the hospital and sure enough, there was a large DVT in my right leg. I was referred to a hematologist and took warfarin for 6 months. I made a full recovery, aside from some lagging pain and swelling in my leg.\"}),/*#__PURE__*/e(\"p\",{children:\"But my story doesn\u2019t end there. In 2016, I got an IV in my arm for a procedure and my arm started swelling a week later.\"}),/*#__PURE__*/e(\"p\",{children:\"Did you fear that you had a clot in your arm?\"}),/*#__PURE__*/e(\"p\",{children:\"I knew I had a clot. I get a very distinct feeling when I have a clot. It\u2019s not really pain, but it\u2019s an achy feeling. It\u2019s hard to describe if you haven\u2019t experienced it, but it\u2019s a sensation I\u2019ve had with every clot.\"}),/*#__PURE__*/e(\"p\",{children:\"An ultrasound of my arm confirmed a superficial clot and my doctor prescribed heparin injections. A week went by and my arm got worse. A second ultrasound showed that the clot had grown, even though I was on the injections. I switched to fondaparinux injections for 45 days and the clot went away. My hematologist told me that I\u2019d need lifelong anticoagulation if I were to have another clot.\"}),/*#__PURE__*/e(\"p\",{children:\"And are you on lifelong anticoagulation now?\"}),/*#__PURE__*/e(\"p\",{children:\"Yes. In 2018, I had unexplained pain behind my left ankle. I exercise a lot between running and spin classes, so I thought I just tweaked something. A couple days later, I started getting that achy feeling and went to the emergency room. They didn\u2019t find a clot on my ultrasound \u2013 I was so relieved!\"}),/*#__PURE__*/e(\"p\",{children:\"The swelling subsided a few days later, so I figured whatever injury I had was healing. I went to a spin class and midway through, it felt like there was a wall in my chest and I just couldn\u2019t get any air past it. I went back to the hospital and a CT scan confirmed PEs in both lungs. I was admitted to the hospital overnight and discharged on apixaban for life.\"}),/*#__PURE__*/e(\"p\",{children:\"How have the clots affected your life?\"}),/*#__PURE__*/e(\"p\",{children:\"Physically, I still have pain in my right leg and it\u2019s always swollen in a certain spot. Compression stockings help. I wear them for a few hours every day and when I travel on planes.\"}),/*#__PURE__*/t(\"p\",{children:[\"Mentally and emotionally, the \",/*#__PURE__*/e(o,{href:\"https://pubmed.ncbi.nlm.nih.gov/38965839/\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"anxiety\"})}),\" is the worst part. I think about my clots every day. Whenever I feel something off or weird, I wonder if I have another clot. Before my PE, there was a DVT in my body that didn\u2019t show up on ultrasound or that was too small to see. The doctors couldn\u2019t tell it was there, and that freaks me out.\"]}),/*#__PURE__*/t(\"p\",{children:[\"Since the PE, I\u2019ve been to the ER twice for false alarms \u2013 my leg has been swollen and I\u2019ve had pain that I can\u2019t explain. The \",/*#__PURE__*/e(o,{href:\"https://www.massgeneral.org/news/research-spotlight/anxiety-depression-risk-factors-blood-clots\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"anxious feeling\"})}),\" is always going to be a part of my life.\"]}),/*#__PURE__*/e(\"p\",{children:\"How do you manage the anxiety, and what advice would you give to other blood clot survivors?\"}),/*#__PURE__*/e(\"p\",{children:\"The best way that I can deal with it is to really listen to my body. If I feel that something\u2019s wrong, I\u2019m not afraid to get it checked out. I\u2019d tell anyone else the same thing. You know yourself best. If you think something\u2019s off, call your doctor or go to the emergency room.\"}),/*#__PURE__*/e(\"p\",{children:\"Educate yourself, too. The more educated you are about your condition, the more you can advocate for yourself. In my experience, healthcare providers don\u2019t always think of blood clots right away when a healthy person comes in with shortness of breath or other \u201Cgeneric\u201D symptoms. My knowledge about blood clots has helped me in those situations.\"}),/*#__PURE__*/t(\"p\",{children:[\"I also don\u2019t think \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/women-s-health/\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"women are counseled enough\"})}),\" on the risks that come with birth control. Birth control can be dangerous, and women need to be educated about the risks.\"]}),/*#__PURE__*/e(\"p\",{children:\"Are you back to exercising?\"}),/*#__PURE__*/e(\"p\",{children:'Yes! All of my doctors have told me that being healthy and active really works to my advantage. I was fully recovered from my PE in a month \u2013 I feel very lucky.\"'})]});export const richText3=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:'\"In the winter of 2007, Melissa Hogan woke up with a swollen leg and ankle. As a healthy 24-year-old, she had no idea what was causing the swelling.\"'})});export const richText4=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"It was a warm Saturday in mid-June when Steve noticed that something was 'off.' As an avid athlete, he'd spent years participating in triathlons \u2013 multi-sport races that incorporate biking, swimming, and running.\"})});export const richText5=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/t(\"p\",{children:['\"It was a warm Saturday in mid-June when Steve noticed that something was \u201Coff.\u201D As an avid athlete, he\u2019d spent years ',/*#__PURE__*/e(o,{href:\"https://www.stoptheclot.org/about-clots/athletes-and-blood-clots/\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"participating in triathlons\"})}),\" \u2013 multi-sport races that incorporate biking, swimming, and running. After several years of racing, he qualified for the World Triathlon Championships and spent nearly a year training for the big event. \"]}),/*#__PURE__*/e(\"p\",{children:\"\u201CI was using races to improve my fitness because you never work as hard in training as you do in a race. So, I did a lot of races. In the span of three weekends, I think I did six races of different kinds, all involving running, biking, and swimming. I had a Sunday race, so I spent this particular Saturday going through my normal \u2018day-before-a-race\u2019 routine. I did a 20-mile bike ride and felt a little sluggish but didn\u2019t think much of it at first. I returned from my bike ride and immediately changed into my sneakers for a four-mile run,\u201D Steve recalls.\"}),/*#__PURE__*/e(\"p\",{children:\"As soon as he jogged out of his driveway, he experienced a pain in his ribs so intense that he had to stop. \u201CI walked a little bit and tried running again, but the pain was awful. Something was definitely off, but I rested and ended up doing the race the next day. I didn\u2019t perform well, to no one\u2019s surprise.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Steve continued training for the Championships but started experiencing some breathing issues. \u201CIt seemed like I\u2019d inflate my lungs to a certain point when I was at peak exertion, but then there was a line I couldn\u2019t cross \u2013 if I crossed a line, I experienced meaningful pain.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Steve contacted both his primary care doctor and a cardiologist and had a chest x-ray and echocardiogram. (Also known as an echo, an echocardiogram uses ultrasound waves to look at the heart\u2019s chambers and valves and to assess how blood is moving through the heart.) Steve\u2019s tests didn\u2019t identify anything out of the ordinary. \"}),/*#__PURE__*/e(\"p\",{children:\"The following week, Steve went out for a trail run and vividly remembers feeling like he was at high altitude. A few days later, he found himself stopping three times while running on a familiar route. \u201CI just wasn\u2019t feeling like myself, but I kept running because that\u2019s what I love to do.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"My mind went from blood clots to stroke to \u2018I\u2019m dying and won\u2019t see my kids again.\u2019 That was emotionally very difficult.\"}),/*#__PURE__*/t(\"p\",{children:[\"On the heels of these episodes, Steve saw a pulmonologist and had some more testing done, including a CT scan with contrast. (\",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/thrombosis-and-blood-clots/how-are-blood-clots-diagnosed\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"CT scans\"})}),\" provide a detailed view of the organs and blood vessels, and contrast refers to a dye that\u2019s used to highlight the specific areas of the body that are being evaluated.) \"]}),/*#__PURE__*/e(\"p\",{children:\"\u201CShortly after the scan, I was told \u2018your pulmonary arteries are about 90% blocked and you have blood clots throughout your lungs. We\u2019re taking you to the emergency room.\u2019 My mind went from blood clots to stroke to \u2018I\u2019m dying and won\u2019t see my kids again.\u2019 That was emotionally very difficult. It was also hard to wrap my head around the fact that I was feeling fine if I wasn\u2019t exercising or trying to breathe deeply. Day to day, I felt fine \u2013 but there was this silent thing in me that was potentially deadly. It was tough to process that.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Steve also didn\u2019t know why his PE happened. \u201CI started educating myself about the risk factors for blood clots, but nothing really checked out for me. I wasn\u2019t dehydrated, I wasn\u2019t a smoker, I didn\u2019t take steroids, I hadn\u2019t returned from a long trip on an airplane\u2026my best guess is that I pushed my body to extreme levels. I sort of turn myself inside out when I race; perhaps I created some sort of perfect storm that then caused my PE.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Steve spent two nights in the hospital and was discharged with a prescription for warfarin, a blood thinner used to prevent new blood clots from forming. \u201CWithin a few days, I was able to go for a walk, but I had to drop out of the World Championships. There was just no way that being on a blood thinner, I could risk a bike crash.\u201D \"}),/*#__PURE__*/e(\"p\",{children:\"\u201CBe honest with your doctors\u2026and with yourself. I\u2019d suggest that people take a step back and evaluate why they\u2019re doing what they\u2019re doing. If it\u2019s costing you your health, is it worth it?\u201D\"}),/*#__PURE__*/t(\"p\",{children:[\"But what Steve remembers even more than the disappointment of having to withdraw from the Championships is the \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/stress/blood-clots-and-mental-health\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"anxiety around his diagnosis\"})}),\". \u201CIt was very real for a long time,\u201D he says. \u201CJune 25th was the day I saw the pulmonologist for the first time\u2026and for years after my PE, I had chest pain on June 25th. I gradually built up my exercise and was able to return to my normal level of activity, but the anxiety took a while to get past. That said, the experience wasn\u2019t all bad \u2013 it led to a lot of self-reflection, and I made a few changes in life because of it.\u201D\"]}),/*#__PURE__*/e(\"p\",{children:\"And for fellow athletes who may experience a health setback, Steve offers these words of wisdom: \u201CBe honest with your doctors\u2026and with yourself. Think about why you\u2019re pushing yourself so hard in the first place. A lot of us in the racing world are totally obsessed with activity and competition, but is it that important? There\u2019s an exercise I\u2019ve heard about where you write your own obituary or what\u2019s on your tombstone. Do I want \u2018triathlete\u2019 to be on my tombstone? No, I don\u2019t. So why turn myself inside out for a sport? I\u2019m proud of what I\u2019ve done but I\u2019d suggest that people take a step back and evaluate why they\u2019re doing what they\u2019re doing. If it\u2019s costing you your health, is it worth it? I\u2019m not so sure it is.\u201D\"})]});export const richText6=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"DVT and PE:  A Disease with Extensive Emotional Impact'}),/*#__PURE__*/e(\"p\",{children:\"July 1, 2009\"}),/*#__PURE__*/t(\"p\",{children:[\"A Note to the Reader:  This entry is not indented to provide answers, it is meant to illustrate the \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/stress/recovering-from-a-blood-clot-what-s-mental-health-got-to-do-with-it\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"emotional impact\"})}),\" that Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) can have on a patient\u2019s loved ones.  My wife\u2019s story as experienced by me, her husband, serves to foster awareness of the challenges we, the loved ones, face as we try to push aside our own emotions in an effort to be supportive of the patient\u2019s needs and fears during a time of a medical emergency.\"]}),/*#__PURE__*/t(\"p\",{children:[\"Once the realization and the fear of death from a \u201Csilent killer\u201D -an expression commonly used to describe \",/*#__PURE__*/e(o,{href:\"https://my.clevelandclinic.org/health/diseases/16911-deep-vein-thrombosis-dvt\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"DVT\"})}),\" and PE\u2013 are introduced into your life, you can never forget how quickly and easily your life and that of your loved one can be changed or even lost.  I believe that the emotions I feel \u2013and continue to feel to this day\u2013 are experienced by others who have watched a loved one suffer from DVT or PE.\"]}),/*#__PURE__*/e(\"p\",{children:\"How can I forget that night?  It was the late hours of the night and early hours of the morning, July 23rd and 24th, 2005.  I can recall every detail of the conversations we had with the emergency room staff.  Each time I think about that long night, I am quickly reminded of how lucky we are that Heidi\u2019s life continues:\"}),/*#__PURE__*/t(\"p\",{children:[/*#__PURE__*/e(o,{href:\"https://www.mayoclinic.org/symptoms/blood-clots/basics/when-to-see-doctor/sym-20050850\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"ER Doctor\"})}),\":  Based on the symptoms you describe, we are going to do an ultrasound to ensure you do not have any blood clots in your lungs.\"]}),/*#__PURE__*/e(\"p\",{children:\"Heidi:  What could happen if I do have blood clots?\"}),/*#__PURE__*/e(\"p\",{children:\"ER Doctor:  They can be deadly.\"}),/*#__PURE__*/e(\"p\",{children:\"[Following the ultrasound]\"}),/*#__PURE__*/e(\"p\",{children:\"ER Doctor:  Unfortunately, you have large, multiple blood clots in your lungs.\"}),/*#__PURE__*/e(\"p\",{children:\"Heidi:  Am I going to DIE?\"}),/*#__PURE__*/e(\"p\",{children:\"For the rest of that night, out of fear it would be Heidi\u2019s last, we tried to fight off sleep.  We both lost the battle by dozing off just as the sun was rising.  We were woken by the voice of the cardiologist.  It was our good fortunate that the voice was that of one of the world\u2019s experts in DVT and PE.  Together with his nurse, we were assured that Heidi would survive. Life had become so surreal; we wanted to believe their calm and hopeful words, but, at the time, we could not fully do so:\"}),/*#__PURE__*/e(\"p\",{children:\"Doctor:  Is there anything that I can do for you?\"}),/*#__PURE__*/e(\"p\",{children:\"Heidi:  Can you save my life?\"}),/*#__PURE__*/e(\"p\",{children:\"Doctor (in a very calm voice):  I can do that.\"}),/*#__PURE__*/e(\"p\",{children:\"We put our life\u2019s fate in the hands of these kind and confident medical professionals as Heidi received the world\u2019s best medical care.\"}),/*#__PURE__*/e(\"p\",{children:\"Today Heidi is healthy, but since the diagnosis the emotional scars of that fateful night and ensuing months remain with us.  I keep thinking back to the ominous comment of the ER doctor, \u201CYou will die.\u201D  I recall the conversation between Heidi and the doctor administrating the echocardiogram.  What would have happened if we had not gone to the hospital that evening?  His reply: \u201CI am glad you did.\u201D  Those five simple but chilling words said it all.\"}),/*#__PURE__*/e(\"p\",{children:\"I recall those many nights in the months following Heidi\u2019s diagnosis.  Still to this day I wake up and watch my wife breathe \u2013reassuring myself that she is still alive.  My fear for Heidi\u2019s condition has even led me to spend a morning in the ER, positive that I, myself, was plagued by DVT.  Despite assurance otherwise, on occasion I still must convince myself that a pain in my calf is not a blood clot.\"}),/*#__PURE__*/t(\"p\",{children:[\"While dealing with my own emotions and fear, I need to be there for Heidi.  I continue to struggle with how best to support my wife and her emotional needs.  Together, we attend a \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/support-groups/?sort=asc\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"PE Support Group\"})}),\" where we hear and learn from other patients about the myriad of ways each developed DVT and PE.  Paradoxically, while gaining support from other victims of this \u201Csilent killer\u201D, my fears for Heidi (and myself) increase.  I know that I am not alone in this continuous emotional rollercoaster.\"]}),/*#__PURE__*/e(\"p\",{children:\"It has been four years since that long, fateful night in the ER and I am still wondering how I can best support my wife each time she complains of the slightest calf pain or shortness of breath. Now an \u201Cexpert\u201D in DVT and PE, I mentally eliminate any potential risk: surgery/trauma, genetic, immobility, etc. I push aside my own fear of blood clots, as I try to calm down and reassure my wife.\"}),/*#__PURE__*/t(\"p\",{children:[\"Heidi is now \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/women-s-health/pregnancy-and-blood-clots-what-women-need-to-know\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"pregnant \"})}),\"and back on prophylaxis treatment, daily shots of Lovenox.  I can only imagine the pain she must experience with each shot.  At the same time I silently monitor her compliance in the routine.  As Heidi\u2019s scheduled cesarean section and transition from this low molecular weight heparin draw near, my fears increase that a new trauma to her system will lead to another blood clot.\"]}),/*#__PURE__*/e(\"p\",{children:'And so you see, while the physical or medical consequences of DVT/PE are great, the emotional impact of this potentially devastating disease reaches beyond the patient.  This \u201Csilent killer\u201D results in an emotional rollercoaster for the patient and all those that love them.\"'})]});export const richText7=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"\\\"When Heidi was diagnosed with multiple pulmonary embolisms (PE) in July 2005, our lives changed forever. The fear of losing her to this 'silent killer' was immediate and overwhelming.\\\"\"})});export const richText8=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"Recently, I was out for my typical early morning six-mile run. Two miles in, I suddenly started seeing double, the world was tilting, and I couldn\u2019t continue. At some point I laid down and a passing stranger stopped to check on me. I remember  trying to wave him on, saying I was ok, but he insisted I was not. I then called my wife via my smart watch to get a ride home. She recognized something was seriously wrong with me and took me to the local hospital emergency room, even as I continued to insist that I was just fine and didn\u2019t want to go. Security personnel had to help her get me into the ER, at which point I was quickly diagnosed as having suffered a stroke. '}),/*#__PURE__*/e(\"p\",{children:\"So, this picture shows me running along a sidewalk in a wooded/marsh area. At some point a blood clot in my thalamus kept my brain from sending directions to the right side of my body, spinning me in never-ending circles.  I have no recollection of any of this.\"}),/*#__PURE__*/e(\"p\",{children:\"I am telling this story for two reasons: \"}),/*#__PURE__*/t(\"p\",{children:[\"First, getting treatment early, at the onset of stroke symptoms is critical. There is a \u201Cclotbuster\u201D drug called \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/clinical-resources/clot-chronicles-busting-out-pulmonary-embolism\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"TPA (tissue plasminogen activator)\"})}),\" that may be administered after appropriate scans. I personally equate it to \u201CNarcan\u201D for stroke victims\u2014my symptoms, including paralysis, slurred speech, drooping face, and double vision all began dissipating and mostly disappeared over the next few hours.  \"]}),/*#__PURE__*/e(\"p\",{children:\"Second, know the warning signs of strokes: (Of course there is an acronym) Hey BE FAST!\"}),/*#__PURE__*/e(\"p\",{children:\"H Headache\"}),/*#__PURE__*/e(\"p\",{children:\"B Balance problems\"}),/*#__PURE__*/e(\"p\",{children:\"E Eyesight changes\"}),/*#__PURE__*/e(\"p\",{children:\"F Facial droop\"}),/*#__PURE__*/e(\"p\",{children:\"A Arm Weakness\"}),/*#__PURE__*/e(\"p\",{children:\"S Speech Difficulties\"}),/*#__PURE__*/e(\"p\",{children:\"T Time to call 911\"}),/*#__PURE__*/t(\"p\",{children:[/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/thrombosis-and-blood-clots/stroke-burden-epidemiology-and-new-approaches-to-stroke-prevention\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"Strokes\"})}),\" can happen to anyone and for a variety of reasons. I am 65, have been an avid runner for decades and considered to be in very good health. This really hit me out of nowhere. I strongly suggest that anyone that exercises alone wear a \",/*#__PURE__*/e(o,{href:\"https://pmc.ncbi.nlm.nih.gov/articles/PMC9494381/#:~:text=Pulmonary%20embolism%20is%20an%20important,pulmonary%20embolism%20after%20COVID%2D19.\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"Smart Watch\"})}),' (a watch with cellular capability that will both allow someone to see where you are and allow you to make phone calls from your wrist if you need help.) We all should have one person in this world who knows where we are at any given time!\"']})]});export const richText9=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:'\"Recently, I was out for my typical early morning six-mile run. Two miles in, I suddenly started seeing double, the world was tilting, and I couldn\\'t continue.\"'})});export const richText10=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:\"How My Own Hospital Almost Killed Me: A Doctor\u2019s Story of Survival against the Odds and How All Patients should Protect Themselves from this Silent Killer in the Hospital\"}),/*#__PURE__*/e(\"p\",{children:\"Mary Beth Hanley, D.O.\\u2028\\u2028Kent Hospital \u2013 Warwick, Rhode Island\"}),/*#__PURE__*/e(\"p\",{children:'\"I cannot remember a time in my life when I was not interested in Medicine. As a young child I loved watching medical programs on TV, and pretending to cure my sick stuffed animal patients! These were still the days when girls were not encouraged to pursue careers in medicine. I decided to pursue a career in Nursing. My favorite high school teacher voiced his disappointment to me that I was not going to go to Medical school, but I had been accepted at a wonderful college with an excellent Nursing program and I was going to change the world.'}),/*#__PURE__*/e(\"p\",{children:\"I graduated Magna Cum Laude with a Bachelors degree in Nursing and a double minor in Biology and Spanish. I took my first job in an ICU step down unit and ultimately ended up in the Emergency Department. I became more and more frustrated with the limitations on my practice and skills and finally one of the Chief Surgical residents said to me, \u201CWhen are you going to stop messing around and just go to Med School?\u201D I took my admission tests, got accepted and 4 years later I was in inner-city Baltimore doing my internship year. I did my Anesthesiology and Critical Care Medicine residency at the Johns Hopkins Hospital in Baltimore. I fell in love with Pediatric Anesthesia and with kids in general. I was Chief Resident my senior year, and joined the Faculty of the Johns Hopkins School of Medicine after completing my Residency.\"}),/*#__PURE__*/e(\"p\",{children:\"In 2002, 2 weeks after the birth of my fourth child in 4 years, my husband and I moved our young family back to Connecticut to be closer to my Mother and family. I took a job at a small community hospital in the Northwest part of the state, and settled in to the role of part-time anesthesiologist, full-time Mom! Life was good.\"}),/*#__PURE__*/e(\"p\",{children:\"In May of 2008, I was at work when I noticed my right hand was swollen, red, and becoming more and more painful. I showed it to a hand surgeon colleague who said, \u201Cyou have a hand cellulitis, and you need IV antibiotics\u201D. \u201CO.K.\u201D, I thought, I can finish my shift, have one of the nurses put in an IV and give me the medicine, and that will be it. Unfortunately, it was the beginning of a nightmarish 2 year journey that led to multiple surgeries, loss of the use of my dominant right hand, loss of my job and insurance benefits, the realization that many people who I thought were my friends were not, and near financial ruin for me and my family.\"}),/*#__PURE__*/t(\"p\",{children:[\"My cellulitis progressed to Necrotizing Fasciitis, a potentially deadly infection that almost cost me my arm. I was taken to the OR emergency on a Saturday so a hand surgeon could open up my hand and forearm and de-bride dying tissue and hopefully stop the spread of the infection. I was fortunate that this was done in a timely fashion, otherwise I probably would have lost my arm. It was Mother\u2019s Day 2008 and I was in the hospital fighting for my life when I should have been enjoying brunch with my family. I was discharged home after 8 days in the hospital with a \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/cteph/cteph-you-medications-surgery-and-catheters-oh-my-cteph-treatment-options\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"central IV catheter\"})}),\" called a PICC line that snaked from my left upper arm to the right side of my heart. I gave myself IV antibiotics at home every 4 hours around the clock for 6 weeks. I began a program of intensive hand therapy and splinting that would go on for months. I learned how to dress myself and my children with one hand, how to feed, dress and groom myself with my non dominant hand and most importantly to write with my left hand. I could no longer use a keyboard with 2 hands, play my guitar, or paint and draw as I had enjoyed doing in the past. I battled non-healing wounds and ulcers on my wrist and forearm that stubbornly resisted healing and closure. I wore a Wound Vac, which is a large cumbersome device designed to close wounds, for weeks. I received a phone call from one of my former anesthesia colleagues in January 2009 telling me they did not want me back and that my medical benefits (which I carried for my family), would end February 1. I was profoundly depressed. I felt like my world, and everything I had worked so hard for was falling apart around me. The only thing that kept me going was my children. I was determined to get better to be the Mom that I was before all this; the Mom who taught them how to fish, and ski and play tennis, and played catch with them. I eventually taught myself to do all these things with my left hand, albeit not well.\"]}),/*#__PURE__*/e(\"p\",{children:\"Things sort of continued to drag on with one PICC line after another; one course of IV antibiotics after another; one surgery after another until March of 2009. I was re-infected and had several non healing wounds on my forearm. I had developed a deep ulcer on my wrist where a splint had dug in too deeply. There was black tissue and tendon visible from the surface. I was in agony. The surgeon tried unsuccessfully to debride the wound in the office which was incredibly painful. Every time I moved my arm it throbbed. I was beside myself with pain. I was admitted on a Friday and started on around the clock IV narcotics which helped get the pain down to a manageable level. I was in a private isolation room which was a converted supply closet. It was too small for a comfortable chair for me to get up and sit in. My only trips out of bed were to walk 8 feet to the bathroom and back. On Sunday, March 21, I awoke around 7 AM and took my IV pump into the bathroom with me. As I washed my hands and looked at myself in the mirror, I thought I looked very pale. Then I began to feel short of breath. I just could not catch my breath. I made my way back to my bed and sat down in it. I thought \u201CI\u2019ll just sit here awhile and I\u2019ll be fine.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"When the Nurse came in a few minutes later with my food tray, I was unconscious, unresponsive and blue. I remember a very peaceful feeling came over me and I could see the Nurses and the resuscitative equipment and hear the STAT pages, but I did not care. It was like I was floating above everyone and I did not care in the least what was happening! Then I heard the sounds of my children\u2019s voices all calling \u201CMommy\u201D at different times. When I opened my eyes, they were pushing air into my lungs with a resuscitation bag. I looked at my hands and thought \u201C wow, I am really blue..this is not good\u201D, with a clinical detachment only a doctor turned patient could have. Everyone kept telling me to take a deep breath so my oxygen level would go up, but try as I might, I still felt like I just could not catch my breath. I was being wheeled down to radiology as the Surgeon said , \u201CI think you had a P.E, hang in there\u201D. He looked scared.\"}),/*#__PURE__*/t(\"p\",{children:[\"The emergency CAT scan of my chest showed a \u201Cmassive pulmonary embolism\u201D . There was barely any room in my pulmonary artery for blood carrying oxygen to get through. My right heart was failing due to the increased force it encountered in what is normally a low pressure system. My next stop was the ICU where the Intensivist covering the unit said, \u201Cyou had a massive P.E., you\u2019ll be here for awhile\u201D. I was started on injections of a low molecular weight heparin product to decrease my blood\u2019s ability to clot. This does nothing to dissolve clot that has already been formed, it only prevents further clot propogation. I struggled to breathe for the next few days. My \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/thrombosis-and-blood-clots/blood-clots-the-root-of-major-health-issues\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"oxygen saturation\"})}),\" would plummet to the low 80\u2019s every time I stood up and pivoted to use a bedside commode, (normal is 97-100%) . My feet and ankles swelled up due to the fact that my heart could not pump hard enough to keep everything moving forward. I developed enormous bruises all over my abdomen from where the heparin shots were given. The ulcer in my wrist continuously oozed as my blood became thinner and thinner. I was at grave risk of dying for the first \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/podcasts/cholesterol-conversations-episode-3\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"72 hours\"})}),\". My husband, a physician, came in with my Mother and children, ostensibly to say good-bye. I will never forget the stricken look on my 8 year old son\u2019s face when he saw his Momma in the ICU struggling to breathe. He tried so hard to be brave. His teacher later told me he cried everyday in school and told her he was scared his Mom was going to die. That went on for months even after I came home from the hospital.\"]}),/*#__PURE__*/e(\"p\",{children:\"The ironic part of this horrible situation is that every first year medical student learns about something called \u201CVirchow\u2019s Triad\u201D. The Triad consists of (1) injury to the inner lining of the veins (usually the leg veins), (2) stasis of blood flow in the veins (usually the legs) and (3) hypercoagulability of the blood. One or two of these symptoms puts a patient at an increased risk of a deep vein thrombosis or pulmonary embolism. In my case, I had all three, plus I was overweight, taking hormone replacement therapy, had diabetes and rheumatoid arthritis. I should have just had \u201CHIGH RISK FOR DVT /PE\u201D tattooed on my forehead! So how is it that not one doctor or nurse who saw me, or saw my chart ever thought to do anything to prevent this PREVENTABLE disaster? There was a form in every patient\u2019s chart in my hospital where the attending physician or primary nurse was supposed to assess the patient\u2019s risk for blood clot, and order appropriate interventions. Some of these interventions are as simple as wearing support stockings while hospitalized, or daily low dose injections of heparin while hospitalized. They are simple, relatively painless interventions, and yet in thousands of hospitals and for tens of thousands of patients these simple interventions are overlooked, often leading to catastrophic events. Nobody wrote any orders for DVT/PE prophylaxis in my chart, even though the hospital put the assessment and order sheet in every patients chart. I was an attending anesthesiologist at this hospital, my hospital, and because they did not follow their own protocol, I almost died. The Surgeon General in 2007 called DVT/PE one of the leading killers of hospitalized patients and urged all hospitals to aggressively initiate prophylactic treatment on any patient admitted to the hospital. If this can happen to me, a physician, I can only imagine the danger the lay public faces from this silent killer when hospitalized.\"}),/*#__PURE__*/t(\"p\",{children:[\"After spending 7 days in ICU I was finally discharged home on continuous oxygen therapy, and on lifelong blood thinner medication. I was able to go off the oxygen after about 8 weeks, but I still get short of breath easily. I take medication for my heart everyday as well. There has been some permanent damage to both my heart and lungs, as well as to my faith in my former hospital. I always try to find the best in a situation, and even though this was by far a physically and mentally devastating experience, I now believe that I survived so that I can teach the lay public to ask their physicians about this if you are ever admitted to a hospital, and also to enlighten my fellow medical professionals, hospital administrators and \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/pe/pert-a-new-model-of-care\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"risk management personnel\"})}),' how easy this is to prevent, and how tragic it can be. I survived my PE against the odds; I hope to level the playing field by preaching prevention so no one has to try to beat the same odds that I did.\"']})]});export const richText11=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"In the spring of 2001, Mary Beth underwent foot surgery. A week later, she developed excruciating pain in her right leg that turned out to be a DVT extending from her ankle to her mid-thigh.\"})});export const richText12=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"On September 13th, just two days before her 70th birthday, Nancy Marriott was rushed to the emergency room in Boulder, Colorado with extreme shortness of breath.  She had been near fainting during short trips to the bathroom, only able to sleep sitting up, and experiencing dizziness constantly. She was in very bad condition, having neglected to address her symptoms for weeks and instead attributing them to other health conditions that she had. '}),/*#__PURE__*/e(\"p\",{children:\"Unfortunately, Nancy had been struck by a bout of excruciating trigeminal neuralgia (nerve pain of the facial area) in early August.  In an effort to avoid triggering the intolerable pain, she remained in bed for much of the month and tried to stay as still as possible.  Little did she know the danger that she was putting herself in.\"}),/*#__PURE__*/e(\"p\",{children:\"In combination with other risk factors including obesity, high blood pressure, and diabetes, the prolonged bed rest was the last contributing factor to the \u2018perfect storm\u2019 that caused Nancy to clot.\"}),/*#__PURE__*/e(\"p\",{children:\"In this special interview, Kat and her mother, Nancy, share their perspectives as caregiver and patient, respectively. \"}),/*#__PURE__*/e(\"p\",{children:\"\u201COn a scale of 1-10, 10 being drop dead instantly, you are like an 8.5\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Kat: As Nancy\u2019s daughter, I will never forget hearing the attending doctor quantifying my mother in such a morbid way, \u201COn a scale of 1-10, 10 being drop dead instantly, you are like an 8.5\u201D.  Impressed by how close my mother came to death, the doctor scribbled up whiteboard diagrams of her two massive saddle PE\u2019s, demonstrating how the obstructions kept the blood and oxygen from reaching her lungs.  Seeing my mother in a hospital bed, skin completely gray, trying to comprehend all of it but looking so confused and defeated just broke my heart.\"}),/*#__PURE__*/e(\"p\",{children:\"Nancy, how did you feel when you were first diagnosed?\"}),/*#__PURE__*/e(\"p\",{children:\"I was terrified.  Also, I felt confusion because I didn\u2019t totally understand the relationship between the clots and the compromised oxygen levels and the right heart strain.  I just felt very overwhelmed at the diagnosis and upset that I hadn\u2019t known the risks beforehand.\"}),/*#__PURE__*/e(\"p\",{children:\"Nancy, what was most important to your recovery and rehabilitation?\"}),/*#__PURE__*/e(\"p\",{children:\"My daughter and my medical team were most important.  PE/DVT can be a lot for for one person to handle alone, both emotionally and physically.  My daughter helped me to understand more about my complicated condition and made me feel safe, as well as encouraging me to move forward from the incident and develop a healthier lifestyle.  My medical team was both patient and kind to me.\"}),/*#__PURE__*/e(\"p\",{children:\"Kat, as a caretaker, what advice could you give to other caretakers? \"}),/*#__PURE__*/e(\"p\",{children:\"While it\u2019s easy to freak out when a loved one is sick, I think it is important to harness this anxiety and use it as fuel to educate yourself about their condition.  Seeking knowledge is a great way to care for your loved one because you are putting yourself in a position to help with decision-making, medication, scheduling doctor\u2019s appointments, identifying possible worsening symptoms, and providing great support throughout the treatment process.\"}),/*#__PURE__*/e(\"p\",{children:\"Kat, how has Nancy been since her hospitalization for PE?\"}),/*#__PURE__*/e(\"p\",{children:\"She has made amazing progress.  I don\u2019t think I have ever seen her so proactive about her health \u2013 she is out walking laps, staying out of bed, low fat/low sodium diet  (she has lost 30 pounds!), has lowered her blood pressure, and is  very conscientious about INR testing.  This is all very important in preventing a reoccurrence.\"}),/*#__PURE__*/e(\"p\",{children:\"Nancy, what lessons have you learned?\"}),/*#__PURE__*/e(\"p\",{children:'Understand that health problems naturally have a way of snowballing into greater problems if they are not handled properly, and even sometimes when they are.  Blood clots frequently occur alongside conditions like obesity, diabetes, cancer, and inflammatory bowel disease, to name a few.  These conditions create a great challenge for individuals, but it is important not to give up on your health and to be vigilant about any new symptoms.\"'})]});export const richText13=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"Just two days before her 70th birthday, Nancy Marriott was rushed to the ER in Boulder, Colorado with severe shortness of breath and near-fainting episodes. Diagnosed with massive saddle pulmonary embolisms (PEs), she was on the brink of death.\"})});export const richText14=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"Mark\u2019s life changed dramatically when he was diagnosed with a pulmonary embolism (PE), a blood clot in the lungs. In his own words, here is Mark\u2019s story about how follow-up care saved his life:'}),/*#__PURE__*/e(\"p\",{children:\"My story starts like many others, but does not end in the way you may think, thanks to the follow-up care provided by Massachusetts General Hospital (Mass General) and Dr. Rachel Rosovsky. I woke up on a morning in August of 2016, feeling fine. But, I soon realized I was having trouble breathing. As the minutes went by, it got more difficult to breathe. I told my wife we needed to take a ride to the hospital. I thought I was having a heart attack.\"}),/*#__PURE__*/e(\"p\",{children:\"I got to the local hospital and the emergency staff was wonderful. They told me, \u201CYou are not having a heart attack. You have a pulmonary embolism (PE).\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"\u201CThis was a good thing,\u201D I thought to myself. \u201CI\u2019m not having a heart attack.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"But I was still having trouble getting a breath.\"}),/*#__PURE__*/e(\"p\",{children:\"The doctor in charge told me that they were unable to do anymore at their hospital and asked me which hospital I would like to be transferred to. From the background, my 81-year-old mother Maureen, a retired nurse, yelled, \u201CMass General!\u201D That small statement changed the trajectory of my life.\"}),/*#__PURE__*/e(\"p\",{children:\"Off I went in an ambulance to Mass General. When I got admitted, the doctor assured me that I wouldn\u2019t be waiting long and that their PE response team (PERT) was discussing my case. Within 20 minutes, a doctor walked into my room and told me that they would be removing the blood clot from my lung and that I would be prepped for surgery.\"}),/*#__PURE__*/e(\"p\",{children:\"Every person involved seemed to know exactly what they were doing and what was going to happen. They spoke to me throughout the whole procedure. When the doctor was done, he told me that he was a bit upset, because they were unable to get the complete clot out, but that they would break it up over the coming days with medication.\"}),/*#__PURE__*/e(\"p\",{children:\"After surgery, I was moved to the ICU. The nurses explained everything and made sure I was comfortable. I met with a team of doctors each day, who continued to update me on my progress.\"}),/*#__PURE__*/e(\"p\",{children:\"Finally, I was ready to be discharged. This is where my experience differs from most PE patients\u2019.\"}),/*#__PURE__*/e(\"p\",{children:\"As I was being discharged, my nurse sat down with me and explained to me what I needed to do after I left the hospital. As she was explaining what would happen, all I could hear was Charlie Brown\u2019s teacher going \u201CWah Wah Wah.\u201D My nurse clearly knew I was having trouble following, so she highlighted everything on my post-discharge papers.\"}),/*#__PURE__*/e(\"p\",{children:\"On the paperwork, highlighted in yellow, was a follow-up appointment with Dr. Rachel Rosovsky. I remember my nurse repeatedly saying that I had to go to this follow-up clinic.\"}),/*#__PURE__*/e(\"p\",{children:\"In September, I showed up to my appointment. This was where I began to realize how serious my situation actually had been back in August. You may be asking yourself, \u201CHow did this guy not realize how serious his situation was?\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"I honestly never felt scared or had any questions that went unanswered when I was in the hospital. Everyone seemed extremely calm around me, so I never worried.\"}),/*#__PURE__*/e(\"p\",{children:\"That changed when I met with an assistant working with Dr. Rosovsky. He introduced himself to me and I told him who I was. He replied, \u201CYou are the PE patient? I was on that call the Saturday you were admitted, and I\u2019m surprised I\u2019m actually speaking with you today.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"That was the first time I realized how serious my situation was.\"}),/*#__PURE__*/e(\"p\",{children:\"When Dr. Rosovsky arrived, I was greeted with a big smile.\"}),/*#__PURE__*/e(\"p\",{children:\"She told me they were starting an aftercare program to ensure blood clot patients understood what had happened to them, what treatments were available to them, and to find out what had caused the blood clot in the first place.\"}),/*#__PURE__*/e(\"p\",{children:\"She explained that when people don\u2019t understand what happened or why they are on a certain medication, there tends to be a high rate of folks who stop their treatment. When that happens, patients can develop recurrent blood clots that can be deadly.\"}),/*#__PURE__*/e(\"p\",{children:\"Dr. Rosovsky was part of the PERT team that discussed my case and decided on my best treatment back in August. She told me we were meeting to determine what had caused my PE, how I was doing, and my treatment, so that I could avoid any recurrent blood clots in the future.\"}),/*#__PURE__*/e(\"p\",{children:\"She asked me to tell her my story and she took copious notes. She was interested, because I didn\u2019t have any clotting gene or any family history of clotting. I was also mildly anemic. She decided to run some tests and took some blood.\"}),/*#__PURE__*/e(\"p\",{children:\"On Monday, September 12, 2016, I get a call from Dr. Rosovsky. She told me that she wanted me to come in and meet her and her colleague Dr. Andrew Yee, ASAP. They arranged to meet me on Wednesday. I met with Dr. Rosovsky and Dr. Yee, and she explained that they had found out what had caused my blood clot.\"}),/*#__PURE__*/e(\"p\",{children:\"\u201CYou have a form of cancer called Multiple Myeloma.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Multiple Myeloma is a form of blood cancer that develops in the center of the bones, an area known as bone marrow.\"}),/*#__PURE__*/e(\"p\",{children:\"They explained what the cancer was and how it affects individuals. At this point, Dr. Rosovsky told me Dr. Yee would treat me for the cancer moving forward, but she will still be my PE doctor.\"}),/*#__PURE__*/e(\"p\",{children:\"From that day forward, I have only felt better. I am forever grateful for the follow-up treatment plan that my doctors implemented.\"}),/*#__PURE__*/e(\"p\",{children:\"I want other patients to know that follow-up care is so important. When you\u2019re sick, your care doesn\u2019t end when you leave the hospital. Sometimes, it\u2019s just beginning.\"}),/*#__PURE__*/e(\"p\",{children:\"Mark was able to go on to receive treatment for his cancer. He would like to give a special thank you to his mother, Maureen, who did not miss a single treatment session during the year he was actively being treated. Mark\u2019s story highlights the importance of follow-up care. Patients who have experienced a blood clot should always pay close attention to what their doctors tell them and be sure to stay on top of their medical appointments.\"}),/*#__PURE__*/e(\"p\",{children:'\"'})]});export const richText15=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"Mark's life changed dramatically when he was diagnosed with a pulmonary embolism (PE), a blood clot in the lungs.\"})});export const richText16=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"March 15, 2015 is a date that probably doesn\u2019t stand out to most of us \u2013 but Jared remembers that day clearly. It was the day he was hospitalized with a nearly fatal pulmonary embolism (PE).'}),/*#__PURE__*/e(\"p\",{children:\"Jared works in software sales and had been making round trips from Boston to Minnesota on a weekly basis. \u201CI\u2019d leave Boston on a Monday morning and come back on a Thursday \u2013 that was my life for a long time,\u201D he recalls. \"}),/*#__PURE__*/e(\"p\",{children:\"One weekend, a mere two days after a return flight home, he had a bout of severe pain in his upper back near his left shoulder.\"}),/*#__PURE__*/e(\"p\",{children:\"\u201CI could barely move. I could barely breathe. I had no idea what was happening. I\u2019d had a similar type of pain in the same area a few months prior but it went away after taking ibuprofen and applying heat. I was 29 years old and in relatively good health, so I didn\u2019t think anything too serious was going on at first.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"Things worsened after 24 hours. \u201CWith every breath I took, it was like someone was stabbing me with a five-pronged knife and twisting it in my back. It was the worst pain I had ever experienced \u2013 and it was all localized to this one area. I couldn\u2019t sleep. I couldn\u2019t eat. I finally couldn\u2019t bear the pain any longer and told my wife that we had to go to urgent care. When we got there, I could barely even walk. Every breath I took was more excruciating than the last.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"A CT scan identified a blood clot in Jared\u2019s lung. He was sent to the emergency room and admitted to the hospital shortly after arrival. \"}),/*#__PURE__*/e(\"p\",{children:\"\u201CI was told that I had lung infarctions as a result of the clot, meaning that some of my lung tissue wasn\u2019t receiving enough blood flow or oxygen,\u201D he explains. He was started on high-dose blood thinners and discharged three days later. \u201CI\u2019m so thankful that I caught the PE when I did. My doctor told me that if I had waited any longer, the clot could\u2019ve killed me.\u201D\"}),/*#__PURE__*/e(\"p\",{children:\"What Jared didn\u2019t know at the time is that there were a few risk factors at play that may have provoked his clot, including long-haul travel. \"}),/*#__PURE__*/t(\"p\",{children:[\"\u201CBefore my \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/pe/dvt-pe\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"PE\"})}),\", I don\u2019t think I ever considered my travel to be an issue. I didn\u2019t make a conscious effort to get up, walk around, or get the blood pumping through my legs. I was a typical sit-my-butt, in- the-seat traveler. I\u2019d watch a movie, read a book, or do work from takeoff to landing.\u201D\"]}),/*#__PURE__*/e(\"p\",{children:\"Jared also has ulcerative colitis (UC), a chronic inflammatory bowel disease (IBD) that affects the large intestine (colon). Although his UC has been well controlled for years, it can triple or quadruple his risk for a blood clot compared to people without IBD.\"}),/*#__PURE__*/e(\"p\",{children:\"A few weeks after his PE, Jared followed up with a hematologist and his workup further revealed a prothrombin gene mutation. Prothrombin\u2014also called coagulation factor II\u2014is a protein in the blood that helps the blood clot when the body is injured. With a prothrombin gene mutation, the body can produce too much prothrombin, causing abnormal blood clots to form.\"}),/*#__PURE__*/t(\"p\",{children:[\"\u201CNo one in my family has had a blood clot before, so my genetic screen was a bit of a surprise. My doctor surmised that the frequent plane travel along with my colitis and gene mutation may have been the perfect storm for the blood clot. She made it clear that having a mutation didn\u2019t mean that I would definitely have another blood clot \u2013 but in light of my lifestyle and risk factors, I opted to start lifelong anticoagulation on \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/anticoagulants/rivaroxaban-xarelto-a-deep-dive\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"Xarelto\\xae (rivaroxaban)\"})}),\". It gives me peace of mind and helps me feel protected.\u201D\"]}),/*#__PURE__*/e(\"p\",{children:\"Fortunately, Jared hasn\u2019t had another blood clot in the last six years, but he\u2019s certainly become more in tune with his body. \"}),/*#__PURE__*/e(\"p\",{children:\"\u201CI\u2019m acutely aware of what that pain feels like. In hindsight, I wish I would\u2019ve taken my first episode of pain more seriously. I just thought I had a muscle spasm, and since the pain went away after a few days, I was convinced that\u2019s what it was. Now I\u2019m not so sure. Maybe it was a clot, maybe it wasn\u2019t. Either way, I pay closer attention now when I have pain,\u201D he says.\"}),/*#__PURE__*/e(\"p\",{children:\"On his last trip to Australia, for example, he felt some pain in his upper thigh and decided to go to an imaging center right away for a scan. \"}),/*#__PURE__*/e(\"p\",{children:\"\u201CI had just gotten off a very long flight and was concerned. I didn\u2019t end up having a clot, but my mantra now is that I\u2019d rather be safe than sorry, and I\u2019d advocate for anyone in my shoes to do the same thing. Get your pain checked out. Why not have peace of mind?\u201D\"}),/*#__PURE__*/t(\"p\",{children:[\"Since his PE, Jared has also \",/*#__PURE__*/e(o,{href:\"https://vln.thrombosis.org/c/thrombosis-and-blood-clots/\",motionChild:!0,nodeId:\"p_wfmNz_K\",openInNewTab:!0,scopeId:\"contentManagement\",smoothScroll:!1,children:/*#__PURE__*/e(a.a,{children:\"adopted simple techniques\"})}),\" to prevent future clots. \"]}),/*#__PURE__*/e(\"p\",{children:'\u201CI\u2019ve changed my behavior when I travel. Before COVID grounded all of us, I made it a habit to get up, walk around, and stretch in the aisle, even on short flights. I also wear compression socks for long-haul flights. They\u2019re pretty comfortable, in my opinion! The way I look at it, these adjustments are easy to make. If they\u2019ll help mitigate a future clot, I\u2019m all in.\u201D\"'})]});export const richText17=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:\"March 15, 2015 is a date that probably doesn't stand out to most of us \u2013 but Jared remembers that day clearly. It was the day he was hospitalized with a nearly fatal pulmonary embolism (PE).\"})});export const richText18=/*#__PURE__*/t(n.Fragment,{children:[/*#__PURE__*/e(\"p\",{children:'\"On October 26, 2022, I went downstairs to my basement and felt a heaviness in my chest. I reached the bottom step and I felt like I had just run a marathon. I tried to sit down, but the next thing I knew, I had blacked out and woke up on my basement floor. '}),/*#__PURE__*/e(\"p\",{children:\"I called for my family members, who were all upstairs. I realized with growing panic that something felt very wrong, and I was no longer in harmony with my body. As my dad drove me to the emergency room, I was in and out of consciousness. \"}),/*#__PURE__*/e(\"p\",{children:\"Every breath felt like it was going to be my last. I was transferred to the ICU, and testing revealed I had suffered a massive bilateral pulmonary embolism with heart and respiratory failure. \"}),/*#__PURE__*/e(\"p\",{children:\"They intubated me and used a tissue plasminogen activator (tPA) to bust up the clots in my lungs. Meanwhile, due to the damage to my heart, doctors were preparing for surgery if the tPA didn\u2019t help. \"}),/*#__PURE__*/e(\"p\",{children:\"My parents were informed that my death was a high possibility. Fortunately, with time, the tPA had helped break up the clots, and I was placed on a constant flow of Heparin.  \"}),/*#__PURE__*/e(\"p\",{children:\"On a random Wednesday, my life had changed in a frightening and devastating way, but also in a miraculous one. The love I felt from my family, friends, church members, and their prayers and words of encouragement filled me with hope. My teams of doctors made careful and critical decisions. \"}),/*#__PURE__*/e(\"p\",{children:\"I may never know what triggered the event specifically. I had no symptoms of anything wrong prior to that day. I was on a low dosage of estrogen for severe monthly cramps, and I have a remote desk job, but due to the severity of my clots, doctors are unsure these are direct causes. \"}),/*#__PURE__*/e(\"p\",{children:\"Testing also did not reveal I had any of the protein or factor mutations. I have no answers yet. I am on a blood thinner for long-term until we can discover the cause. \"}),/*#__PURE__*/e(\"p\",{children:'I want to use this opportunity to help spread awareness and education on clotting issues, especially the devastation that can occur with a pulmonary embolism. It can happen to anyone, at any time, at any age. I was 31 years old when this happened to me. \"'})]});export const richText19=/*#__PURE__*/e(n.Fragment,{children:/*#__PURE__*/e(\"p\",{children:'\"At just 31, my life changed forever on a random Wednesday in October 2022. 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