Belo Horizonte, Brazil
As the head of the Hematology and Oncology Unit at University Hospital, Suely Rezende has studied and treated blood clots for many years. She has heard countless stories from patients who suffered from a venous thromboembolism (VTE), but none of that quite prepared her for the moment her heart began racing and she struggled to breathe.
“What happened to me was terrible,” Suely says. “I was coming back on a flight from Lisbon to Sao Paulo. I was supposed to give a talk in two hours about thrombophilia for a national conference on hematology. After I left the aircraft and walked about 50 meters, I fainted.”
When she awoke, paramedics from the airport were attempting to help her.
“At first, I said I was fine and started walking, but as soon as I started walking, I felt very short of breath,” Suely says. “It was really difficult to breathe. Also, I had tachycardia. My heart rate was about 130 beats per minute.”
The paramedics struggled with a diagnosis, so Suely assessed her own symptoms as she had so often done for others.
“I thought, I am a medical doctor, and I started to think about my symptoms. I decided that either I had a heart problem or this was a pulmonary embolism (PE),” she says. “…the two medical doctors in the airport could not make a diagnosis; they did not even think about the possibility of having a PE. They thought I was nervous or anxious about something.”
At that point, Suely knew she needed to take action and called her husband and asked him to send a car to take her to the hospital.
When she made it to the hospital, doctors discovered she had extensive bi-lateral pulmonary emboli and was placed in the intensive care unit for 48 hours. She stayed in Sao Paulo for a week before returning home. She never gave her conference talk about thrombophilia.
Suely has not suffered any complications since the event in November 2011 at age 45, but now she takes extra precautions when flying long distances.
“We know that long haul flights are a risk factor for venous thrombosis,” she says. “I think I was very fortunate. I did everything that we recommend patients don’t do. I was very tired in economy class on the plane. I had a boot that came to my knee, and I didn’t move at all. I slept the whole flight, and I was very stuck to the seat.”
When she has long flights now, Suely makes sure to take precautions. “We don’t have recommendations based on evidence when it comes to long distance flights, but I use the compression stocking if I fly more than six hours,” she adds. “And if I fly more than eight hours, I use heparin. Some people recommend oral anticoagulants, but I’ve never taken them.”
Now that she has suffered her own PE and was misdiagnosed, Suely is even more vigilant about the importance of education not only for the public, but also health professionals.
“In Brazil and other developing countries, people need lots of education,” she says. “It is really difficult for you to judge sometimes, but my event was really severe; you could not miss it. I am not only saying I had shortness of breath, but I had all the other symptoms of someone having a PE…We need lots of education and lots of awareness. This shows exactly that even people who should be able to diagnose it could not. PE is a very easy disease to miss. People don’t think about PE.”
With that in mind, it is easy to imagine an alternative ending to Suely’s event. Had it not been for her quick thinking, the outcome could have been drastically different.
“I think I could be dead now,” she says. “Really, I wouldn’t be here to tell you the story. If this were just a regular person, especially if they were not a very demanding person, he or she would probably be sent home and feel bad for few more days. This would cause terrible complications such as chronic pulmonary hypertension and cardiac failure if they did not see a medical doctor that could diagnose it. I think there is a chance that we see patients like this and miss the diagnosis. And then they develop complications that are very difficult to be treated and can really harm their life.
“This is serious,” she adds. “On World Thrombosis Day, we need lots of awareness, especially for medical doctors. I acted very quickly, very fast, like we recommend to patients. If I had not been treated very quickly, I would have had complications. I was very fortunate.”
Suely Rezende, MD, PhD, is the head of the Hematology and Oncology Unity at University Hospital and an associate professor for the Universidade Federal de Minas Gerais in Belo Horizonte, Brazil. She is also a Council member of the International Society on Thrombosis and Haemostasis (ISTH).