“My leg hurts,” my mom said as we climbed the stairs to our hotel rooms. We were in South Dakota to visit old friends, and we had been driving for hours, after flying for hours before that.

Mom occasionally has arthritis-like aches and pains, so I didn’t think too much of it. “We can try ice on it,” I suggested, “or maybe a heating pad. Why don’t you take it easy and prop it up for a while?”

The next day, as we were walking through the botanical gardens, one of mom’s favorite things to do anywhere, she whispered, “Boy, that leg really does hurt.”

I suggested we find her a doctor, but she said no, she didn’t want to complain and spoil anyone’s fun. Being a health journalist with lots of medical knowledge (although no clinical training), I was worried that she might have developed deep vein thrombosis (DVT), a blood clot in the leg that can block blood flow and cause pain. In rare cases, it can lead to pulmonary embolism (PE), when the clot breaks loose and travels to the lungs, where it can block an artery and be fatal. Sitting still for long periods of time (as in a cramped airplane seat) can cause the condition.

A Journalist’s Tragic Death

I was reminded of the tragic death of journalist David Bloom. He was embedded with the Army in Iraq in 2003 and had been confined in a tiny space in a tank, hot and dehydrated, for days. He developed DVT, which resulted in the pulmonary embolism that killed him. He was only 39.

Julie and her mom in the botanical garden in Brookings, South Dakota, this summer, when her mom's severe leg pain had them scared. Luckily, it wasn't DVT.

A Surgeon General’s Call to Action

On Monday this week, the acting surgeon general, Rear Admiral Steven K. Galson, MD, released a Call to Action to prevent DVT and PE. (Previous Calls to Action have focused on important public health issues such as underage drinking and oral health.) In his remarks, Dr. Galson said:

• DVT affects an estimated 350,000 to 600,000 Americans each year.

• Together, DVT and PE contribute to at least 100,000 deaths each year.

• DVT and PE can occur suddenly and without symptoms.

• Triggers include: being hospitalized or confined to bed rest, having major surgery, breaking a leg, even traveling for several hours and being dehydrated.

• Risk factors include: Genetic clotting problems, smoking, obesity, a sedentary lifestyle, being over 50, and taking hormones, such as birth control or menopausal therapy.

Back to Mom’s Case

The next day, mom’s leg still hurt, and she had developed a rash. So how would I know if her pain was serious? I didn’t know then, but I do now: I called DVT expert Geoffrey Westrich, MD, an orthopedic surgeon at the Hospital for Special Surgery in New York City, who has published more than 20 studies on DVT prevention.

“When there’s a clot in the leg,” he says, “the vein gets very inflamed. That constricts blood flow, and the leg will usually become very swollen and tender. It will hurt when you move the foot up and down. And DVT is very easily diagnosed with an ultrasound.”

Mom’s leg was not swollen, but the rash and pain were getting worse. When she saw a doctor, it turned out to be shingles, which is caused by the same virus that causes chickenpox. While not DVT, this nasty virus is no picnic, either. But that’s a topic for another blog, another day! (Mom’s feeling better now.)

Surgery and DVT

Dr. Westrich says patients having long surgeries (in which you’re immobile for a long time) and orthopedic surgeries, such as hip and knee replacements (surgery involving bones affects clotting), are especially vulnerable to DVT. And it’s harder to recognize and diagnose DVT after surgery, when almost all patients have some swelling and pain. People who are obese, sedentary, or have less range of motion are at higher risk. So are cancer patients.

If you’re having major surgery, ask about:

• “Regional” anesthesia (such as an epidural) instead of general anesthesia. (You’ll still be sedated, not awake.) Dr. Westrich says studies show that these patients generally have less blood loss and less clotting.

• Preventive measures after surgery, such as mechanical compression (a device that helps increase blood flow in the lower extremities).

• Blood thinning medications. Drugs such as Coumadin (warfarin) are often given to patients after surgery, but, Dr. Westrich cautions, they can take three to five days to work and can increase risk of bleeding, which can be worse than DVT. Better drugs are in the pipeline, he says, but they’re very expensive. If you’re young and healthy, mechanical compression and aspirin may be enough to reduce your risk.

Potential Breakthrough: Dr. Westrich says a study of patients who had a pulmonary embolism found that they tend to have a genetic abnormality. A blood test could show if you have this genetic predisposition, but so far it costs a prohibitive $1,000 a patient. That cost will come down as the technology is developed further, and that could help prevent many tragedies. Meanwhile, do what you can to keep your own risk low:

Trips for Travelers on Long Flights

• Get up and walk around as often as possible (an aisle seat makes this easier).

• Don’t just sit still. Move around and do leg and foot exercises in your seat.

• Drink lots water to stay hydrated, and avoid alcohol.

• If you know you can tolerate aspirin without side effects, take one before getting on the plane.