Silent killer that 'loves' women

“When you survive this disease, know that God loves you.” Those are the words of Faith Joy Kiki, a medic at Nazareth Hospital.

This writer’s neighbour Mama Ndanu and many others did not survive the attack. Mama Ndanu died ‘just like that’ while sleeping.

According to her husband, she just jolted from her sleep and the next thing she was dead. She was recovering from a caesarean section. Post-mortem results showed that she had died of pulmonary embolism, which in layman terms, is a blood clot in the lungs.

Although there is no concrete research on it in Kenya, medics agree that pulmonary embolism is now one of the fastest killers and increasingly more people are succumbing to it. Government pathologist Dr Johanssen Oduor attests to this fact.

“Yes we are seeing more cases. My colleagues who are pathologists have also noticed that for most of the bodies we are handling, the cause of death is a blood clot. Like for me, in a month, I must at least get one case of death due to a clot. It is worrying,” Dr Oduor says.

In fact, Dr Oduor adds, the reason behind the absence of statistics on the prevalence of the disease is that many of the cases are not diagnosed until the patient dies and an autopsy is done to establish cause of death.

A few weeks ago, United States International University Information and Technology Director Regina Mutoko, died as a result of pulmonary embolism. Regina was found unconscious, with some vomit, in her bathroom.

On August 7, Rehema Kanini,29, died in an Indian hospital after donating a kidney to her ailing uncle. An autopsy report showed that she died from a blood clot. Rehema was also suffering from fibroids, which are known to exert pressure on the abdominal veins.

In 2011, celebrated tennis player Serena Williams, suffered a blood clot in her lungs that almost brought her thriving career to an end.

Edwin Were, an associate professor at Moi University School of Medicine’s Department of Reproductive Health says they are seeing more reported cases at the hospital, especially among women.

“At every one time, there are three admission cases in the ward of people suffering from a blood clot. Most of them are pregnant women,” the professor notes.

So how does pulmonary embolism manifest? According to Prof Were, when a blood clot (thrombus) in the leg breaks loose (called an embolism) and travels to the lungs, the condition is called pulmonary embolism and it is fatal in most instances.

“It is such a dramatic effect. When a big clot breaks and goes to the lungs, it blocks the main artery, taking blood to the heart, which is fatal. When it happens, one chokes and vomits, feels like they are being strangled and you die in less than 15 minutes. It happens so fast,” the professor explains.

FIVE Fs

He adds: “This is a serious disease and women are particularly at risk because of several predisposing factors.”

The Government pathologist lists five ‘F’s to watch out for: “If you are Female, are Fat, are on a Family planning, have a Family history of such and are over Forty, you need to be concerned.”

Broadly speaking, there are three factors that determine whether one will get blood clots.

“First, if you have had injury in any part of your body, if you have reduced speed of blood flow in your veins (due to sitting for long and being sedentary) and if there has been a change in composition of your blood due to hormonal changes,” Prof Were explains.

That insight explains why women are at particularly at a higher risk of getting the disease.

“The fact that women carry a pregnancy puts them at a higher risk. You see, pregnancy presents a whole spectrum of risk. First, it changes composition of blood due to the many hormonal changes that take place. At the same time, the pregnancy puts pressure on the abdomen, and by extension the abdominal veins, and there is a slow movement of blood to the veins in the legs. When a woman goes through CS, she suffers injuries, which put her at risk of having clots,” he explains.

Dr John Ong'ech, a specialist obstetrician, gynaecologist and consultant at the Kenyatta National Hospital (KNH) elaborates further: “Women are particularly at risk because of the hormone oestrogen, which make blood hyper-coagulable (easy to clot).”

That explains why using oestrogen-based family planning also predisposes one to clots. Most oral contraceptive pills contain the hormone oestrogen. Other factors that contribute to clots are obesity, cancer and smoking.

HOW THEY BREAK AWAY

The worrying thing about having clots is that it is not so easy to diagnose and by the time they are discovered, it has done catastrophic damage or it is too late.

“The depressing bit with clots is that they are not symptomatic. They show few symptoms when starting or mild ones. It may start with a little discomfort in the inner thigh, which one can easily ignore,” says Prof Were.

Charles Were, who suffered from the same recently and is still recovering, demonstrates this reality.

“I started feeling breathless and having some pains on my leg for a month or so. I ignored it because it was not serious. But one day, I woke up and my leg was swollen and heavy, I had to be rushed to a nearby hospital. The doctor just saw me and assumed it was an inflammation of the legs and gave me painkillers and antibiotics. I went home worse off. Luckily, I was introduced to a doctor who diagnosed the problem. The doctor recommended a series of tests including an X-Ray on the swollen part of my leg. That is how the problem was nailed. I was admitted immediately, put on anti-coagulants and now I am on the way to full recovery. My doctors tell me it is a miracle I am still alive,” Charles says.

Resident doctor in obstetrics and gynaecology at KNH Dr Okola Vitalis, who presented a paper on management of blood clots before a team of gynaecologists from KNH recently, notes that there is little information in terms of research in Africa and that’s why when a patient presents themselves at a health facility, it is rarely in the doctors’ radar that it could be a blood clot.

“It happens so fast. By the time you are handling the patient and doing the test to verify the cause of the problem, you are almost losing the patient,” says Dr Okola.

According to Dr Okola, pulmonary embolism was, for long, associated with the West and that’s why there is little awareness on it in the medical world.

“We have been exposed to so much of Western lifestyles like air travel and sitting for long on computers, which makes us immobile,” Dr Okola explains.

THE WAY FORWARD

So what can be done to stem the problem? “We should be on the lookout but most importantly, people with those predisposing factors should watch out. If you are travelling for long distances, take frequent walks to ensure blood flows smoothly in your legs. If you work in an office, do not sit for  long, otherwise you will be putting too much pressure on your veins. Get up and walk around,” Prof Were advises.

ASPIRIN THERAPY

What about aspirin, should one occasionally take a tablet as a precautionary measure to thin their blood? Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding. Aspirin is known to interfere with your blood clotting action.

Dr Okola warns against taking aspirin without the advice of your doctor. “All drugs must be followed up by a physician and its not recommended to take aspirin as a precautionary measure unless your physician deems it fit to have you on aspirin for a particular problem,” he says.

People with a family history of thrombophilia (an abnormality of blood coagulation that increases the risk of clotting) should be on the lookout and not ignore any of the first symptoms that normally presents itself.

The county governments also need to invest in the county hospitals so that doctors can make the right diagnosis and start treatment immediately.

“If you get clots and you are far from Nairobi, chances are high that you will die before getting the right medical attention. County hospitals are handicapped when it comes to dealing with such,” Dr Okola concludes.