Me? Yes, you! In a recent DK poll, over a third of the respondents or their near and dear had had a deep vein thrombosis (DVT). These are clots in the deeper veins, usually of the leg. Why worry? Because DVTs are the principal cause of pulmonary embolism (PE; clots in the lung).
But that doesn’t have to include you. DVT is “a common but elusive illness that can result in suffering and death if not recognized and treated effectively.” My goal here is to help you recognize a DVT or PE and to motivate you to seek treatment.
DVT is elusive because in its early presentation it is vague, almost nondescript. My first DVT began as intermittent pain in the calf that was relieved with lying down, raising the leg and taking ibuprofen. This persisted for two months until I sought help and found that a clot had formed for over a foot in my right leg. My second DVTs presented as a diffuse calf pain that I thought might have come from missing two sessions at the gym (it didn’t).
Others in the earlier diary described their symptoms as well:
Thea Lake: My only symptom was that my calf felt sore, somewhat as though I’d pulled a muscle or something, but I knew I hadn’t . . . I was mulling it over with a co-worker, and for whatever reason decided I should call my doctor. They got me in right away—she looked at it, then kind of pushed at it, then said she was going to send me down for an ultra-sound to just have a look. I was shocked.
Ginny in Co (with excellent prevention advice): I had my DVT in ‘08, just after the election. I had been sitting at the computer for a long time doing some research without drinking enough fluid or moving enough.
Sometimes, the only symptom of a DVT is the PE that split off from the DVT. This usually manifests as shortness of breath, sometimes with chest pain.
Kathy S: I don’t know where my blood clots started (probably in my calf), but they ended up in my lungs. One thing people need to know is that it isn’t always painful. My only symptom was extreme shortness of breath. Took an MRI to diagnose.
Timaeus: Yes, that was my experience. No local pain. But EXTREME shortness of breath and INCREDIBLE heart-pounding after walking 50 feet.
Sometimes, the first symptom of the PE is death:
Meteor Blades: When I had my two pulmonary embolisms in 2004 (and flat-lined for 90 seconds), I did some reading and learned that about a third of the people who get embolisms find out about it when they drop dead. Mine were not the product of thickened blood but a trauma (I slipped and fell, causing a very large bruise on my thigh), but I was still on anti-coagulants for five months. Take care.
Some of you probably know the mnemonic for stroke, STRoke: Smile is asymmetric, Talking is garbled or fuzzy, Raised arms are uneven. Since I couldn’t find a similar mnemonic for DVT, I’ve made one. Any one of these three signs should get your attention!
- Deep, dull (sometimes sharp) pain, usually in the calf or higher in the leg. DVTs can also occur in the arm more rarely.
- Violet or red color to the leg (or arm). It may be continuous or mottled.
- Tense, swollen leg. When clots develop over time, the blocked circulation can lead to swelling of the leg, sometimes increasing it dramatically over the opposite leg.
If you suspect you or someone else has a DVT, have it checked out. Neglecting it can cost you the limb or your life. Fortunately today there is much that can be done to treat a DVT.
Treating DVT and PE
The key step in treatment is to stop further clotting. This usually means an injection of fast acting anticoagulant, usually Lovenox, a fractionated heparin. The injections continue until long term anticoagulation is in place. Coumadin (warfarin) is the usual first round of protection, but it takes several days to be fully effective. It acts to block Vitamin K, a dietary cofactor needed to make some of the clotting proteins. Less often, one of the newer anticoagulants like Xarelto are used. These don’t need ongoing blood tests and dietary discipline, but they are more expensive and until recently had no easy way to be reversed if a bleeding episode happened.
When I had my first DVT in 2009, it was thought that newly diagnosed DVT should be treated with bed rest to avoid shedding clots and causing a PE. Good research has reversed that and walking is encouraged now as soon as anticoagulation is in place.
The more serious DVTs can be actively removed. The use of drugs to dissolve the clot and intravenous devices to ream it out mean that the graver ones can be reduced more quickly than the body can acting by itself.
DVT in the old days was a dire diagnosis. The continuing process of clotting kept splitting off clots putting people at risk of PE. Nowadays the risk is much lower so it is well worthwhile to seek out treatment.
Preventing DVT
Prevention is always better than cure! From Ginny in Co’s comment, linked above:
Highlights. Stay hydrated with non caffeinated fluids. Pee should be medium to light yellow — not dark. Pain, if any, will most likely be back of the calf. Move your legs, especially when sitting more than 90 minutes — earlier is fine. Move the toes towards the head and then point them away — think walking speed. This stimulates the muscle pumps in the legs to move the blood back to the trunk. No constricting sock or nylon tops , if any, around the calf. If you need or prefer high top, use the kind with a broad band that doesn’t create swelling below it. If you have swelling in the feet and calves at the end of the day,elevate the legs above your heart at night.
If you have pain when pulling the toes to your head, if could be an early DVT sign. Think if there is anything you did that might have injured the muscle. Homan’s sign had fallen down in the probable signs when I had mine. But my doctor’s PA sent me for the ultra sound and there it was.
Walking is for this, like so many conditions, a sovereign preventative. The muscles in the calves move so much blood when we walk that they function as a second heart, pumping nearly as much blood as the heart itself does. Move it, move it!
Oral or other estrogen contraceptives carry a risk of DVT. Young women taking them or those who care about them should be ready to act if there is calf pain that continues. Our daughter ended up with a clot from knee to groin, about the thickness of a sausage. Mercifully she came through but some young women don’t.
I’ve said it before, but I’ll say it again:
They’re nothing to fool with — anyone who suspects a clot should get it checked pronto.