On September 14, 2017, Stephani Turner nearly died.
The otherwise healthy, active mother of four hadn’t been feeling well for a while before she landed in the emergency room with life-threatening blood clots in her lungs. “I had been complaining of abdominal thickness and low pelvic pain for months.” Then she developed “a very swollen left leg, shortness of breath and nausea.” The emergency room doctors knew she had a blood clot in her lungs, but they didn’t know why.
As a favor to a friend of Stephani’s, Interventional Radiologist Dr. Thomas Bey of Redding, California, took one look at her images and suspected a deeper cause: May-Thurner Syndrome. And he was correct.
May-Thurner Syndrome is a congenital condition where the large left vein in the pelvis is pinched between the large left artery and the spine. Dr. Bey, whose practice is three hours away from Stephani in Sacramento, referred her to Interventional Radiologist Dr. Mark Davidian. Dr. Davidian explains: “This [syndrome] can cause leg swelling as the venous blood can’t drain up from the leg back to the heart. In a worst case scenario, the venous blood can clot, as blood is stagnant below this narrowing. When clot forms, it can break apart and travel to the lungs. If this happens, the heart can suddenly fail due to the tremendous strain as the heart tries to pump against the clot plugging up the arteries going into the lungs to get oxygenated.” This can be fatal. “My aunt actually died of this exact thing over twenty years ago,” he added. Fortunately, Stephani survived.
Dr. Davidian recounts that Stephani “went to the emergency room because she had leg swelling and shortness of breath. Those two symptoms usually indicate a potentially lethal clot in the vein that has already broken off and travelled to the lungs. A CT scan of the chest confirmed that clot had indeed already lodged in the arteries going to the lung. An ultrasound of the left leg was interpreted as normal. She was then sent home on a blood thinner. The next day, my phone was buzzing with pictures of a swollen leg and requests for me to see her. She was in my office a few hours later. I immediately knew the problem. Any previously healthy woman should not have leg swelling, especially one-sided. I immediately scheduled her for a procedure to look at the veins of the pelvis, suspecting she had clot that had gone undiagnosed.”
Stephani agreed to undergo a minimally invasive, image-guided procedure (MIIP) to evaluate and treat the blood clots and narrowing in her vein. Although she was offered the risky alternatives of doing nothing and living with the swollen leg and risk of future blood clots in the lung or of undergoing major invasive surgery, for Stephani “there were no alternatives.”
Dr. Davidian describes the MIIP he performed on Stephani: “Indeed the first image of the dye injected into her vein clearly showed a monster of a clot in her pelvis. I immediately went to work. We have a great device that sucks clot out of veins and arteries that I used to great effect. I also used a blood clot dissolving medicine to help things along. After getting the clot sucked out, we discovered that she had this narrowing phenomenon as the underlying cause of her whole presentation: the leg swelling, the clotting, and the clot in her lungs. We placed a [woven metal tube called a] stent in the vein [to open it up] and the vein looked so good we were all smiles in the [interventional] lab. Even Stephani! As these procedures are so painless, she was watching the X-ray monitor during the whole procedure, and I was giving her the play-by-play at each step of the procedure.”
Stephani responded well to the MIIP, after which she reported a swift recovery: “I had to walk only for one week, no riding and no work. I went back to everything one week post procedure.” It was very important to her to be able to return to her active lifestyle so soon: “I have worked as an academic account specialist for 28 years for AstraZeneca. I teach fitness classes, ride and rescue horses and rescue dogs. I also love to cook and be outside.”
Research shows that the public is largely unaware of Interventional Radiologists or of the array of minimally invasive, image-guided procedures (MIIPs) they perform. Indeed Stephani admits “I knew nothing about May-Thurner or it's treatment.” Fortunately for Stephani, her friend pointed her in the direction of an Interventional Radiologist, but, for many, a lack of awareness means a lack of access to potentially life-saving MIIPs. Dr. Davidian adds: “Most of the general public has no idea what an interventional radiologist is or what we do. My mom even asks me all the time ‘Mark, what is it you do again?’ It’s very difficult to explain. First off it’s very technical. We use small catheters, needles, balloons, chemotherapy, radiation particles, lasers to treat an extremely diverse set of diseases. We do a lot of vein and arterial work. We use devices with spinning blades or burrs to open arteries, sometimes then treating with balloon angioplasty with balloons coated with chemotherapy to prevent scarring that tends to re-narrow the vessel. We treat osteoporotic patients who have fractures of the spine by injecting bone cement into the marrow of the fracture. We treat kidney cancers with cryotherapy, or needles hooked up to medical gasses that produce an ice ball around the tumor, killing it. It’s hard to put that into a good sound bite! Surgery through a tiny hole. Surgery without a scalpel. Minimally invasive surgery. You pick!”
Being an Interventional Radiologist takes passion. “I really love what I do,” Dr. Davidian exclaims. “I’ve always liked working with my hands. When I was a kid, I built model airplanes, ships, and cars. I worked on my parents’ farm growing up, which is all about working with your hands. And since very early in my life, my mom instilled in me an ethic that it was important to lead a life of helping others. So being an Interventional Radiologist is my dream job.”
Dr. Davidian appreciates the importance of returning patients to their normal lives as fast as possible. He, too, values his family and his personal time. “I’m 54-years-old and am married and have three wonderful girls aged 16, 18, and 22. My wife and girls are the true joys in my life. My wife’s battle with cancer twenty years ago instilled in us an appreciation for life that I don’t think we would have had otherwise. We are very lucky to have her around. I really enjoy my free time. Traveling or skiing with the family is one of my favorites. My latest joy is road racing. I started racing cars over a year ago and can’t get enough of it! “
Since being treated by Dr. Davidian for her May-Thurner syndrome and blood clots, Stephani feels like her life has returned to normal: “All symptoms are completely resolved including a 10 pound weight loss (all [swelling] as it turned out). Now my abdomen is basically deflated and looks normal again, my legs feel perfect, and I have no pelvic pain.”
After such a dramatic recovery from an illness she had never heard of thanks to a MIIP she never knew existed, it is no wonder that Stephani is grateful and eager to spread the word: “I want everyone to know that Dr. Mark Davidian saved my life. Because of Dr. Davidian’s efforts and excellent healthcare, I am alive and have no issues with my left leg. Because of his ongoing efforts and passion, more lives and limbs will be spared.” Stephani is dedicated to making sure others know about diseases like May-Thurner and the MIIPs used to treat them. “I have become very passionate about venous education. So little is known about it. It's a tragedy.”
MIIPs have the potential to impact patient’s lives in major ways with minimal side effects and swift recovery times. For Interventional Radiologist Dr. Bey, treating patients with MIIPs is a privilege and an honor: “These stories happen literally weekly and it gives me [the] greatest satisfaction knowing we have altered the life path of a patient for the better by using minimally invasive techniques.”
For more information about May-Thurner syndrome and MIIPs, visit www.theii.org.