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28: Men's Health Essentials — Pulmonary Embolism, The Silent Killer

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28: Men's Health Essentials — Pulmonary Embolism, The Silent Killer

Jan 14, 2020

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Life-threatening Blood Clots Can Happen to Anyone

One of the primary goals of the Who Cares About Men's Health podcast is to make our listeners aware of potential health threats they may face. For the most part, younger men don't face too many threats to their health, but there is one thing that will suddenly kill a young, healthy person: a pulmonary embolism.

A pulmonary embolism is a blood clot that typically starts in the deep veins in the legs or arms. This blood clot can break free and travel through the body towards the lungs. Once the clot reaches the lungs, the patient can experience extreme chest pain with a high chance of cardiac arrest.

What Does a Pulmonary Embolism Feel Like?

Up to one-third of patients with a pulmonary embolism (PE) will die of cardiac arrest before the dangerous clot is identified in a hospital or emergency department. A big reason for the high mortality rate is that the symptoms of PE are typically non-specific until it progresses to an emergency situation.

Patients have described their pulmonary embolisms as feeling like indigestion, a strange calf pain, or even unexplained shortness of breath over a week. All symptoms that could understandably be confused for something more benign.

More severe symptoms of PE may include:

  • Sudden onset of breathing issues
  • Chronic shortness of breath that appears overnight
  • Pain or pressure in the chest
  • Dizziness
  • Fainting
  • Temporary loss of consciousness
  • Coughing up blood

According to PE specialist Dr. Stacy Johnson, the problem with these clots is that the symptoms are not only non-specific, but they're also unpredictable. Dr. Johnson has seen patients with relatively mild symptoms, but when the tests come back, the patient has an extremely large clot. On the flip side, some patients with extreme pain have a relatively minor embolism that can be treated with medication.

Do Not Wait to Go to the ER if You Suspect a Clot

Again, over one-third of patients with pulmonary embolism don't make it to the hospital in time. Unless it's caught in time by a physician or - in some extreme cases - another person witnesses a patient as they enter cardiac arrest, it's hard to prevent or catch a pulmonary embolism.

"Unfortunately, that's the nature of the disease," says Dr. Johnson.

So what's a patient to do? There are some descriptors of symptoms you can keep on the lookout for:

  • A charlie horse that will not go away no matter what you do
  • A pulled muscle accompanied by uneven swelling
  • An unexplained pressure or pain in your chest

According to Dr. Madsen, f you have any of these symptoms, go get an ultrasound or a CT scan at the ER as soon as possible. Don't wait to schedule it a week or two out.

"It's definitely a killer of young people," says Troy. He explains anecdotally that if a young person comes into the ER experiencing sudden cardiac arrest, pulmonary embolism is the first thing he thinks of.

If these symptoms hit you or a loved one, do not wait to seek treatment.

There is No Single Cause for Pulmonary Embolism

Dr. Stacy Johnson explains that pulmonary embolisms can be caused by a long list of potential risk factors including:

  • Long, sustained airplane flights
  • Undergoing surgery
  • Injury
  • Cancer
  • Diabetes
  • Smoking
  • Age
  • Testosterone supplements

Genetics does play a role in some cases of pulmonary embolism. There has been a lot of research during the 1990s and early 2000s looking into a potential genetic or familial link and risk of forming PE. There are multiple genes and mutations that have been shown to increase a person's chance of forming blood clots. Several of the current at-home genetics tests even screen for some of these mutations.

However, there is no way to apply these genetic findings clinically. Recent studies have identified as many as 100 different genes involved in the clotting cascade process and potential 5,000 mutations that can increase or decrease a person's chance of forming a dangerous clot.

Considering most DNA tests only test for five or fewer of these mutations, it's important to realize that a negative result will only give a false sense of security.

Life After Pulmonary Embolism

The life-long repercussions following a PE event are not as bad as it used to be. If you've heard of the terrible "rat-poison" that used to be prescribed, rest assured those days are long behind us.

Physicians stratify the risks of each PE patient, both before and after treatment. They identify the severity of the clot, what level of risk it presented, potential recurring causes, etc. etc. This stratification informs the type of treatment and after-care a patient can expect.

For lower-risk patients, the PE can be treated with a blood thinner medication and sent home either the same day or after a few days of observation in the hospital.

For higher-risk patients, the clot will often be treated immediately through "heroic efforts," including clot-busting medications and/or surgery.

After treatment of the embolism, patients can expect a certain level of after-care depending on the same type of risk assessment they had for treatment.

Patients with a low risk of forming another clot can expect to take blood-thinning medication for just a few months after treatment.

For patients at a high risk of forming a clot again, they can expect to be on long term medication treatment.

Lucky for patients, the blood-thinning medications available today are safer, simpler, and more effective. These medications are taken as a one or two pills a day and don't require the frequent blood work or dietary changes the older medications required.

Considering the Realities of At-Home Genetic Testing

Scot is still on the fence about taking the genetics test he got for Christmas. He was originally a little concerned about whether or not he wanted to know about his likelihood of forming particular diseases and what that would mean for his future. But as he does more research into consumer genetics tests he's learning there's a lot more he has to consider before spitting in that cup.

Scot shares with Mitch and Troy a recent article entitled The Horrifying Reality of Consumer Genetics Testing that lists 6 of the lesser-known concerns with at-home genetics testing.

If you're interested in knowing your DNA or engaging with the results, go to our website, Facebook, or use this link to take a short 5 question survey and be entered to win your very own DNA kit.

Housekeeping — Mitch's 100 Day Quitversary

It's been one hundred days since producer Mitch started his latest attempt to quit smoking. This is the longest he's gone without smoking and he's committed to making it stick.

Since Episode 26: Trying to Quit for the 7th Time, Mitch went through two more nicotine patch steps downs. He explains that they were both pretty rough and miserable. He suffered from strong cravings, extreme irritability, and physical side effects of withdrawal. But he made it through.

He still experiences craving now and then, so he will occasionally turn to low-dose nicotine gum to help get him through potential stress triggers.

Mitch says he learned that everyone is on their own personal journey. Just because some people had an easier time quitting doesn't mean you've failed. It's important to keep that perspective and judge your own success against the success of others.

He admits that quitting this time was hard, but the light at the end of the tunnel is the piece of mind knowing he is more likely to have a long and healthy life without cigarettes and vaping.

"Yes I still am irritable. Yes I still have cravings," says Mitch, "But I'm taking control of my future and my health and that's what it's all about."

Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy laments the pains of getting a new smartphone after his old one died, and Scot has been diagnosed with a particularly not-so-manly orthopedic issue.

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