DVT – DEEP VEIN THROMBOSIS – POTENTIAL SILENT KILLER – planes, trains, and surgeries

YEARS AGO, MY FATHER RETURNED AFTER SEEING MY GRANDFATHER,  FROM THE SMALL HOSPITAL IN THE LITTLE TOWN IN MIN-NEE-SOOO-TAH.

My grandfather had been in the hospital after a minor surgery.  Remember years ago, even small procedures were done in the hospital by the general practitioners or early surgeons and patients were held in the hospital for days.  Just shortly after my father returned from seeing his father, our telephone rang.  I remember seeing his face change and his voice quiver slightly.  But dad was a strong man.  He said to all of us, a big family, and my mother, that grandpa had "some trouble" and that he needed to go to the hospital right away.  Only, not just dad went, but mom went hurriedly along also.  Grandpa died that few moments between my dad seeing him, and returning home, about 5-10 minutes.  Grandpa died of a pulmonary embolism, a clot in the lungs that travelled from his leg, after that small procedure.  Certainly a sudden and quick death, a reality that still exists these days.

Deep vein clot (thrombosis) is a relatively common, and a very serious potential disease.  We see those patients in the emergency room, immediate care, and certainly worry about many more.  The mortality and further injury (morbidity) from clots in the legs is not in the leg!  The risk occurs from associated lung clots (pulmonary embolism) and a rare condition of post-clot syndrom (post-thrombotic syndrome). 

There is not one specific symptom or sign that clinches the diagnosis.  The elderly have rates of DVTs in the 200/100,000 range while younger people have rates of about 50 per 100K.  The clots occur in the higher deep veins of the legs, or from extension of clots in the lower legs – even though this risk is lesser.  When clots in the lower leg veins extend, the risk of lung clots goes up.  The problem with DVTs creating the lung clot (PE) is that symptoms can range from sudden death to minimal at all symptoms.

In a doctor I knew, his clot formed during a long airplane ride and he lived.  In my grandpa's case as told by my father, it was sudden death.

Risks for developing DVTs in the leg veins are:

conditions:  cancer, pregnancy, blood disorders, kidney disorders, estrogens, and smoking

stagnant movement:  surgery, immobility, paralysis, obesity, extended travel

other:  previous DVT or PE increases risk, and trauma increases risk.

If patients have any two or more of these, they really become at risk.  Symptoms that patients can feel or see are: swelling of the leg compared to the other side, calf swelling, localized tenderness of the calf or leg, new pain or numbness in the leg.  There are other causes of these same symptoms, therefore you should see a doctor without hesitation.

Your doctor will most likely go through the above lists with you.  But your doctor will be concerned.  Lab tests will be drawn most likely and an ultrasound of your leg will be ordered stat.  Usually if both of these are negative, the cause is not a clot.  If the ultrasound is positive, you will begin treatment.  If the blood test is positive and the ultrasound is negative, you will probably have a repeat ultrasound in about a week.

Treatment consists of starting the pill, warfarin, for "thinning the blood."  But this takes days for the body to change.  Therefore, almost all patients will need to use injections of a heparin substance that "thins" the blood quickly.  Usually, patients will need to be on heparin medicine for 5 days or so, or at least until the pill warfarin reaches a therapeutic level in your bloodstream. 

Patients will need to use compression stockings during this time and after the event to minimize risk of recurrence of DVT.  These stockings also help prevent the post-thrombotic syndrome of pain, swelling, inflammation that can become a chronic condition. 

Risk of recurrence never goes away.  That is why proper treatment and post-event planning is so important.  Expect to be on medicine for 3-12 months after a DVT or PE.  Risk reduction knowledge goes a long way. 

TALK WITH YOUR DOCTOR ABOUT CONCERNS AND PREVENTION.  Bye

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