At some point during our lives, most of us will have an increased risk for developing a blood clot. Thirty-three year-old Lisa Boyd had no idea that her moment would come a few days after the birth of her second child. Her symptoms started with a pain in her hip.
"I thought maybe it felt a little bit like a pulled muscle," says Boyd. "But what was strange was I didn't have that pain immediately after delivery or even in the few days following delivery. It just seemed to come out of nowhere and it was sudden. And I really couldn't tie it to anything in particular."
It was odd enough that she called her clinic's nurse line. They agreed it was probably pain related to giving birth and told her to ice her hip and rest. She did. But the pain didn't go away. A few days later she called her family doctor after she says the pain became almost unbearable. Again, she was told to rest and take an anti-inflammatory medication.
“I think there's a gross under-awareness amongst physicians. It's not stuff I was taught in med school.”Dr. Mark Reding
Then two weeks after the birth of her child, her husband noticed something was wrong after she got out of the shower.
"He said, 'Oh my God. Look at your leg.' And I looked down and I couldn't believe what I saw," says Boyd. "It was incredibly swollen, the whole leg from foot to all the way up to my hip and it was red and blotchy. And I said back to my husband, 'They are going to see me tomorrow.' And he said, 'No. You're going to call tonight. This is serious. There's something really wrong.'"
Boyd went to the emergency room where doctors found a 12-inch blood clot. It ran from her mid-thigh up her deep vein toward her lungs. It was so serious, she could have died at any moment if it had broken off in her bloodstream and traveled to her lungs - a condition called a pulmonary embolism.
She was immediately given a blood thinner to stop any more clotting. But she wasn't out of danger for more than a week while her body absorbed the massive clump of blood in her leg.
Eighteen months later, she still can't shake the feeling that her health crisis shouldn't have gotten to the point that it did.
"I was a walking, ticking time bomb ready to collapse from an embolism at any time. And I was making these phone calls and the very people who were charged with caring for me never recognized it and I could have died before I got to make that third phone call or before my husband got to see my leg and make me get help," says Boyd.
Unfortunately her situation is rather common, according to Dr. Mark Reding.
"A lot of people that we see have stories like that where they had symptoms for a few days or sometimes even a few weeks before the answer finally is found. I hear that over and over again."
Reding directs the Center for Bleeding and Clotting Disorders at the University of Minnesota Medical Center, Fairview. Blood clots are his expertise. He's well aware of the situations that are most likely to cause them. For example, a woman who is pregnant or has just given birth is at a greater risk of blood clots because of the elevated estrogen levels in her system. Her odds go up even more if she's dehydrated or sedentary following birth - something Lisa Boyd says she wasn't warned against.
Women who take birth control pills also have a higher clot risk, along with cancer patients and people who have had orthopedic surgery, leg trauma or are elderly. Some people even have a genetic condition that predisposes them to clots.
To varying degrees this information hasn't made it into medical training, Reding says.
"I think there's a gross under-awareness amongst physicians. It's not stuff I was taught in med school."
Reding hopes a recent "call to action" on blood clots from the acting U.S. Surgeon General will get more doctors thinking about the issue. And if that doesn't work, he suspects that new penalties will. The federal government is now classifying the failure to provide blood clot screening and preventive treatment to at-risk patients in the hospital as a medical error.
Starting next fall if a patient with publicly-subsidized health insurance develops a blood clot in the hospital that could have been prevented, the Centers for Medicare and Medicaid Services will not reimburse the hospital for the cost of the patient's care. And the patient, if he or she survives, won't have to pay the bill either.