12/28/16: A REPEAT WARNING: Think Clot, Think Clot, Think Clot; Garry Shandling’s Death is a Cautionary Tale

garryshandling

I was much saddened to learn yesterday, shortly after reading about Carrie Fisher’s death, that sardonic comedian Garry Shandling, who died suddenly March 24, died from a pulmonary embolus. The Los Angeles County coroner who autopsied Shandling concluded that a blood clot in the 66-year-old’s leg traveled to his lung and killed him.

This should NEVER have happened. When I read about preventable deaths like Shandling’s, I get angry. Ignorance is not bliss. Ignorance—perhaps overlapping with neglect—can be fatal. 

Shortly before his death, Shandling apparently had complained of leg pain and shortness of breath—two classic symptoms of deep vein thrombosis and a pulmonary embolus. Red flag, red flag!

Those of you who have read my book, “Our Parents in Crisis,” or my blogs know how seriously I take the threat of blood clots, especially during hospitalizations, and how much I admonish others to do the same. As I write in my book:

“Being sedentary for a prolonged period, as with bed rest [or during a long airplane flight], slows your venous blood circulation. Deep vein thrombosis occurs when a thrombus (a clot) forms in a wall of one of your large veins, usually in your calf, in an area where the blood flow is slow or disturbed. . . . 

“A pulmonary embolus or embolism (PE) occurs when a fragment of a thrombus breaks loose from a vein wall and migrates through the systemic circulation to the lungs, where it blocks (embolizes) vessels encountered there. If the clot is large enough to obstruct one of the pulmonary arteries, sudden death can result. . . . Anticoagulants, such as Coumadin® (warfarin), thwart clotting and, thus, keep blood flowing. Aspirin also inhibits platelet clumping, but it is not classified as an anticoagulant.”

Shandling flew from Los Angeles, where he lived, to Hawaii in March and felt ill throughout his time away. After returning home, he deteriorated further and called 911 in grave distress, but it was too late for paramedics to save him.

Carrie Fisher, too, was stricken after a long flight from London to Los Angeles. In time, perhaps, we will learn what actually happened to her. “Massive heart attack”–the catch phrase applied by the media to Fisher’s cardiac event–is not a medical diagnosis.  

**

A REFRESHER ON BLOOD FLOW

Your venous blood circulation is the flow of deoxygenated blood back to your lungs for oxygenation. Once oxygenated, the return blood goes to your heart, which pumps it back out to your system. Everyone with a human body and a mature mind should understand the basics of circulation. Below, I present an edited excerpt from “Our Parents in Crisis” as a refresher. The heart’s atria and ventricles are cavities or rooms, if you will, made up of muscular walls. They are not blood vessels.

“Your heart has two sides that function independently of each other to pump blood into two different circulatory systems. They are the systemic circulation (left side) and the pulmonary circulation (right side). The heart also has its own circulation, which is served by the two main coronary arteries and their branches.

“Your left heart pumps oxygenated blood out into the body (the system), including the head and brain, through big arteries that eventually decrease in size until they end in microscopic capillaries that are wide enough for only one blood cell to pass. This is where the key exchange of oxygen, carbon dioxide, nutrients, and waste occurs in the tissues. Capillaries are vitally important. If you were to lay them end-to-end, these tiny vessels would stretch more than 50,000 miles.

“Arterial (i.e. oxygenated) blood capillaries exist in beds with venous capillaries, such that you may think of a single capillary as having an arterial end and a venous end. By the time blood reaches the venous capillaries, it is deoxygenated. It flows from the venous capillaries into venules and progressively larger veins until it returns to the right atrium of the heart, thus completing the systemic loop.

“The right atrium primes its ventricle with this return venous blood, which is not only lacking oxygen, but now contains carbon dioxide that must be expelled into the air. The right ventricle pumps this blood through the pulmonary trunk, which branches to form the right and left pulmonary arteries that go to their respective lungs. Through the respiratory exchange process, this blood releases carbon dioxide and receives oxygen. Oxygen-enriched blood then flows through the four pulmonary veins—two from each lung—into the heart’s left atrium, thus completing the pulmonary circulatory loop.

“Perhaps now you can better see that if a blood clot forms in a lower-body vein, breaks off, and travels in the systemic circulation, it can enter the heart through the right atrium and upon exiting the right ventricle get lodged in one of the pulmonary arteries.

“Pressure generated by the heart propels arterial blood, whereas skeletal-muscle contractions constrict the vessels to move venous blood back to the heart. Medium and large veins also have valves that keep blood from yielding to gravity and flowing backward. Thus, in addition to prolonged inactivity, a failure of muscle contraction and/or insufficient valves can result in blood pooling and clotting in the lower extremities.”

**

MOVE, MOVE, MOVE

Movement is vital to keeping your venous blood flowing efficiently. Prolonged immobility is a health risk that even many doctors don’t recognize. ALWAYS get up and move about the cabin when you are flying a long distance. (I get a seat in one of the last few rows so I can easily stand next to the restroom and stretch.) The same is true of long car trips. Stop periodically and get out and stretch your legs. If it is not otherwise contraindicated for you, consider taking a baby aspirin before flying.

Some of you may recall 39-year-old NBC reporter David Bloom’s sudden death from a clot in April 2003. Embedded in Iraq, Bloom slept in a Humvee, hunched over, with his legs folded under him, and, thus, with his circulation impaired. The next morning, a pulmonary embolus killed him.

Such a death is preventable. Please, please think clot.

Ann, 12/28/16

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s