Pulmonary embolism
A Pulmonary embolism is the abrupt blockage, by a blood clot, of an artery in the lungs. While the majority of clots are miniscule and nonlethal (though potentially damaging to the lung) some clots can be quite large, leading to the obstruction of blood flow to the lungs and very likely death, if not treated immediately. The clots responsible for the embolism often form in the deep leg veins, which circulate more blood back to the heart than surface veins, from where they travel to the lungs and become lodged in an artery. Embolisms can also be caused by materials other than clots, including small batches of infectious substances; fat (released into the bloodstream via trauma including surgery, bone fractures, burns, etc.); as well as cancerous tumors.
Among the risk factors for a pulmonary embolism are slow blood circulation, abnormal clotting (where an individual’s blood clots too quickly or easily), aging (people over 70 are more likely to develop clots), and obesity.
If you have a Pulmonary embolism
The most common form of embolism treatment is anticoagulant medication, which inhibit existing clots from growing as well as prevent new ones from arising. If the blockage is critical and potentially lethal thrombolytic medicine may be used to quickly dissolve a clot. Use of this medicine, however, also increases the chance of severe bleeding. Another treatment method for the removal of a large embolism is to remove the clot by an embolectomy surgery. One final treat option is the insertion into the large central vein of a vena cava filter, which helps prevent clots from reaching the lungs. The filter is an alternative to those who cannot take an anticoagulant medicine.
A Whole Health Perspective
Looking at Hodgkin’s through a Whole Health model, we explore the individual’s unique presentation from the 5 Aspects of Whole Health™ perspective.
1. Physical – A pulmonary embolism occurs when something, usually a clot, blocks a blood vessel in the lung. This causes symptoms including shortness of breath and chest pain, which usually exhibit a sudden onset, get worse with exertion, but do not completely resolve with rest. Cough which produces blood streaked sputum may also be present. The clots involved with PE most commonly travel from the veins in the legs, called a deep vein thrombosis. Thus, other symptoms one may notice include redness, throbbing and/or swelling in the calves. Other systemic symptoms include light headedness, sweating, fever, and/or irregular heartbeat.
Some factors which may predispose one to developing a pulmonary embolism include prior surgery, childbirth, and severe burns or fractures, as these situations can release tissue or clots into the blood stream. This may also occur after heart attack or stroke, and high blood pressure (hypertension) may contribute to this process as well. Some cancers, especially those that affect the clotting factors in the blood, can increase PE risk. Women being treated with certain medications for breast cancer are also at increased risk, as are women being treated with hormones or birth control pills. Those who are immobile or sedentary, or have been sitting for long periods of time, such as on an airplane or car ride, are also at a higher risk. These situations allow blood to pool and potentially clot in the veins of the lower extremities. Additionally, pregnancy can increase the risk of clot formation due to the weight of the fetus on the blood vessels in the pelvis and legs. Some genetic clotting disorders also predispose people to pulmonary embolism development. Smoking increases the risk of both pulmonary embolism and further complications such as pulmonary infarction. Obesity is also a risk factor for pulmonary embolism.
Clotting occurs after an injury to a blood vessel, in an attempt to stem further damage and repair the vessel. Once an injury occurs, the clotting cascade begins. This is controlled in part by the liver. Damage to the liver, such as in cirrhosis, can affect how the blood clots. Taking care of your liver, especially for those with other clotting or pulmonary embolism risk factors, is very important.
Lifestyle modifications which reduce risk of blood vessel irritation and keep blood vessels healthy (to control atherosclerosis and peripheral artery disease) can potentially decrease the risk of blood clots and pulmonary embolism. A diet low in saturated fat and cholesterol, for example, can potentially reduce atherosclerotic plaque development. Mild to moderate exercise also benefits the cardiovascular and pulmonary systems, as well as reducing obesity, which is another risk factor for pulmonary embolism.
Stress triggers the adrenal glands to produce certain hormones. One such hormone is cortisol. Studies show that increased levels of glucocorticoids, such as cortisol, produced in response to chronic stress, can alter the clotting cascade and potentially increase the risk for clot development and pulmonary embolism. Moderate exercise, engaging in stress reduction activities, proper diet, and adequate amounts of sleep can all assist in overall stress reduction.
2. Nutritional/Chemical – What we consume has the potential to contribute to a state of health or a state of disease. Because pulmonary embolism can be triggered by dysfunction in the cardiovascular system, cancer, obesity, etc., nutritional status can potentially affect the pathogenesis of an embolic event. Food can be used as a tool to reduce predisposing factors to pulmonary embolism (such as hypertension and obesity). In general, limiting saturated fat, caffeine, alcohol, processed foods, refined sugars and carbohydrates, etc. can decrease the risk of many cardiovascular disease processes. A diet high in fruits, vegetables, complex carbohydrates, omega 3 fatty acids, and lean protein may decrease risk factors (such as that proposed by the American Heart Association). For those with high blood pressure, the DASH Diet provides nutritional guidelines for reducing hypertension and obesity. These types of diets also decrease dietary stress and inflammation caused by poor quality food choices.
For those with a history of, or risk factors for, pulmonary embolism, nutritional supplements and vitamins may need to be monitored by a physician. Some substances, such as vitamin K, can affect clotting and the efficacy of oral anticoagulants (medicines).
3. Emotional – Because chronic stress can increase the risk for altered clotting and can affect heart and lung health, learning to recognize, control, and limit exposure to chronic stress could potentially decrease the risk for pulmonary embolism. Stress also contributes to other risk factors associated with pulmonary embolism, such as obesity and heart attack. Stress is accumulated not just through major life events, such as divorce or job changes, but also through every day experiences like weather changes, loud noises and lights, and difficult relationships. Thus, engaging in stress reduction activities, such as yoga, prayer, meditation, mild to moderate exercise, etc. can limit the potential damage of accumulated stress. Talking with a mental health professional for advice and treatment for co-occurring diseases such as depression and anxiety may be helpful as well.
Emotions communicate with all body systems through chemicals called neuropeptides and neurotransmitters, and could potentially play a role in disease progression. Release of adrenal gland hormones such as cortisol is also affected by our emotions. Becoming aware of emotional responses (frustration, anger, grief, joy, contentment, etc.) and engaging in activities such as those listed above can assist in the health of the adrenal, cardiovascular and pulmonary systems, as well as many others.
4. Environmental – Mild to moderate exercise can decrease risk factors for pulmonary embolism development. Those with diagnosed clots in a vein or pulmonary embolism can exercise, but should consult with a physician for appropriate exercise guidance.
Environmental factors which can increase the risk for pulmonary embolism include situations in which one is immobilized or sedentary for long periods of time. Long car rides or air travel should ideally be broken up by opportunities to move and walk, to decrease the risk of blood clots in the extremities which could lead to an embolism. Compression stockings can be used in some situations, to help improve circulation in the legs and reduce the risk of blood clot formation.
Other factors which increase stress, adrenal gland production of cortisol, and potential clotting abnormalities, include abrupt changes in temperature or barometric pressure, bright lights, loud noises, exposure to air, water, and soil toxins, cigarette smoke, etc. Exposure to toxins could potentially compromise heart and lung health, as well as increase risk for cancers, obesity, etc., which predispose one to pulmonary embolism. Exposure to the natural world can decrease stress and could potentially decrease risk factors for pulmonary embolism.
5. Beliefs, Values and Worldview – also identified as Spirituality – Spiritual expression, whether through prayer, meditation, yoga, traditional worship, connection with nature, etc. has an influence on health and wellbeing, often by encouraging an understanding and connection between mind, body, and spirit. Possible feelings of isolation, living in discordance with one’s values, or inability to connect with support and the natural surroundings due to illness or other factors could increase stress and exacerbate symptoms.