Saved by a Whisker: PE Survivor Given a Second Chance

In May of 2006, 52-year-old John Bunch of Springfield, VA, had a knee injury requiring surgery and then went home to recuperate. John then found himself in the emergency room just a day after his release from the hospital with a life-threatening condition known as a pulmonary embolism (PE). PE is a blood clot that breaks free when a thrombus (clot) develops in the large veins of the legs or pelvic area and travels to the lungs (for more information, please see story on page 3). On average, an estimated 650,000 PEs occur annually. PEs are the third most common cause of hospital death.

John went home from the hospital on a Sunday just a few days after his surgery and was surprised to find himself uncomfortable and in pain on Monday morning. He was experiencing chest pains and shortness of breath, so John's wife Anne called for an ambulance. When the emergency workers couldn't get an IV into his arm, they rushed him to the hospital.

"All I remember is that I was sitting on the couch and didn't feel well. I was cold and couldn't breathe," said John. "The next thing I knew, I woke up in intensive careand according to my doctors, it was a miracle that I woke up at all."

With his heart rate elevated and his blood pressure dropping, doctors suspected that he had a pulmonary embolism (blockages of the blood vessels that go to the lungs). Within a very short period of time, he had barely enough oxygen in his blood; one of his lungs was completely blocked and the other lung was 70% blocked by the embolism.

Doctors performed a CT angiogram of John's lungs, which showed a massive pulmonary embolus affecting both lungs. He was transferred immediately to the care of interventional radiologist Dr. Alain Drooz (President of VDF's board of directors), who threaded a mechanical thrombectomy device into the clot in the arteries of his lungs. A thrombectomy device is like a miniature vacuum cleaner on a thin catheter designed to remove enough of the clot to relieve the pressure on his heart and allow new oxygen to enter the blood. The embolus kept him from getting needed oxygen into his blood and caused the blood pressure on the right side of his heart to rise to dangerous, life-threatening levels. Dr. Drooz also administered a small dose of a powerful clot-busting drug called tPa (tissue plasminogen activator) into the clot to soften it for the thrombectomy device to work more effectively. John was also given heparin through an IV.

At the same time, a cardiologist, Dr. Khalid Abousy, placed a temporary pacemaker (which was removed after the procedure) in the left groin to keep John's heart beating regularly while a lung specialist monitored John's oxygen level in his blood. An inferior vena cava filter (IVC) was also installed to prevent more clots from entering the heart or lungs. After the procedure, he was given the blood thinner, heparin, followed by warfarin (Coumadin®), which he still takes almost one year later. The IVC filter was removed late in 2006.

"You can't imagine how quickly all of this occurred," said Anne. "Within a period of no more than 45 minutes, John was on the couch having chest pains and then being wheeled into the interventional radiology suite for clot removal. It was amazing."

The most shocking part of John's scenario is that he was considered to be in very good health. He has no family history of clots or major illnesses and his cholesterol and blood pressure were within normal levels. According to Anne, he took very good care of himself, ate a healthy diet, and exercised regularly. However, John did smoke for about 8-10 years, although he gave it up about 20 years ago. The only health issues he suffered from were sports injuries, thus leading to the knee surgery that precipitated the PE incident.

"This is difficult for me to explain, I have a low-stress job and a great life," he said. "I didn't realize that I was in that kind of trouble. This has been a humbling experience." According to Dr. Drooz, John is lucky to be alive. "John arrived at the hospital in critical condition with a huge PE. His condition was so serious that if we had not intervened, he would have made it only another hour or two. He made it by a whisker," he said.

Over twenty people from John's family crammed into the emergency room to support John during his endovascular procedure. John and Anne have seven children between them and celebrated their first wedding anniversary in the emergency room. "It wasn't really what I had planned for our first anniversary," said Anne. "I was hoping for something a bit more romantic, but it was a big relief that he survived."

Now, almost one year later, John is doing very well. He says that he appreciates things more and sometimes just sits and wonders, "The pulmonary specialist who worked on me said that most people who were as sick as I was don't leave the hospital," he said. "I just feel so lucky that the best doctors

were on call that night to save my life." John and Anne both commented that, if they could impress one thing on the general public, it is their advice to take the doctor's discharge instructions seriously and not wait to go to the hospital if anything doesn't feel right.