Column: How to prevent and treat blood clots this traveling season

The author hiking up to Pioneer Cabin, elevation 9,500 feet. The same day, she hiked almost 8 miles and took aspirin every two hours for a sore calf. She later learned that it was actually a blood clot in her left leg. (WTOP/Alicia Lozano)

Editor’s Note: Doctors discovered a blood clot in WTOP Reporter Alicia Lozano’s leg on June 11 after she returned from vacation. This is her story.

WASHINGTON — It was one of those days where the travel gods seemed to be working against me.

Metro was late thanks to single-tracking; the security lines at Reagan National Airport were longer than normal, and the flight attendants were not particularly interested in allowing me to carry on my carry-on despite ample overheard room.

But once the plane took off for Sun Valley, Idaho, everything seemed to fall into place. That is, until I landed with a horribly sore foot.

Two weeks later — after hiking and mountain-biking my way through the Sawtooth National Forest — I was admitted to the emergency room with a blood clot in my left calf. Doctors were especially concerned because I have a family history of clots, which I later learned is one of the leading risk factors.

At 32 years old, the experience was surreal. I was convinced that the worsening pain in my calf was a strained or torn muscle from my active vacation, not a life-threatening clot.

After one night in the emergency room, two ultrasounds on my leg and a full-body CT scan, I learned that blood clots affect hundreds of thousands of people.

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The exact number of patients diagnosed with deep vein thrombosis (or DVT) is not known, but experts estimate that 300,000 to 600,000 people suffer from these potentially dangerous clots, the CDC reports.

DVT happens when a blood clot forms in one of the deep veins in the body, usually in the leg. These clots can break off and travel to the lungs and cause a pulmonary embolism (or PE). About 60,000 to 100,000 people die from PE every year, the CDC reports.

Not all clots are life-threatening, however. I was diagnosed with a superficial clot — one in a vein near the body’s surface. This kind of clot is usually found below the knee and rarely travels up toward the vital organs.

Superficial clots can sometimes be treated with over-the-counter aspirin, which thins the blood without the use of harsher anticoagulants, whose side effects range from chronic headaches to heavy bleeding.

Several risk factors can lead to clotting, including a family history of DVT, birth control pills, recent surgery and traveling.

The latter is “one of the really basic things that we look for when we’re considering if someone in the clinic has a blood clot … especially with our jet- setting population in D.C.,” says Dr. Will Kimbrough, primary care physician with One Medical Group, in Northwest.

Kimbrough says the cramped nature and dehydration of modern travel can cause unexpected clots. He recommends setting a timer that goes off every one to two hours and getting up, if possible, to stretch your legs. If you’re stuck in a middle seat with two sleeping people next to you, consider doing some calf exercises in your seat. Flex the toes up and down to encourage circulation.

“Just moving the calf can make the muscles act as a natural pump to help blood get out of the lower leg and back to the heart and general circulation,” Kimbrough says.

People with a heightened clotting risk might consider wearing a compression stocking or sock that keeps the blood from pooling up in your legs, he says.

If you do get a blood clot, paying close attention to the symptoms can make the difference between quick treatment and prolonged discomfort or even death.

When my calf started to hurt, I assumed it was a muscle problem from pushing myself too hard on the trails. Kimbrough says confusing a clot for a strained muscle is extremely common, especially among active patients.

Obvious clot symptoms to watch for include redness, swelling and pain in one leg.

Because blood clot symptoms can closely mirror muscle strain, it’s important for patients to have a detailed conversation with their doctors and mention things like traveling, birth control or surgery, Kimbrough says.

Once a clot is diagnosed, your doctor will likely choose from one of the blood thinners on the market.

Coumadin or Warfarin have been the go-to medications for people with DVT since the 1950s. They contain some of the same chemicals used in rat poison, and require frequent blood tests to ensure a normal international normalized ratio (INR) in patients. A high INR means a patient could be at high risk of bleeding, while a low INR means the medication could be ineffective.

People taking Coumadin or Warfarin also have to be careful about eating too much vitamin K, most commonly found in leafy greens such as spinach, kale and lettuce.

“It’s a matter of the fluctuation of vitamin K,” Kimbrough says. “If [my patients] are going to eat leafy greens, then it needs to be on a consistent basis.”

Because vitamin K is needed for normal blood clotting, high amounts of the vitamin can actually work against medications such as Coumadin or Warfarin, the Cleveland Clinic warns.

A new alternative, Xarelto or Rivaroxaban, is now available. Some medical professionals prefer the new drug because it does not require frequent monitoring or dietary changes. It is usually taken once a day, though your doctor might recommend two daily doses within the first three weeks of treatment.

But like most medications, Xarelto comes with side effects, including headaches, dizziness and heavy bleeding.

Kimbrough says the key to navigating any medical condition is a good relationship with your doctor.

“Everything is going to have some negative potential when you’re in the world of blood thinners and blood clots,” he says.

“It’s all about walking through your options with your health care provider and getting some options that are the best fit for you.”

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