By Allison Godin
The waiting room was painfully quiet, and almost empty. A small table displaying various pamphlets sat in the middle of the room, allowing ample space for a walker or a wheelchair to move around it. My mom sat next to me and distracted herself by looking around, commenting on the artwork and whispering questions she planned to ask the doctor. My dad had strategically chosen the chair next to a corner table stacked with magazines. He picked through the pile, hoping to find something that might have an article about golf. Eventually a nurse came out from behind the reception desk to call a name. "Allison?" She addressed the question to my mom. Clearly, she hadn't expected the patient to be a teenager; most visitors to the Thrombosis Assessment and Treatment Unit at the Ottawa Hospital are not 18. "You're Allison?" She looked confused. "Yup," I responded.
Just days before my high school graduation I was diagnosed with blood clots. This was what brought us to this quiet corner of the hospital on a beautiful, sunny afternoon in June. Recently, when I told a friend about this experience she was quick to comment: "What are you, 90?" If that were the case, my presence at Thrombosis Unit probably wouldn't have been so surprising. Once everyone got settled in the exam room, the nurse asked me a series of questions.
“Do you do a lot of physical activity?”
"I used to play soccer, now I only really do yoga."
“Have you had any other medical issues in the past?”
"Nope, no issues."
“Do you have a family history of blood clots?”
"Umm...I think my great aunt is on blood thinners for blood clots." I looked to my mom for confirmation.
“When did the swelling in your leg start?”
"Friday night. I noticed it when I got home from work."
“Are you currently taking any medications?”
“Yes. I’m taking an oral contraceptive. Yasmin, for my acne.”
She stopped writing, and looked up quickly. "They prescribed birth control for acne?"
In the days following, I learned a lot about blood clots, and the dangers of deep-vein thrombosis (DVT), including the risk of death. And while thrombosis is much more prevalent in adults, particularly in the geriatric population, it can occur in children and adolescents. When this happens, it is usually as a result of another medical condition, or it's genetic. The latter proved to be the case for me. Testing showed that I had a genetic alteration called Factor V (five) Leiden, which means that I am predisposed to blood clots.
Before I learned all of these facts that would inform medical decisions for the rest of my life, I had no idea that I should never have taken Yasmin. Besides the obvious use for this medication, some family doctors and dermatologists also prescribe it, and at one time it was actively marketed as acne treatment for females over the age of 14. I was prescribed Yasmin for this purpose and became one of an increasing number who have experienced potentially life-threatening side effects.
According to a 2013 article on cbc.ca, "at least 23 Canadian women who were taking two of the most commonly prescribed birth control pills in the world have died [...].” Health Canada reports that Yaz and Yasmin are suspected in the deaths of the women, who mostly died suddenly from blood clots, the story stated. These brands are both considered low-dose contraceptives. They are widely prescribed and many of the women and girls taking them assume that the risk for potential side effects is low as well. However, the article also states that "in 2011, Health Canada issued a warning about Yaz and Yasmin, saying the risk of blood clots, which is rare overall, is 1.5 to 3 times higher with the drospirenone-containing pills than with some other birth control pills.” While those who have not experienced these negative effects greatly outnumber those who have, the loss of these women has not been forgotten.
When diagnosed, I stopped taking Yasmin immediately, and was prescribed blood thinners. For six months, I took my medication faithfully and went for blood work regularly. I would stand in the line outside the office, waiting for the clinic to open. When others would hand the receptionist their forms, she had a rehearsed response, "Thank you. Please take a seat and wait for your name to be called. Hopefully it won't take too long." When I stepped up to the counter, all I had to say was "hi, my last name is Godin, G-O-D-I-N. I have a standing order," and I would be led back to the available station. I knew most of the nurses by name, but usually ended up with the same two. They knew that one arm was easier to draw blood from than the other, and I learned to drink large amounts of water to help the process along. In January of 2008, my doctor determined that my body had responded to the treatment. My blood clots were gone, and thankfully, I haven't had to go for blood work since.
A few years later, I was sitting at home watching television. The show I was watching went to commercial, so I got up to bring some dishes into the kitchen. I stopped at the door when I heard the lawyer in the commercial talking about a lawsuit being filed (at that time, in the United States only). They were looking for people who had taken oral contraceptives in the last few years; women who had experienced any of the negative conditions associated with them. I listened to the list of side effects, mentally acknowledging those that I had experienced. This was the first time that I really considered how many others were in this same situation. Earlier this year, a class action lawsuit against Bayer, the maker of both Yaz and Yasmin, was certified in Ontario. This lawsuit involves several hundred women who have used these products, and it's only one such class action that have been filed across Canada.
When the doctor told me I had blood clots, I was scared. I was young and didn't know what, or if, treatment was available. Thankfully, since the clots were close to my knee, there was less chance of the clot travelling to my lungs. Despite the side effects I developed, I've never really considered joining any of these lawsuits. My parents and I tend to look at the positive aspects of this unusual experience. Many people live their lives without knowing they have Factor V. Since it is genetic, we now know that at least one of my parents, and possibly my sister, is also affected. This information will allow my family to make informed medical decisions and take necessary precautions if any of us face serious illness or injury in the future.
I know that some day I will likely develop another clot, and this experience will be repeated. In the meantime, I will do what I can to minimize my risk. Besides the obvious, not taking medications that list blood clots as a possible side effect, staying active and not smoking are things that I can control. Avoiding situations, like car rides and airplane trips, where I have to sit in one place for too long is also recommend, but frustrating. Instead, I make sure to move around and stretch my legs frequently.
If, in the future, I develop another clot, I will once again find myself sitting in that same small, quiet waiting room, anticipating the nurse calling my name. Hopefully, when she does, I will feel more prepared for the situations ahead of me. And, if it happens, it would be great if I were closer to 90 years old.