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DVTs-What are they and can we prevent them?

December 2, 2009

Happy Holidays and welcome to the our newest blog entry on a potentially life- threating entity. DVT stands for deep vein thrombosis and it can happen to almost anyone.
It can be self-limited or it may progress to cause other serious problems. It can present with minimal symptoms like calf pain or foot swelling or more dramatically with total leg pain, swelling and discoloration. If the DVT travels to your lungs; chest pain, shortness of breath or passing out may be present. The people who are particularly at high risk are those patients who tend to have inherited or acquired propensity to be clot formers. The risks for DVT formation increases with age especially for the elderly over age 60. These include people with inherited abnormalities in the process of normal clot formation. Typically parents or grandparents or siblings may have the same disorders. Treatment for these individuals may require compression stockings, frequent ambulation or even daily medication (blood thinners) to decrease the chances of forming new or additional unwanted clots.

Increase acquired risks for forming DVTs may include pregnant patients, patients on birth control pill, clot forming syndromes associated with certain types of cancers, trauma patients, patients with recent surgery especially total knee and hip replacement, bedridden hospitalized patients, and patients who recently experienced long plane or car trips. These patients may form DVTs days or weeks after exposure to such events.

Prevention, high index of suspicion and early diagnosis is of course the best way to minimize the potential serious consequences of DVTs. Proper diagnosis should begin with a full medical history, comprehensive ultrasound exam, specific blood lab tests, and if indicated specific CT or MRI scans of lungs and perhaps pelvic vessels. If the clot travels to the lungs it is called a pulmonary embolus and it poses a true life-threatening problem. Although occassionaly diagnosed in a vein specialist’s office, once confirmed follow-up testing and treatment should begin immediately at your nearest hospital. Treatment may include both injectable and oral blood thinners, compression stockings, daily ambulation and depending on the location of the clot, and perhaps early minimally invasive technigues to break the DVT down. This new approach is not done at all hospitals, but if a clot is less than 2 weeks old, early treatment may help prevent many future problems with recurrent leg pain and DVT formation. Please remember the earlier the proper diagnosis is made the better your chances of surviving such a event. Do not ignore any of the early symptoms as they may help to save you or a loved one’s life.


Varicose Veins-Why me & why now?

October 16, 2009

Many patients who develop spider or varicose veins often don’t understand why this happens to them. Often they try to correlate new vein outbreaks to a region of local trauma near a large vein or standing too long on their feet. The truth about the vast majority of vein problems does not relate to trauma, always working out, never exercising, high heel shoes or too much sun exposure. Venous disease most frequently is heritary in nature. Typically your parents or grandparents had similar issues that were transferred to you. Other risk factors that may increase the frequency or severity of your vein probems include morbid obesity, # of pregnancies,
birth control pill, hormone replacement therapy, and even crossing your legs.

Today, most vein problems can be well manage by a vein specialist with minimally invasive techniques. Most vein problems fall into 2 large areas. Those that receive flow only from surface vessels and those that have deep feeder vessels that often supply most of the blood to what you see on the skin surface. A complete duplex ultrasound exam is the only true method to figure out what type of vein problem you may have in your legs. Without this exam, the physician is blindly guessing and treating you veins. The results will be far inferior without an accurate initial ultrasound exam.

Future vein outbreaks can not be eliminated by any physician no matter how talented they may be at treating venous disease. Yearly evaluations and annual treatments can help control new outbreaks. Since we can not currently change your DNA, your risk factors will always be present. However, similar to annual dental teeth cleaning, annual vein exams can very successfully keep your legs looking and feeling well. Frequent new outbreaks or treatment failures are often due to inaccurate initial evaluation and treatment plan. If you avoid pregnancy, obesity, leg crossing, HRT or birth control pill you can perhaps decrease the frequency of new outbreaks, but ultimately you heritary will be the final decision maker on who developes new vein issues.

Pregnancy & Vein Treatment

September 2, 2009

HIgh risk pregnancy specialist Submitted on 2009/09/01 at 4:29am
I have several pregnant patients who complain about painful varicose veins which have gotten worse during their pregnancy. Conservative measures – stockings, bedrest – have not appreciably improved their condition. Is sclerotheraphy or laser ablation safe and effective in pregnancy?
Author Comment In Response To
Author Comment In Response To
veindoc Submitted on 2009/09/01 at 2:44pm
In general elective vein therapy, both scelerotherapy and endovenous laser, is avoided until approximately 3 months post delivery. This relates to the increase of clot forming during pregnancy and early postpartum. We certainly will evaluate pregnant patients with vascular ultrasound exams and rule out clots, phlebitis and inform patient what may need to be treated in the future. Much of the pregnancy related increase of surface spider and blue green reticular veins will regress quickly postpartum. Documented venous insufficiency of the main veins of the superficial venous system(greater & small saphenous veins) usually will require treatment in the future. Pregnant patients with vein related bleeding can be treated with elevation, compression, and rarely ligation performed with local anesthesia.

The good news for subsequent pregancies in patients with severe vein related pain and venous insufficiency is endovenous thermal ablation. The somewhat dated approach of suffering with leg vein pain until you are done having children now has better alternatives. In the past, the high recurrence rate & permanent leg scarring of surgical stripping and ligation made enduring multiple pregnancies with severe vein related leg pain very common. However, less invasive techniques with much lower recurrence and no downtime, make endovenous thermal ablation a truly viable option. It should be done electively between pregnancies. We have treated many patients who have benefited with minimal or no leg pain in future pregnancies.
Finally, for mothers who are breast feeding, sclerotherapy and endovenous laser can be safely done. For sclerotherapy a conservative approach is to pump prior to procedure and discard breast milk for perhaps 24 hours so as not impart a taste issue.
Thanks very much for your query.

Varicose vein treatment can improve your circulation.

August 28, 2009

Coincidently, 3 patients today all asked the very same question as to what effect vein treatment would have on their circulation. The simple answer requires a basic understanding of the structure of the human circulatory system. 2 main divisions exist-oxygenated blood travels thru arteries away from the heart to cells. Deoxygenated blood returns to the heart thru veins. Disease states like diabetes or smoking can lead to narrowed arteries compromising nutrients and oxygen to cells. This is one form of “poor arterial circulation”. Varicose veins and sometimes foot swelling is often a venous form of poor circulation. Inflammation and back pressure can lead to blood traveling down your leg instead of returning back towards the heart. By eliminating these diseased vessels other normal veins with normal valve function can help to return venous blood in the proper direction. So patients with lower leg swelling can often benefit greatly by having treatment of their damage veins and thus improve some of their venous circulation. Deep vein clots, pregnancy, heart disease, and other disease states must be ruled out or treated properly prior to simply eliminating diseased varicose veins to fully improve vein circulation. A complete medical history and physical plus a venous ultrasound exam is the best initial screening prior to having any vein treatment.

Welcome to VeinChat!

August 26, 2009

Welcome to VeinChat! This forum will hopefully provide a home for both patients and healthcare providers to discuss issues related to modern vein care. Everything from simple cosmetic spider veins to complex recurrent varicose veins are perfect for this blog. Leg pain, venous and arterial circulation, DVT’s, endovenous laser treatment, pitfalls of surgical stripping and ligation, and recent advances in the field will be discussed. What type of physicians treat venous disease, are they board certified, can you ever be cured, does insurance cover my treatment and did pregnancy cause my veiny legs will all be discussed. Patient’s questions or experiences and physician input is wholeheartedly welcomed.

Disclaimer for Veinchat blog. Veinchat, Nicholas Hyde, MD, and Elite Vein Specialists (EVS) are providing an on-line discussion blog on the internet for the purpose of education, communication, and information and accepts no liability relative to the contents, accuracy, and use of these opinions. We are not responsible, nor do we exert responsibility, editorial or other control over the contents of the links to the other Internet sites, messages or materials posted by any third party. Veinchat and its partners disclaim and and all liability for injury and or other damages which result from an individual using techniques discussed/presented on the Internet, whether these claims are asserted by a physician or any other person. The material discussed is not intended to represent the only or necessarily the best method of treatment for any particular individual or situation. Dr. Hyde’s best advice is to consult in person to a qualified MD who specializes in vein disease prior to committing to any clinical intervention.