A Not-So-Ordinary Day: How DVT Almost Cost One Women Her Foot

It was an ordinary Wednesday morning in August for Linda F. when she went to the barn to check on her horse "Snickers." She bent down to pick up a bucket, and when she stood up she suddenly couldn't breathe. The side effects for the new prescription she was taking suddenly flashed through her mind and a wave of anxiety fell over her; "Warning: If this medication causes sudden onset of shortness of breath, seek emergency attention immediately."

Linda's mind raced. She was in the horse barn alone without a phone and her husband was at work. She sat down and took slow deep breaths to calm down. Eventually she calmed down enough to walk to the house and call the doctor, who instructed her to go to the emergency room (ER) right away.

Once in the ER she felt better and wondered if she had made too much of her symptoms. Little did she know that her sudden loss of breath had been caused by several pulmonary emboli (PE) in both of her lung arteries.

"The doctor told me I was very lucky to be sitting there talking to her and, if I hadn't come to the ER when I did, I probably wouldn't still be alive," said Linda. "What started out as an ordinary day turned out to be not so ordinary. I was fortunate to have read and paid attention to the warnings on the package insert for the prescription I was taking."

Fifty-two-year-old Linda had no prior risk factors or family history of deep vein thrombosis (DVT) or blood clots except for being a smoker during her college years. Doctors suspect that the clot was caused by a prescription for birth control pills given to her by her health-care provider, on the Saturday before she experienced the PE, to manage some peri-menopausal symptoms she was having. Other than the sudden shortness of breath, she had none of the other usual warning signs: leg pain, swelling, discoloration or heat.

She was placed on Coumadin¨ (or warfarin, a blood thinner used to prevent the formation of clots), taken off the birth control pills, and told it would take about six months for her body to absorb the clots in her lungs as well as the initial clot in her calf. Seven months later Linda was still taking warfarin and had resumed her normal activities. She had no after-effects from the blood clot or symptoms.

One afternoon the following March, Linda was riding Snickers when a sudden accident happened. The horse lost footing and fell on his left side, trapping Linda's left foot underneath him.

"It was such a freak accident. He went down so quickly, for one or two seconds, and then regained his balance," she said. "When a horse falls, it gets to its feet immediately, but I had over 1,100 pounds of horse fall on my foot and the sheer force of the impact, even for an instant, crushed my foot and broke the ankle in two places."

It took Linda about an hour and a half to get home after putting the horse back into the paddock. By the time she took off her riding boot, her foot was swollen, purple in color, had blisters, and, in her words, "was huge." Linda went to the doctor, who took x-rays and treated the blisters. A traveling nurse came to check on her several days later, she became very concerned when she noticed that Linda's leg was red, hot to the touch, swollen up to her knee, and that her foot was giving off a putrid odor. Linda had developed celluloids (skin infection) and gangrene (tissue death caused by poor blood flow, usually a black color, often with a foul odor) from the fall, compounded by being on warfarin. She was immediately taken to the hospital where a limb-recovery team was waiting for her.

"I couldn't believe this was happening," said Linda. "Just a few days after the fall, they were talking about the possibility of amputating my foot. It was unbelievable."

The limb-recovery team could not perform surgery immediately because of the risk of bleeding, because Linda was on warfarin. They had to give her intravenous vitamin K for three days to reverse the effects of the blood-thinning medication prior to the surgery. An ultrasound (Doppler) was performed as well as a CT scan to assure the surgical team that the blood clots in Linda's lungs and right leg were no longer present to pose a risk during surgery. The clots had been totally absorbed and she was clot-free.

While doctors were able to save her foot, Linda spent six weeks attached to a wound VAC (a device that uses negative pressure by forming an airtight seal over an open wound to promote healing) to try to rebuild enough healthy tissue around the injury to perform a skin graft to cover the open wound. While she was at home resting from her injury, she woke up one morning with pain in both of her calves. A D-dimer test (a blood test that measures recent clotting) showed high results indicating that she now had blood clots in both of her legs because she had been immobile for two weeks.

She was immediately restarted on warfarin and she was also given Lovenox¨ shots until the warfarin reached a therapeutic level to reduce the risk of further clotting in her legs. She was fortunate that the clots did not break loose and cause another PE. It was then the doctor told her she would be on warfarin for a least a year, possibly for life. As her body started to recover, she was given a skin graft to the injured area and her leg started to heal. A year later, after many months of physical therapy, Linda was back to riding and walking again. She still had minor pain, but her life was returning to normal.

A year after the initial incident, Linda was scheduled for shoulder surgery to repair her left rotator cuff, which was successful. She asked the doctor to take her permanently off the warfarin after the surgery. Considering her lifestyle and that she had no other risk factors and that her D-dimer levels were normal, he agreed that she did not have to go back on the blood-thinning medication.

Linda was told that she had a 25 percent chance of having another DVT within the first year of being off warfarin. A year later, she has had no recurrence of DVT and is pain free. For Linda, her DVT was an ordeal that she never would have imagined. She considers herself lucky to be alive.

"I really want people to know two things. First, they shouldn't think they're being foolish about going to the doctor if they're worried about something, even if it seems stupid. I though I was being stupid going to the ER, had I not gone, I wouldn't be here today," said Linda. "Second, if they're on blood thinners such as warfarin, consider their sports, activities and lifestyle. Warfarin has permanently changed my life and I am fortunate to be alive today to tell my story."