As a physio, Bev was sure she had a DVT – but it was only diagnosed after she nearly died

After completing the challenging 73-mile Hadrian’s Wall hike in North-East England, physiotherapist Bev Strathearn was feeling on top on the world.

‘I felt fit for my age and healthy,’ says 56-year-old Bev. Yet only weeks later she found herself in hospital suffering from life-threatening blood clots that had been caused by a foot injury she sustained during the hike.

‘I began to sit with my right leg bent back under my chair at work to avoid putting pressure on the sole of my foot,’ recalls Bev, who lives in Beverley, East Yorkshire, with her husband and their two adult daughters.

‘Two weeks later I noticed a pain in my right calf, and I didn’t sleep well because of it. But I was busy looking after my elderly dad so I put off doing anything about it.’

But then Bev noticed a red patch the size of a golf ball on her right calf. As a physiotherapist, she knew she had some of the risk factors for a blood clot: she’d been sitting down at work much more doing online consultations, was dehydrated and was also on oral hormone replacement therapy (HRT) for the menopause.

‘But by the evening it was killing me and I decided to seek medical advice the following morning,’ she says.

‘I felt fit for my age and healthy,’ says 56-year-old Bev Strathearn (pictured). Yet only weeks later she found herself in hospital suffering from life-threatening blood clots that had been caused by a foot injury she sustained during the hike.

Bev contacted NHS 111, saying she suspected she had a blood clot (also known as deep vein thrombosis, or DVT). They referred her to a minor injuries unit. DVTs are clots that form in the deep veins of the leg. Symptoms include redness, pain, a heavy ache and sometimes swelling, usually in the calf or thigh.

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Risk factors for developing a DVT include being immobile — for instance, sitting for long periods or being admitted to hospital — plus cancer, pregnancy, injury, older age, obesity, the Pill and HRT, which all make the blood more ‘sticky’ and likely to clot.

One of the most serious complications of a DVT is when a part of the clot breaks off and travels through the bloodstream to the lungs, leading to a blockage called a pulmonary embolism — this can cause chest pain, breathing difficulties, a faster heartbeat, coughing up blood, and can be life-threatening if not treated quickly.

Worryingly, research suggests 40 per cent of patients who die from a pulmonary embolism complained of nagging symptoms for weeks before their death.

For every pulmonary embolism diagnosed in time, there are at least another two where the diagnosis was missed and resulted in sudden death, according to the charity Thrombosis UK.

The number of deaths caused by blood clots has risen in England from 12,457 a year in 2019/20 to 14,846 in 2021/22.

Beverley Hunt, a professor of thrombosis and founder of Thrombosis UK, says the charity has major concerns over the number of clots being missed.

‘Many people contact us who have been turned away by healthcare professionals because either they don’t have the ‘classic’ symptoms of clots, or it is wrongly thought that they’re too young to have a clot,’ she explains.

‘In the old medical textbooks the ‘classic’ picture of a DVT shows a large, swollen red leg, for instance — but we now know that 80 per cent of clots present with just pain in the calf or thigh, with no swelling or colour change. Yet these facts are not widely known.’

She adds: ‘Similarly, a pulmonary embolism doesn’t always present with sudden chest pain and breathlessness — they can sometimes lead to gradual shortness of breath or sudden collapse or fainting.’

An inquest in July into the death of actress Emily Chesterton, 30, heard how she’d twice sought medical help for calf pain, a swollen leg and breathlessness. She was initially diagnosed with a leg sprain and long Covid and prescribed an anti-anxiety drug.

Tragically, she collapsed a few hours after her second appointment with a physician associate, a new type of health professional, and died shortly afterwards from a pulmonary embolism.

The inquest concluded that the physician associate should have sent Emily to A&E and if she’d been treated for a pulmonary embolism, she would probably have survived.

Bev also saw two health professionals with her symptoms.

‘First, I saw a nurse practitioner and told him I suspected I had a DVT and that I had some of the risk factors for a clot,’ she recalls.

Risk factors for developing a DVT include being immobile — for instance, sitting for long periods or being admitted to hospital — plus cancer, pregnancy, injury, older age, obesity, the Pill and HRT, which all make the blood more ‘sticky’ and likely to clot (file image)

Bev asked for a D-dimer blood test that can detect clots — D-dimer is a protein the body uses to break down a clot. A positive test means your D-dimer level is higher than normal and suggests a DVT (although levels may be high for other reasons).

‘But he measured the circumference of my right calf and as it was only 1.5cm bigger than the left one, he didn’t think I had a DVT and said I didn’t need a D-dimer test,’ says Bev.

That night she was in agony and could only sleep on her tummy with her feet dangling off the bed.

Still in pain a few days later, ‘I went to my GP and repeated my story about the intense calf pain and redness’, she recalls.

‘Again, I asked for a D-dimer test — I even offered to pay for it. I said I thought the patch was getting bigger — it was now the size of a satsuma.’

The GP consulted with a colleague and concluded it was probably cellulitis (a bacterial infection in the deeper layers of the skin) or superficial thrombo- phlebitis, a clot in a vein near the surface of the skin. Bev was sent home, told to rest and to come back the following week if there was no improvement. She tried to relieve her calf pain with ibuprofen gel, ice and rest, but ‘I was still finding it difficult to walk and the pain moved to behind my knee’, she says.

Ten days after her symptoms started, Bev went for a walk but had to stop after five minutes as she was getting sharp chest pains. By the evening, this was happening every time she took a breath.

READ MORE: The dangers of deep vein thrombosis 

At 7am next day she woke feeling ‘as if she had run a marathon overnight’, with a racing heartbeat, and so called her GP.

She was told to come into the surgery immediately and after her heart rate and oxygen levels in her blood had been checked, she was told to go to A&E immediately — as they suspected she had a pulmonary embolism.

‘I remember walking across the car park at the hospital like a snail,’ says Bev. ‘I was dizzy and lightheaded and knew something was very wrong.’

A D-dimer test revealed her levelswere 9,000 ng/ml — normal is 500. A CT scan showed she hadmultiple blood clots in her lungs.

‘I asked my consultant if I was going to die and she admitted I was at increased risk of heart attack or stroke in the next two weeks,’ says Bev.

She was immediately prescribed fragmin, an anti-clotting injection administered daily. She had to come off the HRT.

‘Over the next few weeks I was so worried and stressed, some of my hair fell out,’ she says.

‘I felt dizzy and there were a couple of times when my heart rate went through the roof and I had to call an ambulance to check me out.’

After three months, Bev was finally well enough to go back to work on a phased return.

Thrombosis UK is calling for better medical education on the symptoms of DVTs. The charity is also concerned that NHS England relaxed the requirement on hospital trusts to provide proof they risk assess more than 95 per cent of adult admissions for clots. This changed during the pandemic and has not yet restarted.

Professor Hunt said: ‘It appears that some trusts have reduced their attention to this area of care, and prevention is not as good as it should be.’

Analysis by Thrombosis UK found the annual cost of treating clots is £187 million, and litigation costs for missed clots was £23 million from 2012 to 2022.

Bev has since made a full physical recovery, and walked 268 miles across the Pennine Way, but the experience has left her anxious about the risk of suffering another clot (having one clot puts you at higher risk of another).

‘I nearly died because of a blood clot that wasn’t diagnosed in time,’ she says. ‘I was a health professional who was pretty sure I had a blood clot, but no one listened.’

• thrombosisuk.org

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