The thought that a twisted ankle can turn fatal for someone is perhaps hard to grasp. But it can happen, and it is rumored to be the case in the death of American Idol finalist Michael Johns who died earlier this month.
The 35-year-old Australian singer-songwriter who finished in eighth place on the seventh season of American Idol, reportedly twisted his ankle, experienced bruising and swelling up to his knee and went to the doctor. He was sent home and the next day was found unresponsive at a friend’s California home. He was dead when paramedics arrived.
An autopsy report has not yet been completed but it is suspected that his death was caused by a blood clot that originated in his ankle.
Blood clots are an underestimated killer in this country. If treated, only 1 to 2 percent of clots will turn fatal. If left untreated, on the other hand, that risk shoots up to a 25 to 30 percent chance.
Typically, the body will naturally dissolve the blood clot after the injury has healed. Sometimes, however, clots form on the inside of vessels without an obvious injury or do not dissolve naturally. These situations can be dangerous and require accurate diagnosis and appropriate treatment.
Thrombosis occurs when a clot forms in a place where it doesn’t belong. When it’s in a deep or large vessel, it’s called a deep vein thrombosis (DVT), and is sometimes big enough to block the flow of blood.
In many cases, the blood clot will dissolve and go away on its own. Or the clot can remain and not cause any problems. But a blood clot formed in the deep veins of the leg may detach and travel to the lungs, causing a pulmonary embolism (PE). About 100,000 people die of pulmonary embolisms in the U.S. every year — more than the sum of those who die of car accidents, AIDS, and breast cancer, according to the American Society of Hematology.
And while Dr. Raul Storey, a local board-certified hematologist and oncologist, is not familiar with the specifics of the Johns case, he says it’s possible that this is what occurred.
“They are tricky to detect,” says Storey. Frequently people with recent traumas or sport injuries could present with the same symptoms of a patient with a blood clot. That’s why imaging studies using ultrasound/doppler are needed to determine if a clot is present.
The real tragedy of people dying of blood clots is that it’s a very treatable disease. It’s just that too many people are unaware of both the symptoms and risk factors involved. Those who are at heightened risk for DVT include those who have sustained an injury, had recent surgery, or are older, as well as women who are pregnant or on birth control or hormone-replacement therapy.
Symptoms of DVT can include site pain, swelling, warmth, heaviness and redness. And DVT can be diagnosed in many ways, including a blood test, a CAT scan or an ultrasound. Treatments including a host of blood thinners or “clot busters,” are extremely effective, according to Storey.
“People with traumas or minor injuries can develop DVT (or blood clots),” he said, adding that how frequently it happens is debatable but there have been some studies that indicate an increase of the risk of thrombosis in all forms of major injury.
A National Institutes of Health study showed that of 716 patients admitted to a regional trauma unit, DVT in the lower extremities was found in up to 50-60 percent of patients with major head injuries, pelvic fracture, tibial fracture and femoral fractures.
DVT is the most common type of venous thrombosis. However, venous thrombosis can form anywhere in the venous system.
Venous thromboembolism or (VTE) is a major healthcare problem. Approximately 1 percent of hospital admissions in the U.S. are for VTE. It has been estimated that there are 900,000 cases of pulmonary emboli and DVT per year.
The majority of these deaths occur in untreated patients, where the diagnosis is made postmortem or not diagnosed, and attributed to another etiology such as heart attacks or infections.
The risk factors for developing a venous clot are different from those for an arterial clot, and people at risk for getting one are not necessarily at risk for getting the other.
The following factors increase the risk of developing a venous blood clot: obesity, pregnancy, immobility, smoking, oral contraceptives, certain cancers, trauma, certain surgeries, age (increased risk after age 60), inherited clotting disorders and chronic inflammatory diseases.
Blood clotting, or coagulation, can also be an important process that prevents excessive bleeding when a blood vessel is injured. Platelets (a type of blood cell) and proteins in the plasma (the liquid part of blood) work together to stop the bleeding by forming a clot over the injury.
There are molecules in the system that signal the body to let it know when, where, and how quickly to form a clot, and genetics plays a role in how quickly the body reacts to these signals.
Certain risk factors, such as obesity, slow the flow of blood in the veins, while others, such as age, can increase the body’s natural ability to clot. Even certain medications can affect how quickly the blood clots.
Arterial clots can be modified through changes in lifestyle or by medical treatment. Obesity, lack of physical activity, smoking, diabetes, high blood pressure and high cholesterol should be addressed.
Blood clots are treated differently depending on the location of the clot and the person’s health.
Treatments for blood clots have come a long way, according to Storey. “Nowadays we have multiple medications to treat blood clots,” he said, adding that there have been many research advances made in antithrombotic therapy.
Some current treatments include: Anticoagulants – medicine that prevents clots from forming; clot busters, medicine that dissolves blood clots; catheter-directed thrombolysis – a procedure in which a catheter is surgically inserted and directed toward the blood clot where it delivers clot-dissolving medication; and thrombectomy – surgical removal of a clot.
