Bill utilizes UpToDate to weigh the risks and
benefits of treatment for a pulmonary embolism
Bill, a 67-year-old from Colorado, worked as a pilot for a
major airline for 35 years and also flew in the Navy during the
Vietnam War. Today Bill and his wife Phyllis, also a pilot, are
retired and enjoy an active lifestyle that includes flying their own
plane to different destinations around the world. "Flying our
airplane and travel in general have been a large part of our life,"
says Bill.
"We do everything we can to stay healthy, as far as exercise
and diet," explains Bill. "But as we have gotten older those little
aches and pains or problems end up being very serious and that is
distressing."
On a recent trip to Mexico, Bill awoke one night with a pain
in his right lower rib cage. He attributed it to muscle soreness
from reeling in a big marlin the day before. He took pain medication
and the pain subsided for a day but then quickly returned.
“I had never seen that piece of
information before having access to UpToDate.”
Bill is diagnosed with a pulmonary embolism
Upon his return to the United States, Bill went to see his
doctor, who determined that the pain was not caused by muscles
soreness; instead the doctor suspected it to be a blood clot. A
MRI confirmed that Bill had a blood clot in his lower right lung,
called a
pulmonary embolism (PE).
Pulmonary embolism is a serious and sometimes life-threatening
condition that leads to over 50,000 deaths a year in the United
States. In most cases, PE occurs when part of a blood clot in a deep
vein in the leg (a deep vein thrombosis or DVT) breaks off and
lodges in the lung. A blood test also indicated that he was positive
for factor V Leiden, an inherited genetic problem that causes the
blood to clot more easily than normal. Factor V Leiden increases a
person's risk of developing a blood clot.
Bill was immediately treated with injections of heparin, a
blood thinner (anticoagulant). At the same time, he started an oral
blood thinner, warfarin, which he would take for at least 12 months.
Bill uses UpToDate to weigh the risks of ongoing
treatment with anticoagulants
For patients with an active lifestyle like Bill, being on a
blood thinning medication can be dangerous because his chances of
uncontrolled bleeding are increased, even after a small injury. But
as a pilot, Bill has to weigh this risk with the fact that warfarin
may prevent him from having another PE while piloting his plane. If
Bill became incapacitated as a result of a PE while flying his
plane, he could injure himself and potentially many other people.
Bill was introduced to UpToDate by a family member
and is using the information from the service to weigh the risks and
benefits of long-term anticoagulation treatment. For example, Bill
found a topic review in UpToDate called
Management of inherited thrombophilia
that pointed to several studies that argue against the use of
long-term warfarin therapy in his situation. Bill shared the UpToDate
topic review with his doctor and is using it as a starting place for
making a treatment decision. "I had never seen that piece of
information before having access to UpToDate," said Bill.
“Having access to UpToDate
makes me an informed consumer.”
UpToDate provided more in-depth information than
other internet resources
Bill has spent a significant amount of time on the internet
looking for information about his condition and found UpToDate
to be much more in-depth than other resources. For example he says,
"You can plug the term warfarin into Google and find out what it is
supposed to do, but that's just the tip of the iceberg. With UpToDate
you get more information about drug and food interactions and
activity restrictions... everything you would ever want to know."
With the help of information from UpToDate Bill is
working with his physicians and the FAA to determine the best
treatment regimen that will allow him to continue to safely pilot his
plane. He has also advised his two grown children to talk to their
doctors about the need to screen for his blood clotting condition.
"Having access to UpToDate makes me an informed consumer,"
Bill concludes.
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