Deadliest Cough on Deadliest Catch

I watched Captain Phil of the Cornelia Marie, a crab boat in the Bering Sea that’s part of Discovery Channel’s exciting show, Deadliest Catch cough up blood the other night. Immediately, my Nurse Practitioner hat popped on as I thought about the long list of differential diagnosis that could be plaguing Phil.First of all, a confession. Deadliest Catch is one of my favorite shows, partly because I grew up in Kodiak, Alaska. The Cornelia Marie is one of my favorite boats because its home port is, you guessed it…. Kodiak.

Back to Captain Phil:

Hmmm, he’s a heavy smoker, with a smoker’s voice and cough and he sits for long periods of time, which can lead to clot formation. I re-wound the show to look at the x-ray a few times to try to figure out whether he had an infiltrate, a spot or something else. Hmmm, I’m not a radiologist, women’s health is my specialty, but I did think, with his symptoms, I wonder if he threw a clot. Pregnant women are also at risk for developing clots, so this is a good topic to explore.

Using the Power of TV for Good:

Let’s learn about Pulmonary Embolism – PEWhat happens:

• A clot (Thrombus) forms in a different part of the body, usually in a Deep Vein in the legs

• We call that a Deep Vein Thrombus – DVT

• The clot becomes dislodged and travels back to the heart

• The heart’s job is to pump blood from the veins to the lungs to pick up some oxygen and then send it through the arteries back to the body

• If there is a clot from the veins, it can get lodged in an artery in the lungs, is known as thromboembolism which is Not Good and can be DEADLY

Symptoms

• Difficulty breathing

• Chest pain when breathing

• Bloody cough

• Pain that may mimic an injury or pulled muscle

• Inability to breathe while lying down

• Feeling short of breath or that you can’t catch your breath

• Breathing rapidly

What to do

• Get to a hospital right away

• Call 911 if the person has collapsed or is in distress

What not to do

• Wait and see if the symptoms improve, as this is DEADLY in about 75% of people

How it’s treated

• Most people are given anti-coagulants to prevent more clots from forming

• Pain relief

• Oxygen

• Some people need surgery to remove the clot

How to prevent clots from forming

• Try not to sit for long periods of time, get up and move around, especially when flying long distances

• Women who use Estrogen should also keep moving especially on long flights

• Stop smoking as smoking causes veins to constrict and aids in clot formation

• Get checked if you notice swelling, redness, and/or pain in your calfs or lower legs

I hope that Captain Phil is recovering and feeling back to normal again. His experience, while painful and difficult to watch on Deadliest Catch may help others get quick life-saving treatment. I hope he can get back to the activities he enjoys.

Submitted by NurseBarb (view blog

) on Wed, 08/20/2008 - 11:41

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My PE

Hi Barb! Deadliest catch is one of my fav shows too! I am 32 & last October I went to the hospital with the EXACT symptoms as Captain Phil. After I got home I remember watching Deadliest Catch thinking- "I hope non of those guys gets one- They sit in the same spot for HOURS"- I wanted to thank you for the information you posted. It has been almost 1 year & I am still struggling to find out why I went to the ER with severe pain in my lower left lung/rib area- however the PE was located in the upper Right lung. The pain has started to subside but NO ONE has been able to definitively explain why I have pain in the left. I have seen so many specialists and what it really comes down to with every dr is- Let do more tests and spend more $- but no answers.You’re the first person to list: Pain that may mimic an injury or pulled muscleThat’s exactly what I felt! Does anyone know why or what is happening to cause that symptom? Why was it in the left and not the right where the PE was? I really want to understand but I know now that asking a Dr is pointless unless you agree to jump threw their hoops. Thanks Again!

Submitted by stark2976 on Fri, 08/22/2008 - 04:40

Pain and Pulmonary Embolus

Hi,

Sorry this happened. You're so young! You didn't mention whether you're a woman or man and whether pregnancy, estrogen use and/or smoking are some of your risk factors. What do you do for work? Can you provide me a little bit more information so that I can try to help you figure it out.

As I tell my students at Stanford, pretend you're a CSI detective. Ask more questions, and if you take a good and detailed history, the tests should confirm your differential diagnosis.

OK, let's crack this case!

Nurse Barb

Submitted by NurseBarb on Fri, 08/22/2008 - 07:54

My Case

Sorry about the lack of info- It just seams like there is a book that can be written about my case so I try to limit what I write, but here it is:

I’m a 32 Female diagnosed with Factor V Leiden. At the time of my PE, I had had a laparoscopy 2 weeks prior; I smoked and was on Birth Control. (A recipe for disaster)

The day my symptoms started it was around lunch time that I noticed a really bad cramp in my lower left side by the ribs. I thought I pulled a mussel or something and kept trying to do stretches to get it to work out. By the time I was ready to leave work for the day I was feeling very tired and like I was coming down with the flu or something. I came home and fell asleep for about 2 hours. Just like Captain Phil I thought I was fine and not that bad. I knew something was wrong but it didn’t seam life threatening. When I woke up the pain was still there so I decided to call my dr. She told me to go to the ER when I described my symptoms: Very sharp pain in my side, kind of hard to breath, flu like. I went to the ER and was kept in the waiting room for over 2 hours- I finally got so irritated I left (filling out a survey on my way out). I went home and slept through the night. In the morning with my symptoms still the same I went to work. At 9 AM I called my Dr again and again she told me to go to the ER, any ER. I went into another local hospital and was diagnosed with several clots in the upper right lung, admitted and on Heparin within 3 hours. That night around 9 PM the pain in my side suddenly became horrible intense and sharp. The Dr’s came in and began giving me morphine until they could confirm I was not having a heart attack. I really think that is what a heart attack feels like- I couldn’t breathe and the pain in my chest was unbearable. The EKG was fine and the next thing they gave me was Toradol. The Morphine didn’t touch the pain but within seconds of getting the toradol the pain subsided and my chest relaxed. I was released 7 days later and have been told I will need to be on Warfrin for the rest of my life due to the Factor V deficiency.

I have seen over 3 Pulmonary specialists at different hospitals and they all have different answers as to what the pain in my side is: 1. A stroke of luck and probably something completely unrelated 2. Pulmonary infarction 3. Small area of collapsed lung. – The only thing they do agree on is they really are not 100% sure what it is. I have had several CT scans and X-rays – still nothing. Honestly I have given up hope and have just accepted it and hope it will eventually completely go away.

Submitted by stark2976 on Fri, 08/22/2008 - 12:54

What an ordeal!

I'm still trying to process this, thanks for trying to be concise. I'm shaking my head, because you are VERY fortunate in some ways and probably don't feel very lucky in others.

#1 you survived! Thank goodness, because your risk factors of Factor V Leiden, smoking and the pill were the "perfect storm" and could easily have led to the Full Catastrophe.

#2 Without looking at your X-rays and CT scan, I would say that you might have had "referred pain" which means that the pain from your clots and PE migrated to a part of your body that was close but not right on top of the problem area.– I've seen this in many other cases and in my mom's lung cancer, her pain was in a different part of her torso too.

#3 Sometimes, because of legal liability, we in the health care fields can not give absolute or 100% certain explanations - I wish we could, because it's confusing for people, and I get your frustration, but our bodies don't always act logically.

#4 I too, hate it when everyone you talk to has a different opinion about what's going on and I wish there was something we could do to be more consistent, but then again that's why they call them opinions.

#5 Most people's pain will improve over time, and everyone is different. Sorry, I wish i could be more exact here, but there are lots of contributing factors.

#6 You absolutely need to go off the pill, as this increases your risk of another clot. We can talk about other options in another post

#7, I hope you are going to use some type of blood thinner like Warfarin, Heparin, Lovenox, etc. This is especially important for your long term health.

I hope this helps. I know it's not complete, but I have to run to my son's soccer practice.

I'm glad you're here and you survived this.

Barb

www.nursebarb.com

Submitted by NurseBarb on Fri, 08/22/2008 - 14:45

Thank you!

Thank you so much Barb. The info you provided about referred pain is so interesting and truthfully the first answer than sounds very logical and reasonable. I guess that’s why they call this a Practice huh?Well just to update you- I no longer take Birth Control and will be on Warfarin for the rest of my life. I have been told this is the safest option since I have already had a PE and Factor V Leinden. I have been following up regularly with my Primary Care Physician and get my blood checked a min of once a month. Thank you again for taking the time to explain my situation further and giving me more detailed and helpful information- THANK YOU! THANK YOU! THANK YOU!

Submitted by stark2976 on Mon, 08/25/2008 - 07:14