Clinton’s Venous Sinus Thrombosis
What is a transverse sinus venous thrombosis?
In 2012, then Secretary of State Hilary Clinton became dehydrated and fell down, suffering a concussion. Weeks later she was hospitalized for what was described at the time as a “blood clot.” We weren’t told where the clot was at the time. After several days in the hospital, she was discharged home.
She was later seen to be wearing glasses with a Fresnel prism in them, a common treatment for double vision. Double vision is a not uncommon transient development in concussions. It may also develop from a blood clot on or in the brain.
Yesterday, it was revealed that Secretary Clinton had, in fact, suffered from a transverse sinus venous thrombosis and was treated with blood thinners, which she is apparently still receiving.
As a leading candidate for the Presidency, Secretary Clinton’s health is a public concern. So what, exactly, is a transverse sinus venous thrombosis?
This is easiest if we think of a sinus as a large vein. Specifically, the transverse sinus is one of the major draining veins of the brain. It is located at the back of the head, extending from the midline to a point behind each ear (there is one on each side of the head). Just behind each ear, the transverse sinus makes an ‘S’ turn down into the neck, where it becomes the internal jugular vein. The internal jugular vein is THE major vein draining the brain of blood. Again, it is a paired structure with one on each side.
If we think of the internal jugular vein as a river draining blood from the brain back to the heart, then the transverse sinus is one of the major tributaries of that river. Each transverse sinus carries some percentage of the blood exiting the brain and returning to the heart. What percentage? Hard to say, since the exact size and anatomy of the transverse sinuses vary in different individuals. In many folks, probably most, the transverse sinus is larger on one side or the other. Such a dominant sinus may drain more than 50% of the blood returning from the head. Likewise, a small, nondominant sinus might drain considerably less than 50% (most of the remainder being drained by the opposite transverse sinus).
A venous thrombosis is a clot. A clot in a nondominant transverse sinus might be relatively benign. Of course, a clot in the dominant sinus is more likely to cause serious trouble. It should be noted that venous sinus thrombosis is a relatively common syndrome and that a nondominant sinus is more likely to clot than a dominant sinus.
There are several causes of venous thrombosis, one major cause being dehydration. Secretary Clinton was dehydrated, which likely lead to her clot. Nothing earth shattering there.
How significant is such a clot? It could be very significant, but probably not in this case. In a worst case scenario, such a clot leads to sludging of the blood and engorgement of the brain as the blood backs up. Think of water backing up behind a cofferdam, the difference being that the brain exists in a closed space. Engorgement of the brain (with blood, CSF, or edema fluid) will eventually raise the pressure inside the head (see my article Brain Squeeze here). Increased pressure inside the head can make a person very sick, or worse.
So how is venous thrombosis treated? For starters, with avoidance of dehydration. Second, if the clot is nonocclusive (that is, only partially occludes the sinus) and thus the sinus is still functional (blood is able to get through), then the goal is to prevent further clotting in the short run (this is probably why she was hospitalized for several days, to monitor her and prevent further clotting) and to passively dissolve the clot in the long run (with good hydration and blood thinners over months). Such patients may have a headache, and sometimes double vision, at the onset. Full recovery without a stroke is the rule.
If the clot is occlusive and no blood is getting through, the blood backs up faster, causing severe congestion of the brain and, if unchecked, a stroke. This situation warrants very aggressive treatment, requiring an ICU stay and multiple angiograms with administration of medications directly into the clot to actively dissolve it.
It does not appear that Secretary Clinton has had a stroke.
Overall, her transverse sinus venous thrombosis appears to have been a relatively minor affair, one that was treated quickly and appropriately and without significant sequelae. In this physician writer’s opinion, it should not be a consideration in her run for the Presidency, nor will it impact her decision making skills.
The Worst Club in the World
Everyday coping after the death of a child
It’s 2:00 in the morning and I can’t sleep. I’m sitting in a hotel room in a city not my own. In fact, it’s seven hundred miles from my house. I came here to take care of some business and take in a few ballgames. I do this once in a while when I feel the need to get away. When the silence has become unbearable.
Seven hundred miles is a long drive but a short distance compared to the journey I’ve been on for the last thirteen years. That was when I joined THE CLUB. February 25th, 2003. Hardest day of my life, no question. I can’t imagine there will ever be a more difficult one, and if there is I’m not sure I want to live it.
THE CLUB. This isn’t one you’ll ever want to join, though I’m guessing if the “opportunity” comes your way you won’t have much choice in the matter. And the price will be steep, up to and including a bankrupt soul and the irreparable loss of your future. The deal, such as it is, includes an unavoidable—and rapid—descent into hell. For some unfortunate few, hell is surpassed in favor of a slow descent into madness. Not surprisingly, this is the worst club in the world to be a member of.
There is no more lonely an experience in life than losing a child, and the only folks who can truly appreciate the level of grief one feels are those who have themselves lost a child—other members of THE CLUB, so to speak. Losing a child, even as an adult, is not only devastating beyond belief, it’s socially isolating. There’s a sense you are in it alone, as if in the vast panoply of the human experiment, some six billion and counting, this has never happened before. Losing a child is quite simply the wrong order of things. Our brains aren’t meant to bend that way. Children are our future. We aren’t suppose to bury them—they are suppose to bury us.
So what’s it like? What’s it like to have your soul filleted by the reaper’s blade, opened wide for all to see?
Imagine living with a deep down bellyache, one you can’t get at no matter how hard you try. The pain is intense. Physical, emotional, spiritual. It’s everywhere you look and in everything you touch. The very air you breathe is tainted. If you could somehow hold your breath and just cease being, that would be ok. You want only the impossible, to breathe life back into your loved one.
If the first days are hard, and few things are harder I assure you, what evolves is nearly surreal. About four months after my son died, we ventured out as a family for the first time since his sudden death. We choose a restaurant we had never been to before. One without memories. Unfortunately, the five of us were seated—completely innocently I am sure—at a table for six. There was, of course, one empty chair.
And of course, it’s been such ever since. One empty chair. At Thanksgiving. At Christmas. At every dinner and every meal. At high school graduations and college commencements. On road trips and family vacations. One empty chair. There’s always someone missing.
The weight of that empty chair can become oppressive, but it needn’t be. Some years ago my wife started putting a lit candle at my son’s place—his name was Endyll, our first born—during family dinners like Thanksgiving and Christmas. My wife and I haven’t always been together in our grief (one reason so many couples become singles after the death of a child), but on this point she was a beacon in the darkness. And my daughter, who was only eight when her older brother died, surprised the family this past year with a montage of memories written by Endyll’s friends all these years later. Turns out she tracked them down on Facebook and they were delighted to give of themselves. She turned twenty-one herself this year (the same age as Endyll when he died) and felt she’d been too young to really know her brother. What sort of person had he been? And so she asked a few of his friends for vignettes that might reveal something of her brother.
I could well understand her desire. I myself had spent years searching for clues as to who he was or might have become. I poured over notebooks I found in his bedroom, in which I discovered a trove of unfinished stories. He had been a writer. Sci Fi and fantasy. Wonderful. But reading those vignettes from his friends was like finding an ancient scroll thought lost forever. It was relavatory, like bathing in the waters of the River Jordan.
The acuity of the pain fades with time. Folks will tell you this and it’s hard to fathom, but it’s true. I doubt, however, it ever dissipates entirely. At least it hasn’t for me, for us. What really happens is that eventually the good days outnumber the bad days. The memories become more deliberate, more welcome. The bombs, once seemingly implanted everywhere, defuse over time. Or at least lose some of their explosive power.
They are still there though. In the curious glance of a stranger, whose eyes have the same light as your lost one. Or inside an old box from the attic, where you find his stash of men’s magazines—and thus a glimpse of his very human needs. Or perhaps the box contains the clown costume he wore to school for Halloween when he was five, when he was still your precious boy and you couldn’t imagine a time when he’d pull away from your touch. He was—is—a part of you. His life permeates your own. He will always be your precious boy.
And then comes that singular question, ever uttered with innocence, despite which can always be counted upon to bring up a ghost. How many kids do you have? This may be the hardest question in the English language—hell, in any language.
How many kids do you have?
Like the weather, asking about children seems benign. But it’s not when you’ve lost a child. More often than not, the question scratches an old wound. And deciding to tell or not is another kind of pain altogether.
If I answer one way and leave him out of the equation, it feels as if I am denying my son’s existence. I can hardly bear that, even after all these years. Especially after all these years. He died just before the internet came of age and so was never immortalized on facebook. He never had a digital life. He doesn’t go on ad infinitum in electronic limbo. I can’t pull up an infinite stream of pictures of him. To deny his existence, which remains very real to me, means he will be forgotten once I am gone. That is, for whatever reason, one of the harder things for me to deal with. I don’t know why.
Yet, if I answer the other way, there’s an awkward silence in the making. Invariably, the next questions are how old are they? Where do they live? What school do they attend? What do they do? Etc., etc,. etc. Having seemingly numbered him among the living, at least in the ears of the questioner, I now have to step back and explain. Sometimes that’s exactly what I want because it gives me a chance to talk about him, to keep him alive I suppose. But often there isn’t time, or the person asking is taken aback, feeling they’ve intruded. Or worse, they’ve overstepped. Or worse yet they were just being kind, as in making small talk. Then I’ve overstepped and it’s just plain awkward.
Other times I can’t say anything and the silence can be unbearable. It’s as if the pain has stolen my words.
I still haven’t found a good way to answer that damn question.
For awhile, I attended survivor meetings. Parents who’ve lost a child. Survivors of suicide. Grief counseling. It helped. It still helps. Talking about him (or writing about him) soothes me. I feel less alone. He feels less gone to me.
This journey is a solitary one. My wife—she joined THE CLUB too that day—and I take solace in each other of course, but even couples must grieve in their own time and space. Each parent must walk the journey on their own. She finds survivor meetings loathsome. She attended one and never again. When I’m having what I call a bad Endyll day, usually she’s more composed, and vice versa. We persevere. Whatever, it seems to have worked. We are still together and that’s saying something. Few things stress a marriage more than the death of a child. The pain of the reaper’s blade is deep; the swath it cuts is wide.
Eventually though, a scar forms. And as with any scar, you can look at it and see pain and suffering. Or you can look at it and see healing.