Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board medical issues - blood clots

I know there are many long-term hikers on this board, so I thought I might post this here. I was just diagnosed with blood clots in my lungs, and I'm trying to figure out possible causes. As a person in her 20's who has never smoked and leads a very active lifestyle, it's been a little difficult. It doesn't help that my doctor doesn't seem to know or care how I got them. Since clots aren't so uncommon, I thought that maybe other people on this board with similar lifestyles might have some information.

I know hiking is supposed to keep clots from developing, but has anyone else had any experiences like this following a trip? One suggestion has been that they formed during the carride home, but I don't know how likely this is.

The only other possible factor I have been able to identify is hypothermia. I know that I was in the beginning stages one nite during the trip.

Does anyone have any information that might help?

Thanks,
mry

I have heard soemthing similar to what you suggest about the car ride. When someone gets sedentary it can lead to this. But, I'm not the expert. We have a couple MD's who contribute here though.

Ken, or anyone else... any thoughts. I'm curious too.

http://www.drdonnica.com/fastfacts/00004671.htm
Link to some quick facts.

hi i have seen a few people in the field i am an EMT one big risk factor is smoking but the other is birth control are you on birth control there are some disorders that can cause this also some people develope blood clots is your blood work ok like hemoglobin rbc any way might wana check if it might be your birth control if you on it.

The risk factors for blood clots that travel to your lungs (Pulmonary Embolism) are; immobility, especially people who have just had surgery or sitting for long periods, smoking, obesity, birth control pills, pregnancy, cancer,and conditions that make your blood thick (polycythemia etc) Your MD can
run certain tests to determine if your blood is
thick or hypercoaguable.

as mentioned, long ride home cooped up in a car, long distance truck driving, or plane, is common cause of leg clots, which then can move to lungs. The airlines now even include literature with warning about Traveler's DVT (Deep Vein Thromosis) get up, wiggle and squirm in seats, etc.

As for hiking, there is nothing you did wrong there, unless you were severely dehydrated, tentbound and sedentary for a long time, or ill on an extended trip, or had a leg or pelvic fracture. Clotting problems have been reported on Denali, Himalaya, etc under extreme conditions, such as snowbound. The famous Art Gilkey death on K2 many years ago comes to mind. Your beginning stages of hypothermia ( details?) would not likely to do it. And you were not there long enough to thicken your blood, that takes 2 weeks and more.

You must supply your MD with the necessary clues for any detective work to be accomplished. Even then, there may be no explanation. It is such a common diagnosis often without known inciting event, so that's why he may be apathetic. So what to do? Get a second opinion. like jimdlf says, get checked.

I have a friend who was an avid hiker, but blood clots have shut down his hiking. He now takes koumadin (sp?) to thin his blood, but he does not hike any more. The clots caused serious arm and leg swelling, and also left him with really poor aerobic ability (due to clots in the lungs). So the clots can be serious. He attributes it to blood that is too thick. He first started having problems in his late 50s.

Mry...This sounds a little like what happen to me in 2001..I will tell you my story about my blood clot, I had got back from a 7 day backpacking trip which had us camping most of those nights at over 11K..the highest elevation we went to was 13K at Forester Pass. During the trip I felt great, had no problems with the elevation & had good energy during the whole time.
The day after I got home, I started feeling very tired & all I wanted to do was sleep. I felt like I was having to breath harder to catch any air..it was like I was not getting enough oxygen in me...and I was so tired. I thought it was just because I was tired from the trip...but when the breathing thing and not feeling I was not getting enough air was not getting better, I got really worried. I went to the urgent care, they did an EKG on me, the doctor that was there told me I had an irregular heartbeat, that my heart was skipping beats. He then told me he thought I was having anxiety problems and wanted to put me on zoloft or prosac... I could not believe I was hearing this.

I then got an appointment to see a Heart Specialist cardiologist...about two days had passed and I was feeling a bit better & my breathing was improving, but I still wanted to see what was going on. She took another EKG and found that my heart has healthy and normal as can be. She then asked me if I was taking Birth control pills. I told her that my doctor told me if I wanted to keep my period from starting during my trip, that I could take birth control pills and it should keep it from starting..so this is what I did. The heart doctor then asked me what elevation I was hiking at..I told her most of the time above 11K....right when I said that, a hugh light went off with her!!! She told me because I was taking birth control pills while at a high elevation, the pills caused a blood clot...and the reason you are feeling better now is because the blood clot thank goodness natural dissolved in my body, which she says a lot times they will do. She told me I was very lucky that nothing happened because it could have been a lot worse & that my doctor should have warned me that birth control pills especially taken at a high elevation could cause blood clots & that the doctor at urgent care should have asked if I was taking BC pills. I told her that I had done this before on my trips and had never had a problem..she told me that I was lucky those times. I blame myself on not researching and asking my doctor questions.

Were you at a higher elevation? I don't know if you are taking birth control pills.
But to all the women out there that may read this...Please caution taking birth control pills while at a high elevation..because they can and they did cause me to get a blood clot.
I wish you the best of luck with this & I hope my story may help some..sorry it's so long

A few thoughts/observations:

(1) There seems to be possible implications here concerning blood clots, birth control pills, and long plane flights, a potential concern to millions of Americans a year ( even those intending to fly into Lone Pine International or returning from a climbing trip in Russia).

(2) In the Fourth Edition of Going Higher: Oxygen, Men, and Mountains, Charles Houston,M.D.(p 95) notes:" Women taking contraceptive pills have been reported as more susceptible to high altitude thrombosis, but more recent data tend to downplay this risk."

(3) There are risks to not taking birth control pills. Pregnancy can occur at high altitudes also!

Like many aspects of medicine today, probably each individual must consider her personal health status/ high country goals, consult with her health care provider, and then do a risk/ benefit analysis.

Jim

madeintahoe,
Your story is really similar to mine. I had recently started taking bc for exactly the same reason (not that it worked). I omitted that detail before because I don't believe that can be the only factor involved. It was on such a short term time frame and the rest of my lifestyle specifically counteracts the idea of blood clots forming. It also seems suspect to think that there was enough time for the estrogen to build up if there wasn't even time for it to start regulating my cycles properly.

I did ask my doctor about the possibility that high altitude (Whitney and Forester) could have been a factor, but she promised it would have had no affect and again maintained that the hiking would have helped prevent blood clots. I would be really interested to know if there actually is something going on here.

The warning about bc pills should definitely be reiterated. I've heard of many, many other cases of this in the past week even to young, active women on bc. Although none of these were actually proven to be caused by bc pill use, all were correlated. I'm not sure that doctors know much about it, but it does seem easy enough to check someone's blood clotting factor after they begin bc.

Anyway, I'm off to a new doctor to continue my treatment tomorrow. Hopefully he will work with me to carefully figure out what caused this so I can prevent it in the future. Thanks to everyone who helped out with input here. I really appreciate it.

mry

Just back from the Sierra (west side), and giving my "off the top of my head" thoughts:

Pulmonary embolism in a healthy 20's woman is vanishingly uncommon. I've seen 3 in my 20+ year career. Two were smokers. The third had no obvious risk factors, and ended up having a rare genetic blood predisposition, and is on coumadin for life. Estrogen hormones have a weak association, HOWEVER, the purported effect has to do with inhibition of factors in the blood, which takes MONTHS to take effect. It seems very unlikely that short-term use of BCP's would have this effect.

MadeinTahoe, interesting story, but if the cardiologist did no testing on you, then it was simple speculation as to the cause of your symptoms. A pity, as the testing is accurate, and an abnormality persists some time after the symptoms abate.

The appropriate diagnosis, when a primary care physician is uncomfortable working the cause up, would best be arrived at by a hemotologist (specialist in blood clotting abnormalities).

G'luck!

Just to (redundantly) add a few random thoughts to what Ken and others have mentioned ...

OCP's (aka BC pills) have been well correlated with increases in problems such as blood clots. This has improved recently with newer formulations of OCP's with lower amounts of estrogens, but the risk is not eliminated.

One concern, as Ken alluded to, is that there is always the possibility for other risk factors, such as genetic predispositions. Unfortunately, this is not as simple as testing the clotting time ... and the timing of these tests is important as the therapy - blood thinners such as heparin, Lovenox, and Coumadin/warfarin - can adversely affect the result of many of these tests.

I would add that most doctors are quite aware of the potential dangers of blood clots (i.e. DVT's, PE's). And it is common enough that even young, otherwise 'healthy' people can be affected (though typically they are at less risk than individuals with more risk factors). Unfortunately, testing for evidence of blood clots and underlying risk factors is not always as straightforward as one might like.

Best of luck with your treatment!