As a physio, Bev was sure she had a DVT – but it was only diagnosed after she nearly died

After completing the challenging 75-mile Hadrian’s Wall walk in North East England, physiotherapist Bev Strathearn felt on top of the world.

“I felt fit for my age and healthy,” says 56-year-old Bev. But just weeks later she was in hospital suffering from life-threatening blood clots caused by a foot injury suffered during the walk.

“At work I started sitting with my right leg bent back under my chair to avoid putting pressure on the sole of my foot,” recalls Bev, who lives with her husband and their two adult daughters in Beverley, East Yorkshire.

‘Two weeks later I noticed pain in my right calf and that caused me to not sleep well. But I was busy caring for my elderly father, so I didn’t do anything about it.”

But then Bev noticed a red spot the size of a golf ball on her right calf. As a physiotherapist, she knew she had some risk factors for a blood clot: she was spending a lot more time at work doing online consultations, was dehydrated and was also taking oral hormone replacement therapy (HRT) for menopause.

“But by evening it was killing me and I decided to seek medical advice the next morning,” she says.

Bev contacted NHS 111 and said she suspected she had a blood clot (also known as deep vein thrombosis or DVT). They referred her to a minor injuries unit. DVTs are clots that form in the deep veins of the leg. Symptoms include redness, soreness, severe pain and sometimes swelling, usually in the calf or thigh.

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Risk factors for developing DVT include being immobile – for example sitting for long periods of time or being hospitalized – plus cancer, pregnancy, injury, older age, obesity, the pill and HRT, all of which make the blood ‘stickier’ and more likely to clot .

One of the most serious complications of a DVT is when part of the clot breaks off and travels through the bloodstream to the lungs, leading to a blockage called a pulmonary embolism. This can cause chest pain, difficulty breathing, a faster heart rate and coughing. blood rises and can be life-threatening if not treated quickly.

Worryingly, research shows that 40 percent of patients who die from a pulmonary embolism complained of nagging symptoms weeks before their death.

For every pulmonary embolism diagnosed in time, there are at least two cases where the diagnosis was missed and led to sudden death, according to the charity Thrombosis UK.

Deaths from blood clots in England have risen from 12,457 per year in 2019/20 to 14,846 in 2021/2022.

Beverley Hunt, professor of thrombosis and founder of Thrombosis UK, says the charity has major concerns about the number of missed clots.

“Many people contact us who have been turned away by healthcare professionals because they either don’t have the ‘classic’ symptoms of clots, or mistakenly think they are too young to have a clot,” she explains .

‘For example, in the old medical textbooks, the ‘classic’ picture of a DVT shows a large, swollen red leg – but we now know that 80 percent of clots present with just pain in the calf or thigh, with no swelling or color. change. Yet these facts are not generally known.’

She adds: ‘Similarly, a pulmonary embolism is not always accompanied by sudden chest pain and shortness of breath; they can sometimes lead to gradual shortness of breath or sudden fainting or fainting.’

An inquest in July into the death of actress Emily Chesterton, 30, found she had sought medical attention twice for calf pain, a swollen leg and shortness of breath. Initially, she was diagnosed with a leg sprain and long Covid-19 and prescribed an anti-anxiety drug.

Tragically, a few hours after her second appointment with a physician assistant, a new breed of healthcare worker, she collapsed and died of a pulmonary embolism shortly afterwards.

The inquest concluded that the junior doctor should have sent Emily to A&E and that if she had been treated for a pulmonary embolism she would likely have survived.

Bev also saw two healthcare workers with her symptoms.

“First I saw a nurse and told him I suspected I had a DVT and that I had some risk factors for a clot,” she recalls.

Risk factors for developing DVT include being immobile – for example sitting for long periods of time or being hospitalized – plus cancer, pregnancy, injury, older age, obesity, the pill and HRT, all of which make the blood ‘stickier’ and more likely to clot (file image)

Bev requested a D-dimer blood test that can detect clots. D-dimer is a protein that the body uses to break down a clot. A positive test means your D-dimer level is higher than normal and indicates a DVT (although levels may be high for other reasons).

‘But he measured the circumference of my right calf and because it was only 1.5 cm larger than the left calf, he didn’t think I had a DVT and said I didn’t need a D-dimer test,’ says Bev.

That night she was in pain and could only sleep on her stomach with her feet dangling from the bed.

A few days later I was still in pain. “I went to the doctor and repeated my story about the severe calf pain and redness,” she remembers.

“Again, I asked for a D-dimer test and even offered to pay for it. I said I thought the place was getting bigger; he was now as big as a satsuma.”

The GP consulted with a colleague and concluded that it was probably cellulitis (a bacterial infection in the deeper layers of the skin) or superficial thrombophlebitis, a clot in a vein near the skin’s surface. Bev was sent home, told to rest and return the following week if there was no improvement. She tried to relieve her calf pain with ibuprofen gel, ice and rest, but “I still found it difficult to walk and the pain moved behind my knee,” she says.

Ten days after her symptoms started, Bev went for a walk but had to stop after five minutes because she developed sharp chest pains. By evening this happened every time she took a breath.

The next day at 7 a.m. she woke up feeling “like she had run a marathon last night,” with a rapid heartbeat, and called her doctor.

She was told to come to the operating room immediately and after her heart rate and blood oxygen levels were checked, she was told to go to A&E immediately – as they suspected she had a pulmonary embolism.

“I remember walking like a snail through the hospital parking lot,” Bev says. ‘I was dizzy and light-headed and knew something was very wrong.’

A D-dimer test showed her levels were 9,000 ng/ml – normal is 500. A CT scan showed she had multiple blood clots in her lungs.

‘I asked my consultant if I was going to die and she agreed I was at increased risk of a heart attack or stroke in the next two weeks,’ says Bev.

She was immediately prescribed Fragmin, an anticoagulant injection administered daily. She had to stop taking HRT.

“For the next few weeks I was so worried and stressed that some of my hair fell out,” she says.

‘I felt dizzy and there were a few moments where my heart rate went through the roof and I had to call an ambulance to be checked.’

After three months, Bev was finally well enough to return to work with a phased return.

Thrombosis UK is calling for better medical education about the symptoms of DVTs. The charity is also concerned that NHS England has relaxed the requirement for hospital trusts to provide evidence that they are at risk of assessing more than 95 per cent of adult admissions for clots. This changed during the pandemic and has not restarted yet.

Professor Hunt said: ‘It appears that some trusts have reduced their focus on this area of ​​care, and prevention is not as good as it should be.’

Analysis by Thrombosis UK found that the annual cost of treating clots is £187 million, and litigation costs for missed clots between 2012 and 2022 were £23 million.

Bev has since made a full physical recovery and walked 270 miles on the Pennine Way, but the experience has left her worried about the risk of another clot (if you have one clot you are at greater risk of another).

“I almost died because of a blood clot that wasn’t diagnosed in time,” she says. “I was a healthcare provider who was pretty sure I had a blood clot, but no one listened.”