Health
What People Who’ve Had It Want You to Know
Blood clots may sound like a problem for older people or those who don’t get up and move around much. But potentially life-threatening clots that form in the veins deep within your body can happen to anyone. Even young and active people can get deep vein thrombosis (DVT). People who’ve had it have some things they want you to know:
When clots form in your veins, they can break off, travel through your bloodstream, and get caught in your lungs. This blocks blood flow to your lungs and can lead to death.
DVTs happen most often in one of your legs. The leg might swell and grow warm and red. But that’s not always what happens.
Melissa Day, a 46-year-old physical therapist in Norfolk, VA, stood up from her seat to deboard a plane after a long flight and felt a pain in her back so intense that she thought she might pass out. It wasn’t until 3 days later that her leg started to swell.
For Shauntel McCartney, a 48-year-old store manager in Grand Rapids, MN, it was a severely swollen and discolored arm that tipped her off that something was wrong. “It was purple, red, green, and blue from my shoulder to my fingertips and about three times the size of my other arm,” she says.
Caroline Kelly, now a 33-year-old model and entrepreneur from San Diego, was a soccer-playing 19-year-old when she had DVT for the first time. Dana Pellegrino, a New York City-based lawyer, was 29 and worked out at least three times a week when it happened to her.
“I thought that my calves were getting bigger from all the dance-cardio I had been doing,” Pellegrino recalls. “But they were swollen.”
Patrice Jones, who runs a personal training and meal prep service in Forestville, MD, is a self-described health fanatic. At one point she was running 56 miles a week. She had her first DVT at age 30 and has had a dozen in the 15 years since then.
Doctors might think your symptoms are caused by something else. Both Kelly and Pellegrino were sent home the first time they went to see a doctor about the leg pain they later learned was a DVT clot. In both cases, the doctors assumed it was an exercise-related muscle strain.
Pellegrino’s doctor told her to come back if the pain got worse. “The next day, the pain in my legs was so bad that I could barely get out of bed,” she says.
Doctors told Day, the physical therapist from Norfolk, that her back pain would just pass.
Being older, overweight, and having an inactive lifestyle are top risk factors for blood clots, but other issues can raise your risk, too.
Some people inherit genes from their parents that raise their risk for clots.
McCartney, the store manager in Grand Rapids, learned only after her clot that she had inherited a gene variant, factor V Leiden mutation, from her father that put her at higher risk. Even with this mutation, many people go their whole lives without a blood clot. But McCartney had another risk factor: She smoked. Smoking can interfere with circulation and raise the risk for blood clots.
Jones, the personal trainer, also learned she had an inherited clotting disorder, thrombophilia, which causes the blood to clot unnecessarily.
Birth control that uses hormones to prevent pregnancy, such as the pill, can raise your risk too. A long-haul flight can be a factor also. Day was on the pill when she traveled 32 hours for a vacation with her husband in the Seychelles. It was when the last flight landed that the pain shot through her back. Later, after doctors figured out that blood clots were the problem, they learned she was born with some abnormalities in her vascular system that also made her prone to clots.
Kelly and Pellegrino were taking the pill too. The same week Pellegrino had the clot, she had two 4-hour flights and a couple of 2-hour drives.
After they had blood clots, these women stopped using hormonal contraceptives.
Kelly got tested for every possible genetic clotting disorder, but all were negative. Still, 3 years after her first clot, she took a long flight to Hawaii and had another clot.
Though she doesn’t have a clotting disorder, thicker blood runs in her family. Most everyone on her father’s side takes blood thinners. Now she does too. You may have to continue to take blood thinners for the rest of your life.
Blood thinners can be a life changer, she says. “Since I’m on blood thinners, I can’t get my ears pierced. I can’t work in a kitchen or another job where I might cut myself. I can’t play sports where I can get bruised up. I can’t eat a lot of leafy greens. Most things I want to do, I ask my cardiologist first.”
But, she stresses, she hasn’t let blood thinners, or the fear of another clot, keep her from living her life. She recently launched a lipstick line. “You can still live your life and follow your dreams.”
For some blood clots, the treatment is just to wait for them to break up on their own. Doctors give you medication to thin your blood and sometimes special instructions.
In those first few weeks after her blood clot, Pellegrino was encouraged to keep moving, but only with easy walking. She was forbidden to run or jump for fear the clot would move to her lungs. An ultrasound 6 months later confirmed the clot had finally cleared.
Kelly was on bed rest for more than 3 months while she waited for her clot to dissolve. She couldn’t walk, and the pain was unbearable. “My mom had to quit her job to take care of me,” she recalls.
McCartney was also sent home with medications. It was a full year before the clots in her arm cleared. During that time, she couldn’t lift anything heavy and tasks like painting a bedroom wall, which she tried, left her in pain for days. Her arm is still swollen in places and not yet back to its full strength.
Day’s clots were so bad — they ran from her legs to just below her heart — she had to have surgery to take them out. Through catheters in the affected veins, doctors injected medicine to break down the clots. They used ultrasound to vibrate the veins, which helped separate the clumps of blood. After 24 hours of this, they went into the veins with special tools to remove all the broken pieces of coagulated blood.
Eighteen months later, Day has post-thrombotic syndrome. Her veins got stretched out in this ordeal and blood doesn’t move through them like it should. She wears thigh-high compression stockings whenever she’ll be on her feet to keep her blood circulating. Her legs tire easily, which means she still can’t do some of the things she could before the clots, such as skiing and running.
Jones’ last clotting episode, her twelfth, landed her in the ICU. She had to have the clots broken up and removed in a procedure like the one Day underwent. There were complications. A blood clot reached her esophagus, and she was put on a ventilator for a day and a half. At one point, her blood pressure dropped so low, she texted her sister, “Sis, BP 80/40. Need you to be my voice. Don’t let me die in here.”
When you have a blood clot that hasn’t dissolved, the concern is that it will break off and travel to your heart or your lungs. The clots in McCartney’s arms were dangerously close to her heart. “Every night I kissed my son, not knowing whether I’d wake up the next day,” she says.
Pellegrino was sometimes inconsolable in the months when she waited for her clot to clear. “I would just cry. I was so afraid it could happen any day, that the DVT would break off and go to my lungs, and nobody can tell you that it’s not.”
Both women got comfort from online support groups. “I looked for a group because I just wanted to know, ‘How do I deal with all this anxiety?’” Pellegrino says. McCartney doesn’t think she’d be doing as well as she is today without the support of other people who’ve been through the same thing.
May 10, 2024 – When we’re young, we take our macula for granted. At the center of our retina – the deepest layer of the eye that’s chock-full of photoreceptors and that confers color to our world – the macula is like a high-resolution camera. As light hits our eyes, the retina’s macula recasts our world in a bloom of color with astoundingly high visual sharpness.
But as you age, your vision dulls. What once stood out sharply becomes foggy, like condensation on a windowpane. After some time, a coal-black smudge or cloudy circular area begins to affect your central vision.
This effective blind spot widens over time if left untreated. What remains is a “macular hole” in the center of your retina.
This unfortunate series of events marks the advanced stage of age-related macular degeneration, a dangerous retinal disease that affects about 20 million people in the U.S., and nearly 200 million people worldwide.
And it’s not getting better. Estimates are that by 2040, the disease may affect nearly 300 million people worldwide. We are very limited in our ability to treat or prevent it. Read on for what to know.
First, What Causes Age-Related Macular Degeneration?
AMD’s causes are varied, and whether it will affect you is mostly determined by age and genetics, said Marco Alejandro Gonzalez, MD, an ophthalmologist and vitreoretinal specialist in Delray Beach, FL.
Because of the different cocktails that we have in terms of our genetic makeup, some people’s photoreceptor cells in the macula “basically start to shut down,” he said.
AMD’s development involves over 30 genes, and if you have a first-degree relative – parent, sibling, child – who has the disease, you’re three times more likely to get it, too.
Gonzalez explained how the expected rise to 300 million cases by 2040 is due mostly to improved diagnostic tools, along with the fact that the world is getting older and living longer. (Usually, an optometrist can detect signs of AMD during a routine eye exam.)
Eye experts still struggle to stop AMD’s most harmful sign – the cause of those muddy, milky, or even coal-colored circles in your central vision: geographic atrophy.
Geographic atrophy can occur in either of the two forms of age-related AMD: “dry” AMD and “wet” AMD.
Nearly every case of AMD begins as the dry kind, affecting 80% to 90% of AMD patients.
Retinal disease expert Tiarnán Keenan, MD, PhD, offered a vivid image of geographic atrophy for those who have dry AMD.
“As time passes, the circular patches of GA expand like a brushfire, taking more and more vision with it, often to the point of legal blindness,” he said.
A researcher in the Division of Epidemiology and Clinical Applications at the National Eye Institute, Keenan recently led a study that tested the efficacy of the antibiotic minocycline in slowing geographic atrophy expansion in dry AMD. The study operated on the grounds that the body’s immune system could be at play in developing the disease.
When your body’s immune system is overactive, microglial cells (central nervous system immune cells) can get into the sub-retinal space and possibly eat away at the macula and its sensitive photoreceptors.
Though minocycline had been shown to reduce inflammation and microglial activity in the eye in diabetic retinopathy, it didn’t slow the expansion of geographic atrophy or vision loss in patients with dry AMD during Keenan’s study.
When asked if microglial activity could have very little to do with the atrophy expansion, Keenan said it’s something to consider: “Maybe microglia are just there as bystanders clearing up the debris … so inhibiting them is less likely to slow down progression.”
In future drug trials, “maybe it’s possible the minocycline or another approach to target microglia would be helpful, but it would be needed in combination with some other therapy and be ineffective by itself,” he said.
Two Sides of the Same Disease
In dry AMD, Gonzalez compares macular degeneration to the loss of pixels on a screen. “Some of those pixels burn out … and that’s the way you lose vision classically in the dry form.”
Wet AMD is a more progressive form of the disease. It causes abrupt vision loss due to abnormal blood vessel growth.
“If you don’t treat wet AMD quickly, it’s game over,” warned Gonzalez. “Wet macular degeneration is the quicker process of vision loss because these blood vessels wreak havoc.” These new blood vessels bleed, causing fluid to build in the macula, which ultimately leads to scarring.
Gonzalez shed light on why wet AMD develops. “The wet form, for some reason, is the body’s last-ditch effort to try to kind of ‘help’ a dying macula. … When these blood vessels start to grow under the retina, they quickly destroy the architecture of the macula.”
Stopping the Bleeding in Wet AMD
Though wet AMD is rarer, it’s more treatable than dry AMD. Signs and symptoms can be eased with various therapies injected into the eye.
Putting it simply, Gonzalez said these therapies to treat wet AMD “all basically do the same thing. They make these new blood vessels regress temporarily before they cause damage to the macula.”
The injected medication clears away those blood vessels and restores the architecture of the macula. People can recover some vision in this way, but it’s only a temporary tune-up, and shots must be given as often as once a month.
“Degeneration of the cells is still the main problem. You’re not stopping that. But degeneration itself is a lot slower than actual vision loss associated with these blood vessels.”
The Struggle in Developing New Treatments
According to Keenan, “nobody has been able to stop geographic atrophy from happening” in either form of AMD. “So, that’s the main work in the field with trials.”
In December 2023, the FDA approved two new drugs: Syfovre and Izervay, both of which only slow geographic atrophy. Degeneration still happens, regardless.
Keenan explained how these two new drugs are “complement inhibitors … given by injection into the eye once a month or so.”
“Complement” refers to the body’s complement pathway, a trigger that activates a cascade of proteins in enhancing immune response.
Clinical trials showed Syfovre slowing the rate of geographic atrophy by up to 22% over 2 years, and Izervay up to 14% over 1 year.
Though these drugs are a new weapon against this troublesome affliction, they aren’t without their complications.
“Anytime you give an injection in the eye, there’s always the risk of an infection because you’re introducing something from the outside. So that’s the biggest risk,” explained Gonzalez.
An infection is uncommon, but potentially devastating, as you can lose your eye altogether. There’s also the chance of a damaging reaction to the shot.
“You have to pick and choose your patients,” said Gonzalez. “Not everybody is a good candidate for those new shots … and the patient is never going to see better. … It’s a harder sell than the ones for wet AMD.”
A Common Protective Measure
Keenan and Gonzalez both have a fair degree of confidence in reducing the risk of AMD with vitamin therapy.
As a bit of background on how vitamins were found to act as a sort of preventive measure, Gonzalez said, “In the early and late ‘90s, there were series of studies which were called the age-related eye disease studies.” These are now referred to as AREDS 1 and AREDS 2.
Researchers proved that a certain cocktail of vitamins slowed down degeneration. The most is a combo of antioxidants: vitamins C and E and lutein and zeaxanthin, all of which are in the AREDS 2 formula.
People who took these vitamins had a lower chance of losing their vision over the next 2 to 5 years. “[The combo] seems to be complementary and additive … with a combined treatment effect of 55% to 60%, an excellent safety record, and very low cost,” Keenan said.
Gonzalez recommends the AREDS 2 formula of vitamins to every patient of his. “It’s such an easy thing to take, and the downside is minimal.”
Unfortunately, if your genes make you more likely to have the condition, a change in diet or vitamin use could have no effect.
Dire? Possibly. But not all is lost in this fight.
Vigilance with AMD and What to Do Next if You’re Diagnosed
Gonzalez is adamant in educating his patients before time has run out on treating AMD. Recognition is key. “The most common reason a lot of these people get to me ‘too late’ is they don’t realize there’s a problem.”
He explained a typical scenario: “Let’s say you have macular degeneration in both eyes at different stages. One of your eyes starts developing wet macular degeneration … so the better eye takes over and you may not notice there’s a problem.”
Even after a patient is diagnosed with AMD, they usually see a specialist only twice a year. Gonzalez often tells his patients to cover one of their eyes to make sure their vision is intact in both eyes. “You’ll be able to pick up on subtle differences” in each eye, he said.
This type of self-care and vigilance can be the difference between successfully living with and treating the disease for the rest of your life, and trying to get help when it’s simply too late.
For wet AMD, as mentioned before, a round of injections is basically what everyone does. Without quick, invasive treatment, the point of no return approaches rapidly.
May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.
Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.
Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.
With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.
Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”
People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.
It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.
An ‘Experimental Hamburger’
If one take-home message emerged from the event, it was that the threat to the general public remains low.
The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.
As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.
For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.
The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.
The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.
Vaccination Not Recommended Now
Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.
If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.
An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”
Treatments Stockpiled and Ready
Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.
When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.
“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”
ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.
“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”
Science in Action
The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.
“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.
Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”
For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.
May 16, 2024 – Multiple U.S. agencies are working to contain the recent bird flu outbreak among cattle to prevent further spread to humans (beyond one case reported in early April) and use what we learned before, during, and after the COVID-19 pandemic to keep farm workers and the general public safe.
Fingers crossed, the bird flu will be contained and peter out. Or the outbreak could continue to spread among dairy cattle and other animals, threatening the health and livelihoods of farmers and others who work with livestock.
Or the virus could change in a way that makes it easier to infect and spread among people. If this happens, the worst-case scenario could be a new influenza pandemic.
With so many unknowns, WebMD brought together experts from four federal agencies to talk prevention, monitoring, and what the “what ifs” of bird flu might look like.
Communication with the public “about what we know, what we don’t know, and ways you and your family can stay safe is a priority for us at CDC,” said Nirav D. Shah, MD, JD, the CDC’s principal deputy director. “We at the federal level are responding, and we want the public to be following along.”
People should consult the websites for the CDC, FDA, U.S. Department of Agriculture (USDA), and the Administration for Strategic Preparedness and Response (ASPR) for updates.
It is essential to not only stay informed, but to seek trusted sources of information, Shah said during “Bird Flu 2024 – What You Need to Know,” an online briefing jointly sponsored by the CDC and WebMD.
An ‘Experimental Hamburger’
If one take-home message emerged from the event, it was that the threat to the general public remains low.
The retail milk supply is safe, although consuming raw or unpasteurized milk is not recommended. “While commercial milk supply is safe, we strongly advise against drinking raw milk,” said Donald A. Prater, DVM, acting director for the FDA’s Center for Food Safety and Applied Nutrition.
As for other foods, thoroughly cooked eggs are less risky than raw eggs, and the nation’s beef supply remains free of the virus as well.
For years, federal inspectors have purchased and tested meat at retail stores, said Eric Deeble, DVM, USDA deputy assistant secretary for the Office of Congressional Relations. So far, H5N1, the virus behind bird flu, has not been detected in beef.
The USDA took testing a step further and recently cooked ground beef from dairy cows in their lab. Using what Deeble described as an “experimental hamburger,” the agency showed cooking beef to 165 F or higher kills the virus if it ever becomes necessary.
The federal government now requires all cattle be tested and be free of bird flu virus before crossing any state lines. The government is also reimbursing farmers for veterinary care and loss of business related to the outbreak, and supply personal protective equipment (PPE) like gloves, masks, and face shields to workers.
Vaccination Not Recommended Now
Federal scientists know enough about H5N1 virus to create vaccines against it quickly if the need arises. It’s more about planning ahead at this point. “Vaccines are not part of our response right now,” said David Boucher, PhD, director of infectious diseases preparedness and response at the Administration for Strategic Preparedness and Response.
If the virus changes and becomes a bigger threat to people, “we have the building blocks to produce a vaccine,” Boucher added.
An event attendee asked if the seasonal flu shot offers any protection. “Unfortunately, the flu shot you got last year does not provide great protection from the avian flu,” Shah responded. “It might do a little bit … but that is the vaccine for seasonal flu. This is something more novel.”
Treatments Stockpiled and Ready
Antiviral medications, which if given early in the course of bird flu infection could shorten the severity or duration of illness, are available now, Shah said. The dairy farmer who was infected with bird flu earlier this year responded to oseltamivir (Tamiflu) treatment, for example.
When it comes to bird flu symptoms, the fact that the only infected person reported so far this year developed pink eye, also known as conjunctivitis, is interesting, Shah said. Officials would have expected to see more typical seasonal flu symptoms, he added.
“Influenza is not a new virus,” Boucher said. “With this strain of influenza, we are not seeing any genetic markers associated with resistance to antivirals. That means the antivirals we take for seasonal influenza would also be available if needed to treat H5N1.”
ASPR has stockpiled Tamiflu and three other antivirals. “We do have tens of millions of courses that can be distributed around the country if we need them,” he added.
“Influenza is an enemy we know well,” Boucher said. That is why “we have antivirals ready to go now and many types of PPE.”
Science in Action
The feds intend to stay on the case. They will continue to monitor emergency department visits, lab test orders, and wastewater samples for any changes suggesting a human pandemic risk is growing.
“While we’ve learned a great deal, there are still many things we do not know,” Deeble said.
Shah added, “As in any outbreak, this is an evolving situation and things can change. What you are seeing now is science in action.”
For the latest updates on bird flu in the United States, visit the CDC’s H5N1 Bird Flu: Current Situation Summary website.
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