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!

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.

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.

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.

Should You Be Worried About “Economy Class Syndrome”?

Concerns about blood clots as a result of Deep Vein Thrombosis (DVT) increase during summer travel season. Blood clots can be dangerous, even fatal – but they can be prevented.

It’s the height of the summer and for many, July marks the beginning of travel season. It’s the time spent en route to vacation destinations that lead to concerns about “economy class syndrome,” a term used to describe leg symptoms that can occur as a result of long periods of immobility.

These extended periods of immobility can be associated with deep vein thrombosis, or DVT, a blood clot in the deep vein system. DVT can be cause for concern because the clot could break free from the vein wall and enter into the blood stream, traveling to the lungs and become a PE (pulmonary embolism), or to the brain and result in a stroke.

Though a familiar term to many, “economy class syndrome,” is actually a misnomer. DVT can occur in a plane, train or automobile, regardless of what class you’re sitting in. The point is that prolonged immobility can slow down circulation and lead to blood pooling in the legs, which significantly increases the risk of DVT.


Prevent DVT During Summer Travel

If you’re planning to go on a long flight (or road trip, for that matter), you can minimize the risk of DVT. First, stay hydrated. Then, make a point of walking in the aisles (or at the rest stop) occasionally. Finally, periodically do simple toe-tap exercises – that means tapping the feet for a minute or two, going back and forth between heels and toes. This “foot pump” squeezes the deep veins in the legs, forcing the blood to circulate.

By increasing mobility and making healthy blood flow a priority while you travel, you can help keep blood clots at bay this summer – and any time of year.

Are you at risk for DVT? Visit the Vein Healthcare Center to learn about the risks and steps toward prevention.

The Centers of Disease Control and Prevention also offers more information about Deep Vein Thrombosis and its symptoms and risk factors.

DVT Awareness: Reality Check

Mortality Rates For Blood Clots Are Startling. But How Focused Are We On Awareness?  

In the past decade, breast cancer awareness campaigns have grown to include their own merchandise and
even a signature color. The general public seems highly educated about this issue and that’s a good thing. But did you know that the number of deaths from blood clots in the U.S. exceeds the number of deaths from what we consider some our biggest killers?

Studies show that in the United States and United Kingdom, VTEs (Venous Thromboembolisms) kill more people than AIDS, breast cancer, prostate cancer and traffic accidents combined. A study by the Mayo Clinic estimates that more than one thousand Mainers die as a result of blood clots every year (a figure that is likely on the low side).

According to recent federal research published in the Journal of the American Medical Association, it is estimated that venous thromboembolism (deep vein thrombosis and pulmonary embolisms collectively) costs the U.S. hospital system more than $340 million per year.

Our Efforts Are Making a Difference

• In 2003, more than 50 organizations assembled in Washington, DC, to discuss the need to make DVT a national public health priority. This gathering resulted in the establishment of the Coalition to Prevent DVT, which declared March as DVT Awareness Month. Their efforts included encouraging DVT screenings, producing an educational video with mobility tips and exercises, and customizing an RV to visit hospitals and communities across the country. 

• Here in Maine, then-Governor John Baldacci, proclaimed November 2008 as “Thrombosis Awareness Month" in the state.  

• The mission of the National Blood Clot Association (NBCA), also founded in 2003, is to educate people about the danger, prevention, and treatment of blood clots and clotting disorders, and DVT awareness is a cornerstone of its work.

• In 2009, the NBCA received two program grants totaling $2.6 million over five years from the Centers for Disease Control and Prevention. These funds support programs directed at curbing the devastating effects caused each year to over 350,000 Americans who develop a blood clot. 

Because of the efforts of these and other patient-led and professional advocacy groups, public awareness of DVT and blood clots is increasing, but it hasn’t yet reached the level of ubiquity that breast cancer awareness has.

Learn More About DVT Prevention 

If you are a patient, ask your physician about DVT prevention, or make an appointment with a vein specialist to learn about your risk and prevention techniques. Or, find out more from the following online resources:

StopTheClot.org – from The National Blood Clot Alliance
PreventDVT.org – created by Coalition to Prevent Deep-Vein Thrombosis
OneBreath.org – from The CHEST Foundation of the ACCP
ThisIsSerious.org – information about women and DVT

Are you a Physician?

Primary care doctors are on the front lines of reducing the growing number of people suffering with symptoms of venous disease.  Vein Health News serves as a resource for well-researched meaningful information that you can pass on to your patients.

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Blood Clots Can Strike Long-distance Travelers, Patients on Bed Rest

Phlebologist Shares Prevention Techniques to Prevent Deadly Clots  

Deep vein thrombosis affects approximately 2 million Americans every year. What can you do to prevent DVT?

“The goals are to prevent the blood clot from getting bigger and breaking loose and to reduce the chances of another clot,” said Dr. Cindy Asbjornsen.

Dr. Asbjornsen is a nationally recognized vein specialist, member of the American College of Phlebology, and a board certified Phlebologist. She is the founder of the Vein Healthcare Center in South Portland and the Maine Phlebology Association. This month, which is DVT Awareness Month, Dr. Asbjornsen shared prevention techniques with the Bangor Daily News.

Recommendations include moving as soon as possible after an illness or injury, getting up to walk during travel or periods of sitting for more than four hours, and pumping your feet during times when you are on bed rest. Read more Dangerous Blood Clots Can Strike.

DVT is a serious, life-threatening condition that requires immediate medical care but it can be prevented. Find out more about DVT. 

DVT Dangers: Are You At Risk of a Blood Clot?

March is DVT Awareness Month, A Time to Learn About Your Risk

Two million Americans suffer from blood clots every year. In fact, more Americans die of DVT and PE each year than die from breast cancer, AIDS and automobile accidents combined. But what is it and why is it so dangerous?

What is DVT? 

Deep vein thrombosis (DVT), is a blood clot in the deep vein system. The danger of DVT 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. Learn more about how DVT and PE put your health at risk.

Who’s at Risk? 

Many factors contribute to DVT risk, including age, inherited blood clotting disorders, certain medications, or vein injuries. Sitting in a confined space or traveling for long periods can also increase the risk of DVT. There are a number of risk assessment quizzes available online at sites such as StoptheClot.org and PreventDVT.org.

What are the Symptoms?

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. About half of the time, DVT has no symptoms at all.


DVT Awareness Month: Learn About Your Risk In March

March is DVT Awareness Month, The perfect time for everyone to find out their level of risk, and talk to someone on their medical team, especially if they’re in a high-risk group.

Find out more about yours DVT Risk Factors, symptoms and ways to prevent DVT at the Centers for Disease Control and Prevention.

Do you have questions about DVT, venous disease and its treatment? Find out more by visiting Vein Healthcare Center.