Hillary Clinton hospitalized after doctors discover blood clot
[NBC Politics.NBC News] Secretary of State Hillary Clinton
... sometimes described as America's Blond Eminence and at other times as Mrs. Bill, never as Another Charles Evans Hughes ...
was admitted to a New York City hospital on Sunday after doctors discovered that a blood clot had formed, the State Department said in a statement.
Blood clot WHERE?

I've checked multiple news sources and no one says.

Now this is an area within my subspecialty, so permit me to mount my soapbox.

Given what we are told, there are four reasonable potential locations --

1) leg below the knee. That could be due to inactivity stemming from her concussion. We usually do NOT treat these with anti-coagulants. However, 20% of below the knee thrombi will propagate to above the knee so they should be monitored at frequent intervals (ultrasound). We do use NSAIDs, rest and physical therapy.

2) leg above the knee (proximal deep vein thrombosis, DVT). This is a serious medical situation. About 20% of these will break off and cause a pulmonary embolism, and 5 to 20% of those (1 to 4% of all proximal DVT) are fatal. We treat these immediately with a proper anti-coagulant (heparin followed by warfarin or with a low-molecular weight heparin such as Lovenox). A patient usually is hospitalized for a proximal DVT though lately we've had success keeping them at home with daily or twice-daily Lovenox injections. There is some enforced reduction in activity but we don't like to keep people immobile, since immobility is one of the risk factors to get a DVT in the first place.

3) pulmonary embolism (PE). This is serious and can be life-threatening, indeed fatal. These require immediate hospitalization, immediate anti-coagulation, and careful monitoring. There are a number of complications that may occur, from right heart failure to arrhythmias, circulatory collapse, pneumonia, etc.

Both a proximal DVT and PE require a diligent search for why they occurred. The usual causes are 1) advancing age 2) immobility 3) trauma 4) cancer 5) genetic pre-disposition to clotting 6) use of certain medications (e.g., oral contraceptives). Recurrence is common, particularly in the time period following cessation of anti-coagulation (usually done for 6 to 12 months).

4) blood clot within or just above the brain (e.g., subdural hematoma or traumatic brain contusion). If this, the cause is almost certainly trauma from a fall. I note this is how Katherine Graham, past publisher of the Washington Post, died -- she slipped and fell and suffered head trauma with a bleed and clot. These are, of course, extremely serious. Note that head trauma with a bleed/clot is very different than a DVT/PE situation.

So again I repeat my question -- where is the clot?

If #2, #3, or #4, and I were her doctor, she wouldn't be doing anything other than house rest and computer solitaire for a couple weeks until I knew that I had the problem well in hand.

That no one will say, and that we now see that there is and has been a fair bit of the story withheld, and that there has been phony stories put out there (e.g., partying in the Dominican), suggests to me that there is something serious going on.

She's entitled to privacy in her medical affairs as a person. But as Secretary of State, we the public need to know if she can do the job or not.
Philippe Reines, a deputy assistant secretary, said in the statement that the clot stems from a concussion Clinton sustained several weeks ago.

Reines said that Clinton, 65, is being treated with anti-coagulants at New York-Presbyterian Hospital in Manhattan. She will be monitored there for the next 48 hours, he said.

"Her doctors will continue to assess her condition, including other issues associated with her concussion," he said. "They will determine if any further action is required."
Of course they will. Again, where is the clot?

Posted by: Fred 2012-12-31