This past spring, Justine Ezarik, known by her YouTube fans as iJustine, noticed her arm felt numb. It went away but soon returned. Then her arm became swollen and turned purple.
“I couldn’t even flex my arm because my bicep was so massive that it looked like I was so shredded from the gym — but it was just swollen,” Ezarik, 38, from Los Angeles, told TODAY. “I went to (an emergency clinic) and a nurse looked at it. She’s like, ‘We’re not equipped to handle that.’”
She visited a local emergency department for treatment and learned that deep vein thrombosis, a blood clot located in deep veins, caused her numb, swollen arm.
“I went from (being) perfectly fine to almost (dying) in the course of a few hours,” she said.
Numbness for a few days
During the last week of March, Ezarik noticed that her arm felt numb occasionally. As the week went on, it became worse, and then her arm swelled up and turned purple. When she arrived at the emergency room on April 1, she told staff she thought she had a blood clot.
“Upon first look at someone who’s young and seemingly healthy, they were just like, 'OK,’” she said.They admitted her to the hospital and started running tests. Ezarik had deep vein thrombosis, and there was a blood clot in her arm. She was prescribed high doses of blood thinners. Doctors wanted to admit her to another hospital better equipped to treat her clot, but transferring her became a challenge.
“They had to have an extra nurse there in the ambulance because of your risk (of bleeding too much) on blood thinners,” she said. “You have to be watched like a child.”
At the second hospital, she underwent a thrombectomy, which, for Ezarik's medical team, involved using a catheter to break up the clot to prevent it from moving to her heart or brain, which can be deadly.
“It basically was injecting the medication directly to the clot,” Ezarik said. “We had to do it twice.”
After the first thrombectomy, they kept Ezarik’s catheter in to make sure the clot broke apart, but it didn’t. So they performed it again.
“I was basically bedridden. I couldn’t move either of my arms because one had the catheter (and) the other had so many needles,” she said. “My sister was brushing my teeth and feeding me. I was basically in bed for four days without moving.”
It felt tough being immobile for so long, especially considering the day prior to her hospital visit, she had run seven miles.
“My body was not letting me be myself,” she said. “It was very very difficult.”
Despite the two thrombectomies, a part of the clot broke off and moved into her lungs, becoming a pulmonary embolism, which can block blood flow to the lungs and become life-threatening, according to Mayo Clinic. It was successfully treated with blood thinners.
“The clot is one thing that’s dangerous, but the aftereffects of that are also something to think about," Ezarik said.
When young people without known risk factors for blood clots, like Ezarik, experience them, doctors run tests to understand why. After some exams and tests, doctors diagnosed Ezarik with thoracic outlet syndrome, a condition where the blood vessels or nerves between the collarbone and the top rib bone are compressed, according to Mayo Clinic. Blood clots in the upper body are a common symptom.
“They found the rib is actually set in a way that it pinches the vein, and that’s what caused the clot to actually happen,” Ezarik said. “I do a lot of martial arts and also sword and lightsaber training, and there’s a lot of repetitive arm movements, like circular spinning. … Thoracic outlet syndrome is very common among athletes.”
Blood clots and thoracic outlet syndrome
Deep vein thrombosis is the most common type of blood clot, Dr. Jean Connors, a hematologist at Brigham and Women’s Hospital and Dana Farber Cancer Institute, who did not treat Ezarik, told TODAY. “When a younger patient does get a blood clot, they usually have some strong trigger factors that result in the formation of a clot.”
Various conditions, such as COVID-19 or an irregular heartbeat, can cause people to experience a blood clot, as can being immobile for an extended period, like on a long flight. Thoracic outlet syndrome is rare but often affects athletes, Connors said.
“The first rib under the collarbone can press on the veins,” Connors, also the spokesperson for the World Thrombosis Day on Oct. 13, said. As a result, “blood flow to the arms increases, (and) the muscles get swollen.”
Often, repetitive activities, such as rowing, swimming or swinging, can worsen the compression.
“We usually think of young athletes,” Connors said. “But it can happen if you’re constantly using your arm like that.”
After being treated for a clot, some patients with thoracic outlet syndrome need to undergo surgery. Doctors generally using imaging to see if the vein has narrowed or is scarred from the rib pressing against the vein, Connors explained. If so, using medications that prevent blood clots might not be enough.
“They remove the section of bone that’s pressing on the vessels so you do not get a recurrent blood clot,” Connors said. “You can imagine repetitively getting clots in that same area could be a chronic problem.”
If people notice swelling or deep pain in their arms, they might want to speak with a doctor, Connors said.
“Particularly for athletes or young people who are doing repetitive sports and an activity with repetitive arm motion ... they should be aware specifically of the fact that they can get a clot in their arm,” Connors said. “They should see a doctor promptly when they realize that they might have it.”
It’s been almost five months since Ezarik experienced her clot. Recovery was tough — especially at first.
“I rested as much as possible because the first three days my body felt so weird. Just standing up and walking, I was just very, very weak,” she said. “That first month I took it very easy.”
She started working out again slowly, lifting light weights and trying to run. But because some of the clot had made it into her lung, she felt winded easily. Ezarik is considering the surgery to remove part of her rib and what it might mean for her health. She’s shared her story to raise awareness of thrombosis and encourage people to get help if they feel unwell.
“I hate that this happened to me, but I’m so glad I have this platform to be able to let people know,” Ezarik said. “No one would ever think about blood clots until it happens to you.”