The Other “Silent Killer” You May Not Know

So, what’s the problem with sitting around all day?

Millions of people sit at desks for long hours and travel to and from meetings and conferences, making it hard to get daily exercise. The average American spends too many hours sitting every day – but its just part of the way we work.

Besides the idea of exercise, however, it is very important for people to remember deep vein thrombosis – a killer disease that comes on quickly, and when you least expect it.

NBC Correspondent David Bloom spent days traveling in a M88, a tank recovery vehicle in Iraq in 2003. He complained of pain behind a knee, but stayed on the job. Eventually he collapsed and died of a pulmonary embolism, but the killer was really Deep Vein Thrombosis, or DVT, sometimes called “economy class syndrome.”

DVT, caused by long periods of inactivity, causes clots to develop in the veins of the artery or pelvis. When a piece breaks off and travels to a major artery, cutting off oxygen to the lungs, for instance, death is quick.

“If you are obese, a smoker, and hypertensive, and you get on Jet Blue to go to Miami, you put yourself at great risk,” said Ron Clark, MD, a Southbury resident who is Director of the Emergency Department at New Britain Hospital of Central Connecticut. “I had four patients in one recent week with this and they all developed it by flying.”

The problem with flying - and you apply this to trains, buses, cars, the office and even cramped armored vehicles in a war zone - is that extended periods of immobility means that your blood isn’t circulating, a condition called venus statis.

“Pregnancy, recent surgery on the hip or knee, aging, vascular injury and high blood pressure can all contribute to DVT, “ Clark said. “We call it Virchow’s Triad, venus statis, hyper coagulability, and trauma. These are the big three risk factors. If a person goes hours without getting up – especially if they are post-operative from something like joint replacement, they are particularly high risk.”

DVT is fairly easy to recognize – especially in the legs. First you have swelling, probably one sided, and there is pain and redness. Other symptoms include discoloration of the site and deep muscle pain. If this happens, and you have been sitting for an extended period of time, it’s a good idea to check it out. One blood test can indicate that this is the problem, and then an ultrasound will confirm the diagnosis.

“It’s an Emergency Room thing,” Dr. Clark said. “You come in, get an ultrasound, and you are admitted within an hour. If it develops into an embolism you might have chest pain and trouble breathing, and it can easily be fatal, all within a minute. You can be sitting there one minute and dead the next.”

Risk factors for DVT include:

• Older than 40 – probability increases with age
• Prolonged immobility or paralysis
• Surgery – especially orthopedic, pelvic and abdominal operations
• Trauma – up to 60% of patients with leg fractures
• Prior DVT
• Cancer – particularly ovarian, pancreatic, lymphatic, liver, stomach and colon
• Inherited clotting disorders
• Hormone replacement therapy and birth control medications

DVT usually strikes without much warning, and because you might easily pass out, getting help in a hurry is important. Patients experience: shortness of breath, rapid pulse, sweating, anxiety, sharp chest pain that worsens with deep breathing, coughing up bloody sputum, and loss of consciousness due to very low blood pressure.

Treatment usually begins with oxygen and pain relievers if necessary. For uncomplicated DVT, anticoagulants are used to keep existing clots from growing and additional clots from developing until the body can naturally dissolve the clot formations. People in danger of imminent death may need strong clot-busting drugs called thrombolytics or emergency surgery.

The National Heart and Lung Institute offer some simple advice that can help prevent DVT. Wear loose, comfortable clothing. If you are driving or flying, try to walk around once an hour. Drink water, avoid coffee and be alert to signs of a problem, especially if you are in a high-risk category.

Dr. Clark, Director of Emergency Medicine at the Hospital of Central Connecticut in New Britain, is also the author of “Surviving the Emergency Room, published by Amazon in October 2010.