How Sitting for Too Long Can Result in Dangerous Pulmonary Embolisms

After spending days driving in an RV from Ohio, Mike Hummel was happy to join friends for a highly anticipated fishing trip in the Florida Keys. But while the weather was mild and the company was great, something didn’t feel quite right, and it had nothing to do with how many fish they reeled in.

On the third day of the fishing trip, Mr. Hummel awoke with significant discomfort in his back and sides. He thought he might be dehydrated after a long boat excursion, so he loaded up on sports drinks and bananas, hoping to rebalance his fluids. But things only got worse.

As she watched her husband’s pain intensify, Mr. Hummel’s wife, Penny, insisted they go to the Emergency Department at Mariners Hospital. It was a decision that may have saved his life.

Unraveling the Mystery
“I thought it was kidney stones,” recalls Mr. Hummel, pictured at left with his wife. He was wrong.

After a number of diagnostic tests, the Mariners team led by emergency medicine specialist Kevin Holcombe, M.D., determined Mr. Hummel, 63, was suffering from multiple pulmonary embolisms that formed during the long hours he spent driving to Florida.

“His symptoms weren’t fitting what he thought he had, so I just had to keep digging deeper,” said Dr. Holcombe, who put it all together and ordered a CT scan after hearing about Mr. Hummel’s travels. “I’m glad we found it… Cases like this can progress to be fatal.”

A pulmonary embolism is a sudden blockage in a lung artery, interfering with the pumping of the heart and preventing it from taking in oxygen. If left untreated, about 30 percent of patients who have PE will die, according to the National Institutes of Health.

Pulmonary embolisms usually originate as a blood clot called a deep vein thrombosis (DVT) that can be caused by long periods of inactivity, like too much sitting, extended bed-rest or long trips. (For additional risk factors, see below.) According to the U.S. Center for Disease Control and Prevention, anyone traveling more than four hours, whether by air, car, bus, or train, can be at risk for these blood clots.

That most likely was what caused the embolisms experienced by Mr. Hummel, who conceded he spent longer periods at the wheel than he was accustomed. Although he and his wife had made the trip to Florida before, they usually drove in their pickup truck and stopped more frequently for breaks. This time, the Hummels travelled in an RV, which offered comforts and conveniences that allowed Mr. Hummel to drive for long stretches without a break, he said.

Treating the Problem
Depending on the severity, treatment for PE can range from blood-thinning medicines to powerful “clot-busting” drugs. In some cases, an interventional radiologist may thread a catheter to the pulmonary artery to break up and suck out the clot, relieving the obstruction immediately in a minimally invasive procedure. Vascular medicine specialists at Miami Cardiac & Vascular Institute are currently involved in clinical research to test a new device that can help remove pulmonary blood clots in this manner.

In Mr. Hummel’s case, he was given blood-thinning medicine and carefully monitored in intensive care by Thomas Morrison, M.D. When Mr. Hummel was released and cleared to travel, he and his wife drove the RV back to Ohio, but this time he stopped frequently and did exercises to keep his blood moving. Once home, he went back to work and life as usual, although he stayed on the blood thinner.

Mr. Hummel was happy to share his story because of the great outcome and outstanding care he said he received at Mariners Hospital. But he also wants to spread the word about the dangers of deep vein thrombosis and pulmonary embolisms.

“I am surprised how many people are poorly informed on PE and extended driving,” he said. “I have been telling everyone I know about it, and I have found few people know anything about it.”

What You Need to Know
In addition to sitting for long periods, factors that can increase the risk for pulmonary embolisms include:

• Being overweight or obese
• Smoking
• Age (Although PE can occur at any time, the risk doubles every 10 years after age 60)
• Pregnancy and the first six weeks after giving birth
• Being bedridden or unable to move much
• Breaking a bone, injuring a muscle or sustaining an injury that could impact the arteries
• Having certain conditions, such as a stroke, chronic heart disease or high blood pressure
• Having surgery
• A family history or conditions that may affect how the blood clots

To help prevent blood clots, consider the following tips:

• Move around as soon as possible after having been confined to bed, such as after surgery, illness or injury.
• When sitting for long periods, such as when traveling, get up and walk around every 2 to 3 hours.
• Exercise your legs while you’re sitting by raising and lowering your heels while keeping your toes on the floor, raising and lowering your toes while keeping your heels on the floor, and tightening and releasing your leg muscles.
• If you’re at risk for DVT, talk to your doctor about getting compression stockings and taking low-dose aspirin or other anticoagulant medication.
• Maintain a healthy weight, avoid a sedentary lifestyle and follow your doctor’s recommendations based on your individual risk factors.

Tags: Mariners Hospital, pulmonary embolism