Advertisement
  1. Health

Effort thrombosis, a rare condition afflicting mostly athletes, is treatable

University of Tampa junior Heather Glenday takes a break for a portrait while swimming at the university’s aquatic center. Glenday was diagnosed with effort thrombosis last year.
Published Apr. 25, 2013

TAMPA

Heather Glenday is used to discomfort. A competitive swimmer since childhood, Glenday, now 21, swims for the University of Tampa. She has had to push past being tired and achy to train and win at national events.

But a year ago, she had unusual pain on her right side that persisted even in the off season. One day, she awoke and found she could barely bend her right arm, which had swollen to about three times the size of her left. Doctors at Tampa General Hospital found a blood clot in her upper arm, just below her collar bone.

"I got really upset," said Glenday, an accounting major in her junior year at UT. "It was like a ticking time bomb in my body."

Blood clots often form in the legs, frequently in people who are sedentary. But Glenday's clot was another thing entirely.

"It's a rare condition, but it's very strongly associated with athletes and exertion," said professor of surgery and director of the division of vascular surgery at USF Health, Dr. Karl Illig. "I've treated professional baseball players, swimmers, badminton players, painters, kayakers, even a professional guitarist and a professional violinist."

Effort thrombosis is also known as Paget-Schroetter syndrome after the men who identified it in the 1800s. Repetitive, strenuous arm movement damages a large vein between the collarbone and the top of the rib cage. The bones and other structures in that area repeatedly squeeze the vein, causing blood to stagnate and creating enough irritation in the vein walls for a clot to form.

The condition usually affects young, healthy individuals; more men than women; and tends to occur in the dominant arm. Football, rugby and tennis players, golfers, weight lifters, cheerleaders, backpackers, and rowers have also been diagnosed with the condition. It frequently is misdiagnosed, because it's so unusual for a blood clot to occur in a healthy young person, and particularly rare in the arm.

But, if diagnosed promptly and treated properly, athletes can usually return to their sport.

"The worst thing you can do is treat it like a blood clot in the leg," said Illig, who heads one of a handful of clinics across the country that specialize in treating effort thrombosis. A clot in the leg is usually treated with blood thinners, which isn't always enough to resolve effort thrombosis. "That results in disability in a quarter to half the people. It can also leave you with a swollen, achy arm for the rest of your life," he said.

The recommended treatment is a clot dissolving drug, often delivered directly to the center of the clot, and surgical removal of the first rib. That's a small bone at the top of the rib cage, one Illig says "you won't miss.''

The two-pronged approach relieves pressure on the vein and prevents clots from reforming. "That leaves patients with a 95 to 100 percent chance for a normal life," said Illig, who did Glenday's surgery at Tampa General.

It's a condition that comes on gradually. During the 2011-12 school year, Glenday's right side bothered her almost daily, an early sign that the vein in her upper arm was being compressed. She thought it was just another sports-related issue and ignored it. The clot most likely formed in early spring 2012 after heavy training for a national competition.

After she was admitted to TGH in April 2012, Glenday was put on blood thinners and a week later had surgery to remove her first rib bone.

She missed three weeks of school but was able to finish her class work while recovering at home in Babylon, N.Y. She was back in the pool in a month, worked as a lifeguard that summer on a Long Island beach, and by fall she was back in Tampa, ready to train and compete.

Illig said the key to that kind of a happy outcome is getting proper treatment quickly. Wait too long and the clot may solidify so much that it can't be dissolved. Also, there is a small risk that a piece of the clot could get to the lungs or brain resulting in a stroke or death. A more likely consequence of delaying treatment is chronic arm pain or disability.

"If Heather had ignored the swelling and discomfort, she wouldn't have been able to return to swimming competitively," said Illig, who sees two to three new patients a month with this condition. "It's curable if treated correctly. It's not just another blood clot in your leg."

ALSO IN THIS SECTION

  1. Dr. James Quintessenza, left, will return as the head of the Johns Hopkins All Children's heart surgery program department. UNIVERSITY OF KENTUCKY HOSPITAL  |  Times
    The heart surgery program’s mortality rate spiked after the surgeon left, a 2018 Times investigation revealed.
  2. Stephanie Vold, a medical assistant and intake specialist for OnMed, holds the door while Austin White, president and CEO of the company, talks with a nurse practitioner during a demonstration of their new telehealth system at Tampa General Hospital on Tuesday. The hospital is the first to deploy the OnMed station and plans to install them at other locations. OCTAVIO JONES  |  Times
    The closet-size “office” with a life-size screen is another example of the changing face of medicine.
  3. Marijuana plants grow in a greenhouse environment in this room at the Curaleaf Homestead Cultivation Facility. This environment controls the amount of natural sunlight and artificial light the plants are exposed to, as well as the temperature. EMILY MICHOT  |  Miami Herald
    An Atlanta broker is listing one license for $40 million and the other for $55 million.
  4. A page from the Medicare Handbook focuses on Medicare Advantage plans, which have become increasingly popular in recent years. Medicare's open enrollment period for 2020 begins Oct. 15 and lasts through Dec. 7. PABLO MARTINEZ MONSIVAIS  |  AP
    New benefits are giving an extra boost to Medicare Advantage, the already popular alternative to traditional Medicare.
  5. The Tampa Bay Times' annual Medicare Guide explains how the program is set up, helps you compare options available in the Tampa Bay area, and points the way toward help, including free, one-on-one assistance. This illustration will grace the cover of LifeTimes on Oct. 23, when the guide will be published in print. RON BORRESEN  |  Tampa Bay Times
    As the open enrollment period begins, it’s time to review your coverage.
  6. The Medicare Handbook for 2020 is a good resource to have as the annual open enrollment period gets under way. The government usually mails beneficiaries a copy. Find a PDF version to print at medicare.gov/pub/medicare-you-handbook, or call 1-800-633-4227 (1-800-MEDICARE) to order a copy. THOMAS TOBIN  |  Tampa Bay Times
    The open enrollment period, which lasts into December, is a time for millions of beneficiaries to review, and possibly change, their coverage.
  7. Medicare's online Plan Finder has been redesigned and is available at medicare.gov/find-a-plan. THOMAS TOBIN  |  Tampa Bay Times
    The most-used tool on Medicare.gov will look different this year.
  8. Jim Tolbert, left, staffs a booth at a senior expo for Serving Health Insurance Needs of Elders, or SHINE, a state program that answers Medicare and other insurance questions. The program has scheduled a number of events around the Tampa Bay area during Medicare's open enrollment period, Oct. 15 to Dec. 7. Times (2015)
    About 500 volunteers statewide are at the ready. They work for Serving Health Insurance Needs of Elders, or SHINE, now in its 28th year.
  9. In this Sept. 6, 2019, photo, Donna Cryer holds up family photos that include her father Roland Henry, as she poses for a photo in Washington. When her father died, she tried to donate his organs, yet the local organ collection agency said no, without talking to the family or providing a reason. "It was devastating to be told there was nothing they considered worthy of donation. Nada. Not a kidney, not a liver, not tissue,” recalled Donna Cryer, president of the nonprofit Global Liver Institute and herself a recipient of a liver transplant. SUSAN WALSH  |  AP
    Under U.S. transplant rules, the country is divided into 58 zones, each assigned an “organ procurement organization” in charge of donation at death.
  10. Kreshae Humphrey, 26, bathes her daughter, Nevaeh Soto De Jesus, 3, inside of a baby bath tub in the middle of their living room. The parents bathe all three of their girls with bottled water because they believe the children were sickened by the tap water at the Southern Comfort mobile home park off U.S. 19 in Clearwater. The family is suing the park's owner over the issue, but the owner and the state say there are no problems with the drinking water there. MARTHA ASENCIO-RHINE  |  Times
    The owner of Southern Comfort denies there are problems with the drinking water. But the park is still being shut down. All families must be out by Oct. 31.
Advertisement
Advertisement
Advertisement