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Hillary Clinton Overcomes a Medical Challenge

Unknown to many Americans, Hillary Clinton has shown courage in overcoming the challenge of recurrent blood clots. Her story reminds us of the health threat that excess blood clotting poses.
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Excessive clotting is a common problem in America, resulting in deep vein thrombosis (blood clot in the leg), pulmonary embolus (blood clot on the lung), frequent miscarriages, or even blood clots in unusual places. Unknown to many Americans, Hillary Clinton has shown courage in overcoming the challenge of recurrent blood clots. Her story reminds us of the health threat that excess blood clotting poses.

When a political leader and celebrity of the stature of Hillary Clinton is overcoming an illness, it serves as a reminder to us to think about the nature of her illness and how it might effect us. I discussed this during my appearance with Dr. Drew on KABC on January 18, 2016 in Los Angeles.

Blood clots in the legs (DVTs) and lungs (pulmonary emboli) are common. According to the CDC, 900,000 serious blood clots are diagnosed annually, resulting in 100,000 deaths. One third of DVTs recur within 10 years. This is exactly what happened to Hillary Clinton. The feared complication of blood clots is pulmonary embolus, which results in sudden death in 25% of patients and death after hospitalization in another 15% of patients.

There is a common syndrome known as hypercoagulable state (or thrombophilia) which results in clots at a young age, or recurrent clots. In America, 5 to 8 % of people have a genetic mutation or blood disorder resulting in a hypercoagulable state. There are many conditions with long names that cause hypercoagulable state, including genetic mutations that can be inherited (in clotting factor V, the Leiden mutation, factor 2 prothrombin, or MTHFR), deficiencies in clotting proteins (antithrombin 3, proteins S or S), high homocysteine levels, antibodies (antiphospholipid syndrome), excess clotting factors (factor 8 or fibrinogen), many cancers, excess platelets, and PNH (paroxysmal nocturnal hemoglobinuria). Hillary Clinton's doctor has said that she "tested negative for all clotting disorders". Because I think she has had a hypercoagulable state with a documented history of 3 clots, she has shown courage in being tested, treated and continuing therapy to prevent further complications. This should inspire people who develop clots to also get the care to prevent further problems, and to stick with anti clotting treatments forever if necessary.

Here are Dr. Cary's tips to help you deal with the threat of blood clots:
• Prevent clots by keeping your legs moving. When on an airplane, get up and walk every hour. Do not wear socks or stockings that block the flow or blood in your leg veins.
• If you have trauma, leg immobilization, hospitalization that keeps you bedridden, or have surgery, be sure to ask your doctor to prevent blood clots by using leg compression and/or using anticoagulants where appropriate.
• Get evaluated by a hematologist if you have a blood clot. The hematologist will determine if you should have the blood tests for a hypercoagulable state. You should expect to have the testing (it takes up to 10 tubes of blood, but it is worth it to make a diagnosis that can save your life) if you have the following: DVT or embolus under age 45, or DVT with a family history of clots, or DVT which is recurrent, or clot which is in an unusual site (head, liver, abdomen or kidney), or if you have had 3 miscarriages in the first trimester of pregnancy, or if you have a family history of blood clots. If you have any of these and your doctor has not recommended testing, get a second opinion from a hematologist. See my book Surviving American Medicine for tips on getting a second opinion.
• If blood thinners are prescribed for a clot, be sure you understand the recommended length of anticoagulation and take the medicines for the entire time. Do not miss days, or you could be at risk for recurrent or life threatening clots.
• If you have a hypercoagulable state, be sure to ask your doctor if your family should be tested or if they are at risk. If they have a hypercoagulable state but have not yet had any clots, their future risk of clots could be between 2 and 40%, so prevention could save their life.

Clotting is like Goldilocks and the 3 bears: you don't want too much (hypercoagulable state, DVTs or emboli), nor too little (excess bleeding), you want just the right amount to keep you healthy forever.

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