11 Oct 2019

Blood clot danger: How I nearly died and what happened next

4:31 pm on 11 October 2019

By Nik Dirga*

First Person - Blood clots kill tens of thousands of people worldwide every year. With World Thrombosis Day this weekend, Nik Dirga writes of his brush with death.

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Photo: 123 RF

When I was finishing high school, I'd have a ready answer for other kids who asked where I'd be for our 25-year class reunion.

"I'll arrive in a safari suit, bearded and with mysterious tales of my adventures. Then I'll vanish into a jungle at age 45 and never be heard from again."

I never have owned a safari suit, but I have the beard and I didn't vanish at 45.

Instead, I was 46 when I nearly died.

At the start of 2018, I had been feeling out of sorts for a while. I'd been easily exhausted, weirdly out of breath at odd moments. I just thought I had a cold that hadn't quite gone away.

Turns out if you mention "shortness of breath" to your GP you get the full treatment of blood tests, chest x-rays and an EKG, none of which showed anything weird. My GP thought to ask for one more blood test of something called "D-dimer levels."

It's a protein byproduct none of us really care about, but if it's elevated you're in trouble. And my D-dimer levels were sky high.

Four hours after I had that test, I was rushed to hospital being treated for blood clots - pulmonary embolisms in both lungs.

The full severity didn't hit me until one of the doctors said the words, "this is often fatal".

World Thrombosis Day is this Sunday. It's a day meant to raise awareness of this often-silent killer.

According to Southern Cross, approximately one in every 1200 New Zealanders will develop a deep vein thrombosis each year. In the US, on average, one person dies of a blood clot every six minutes, according to the National Blood Clot Alliance.

I thought at first I had maybe one troublesome clot in one lung, but after my MRI scan I asked a doctor. He clarified that I had "lots" of clots, spattered all through my lungs, and his brow furrowed in a way I didn't like.

The immediate treatment was injecting blood thinners into my stomach, first by nurses over two nights in hospital and then doing it myself at home for 10 days. Then I took oral blood thinners twice a day for six months and had another MRI scan to see how I was doing.

I won't hold you in suspense - I was cleared after six months. But being told you've got an invisible disease that may kill you screwed me up deeper than I could've imagined and it's a journey that a year and a half later, I'm still on.

Sudden death is the first symptom in about one-quarter of the people who have a pulmonary embolism. Sudden death is a hell of a symptom to have.

I couldn't stop thinking that if I had taken my shortness of breath a little less seriously, that could have been me.

Depression and blood clots go together like crackers and cheese. The very nature of blood clots - the way that an ordinary bodily function like the flow of your veins can betray you - can leave a person paranoid and uneasy ever after.

After I was cleared of the original pulmonary embolism, I was put on a lower dose of blood thinners, which I'll have to take for the rest of my life because of the risk of recurrence.

So in theory, I'm at pretty low risk of keeling over. But the mind can be your worst enemy. The blood thinners left me often exhausted, and then hypochondria came to play. Every twinge and ache was a possible symptom, a possible way to drop dead.

I ended up in hospital overnight for a second visit four months after my initial diagnosis when I began having weird chest pains, which turned out to be severe acid reflux, a common side effect of blood thinners, not helped by my anxiety.

After my follow-up scan cleared me, I thought I'd feel better. And I did for a few weeks. But I still found myself lying in bed at night with a hitch in my chest, the feeling that my body could give up at any moment.

I began drinking too much to take away the void I felt pulling at me. I was often cruel and snappish to my family and friends. I tried to count my blessings and all the ways I was incredibly lucky in life. But I still felt cheated and broken down.

Disappearing into a jungle at age 45 would've been far preferable to this slow unravelling at age 46.

And then I started to one day feel a little better. I let go of things.

I wanted to feel fixed. Instead, I started to accept the cracks and the person I was at the other side of being told that you nearly died of something you didn't even know you had. The cloak of depression eased off.

You most often hear of blood clots coming after long flights, or periods of inactivity due to illness. But they can also come from genetic conditions, heart disease or in my case, apparently nowhere at all.

I don't know what caused my embolisms. I didn't have most of the common symptoms, like leg pain or swelling. I didn't have any major chest pain or cough up any blood. All I felt was a little bit wheezy when walking. That's a pretty small red flag for something that might kill you.

Because of the high mortality rate of embolisms, it's important to see your GP if you have any of the major symptoms. There's also plenty of support groups online and offline for people like me that are dealing with depression and anxiety after the immediate danger has passed.

I'm immensely grateful to my GP for running that last little blood test. I'm not the same person I was before the doctor told me I'd nearly died. But at least I'm still here.

Sunday is World Thrombosis Day. For more information, go to:

THANZ (Thrombosis & Haemostasis Society of Australia and NZ)

Health Navigator NZ

Stop The Clot (USA)

* Nik Dirga is an American journalist who moved to New Zealand in 2006.