Unravelling one of Kenya’s silent killers
Growing up, Beatrice Kerubo’s biggest dream was to get married and give birth to many children as beautiful as her. But all that changed by what appeared to be a muscle pull at the back of her right knee.
At 29, Beatrice got pregnant with her first child. She had just moved to Texas, US for higher education and the news was a bonus in her life. However, in her first trimester, she felt a sharp pain at the back of her knee and in her calf. Having been sporty, she attributed it to a muscle pull.
Not knowing what was happening, she decided to rest as she waited for the pain to subside. But it persisted, and she couldn’t do anything as her legs were swollen. She asked her boyfriend to massage the leg to reduce the pain, but in vain.
On the third day, she decided to seek treatment at the nearest hospital. At the back of her mind, it was nothing serious. However, when she arrival at the hospital, the doctors were shocked; they asked her so many questions, none of which seemed to make sense. “They felt my leg, and then asked me to lie down and not move an inch, I was worried. But in my head I thought probably that’s how doctors from the West handle their patients. I felt so important, and easily did what they asked,” she says.
Shortly after, the doctors asked her to undergo a scan. It took an hour of ultrasounds and tests. One thing she noted, however, was how nurses kept telling her how dangerous it was for her to be walking in such a situation. “I thought, what situations were they talking about? I mean I was healthy when I came in the hospital. In fact, I was walking on my own. I didn’t even have any symptoms,” she recalls.
Minutes later, the doctor informed her she had Deep Vein Thrombosis (DVT). “I didn’t even know what that was, so I waited for an explanation. That’s when I got shocked. I mean how could this happen, considering I was very healthy?” she exclaims.
Clotting disorder
DVT occurs when a blood clot forms deep in the body and usually in the lower leg or thigh. If not addressed, it can break through and cause pulmonary embolism, the sudden blockage in a lung artery that could be fatal.
Beatrice was immediately put on blood thinners to stabilise the clot to prevent it from moving to the lungs. “The clot dissolved in two weeks, but while in hospital I just kept thinking what would have happened if I didn’t attend to it. The fact that I had read that so many people die of this made matters worse,” she says.
All along Beatrice thought the trigger might have been her pregnancy. The challenging part was post-hospital care, which included changing her lifestyle and diet. She also had to have daily injections on the soft tissues, usually her stomach, for the rest of her pregnancy as well as visit the hospital twice a week to make sure the clots were dissolved.
Her boyfriend couldn’t understand what was happening. To him, Beatrice was becoming sickly, so he decided to call off the relationship.
On top of this heartche, Beatrice’s medical insurance ran out because the medication was costly. “I would spend about $100, equivalent to Sh10,000, on medication. It was just too much for me, as I was still a student,” she says. Her road to healing was smoothened by her commitment to the doctor’s instructions.
Two weeks to her due date, the doctors decided to induce labour because she could not give birth normally in her condition. “I had a caesarean delivery. Since I had to be in a stable condition throughout the surgery, I was put on heparin (a blood thinner.) Everything turned out well and we got out of the surgery safe,” she says.
But three weeks later, one side of her stomach was in so much pain, she had to be put on morphine, which made her dizzy. When she went to have it checked out, the worst happened. “The doctors said I had a hematoma in my uterus. This is a collection of blood outside of blood vessels caused by an injury to its wall, prompting blood to leak out of the vessel into the surrounding tissues. A hematoma can result from an injury to any blood vessel and it has to be addressed immediately. I wondered why I had to go through surgery on the same place I was operated on when delivering my baby,” she says.
Leading cause of sudden death
But as fate had it, she lost her uterus. “The thought that I will never give birth again weighed on me. I broke down. I couldn’t imagine how anyone I ever wanted to be in a relationship with would take my story,” she cries.
One out of every four deaths in the world is associated with a blood clotting disorder, yet their symptoms are so general that they’re unrecognisable. In Kenya blood clots are the leading cause of sudden death amongst seemingly healthy people, cancer patients and hospitalised patients.
Dr Leonard Ngunga, a consultant cardiologist at Aga Khan University hospital, says when a clot forms the vein is blocked and blood cannot flow through. This causes the limb to swell as pressure builds up because return of blood from the vein to the heart is stopped. Blood is then diverted to a smaller superficial vein that swells up and becomes inflamed and painful.
“If the clot in the vein is not treated it spreads to the veins in the upper body. At any time, the clot may break off then travel through the large veins into the heart and block blood flow into the lungs. This is called pulmonary embolism. If the clot is large, it blocks the entire right heart outflow, leading to death,” he cautions.
He highlights that DVT is a major contributor to premature deaths. It commonly affects people who are immobilised after surgery, for example, in the abdomen, pelvis and lower limbs. “It can also affect people after their limbs are immobilised in casts (like the traditional plaster of Paris), slowing down blood flow, thus increasing likelihood of clot formation,” he adds.
For a blood clot to occur, three scenarios need to happen: sluggish blood flow, abnormalities in the blood that increase its likelihood to clot and abnormalities in the vein wall that make blood sticky. For instance, following trauma to the leg and subsequent immobilisation, blood flow is sluggish and the vessel wall may have small bruises, increasing likelihood of clotting. Same scenario happens after long flights. In pregnancy, blood flow reduces because of pressure from the abdomen and pregnancy hormones make the blood more likely to clot.
Recurrence risk
The commonest symptoms of DVT include pain in the calf or thigh and swelling.
Dr Ngunga cautions that the clot develops slowly. By the time the limb is painful and swollen, the clot has been developing for several days. When the vein is blocked, the warning signs begin to appear. In most cases, DVT may be diagnosed with very mild of these symptoms, using ultrasound.
“Treatment for DVT is now available unlike before. When a diagnosis is made, doctors will start treatment with injections under the skin. Most patients will be discharged with blood thinners tablets to be taken between a few weeks and six months depending on the severity and cause. Some patients get on lifelong blood thinners to prevent recurrence,” he says.
DVT is not the only form of thrombosis: it is a milder form. “More serious clots may migrate to the lungs and cause breathing problems or may block veins in the brain (cerebral venous sinus thrombosis) with catastrophic results or block the veins in the abdomen and cause severe abdominal pain,” he explains.
Once a thrombosis has occurred it can recur. “It is most likely to occur if the first episode did not have a clear cause, such as hospitalisation, using contraceptive pills or following use of a plaster cast. For some reason, it is also more likely to recur in men and in people with abnormal clotting factors,” Dr Ngunga adds.
While women can get both DVT and a blood clot in the uterus, it is not common. It is, however, common to get DVT and bleeding complications in the uterus or stomach. When this occurs, blood thinners are stopped and the bleeding is treated first before the DVT is addressed.
Like in Beatrice’s case, a hematoma in the uterus may not kill. However, it is a common occurrence with pregnancy complications, which may cause death.
Although she has gotten better and made peace with her situation, Beatrice says thrombosis has left a dent in her life— something she would never be able to fix. But, she is grateful that all this happened after she had gotten her first child.
