I really did not want to know this – but I am not surprised.
Tragically, it may have been the long hours he spent cramped in the Army vehicle that caused his death. Three days ago, Bloom had complained of cramps behind his knee. Like most of us journalists “embedded” in the Army, he had endured days and nights of working, eating, and sleeping in our vehicles as convoys snaked their way toward Baghdad.
He consulted military doctors and described his symptoms over the phone to overseas physicians. They suspected DVT, or deep veinous thrombosis, and advised him to seek proper medical attention. He ignored their advice, swallowed some aspirins, and kept on working. On Sunday he died of a pulmonary embolism.
David Bloom’s Last Ride
SARS update
The public health research and epidemiologic experts are working diligently. We learn more about this new disease daily. I refuse to call it a mystery disease, because we do know a great deal. It represents a new and dangerous variety of a well known old virus. Scientists Gear Up for Fight Against a Deadly Lung Disease Identifying Virus Is First Step in Slowing Spread of SARS
The international scientific blitz has produced results in a remarkably short time. Scientists are now fairly certain SARS is caused by an entirely new coronavirus, and geneticists in labs scattered around the world are quickly decoding its entire genetic makeup. That will help them determine whether it’s been hiding in nature for years, was spawned when an animal or human coronavirus mutated, or exchanged genetic material with a second virus when both infected a chicken, pig or some other animal. That’s what many scientists suspect occurred somewhere in southern China last fall. It then was carried around the world by air travelers.
The pathogen transmits primarily through tiny droplets expelled by infected people when they sneeze or cough. The first symptoms, which usually show up a few days after being infected, are a sudden fever of 100.4 or above, a dry cough and other flu-like symptoms. At least 80 percent of those infected recover in about a week. But the rest get much worse, often developing pneumonia and sometimes needing a machine to help them breathe as the virus ravages their lungs. A combination of the antiviral drug ribavirin and steroids may help some of the sickest. But about 3.5 percent die, mostly the old and frail, an apparent death rate that makes it more deadly than the typical flu bug, including the devastating Spanish flu of 1918-19.
But some of the most important questions remain unanswered: Can it spread in other ways, such as through air, water or sewage? How many people who get infected get sick? How many of those who get sick recover? Are people infectious before they have symptoms? Do any existing drugs work against the virus? Does the virus get stronger or weaker as it gets passed from one person to another, and as the seasons change?
“We’re in the third line of a three-act play,” said Michael T. Osterholm, an infectious disease expert at the University of Minnesota. “We have a lot to go yet.”
Scientists react to fearful situations by striving for understanding. We all fear the unknown. Hopefully as we learn more about the epidemiology we can replace fear with respect and caution. We need to respect this infection, learn about it, and hopefully learn to contain it. Fortunately, we have invested greatly in the medical scientists who will quickly learn the relevant details about this virus. In the meantime, we must all remain vigilent.
David Bloom dies from a pulmonary embolus
Many times yesterday, friends asked me why David Bloom died. What is a pulmonary embolism, and why did he have one? Without knowing any of his medical details, one can only speculate. Nonetheless, we can explore pulmonary embolism and perhaps understand why he might have died. NBC?s David Bloom dies in Iraq.
We start by understanding what a pulmonary embolus is and what are the risk factors. We need some definitions – let’s go to Stedman’s Medical Dictionary.
thrombus , pl. thrombi (thrombs, -b) A clot in the cardiovascular systems formed during life from constituents of blood; it may be occlusive or attached to the vessel or heart wall without obstructing the lumen (mural thrombus).
embolus , pl. emboli (emb-ls, -l) A plug, composed of a detached thrombus or vegetation, mass of bacteria, or other foreign body, occluding a vessel.
Restated, a thrombus represents a clot in a blood vessel. When a thrombus “breaks loose” and travels in the blood stream, it land somewhere, plugging that vessel. At that time we call it an embolus.
A pulmonary embolus generally comes from a thrombus which originates in a leg vein. The clot “breaks loose” and travels up the venous system, through the right side of the heart and into the pulmonary artery. The clot plugs there, and if it is a large enough clot, prevents blood flow from the right side of the heart to the left side of the heart. It also causes a lack of blood flow to the lungs, preventing oxygenation of the blood. These events combine to cause death in some patients.
When considering pulmonary embolism, one must always first consider deep vein thrombosis (DVT) of the legs. So what we really want to understand is why an apparently healthy 39 year old man would develop a major blood clot in his leg.
DVT can occur when the blood is hypercoagulable (more likely to clot). Reasons for hypercoagulability include inherited disorders of blood clotting, dehyration, and a variety of cancers.
DVT also can occur when the blood flow in the legs decreases for periods of time. This occurs frequently during surgery (especially knee and hip surgery). It also occurs on long flights (especially when the flier does not move his or her legs for long periods of time).
So now my speculation. I suspect that David Bloom probably had a hypercoagulable state, brought on by dehydration in the desert. He then was sleeping in a position that prevented normal leg movement. Quoting from the MSNBC article:
“Given the fact that we’re filing at all hours of the day and night, you try to pace yourself and get a little sleep,” Bloom told the Post. “You’re sleeping with your knees propped up around you.”
That may have been a risk factor: blood clots frequently form in legs when they’ve been immobilized and travel through the body, said Dr. Harold Palevsky, chief of pulmonary critical care with the University of Pennsylvania health system.
While he may have had other risk factors, these risks (dehydration and his sleeping position) were probably enough to cause the DVT and subsequent pulmonary embolism. This story remains tragic, but I hope that this rant has helped you understand why it happened. Understanding represents just a little solace. Bad things do happen to good people.
