How I Gave Myself Deep Vein Thrombosis
People who develop enlarged neck and shoulder muscles are more likely to form blood clots in their upper extremities.
By Beth W. Orenstein
Medically Reviewed by Farrokh Sohrabi, MD
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One Friday morning in December almost two years ago, New Yorker Heather Cohen, 38, was busy preparing for a work trip to Los Angeles when her arm started to swell and become painful. She thought she must have injured herself in a yoga class and it would go away. But when her hands started turning blue, colleagues encouraged her to go the ER.
It was a good thing she did.
As it turned out, Cohen had a blood clot in her right shoulder that had to be surgically removed. When doctors at Mount Sinai Hospital in New York City performed the surgery, they noticed she had two crossed ribs. The combination of having unusual anatomy, being an athlete, and taking generic birth control pills all contributed to her developing a type of blood clot called deep vein thrombosis (DVT).
Unknowingly, she says, she gave herself DVT.
Understanding Effort-Related DVT
DVT of the upper extremities is rare. When it does occur, it's “most commonly seen in young adults, typically athletes or other individuals who use their arm in a very exercise-focused way,” says Robert Lookstein, MD, a professor of radiology and associate professor of surgery at Mount Sinai Hospital. Cohen was a colleague's patient.
It's likely these patients also are born with an abnormality of the bones and muscles in the neck and shoulder, according to the UCLA surgery department. Then, when they develop the muscles in their neck and upper arm from exercise or repetitive motion, the enlarged muscles can compress the vein beneath their collarbone, known as the subclavian vein. The compression can cause a blood clot (thrombosis) to form. This condition is known as effort-related DVT, or Paget-Schroetter syndrome.
Dr. Lookstein says he’s seen the condition in baseball players, swimmers, weight lifters, football players, and even concert violinists. “Anyone who has a variant anatomy and performs exercise that forcefully lifts their arm over their head is at risk,” he says.
An ultrasound test can show whether there’s narrowing or clotting in the upper arm. A venogram, which is an X-ray taken after dye is injected into the veins, will show whether there’s a clot in the chest or under the collarbone.
RELATED: How Do You Know if It’s Deep Vein Thrombosis
Treating Effort-Related DVT
Lookstein says that the current treatment for Paget-Schroetter syndrome is a two-step process. First, interventional radiologists perform a catheter procedure to remove the clot.
“The procedure involves placing a catheter in the vein where the clot is located to deliver clot-busting medications and using thrombectomy catheters to extract the clot,” he explains.
Some patients need a second surgery to correct their anatomical abnormality. Several different surgeries may be performed, Lookstein says, but one of the most common is to remove the patient’s first rib. “Another surgery is removing the enlarged muscles that could compress the vein that way,” he says. In rare cases, when people are born with an extra rib, that too would be removed.
Cohen was given blood thinners to dissolve the clot she had. She also underwent the catheter procedure to remove the clot. “It took five hours,” she says, but it was successful. Cohen says she was a good candidate for the clot-removal surgery because she was young and otherwise healthy.
Preventing Paget-Schroetter Syndrome
You wouldn’t know you have this variant anatomy unless something happens, Lookstein says. That makes it hard to take preventative measures. However, he says, there are some things you can do:
Stay hydrated.If you participate in competitive sports, especially in the summer, be conscious of the risk of developing blood clots and stay hydrated and in the shade, Lookstein says. Dehydration increases your risk for clot development.
Seek treatment for symptoms.“It’s important that if people who exercise notice arm swelling and persistent pain, they see a vascular specialist in a timely manner so they can get a duplex ultrasound of the vein to see if there’s a clot,” Lookstein says.
As with any DVT, the danger is a piece of the clot breaking off and traveling through your veins. Once it reaches the lungs, it could lodge there and cause shortness of breath, a rapid heartbeat, chest pain, and low blood pressure, notes the U.S. Centers for Disease Control and Prevention, CDC. This blockage, called a pulmonary embolism, requires immediate treatment because it can be life-threatening.
Cohen’s hematologist thought she'd had the clot for a while because “it wasn’t fresh,” she says. As a precaution, Cohen has stopped taking the birth control pills and stayed on blood thinners for six months. She’s fine now and still goes to the gym regularly to work out. However, she avoids heavy lifting.
“I modified what I do,” Cohen says.
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