Be aware of DVT and travel safely this summer

Summer may be BBQ season, but it’s also the time when people travel long distances in planes, trains, and automobiles. For us in vein healthcare, that means increased risks of Deep Vein Thombosis, or DVT.

The deep vein system carries about 80% of blood from the feet back up to the heart. Deep veins are located under the muscle and connective tissue layers in the legs. A blood clot in a deep vein can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. The DVT could then travel up through the legs into another part of the body such as the lungs, where it would become a pulmonary embolism (PE).

DVT or PE symptoms are often misinterpreted as something less serious. A blood clot in the leg may feel like a “charley horse,” shin splints, or a twisted ankle. Symptoms from PE are often attributed to a pulled muscle in the chest, costochondritis (inflammation of the joint between ribs and breast bone), asthma, or a “touch of pneumonia.”

So what are some of the signs to look for? For DVT, the leg may be warm to the touch; swelling in the leg (can also occur in the arm); leg (or arm) pain or tenderness; reddish or bluish skin discoloration.

For PE, be aware of a sudden shortness of breath; sharp, stabbing chest pain (may get worse with deep breath); rapid heart rate or breathing; feeling lightheaded or fainting; unexplained coughing, sometimes with bloody mucus.

In half of DVT and PE cases, no symptoms present at all—but both conditions are medical emergencies. Any of these symptoms should be regarded as a DVT or PE until proven otherwise, especially if someone is in a risk category (including whether there is a history of blood clots in your family).

Awareness is key-- and so is prevention. When traveling long distances, stay well hydrated, stretch legs your legs and pump your feet periodically, avoid or moderate alcohol and caffeine, and consider wearing graduated compression stockings on your trip.

To find out more about DVT and other vein issues, contact us at the Vein Healthcare Center. We will evaluate your vein health — including spider veins, varicose veins, and leg ulcers.

March is Blood Clot Awareness Month

Have you heard of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE)? Maybe you're more familiar with the term blood clots. 

Thousands of lives are lost each year to preventable blood clots, so during Blood Clot Awareness Month -- and throughout the year -- many in the medical community, including Dr. Cindy Asbjornsen, help to spread the word about this common condition. 

Know your risk

The first and most important thing you can do to protect yourself is to learn if you are at risk. 

People being treated for cancer, hospitalized with COVID-19, or getting hip or knee replacements are all at greater risk for developing blood clots. But did you know that even athletes may have increased risk factors too?

Read this risk checklist to learn more.

Signs and symptoms

Common symptoms of a blood clot in the leg or arm (also known as Deep Vein Thrombosis or DVT) include swelling, pain or tenderness (not caused by injury), redness or discoloration of the skin, or skin that is warm to the touch.

Symptoms of a blood clot in the lungs (also known as a Pulmonary Embolism or PE) include difficulty breathing, chest pain that gets worse when you breathe deep or lie down, coughing or coughing up blood, or a heartbeat that's irregular or faster than normal. 

If you experience any signs or symptoms of blood clots, don't ignore them! Let your doctor know, or seek medical attention right away.

Prevention

The good news about blood clots is that they are preventable. Once you consider your risk factors and learn the signs and symptoms, then take a look at your family history. If you learn that there is a history of blood clots in your family, tell your doctor and let other family members know. 

One important way to prevent blood clots is to not be immobile for too long. If you're confined to a bed either in a hospital or at home (especially following hip or knee surgery), talk to your doctor about your options for blood clot prevention. And if you've been sitting for a long time, including in a car or plane seat, get up and move! Stand up, stretch your legs, and try to take a brief walk every couple of hours. Try this simple exercise to keep the blood flowing.

Treatment

If you do develop blood clots, your physician can help you navigate the best treatment choices for your specific situation. Anticoagulants, or so-called "blood thinners," are commonly prescribed. (Note that these medications don't actually "thin" the blood; what they do is slow the body's ability to form new clots and stop existing clots from getting bigger.

Other treatment options can include compression stockings, thrombolytic therapy, and vena cava filters. You can learn more about blood clot treatment here. 

Be aware of DVT and travel safely this summer

Summer may be BBQ season, but it’s also the time when people travel long distances in planes, trains, and automobiles. For us in vein healthcare, that means increased risks of Deep Vein Thombosis, or DVT.

The deep vein system carries about 80% of blood from the feet back up to the heart. Deep veins are located under the muscle and connective tissue layers in the legs. A blood clot in a deep vein can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. The DVT could then travel up through the legs into another part of the body such as the lungs, where it would become a pulmonary embolism (PE).

DVT or PE symptoms are often misinterpreted as something less serious. A blood clot in the leg may feel like a “charley horse,” shin splints, or a twisted ankle. Symptoms from PE are often attributed to a pulled muscle in the chest, costochondritis (inflammation of the joint between ribs and breast bone), asthma, or a “touch of pneumonia.”

So what are some of the signs to look for? For DVT, the leg may be warm to the touch; swelling in the leg (can also occur in the arm); leg (or arm) pain or tenderness; reddish or bluish skin discoloration.

For PE, be aware of a sudden shortness of breath; sharp, stabbing chest pain (may get worse with deep breath); rapid heart rate or breathing; feeling lightheaded or fainting; unexplained coughing, sometimes with bloody mucus.

In half of DVT and PE cases, no symptoms present at all—but both conditions are medical emergencies. Any of these symptoms should be regarded as a DVT or PE until proven otherwise, especially if someone is in a risk category (including whether there is a history of blood clots in your family).

Awareness is key-- and so is prevention. When traveling long distances, stay well hydrated, stretch legs your legs and pump your feet periodically, avoid or moderate alcohol and caffeine, and consider wearing graduated compression stockings on your trip.

To find out more about DVT and other vein issues, contact us at the Vein Healthcare Center. We will evaluate your vein health — including spider veins, varicose veins, and leg ulcers.

Are graduated compression stockings the same as TED hose?

In a word: no. TED hose are not the same as graduated compression stockings. There are many people who do not realize there is a difference.

T.E.D. is an acronym for Thrombo Embolic Deterrent, so T.E.D. hose are "anti-embolic" stockings. They are often worn after surgery to help prevent Deep Vein Thrombosis -- also known as DVT. They work well for this purpose, but they are only 8-15mmHg of compression. As soon as someone is out of bed post surgery and is able to stand, there is more pressure on the veins and the TED hose become much less effective. 

TED hose do not help with the symptoms of venous disease, nor do they halt the progression of venous disease.   

A graduated compression stocking prescribed for chronic superficial venous insufficiency is generally 20-30 mmHg, which means there is approximately 30mmHg of pressure at the ankle, 25 mmHg in the mid-calf, 20 around the knee, 15mmHg in the lower thigh, 10 mmHg in the mid thigh, and 5 mmHg in the upper thigh. This graduation encourages good venous return. Another difference is that, in general, compression stockings are much more tolerable to wear on a daily basis. 

Though compression stockings are much easier to put on than TED hose, they can still be difficult to put on. So if you are prescribed to wear either compression stockings or TED hose, ask your provider for tips -- or even coaching -- for how to put them on and take them off. (That's called "donning" and "doffing" in the compression business.) There are lots of online resources to guide you.

If you have any questions about compression therapy or T.E.D. hose, contact us at the Vein Healthcare Center. We're here to help!

Preventing phlebitis

In our last post, we explained phlebitis, when a vein in the superficial vein system becomes inflamed or swollen. In this post we talk about prevention.

Dr. Cindy Asbjornsen advises that all the things that prevent DVT (deep vein thrombosis) also keep phlebitis at bay:

If you’re interested in learning more about the topic of phlebitis, you can read about it in our current issue of Vein Health News.

Do you have other questions? Give us a call, or email us, at the Vein Healthcare Center.

What is phlebitis?

Phlebitis happens when a vein in the superficial vein system becomes inflamed and swollen. (It is also referred to as superficial phlebitis.) Spontaneous phlebitis happens when there is a sudden onset of vein inflammation.

Three out of 10 patients may develop spontaneous phlebitis after endovenous laser ablation (EVLA) therapy, but it is very preventable, especially if patients follow the post-procedure guidelines closely.

Post-operative requirements include wearing prescribed graduated compression stockings and walking at least 30 minutes a day. If a patient does experience pain or swelling, he or she should apply heat to the area (NEVER ice), elevate the legs, and take a non-steroidal anti-inflammatory drug, such as ibuprofen or naproxen.

If phlebitis does occur and is not treated in its early stages, thrombophlebitis, or the formation of a blood clot associated with phlebitis, can develop. It is important to note that both phlebitis and thrombophlebitis are common conditions that both occur in the superficial vein system, not the deep vein system. (A blood clot in the deep vein system is called a deep vein thrombosis, or DVT.)

In our next post we will talk about how to prevent phlebitis. Contact us at the Vein Healthcare Center if you have any questions about phlebitis or would like to schedule an appointment.

Dr. Cindy Asbjornsen on Catching Health

Earlier this spring, our own Dr. Cindy Asbjornsen spoke with health reporter Diane Atwood on her podcast on the Catching Health blog.

Their topics of conversation were far ranging, everything from how a clot in the deep vein system could possibly cause a stroke, to why blood appears blue in the veins.

Dr. Asbjornsen also explains why vein treatment is NOT a one-size-fits-all proposition. And she talks about how anyone can get deep vein thrombosis -- even someone playing a video game (for many hours in a row). Who knew talking about veins could be so interesting?

This isn't the first time Dr. Asbjornsen has appeared on Catching Health. She wrote a guest post on Catching Health about when you should ask your doctor about your vein problems.

We hope you'll give the Catching Health podcast a listen!

Click here to learn more about Dr. Asbjornsen and her practice the Vein Healthcare Center.

Know Thrombosis: Blood clot awareness campaign returns

On October 13th it will once again be World Thrombosis Day, an opportunity for the general public and health professionals to learn about venous thromboembolism, or VTE. (October 13th is also the birthday of Rudolf Virchow, the German physician who pioneered the pathophysiology of thrombosis.)

We’ve talked a lot about DVT (deep vein thrombosis), PE (pulmonary embolism) and VTE, but it’s always helpful to learn more. For example, did you know that VTE is the leading cause of preventable hospital death, ahead of infection and pneumonia?

Take a look at the infographic below, and seek out more resources at the World Thrombosis Day site – including questions to ask your healthcare professional, risk factors for VTE, and your rights as a patient with regard to VTE.

Athletes and blood clots

In our last post we told you about World Thrombosis Day, and before that we talked about the effect of athletic activity on veins. Now we take a look at the topic of athletes and deep vein thrombosis, or DVT.

Deep veins are located under the muscle and connective tissue layers in the legs. A blood clot in a deep vein—known as deep vein thrombosis, or DVT—can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. The DVT could then travel up through the legs into another part of the body such as the lungs, where it would become a pulmonary embolism (PE).

           

DVT or PE symptoms are often misinterpreted as something less serious. A blood clot in the leg may feel like a “Charlie horse,” shin splints, or a twisted ankle. Symptoms from PE are often attributed to a pulled muscle in the chest, asthma, or a “touch of pneumonia.”

           

In half of DVT and PE cases, no symptoms present at all—but both conditions are medical emergencies. Any of these symptoms should be regarded as a DVT or PE until proven otherwise, especially if someone is in a risk category (including whether there is a history of blood clots in your family).

Remember, being active and fit does not prevent someone from developing blood clots. Athletes, coaches, and trainers should be aware of these risk factors:

·       Traveling long distances to and from a sports competition

·       Dehydration (during and after a strenuous sporting event)

·       Significant trauma

·       Immobilization (in a brace or cast)

·       Bone fracture or major surgery

·       Family history of DVT or PE

·       Presence of an inherited or acquired clotting disorder

Treatment of blood clots depends on many variables, including your health background and the extent and location of the clot. And, of course, prevention is the best medicine. Go to our latest issue of Vein Health News to learn more.

World Thrombosis Day – October 13th

Last year we told readers about the first World Thrombosis Day. The effort continues this year with the second annual WTD scheduled to take place on October 13th (the birthday of Rudolf Virchow, the German physician who pioneered the pathophysiology of thrombosis).

The goal of this educational campaign is to raise awareness about blood clots and to reduce the number of undiagnosed cases. Community events, lectures, health fairs, and scientific meetings will help spread the word around the world about this preventable condition.

Here’s a quick review of thromboses, a.k.a. blood clots. A blood clot in a deep vein is known as deep vein thrombosis, or DVT. DVT can be dangerous because the high pressure in the system could cause the clot to break free from the vein wall and enter the blood stream. When that happens the DVT becomes a venous thromboembolism, or VTE. The embolism (a blood clot that has “broken free”) could then travel up through the legs, back to the heart and then to the lungs where it blocks some or all of the blood supply to the lungs. This is called a pulmonary embolism, or PE, and it can often be fatal.

To learn more about this common—and commonly overlooked—medical condition, go to www.worldthrombosisday.org. There you’ll find facts about VTE, as well as personal stories of blood clot survivors and their families.

Running on all cylinders

This Saturday the Vein Healthcare Center is co-sponsoring the South Portland MAINEiacs first-ever 5K run, just around the corner from the VHC offices!

We’ve had running, exercise, and athletes on our mind lately, as our latest issue of Vein Health News is hot off the press. In our cover story package, we look at how exercise affects veins (and vice versa); whether athletic compression is worth considering; and how even athletes could be affected by DVT.

Click here to read more about athletes and veins. And get out and enjoy a walk or run in the increasingly crisp autumn air!

Preventing leg ulcers

It's not easy to live with leg ulcers. Open wounds can be painful, difficult to heal, and the likelihood of recurrence is significant. But prevention is possible.

One warning sign that you may be developing a venous ulcer is noticeable skin changes in the lower legs, such as dryness or thickening. Another sign of ulceration may be discoloration of the legs, typically dark red, purplish, or a brown, woody appearance. Other possible indications are aches or pains in the legs, especially when standing or sitting for prolonged periods.

Varicose veins are another possible warning sign. Varicose veins, as with any form of venous disease, are often hereditary. If you have varicose veins—or a family history of varicose veins— consider getting evaluated and treated for them before they lead to ulceration.

Risk factors for venous ulcers include older age, a history of deep vein thrombosis (DVT), venous insufficiency, and previous ulcers or leg injury. Though you can’t change your genetics, you can modify other things. If you have a job where you’re on your feet all day, wear graduated compression stockings.

There is often a misconception among patients and physicians alike that there is nothing you can do for venous ulcers. The fact is wound care specialists use a variety of modalities to heal patients’ wounds, including aggressive compression therapy, skin grafting and “low-tech” therapies like elevation.

It is important to remember that although wound care specialists can treat and even heal wounds, unless the underlying cause is addressed, it will only reoccur. If the wound is identified as a venous ulcer, then treating the incompetent vein valves that contribute to venous ulcers is key for lasting results.

Experts agree that the earlier the intervention and treatment, the better chance a wound has to heal and stay closed. And, of course, patients with venous ulcers are best managed by a multi-disciplinary team of primary care physicians, wound care centers, and professionals who specialize in venous care.

World Thrombosis Day

October 13, 2014 is the first-ever World Thrombosis Day, a chance for people around the world to learn a little about what's more commonly known as "blood clots."

For a quick review on blood clots--what they are, how to spot them, and how to stop them--check out this article in the Bangor Daily News by Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center.

Dr. Asbjornsen also wrote a guest post for Diane Atwood's popular health blog Catching Health. There, you can learn about this man:

And listen to this conversation with Dr. Asbjornsen and two of her colleagues, on an episode of Maine Calling from earlier this year: "Advances in Treating and Detecting Blood Clots."

Finally, go to the World Thrombosis Day website to get all the facts. Reducing your risk begins by educating yourself.

The foot pump

Is “the foot pump” a new dance all the kids are doing? No, it has something to do with veins, of course! Namely, making sure the circulation in your legs is working properly.

As summer draws to a close, many people are returning from vacation, driving in their cars, or hopping a long flight home. In order to prevent deep vein thrombosis (known as DVT), try the foot pump, in the car or on the plane.

It’s a simple toe-tap exercise: tap your feet for a minute or two, going back and forth between heels and toes. This squeezes the deep veins in the legs and forces the blood to circulate through the leg. It also feels good after sitting for a long period of time. Do the foot pump (on each foot) every half-hour or so.

Also, don’t forget to stay hydrated, preferably with water. And try to take a brief walk in the airplane aisles (or at the rest stop) occasionally to keep the blood flowing.  

Life after DVT

The goal for treatment of DVT is to prevent the blood clot from getting bigger and breaking loose, as well as to reduce the chances of another DVT (about one-third of DVT patients will have a recurrence within 10 years). Treatment can include anticoagulation medications (blood thinners) and graduated compression stockings. 

Among people who have had a DVT, one-third experience something called post-thrombotic syndrome, or PTS. Symptoms of PTS include swelling, redness, chronic leg pain, and ulcers. PTS can be expensive to treat and the pain and discomfort it causes can make it extremely difficult for people to get around.

Those with DVT should wear graduated compression stockings on a daily basis, since several studies strongly suggest that they can significantly reduce the likelihood of developing PTS. In fact, according to the American College of Chest Physicians, wearing compression stockings for two years following DVT reduces the incidence of post-thrombotic syndrome by half.

Unlike insufficiency in the superficial venous system, there is no FDA-approved treatment for PTS besides compression stockings and supportive care. 

Of course the best way to prevent PTS is to never have a blood clot in the first place. If you think you might have a DVT, get to the emergency room as soon as you can. In most cases, the affected area— usually in the leg— will be painful, swollen or tender, with a redness or discoloration of the skin. Even a muscle cramp that feels especially sharp and painful can be an indication of DVT. Early detection can go a long way toward preserving your quality of life-- or even saving your life.

Education, of course, is key to preventing this very common disease. Here are a few resources where you can learn more:

• http://www.StopTheClot.org
• http://www.PreventDVT.org
• http://www.ThisIsSerious.org
• http://www.CDC.gov/features/thrombosis

How compression can help-- and help prevent-- DVT

In addition to managing both acute and chronic DVT, compression can be a tool for prevention. When there are risk factors for DVT, such as long distance car or plane travel, immobility, or pregnancy, wearing compression stockings can reduce its occurrence. 

What do we mean by compression? Graduated compression stockings provide a gradient of pressure against the leg. The pressure is highest at the foot and ankle and gradually decreases as the garment rises up the leg. This pressure gradient makes it easier for the body to pump blood up towards the heart (the normal direction) and more difficult for gravity to pull blood downward.

Compression stockings require a prescription and can be purchased at many pharmacies, most major medical supply stores, and specialty stores. Your doctor can tell you if you need knee-highs, thigh-highs, or a “pantyhose” style. 

These days, compression stockings are fashionable, comfortable, and come in a wide variety of styles and colors. Though modern compression stockings usually look like socks or tights, putting them on can be a challenge. 

It’s important to note that “TED hose”— the “anti-embolic" stockings that are often worn after surgery to help prevent DVT— are not the same as graduated compression stockings. TED hose work well for patients who are bed bound, but won’t offer much benefit to patients who are up and walking.

There are many benefits to using graduated compression therapy besides reduced risk factors for DVT, but be sure to consult your physician first. Compression is not appropriate for all patients and can actually have adverse affects on patients with peripheral arterial disease.

To learn more about DVT, read our previous posts.

DVT: symptoms to look for and step toward prevention

Last week we described what DVT is and who is at the greatest risk for getting one. Now let's look at the most common symptoms to watch out for.

In most cases, the affected area-- usually in the leg-- will be painful, swollen or tender, with a redness or discoloration of the skin. Even a muscle cramp that feels especially sharp and painful can be an indication of DVT. DVT is a medical emergency, so any symptoms should be regarded as a DVT until proven otherwise, especially if someone is in a risk category. 

It's important to note that about half of the time, DVT has no symptoms at all.

The good news is that DVT can be prevented! And because DVT can occur with little or no warning, the best action to take is prevention. Without preventive treatment, for example, up to 60 percent of patients who undergo total hip replacement surgery may develop DVT. 

The Centers for Disease Control and Prevention (CDC) recommends the following tips for DVT prevention: 

• Understand your level of risk, and talk to your doctor about DVT, especially if you're in a high-risk group.
• Maintain a healthy weight, eat a healthy diet and don’t smoke.
• Exercise regularly.
• Move around as soon as possible after surgery, illness or injury. Even passive movement helps.
• When traveling or sitting for more than four hours get up and walk around every few hours and exercise legs while sitting.
• Drink plenty of water and avoid alcohol or caffeine.

To find out more about DVT symptoms and prevention, go to www.stoptheclot.org.

March is DVT Awareness Month

More than 1,240 Mainers succumb to DVT- (deep vein thrombosis) and PE-related (pulmonary embolism) deaths every year, according to the Mayo Clinic. And this estimate is likely on the low side.

In fact, the annual mortality rate of blood clots is greater than yearly deaths in the U.S. from breast cancer, AIDS and automobile accidents combined. Though most people know about these issues, DVT is still under-recognized. 

March is DVT and Blood Clot Awareness Month. It's a chance for the medical community to educate the public about a medical condition that affects approximately two million Americans annually.

All month long we'll be taking a closer look at DVT: what it is, who is at risk, and what you can do to prevent ever getting one.

So what is DVT? Deep vein thrombosis (DVT) is a blood clot in the deep vein system. The danger is that the clot could break free from the vein wall and enter into the blood stream. The clot could then travel to the lungs and become a PE (pulmonary embolism), or to the brain and result in a stroke. DVT-related PE is the leading cause of preventable death in U.S. hospitals.

Anyone can get a DVT and at any age. Certain groups, however are at a greater risk of developing a life-threatening blood clot. 

• Those with prolonged immobility or no mobility, like patients in the hospital or on bed rest, or long-distance travelers (so-called “economy class syndrome”)
• People with blood-clotting issues, like those with a genetic disorder, or cancer patients undergoing surgical procedures
• Patients with damage to their vein walls because of surgery or injury
• Pregnant women are more susceptible to DVT because of hormonal changes
• Seniors 

This is, by no means, a complete list of risks, and it's important to remember that risk factors can be compounded. For example, combining an existing blood clot disorder with immobility can dramatically raise the risk of deep vein thrombosis.

Having risk factors does not mean that you will surely get a DVT-- rather, you should be proactive about prevention.

Take this month to learn more about DVT, take an online risk assessment, and ask your physician if you may be at risk.