Newspaper Page Text
PAGE 14, OCTOBER 27, 2008, THE ISLANDER
(News to Q-CeCv
The Best is Yet to Be
By Clark Gillespie M.D.,
Professor Emeritus, the University of Arkansas
Deep Vein Thrombosis - DVT
Deep vein thrombosis (blood clot
formation) is almost exclusively a leg
problem and also, like everything else
except memory, largely dwells in our
senior midst. The disorder produces
pain and swelling in the involved
limb(s) and is the culprit that brings on
such symptoms in the several hundred
thousand of us thus burdened each
year.
So, we need to look at this danger
ous disabler in somewhat more depth.
First, the blood vessel system that
we are here dealing with consists of
all the veins that drain blood from our
lower limbs. Drain is hardly the right
word since the returning blood actually
has to be pumped up the system by
our contracting leg muscles and by our
lower limb movements.
At any rate, internal venous valves
found throughout this system normal
ly help prevent reverse gravitational
downhill flow in such vessels. This
whole venous system is divided into
superficial and deep components and,
as well, into proximal (the upper leg,
really) and distal zones. The superfi
cial drainage veins are mainly those
that we can see (like it or not!) on the
surface of our legs, whilst the deep
arrangement consists of the larger bur
ied vessel system that gathers blood
from the superficial vessels.
Such gathering is protected from
the little clots that result from of this
superficial system’s banging around,
by very strong valves as each skin ves
sel dumps its blood into the deep veins.
The deep system is made up of large
veins - the iliac and femoral proximal-
ly, and the popliteal distally. Got it?
Clots that form in these deep veins
are fearsome in that they can break
loose, float north and cause deadly
pulmonary embolisms. Even when
remaining local, such venous occlu
sions will cause significant pain and
swelling in the affected limb.
Why, then, would clots form in
such veins - vessels which themselves,
unlike coronary vessels, are generally
healthy and intact? The instigating fac
tor appears to consist largely of lower
limb inactivity - sometimes unavoid
able, sometimes couch-potatoing. Let’s
look at all of the assigned contributors -
which, with the exception of pregnancy
- are likely senior instigators::
• Prolonged travel - long airline,
auto or train trips.
• Hospitalization - with or without
surgery.
• Trauma -significant injury to the
leg - with or without surgery or cast
ing.
• Pregnancy - including the early
post-delivery weeks.
• Obesity and continued inactivity.
• Certain medications and hor
mones.
• Smoking
• Genetics
• Certain cancers.
The absolute diagnosis of DVT -
although exceedingly important - has
until recently been very difficult and
painful to establish. There are, after
all, a million or more others amongst
us who have symptomatic swelling of
our lower extremities, and who do not
have DVT, and would enjoy confirma
tion of that fact.
Those of us DVT afflicted, however,
need a diagnosis and proper treatment
without delay. This is particularly true
when DVT takes place in the proximal
venous collecting system where dan
gerous clots form. Present day diagnos
tic procedures usually involve serial
2-point ultrasounds and D-dimer blood
testing.
The 2-point ultrasonography
involves visualization of the proximal
and distal venous systems, while D-
dimer testing chemically measures the
presence of active clot formation or dis
solution. Physicians now using these
available and non-invasive tests can,
with their serial use, demonstrate very
accurately, the presence or absence of
DVT in any vein.
The usual immediate treatment of
DVT involves the administration of
anti-coagulant blood thinners. Hepa
rin and warfarin are the drugs here
involved and their variable use is
closely monitored by our physicians
because they are very powerful and can
have significant side-effects such as the
increased risk of bleeding - anywhere.
The usual course of this anti-coagu
lant therapy is three to five months -
but it can vary. In unusual cases where
these drugs cannot be used, filtering
valves may be inserted into the main
lower abdominal vein which collects
all the returning blood from our legs.
In the long term treatment, support
hose to prevent leg swelling must be
worn for at least the on-coming twelve
months.
h lines and crows feet.
Finally, a pulmonary embolism is a
crushing, sometimes deadly event that
we all rightly fear, but is a very pos
sible complication of DVT.
When a clot breaks away from the
wall of a major leg vein, it is pumped
on up to the left side of our heart, is
propelled on to the right heart side
where it is promptly pumped out to
a pulmonary artery and into a lobe
of lung where it obstructs the lung
area supplied by that artery or branch
thereof.
To remain aware of its occlusive
signs is here fundamental. We would
look for sudden unexplained shortness
of breath, possibly some blood-tinged
sputum, chest pain that might resem
ble a heart attack, wheezing, excessive
sweating, anxiety and light-headed
ness. Any collection of these symptoms
requires immediate hospital care.
Again, DVT may sometimes involve
other body areas. Rarely, brain sub
stance may be so damaged. Here,
though, inactivity is not a causative
factor. If it were, we would have to close
many venerable institutions. □
Know the dangers and
causes of lead poisoning
in children
The Coastal Health District (CHD)
encourages parents and caregivers to
do all they can to keep children from
being exposed to lead.
Although lead poisoning is highly
preventable, more than 300,000 chil
dren in the United States have elevat
ed levels of lead in their blood. Lead
poisoning can cause learning disabili
ties such as Attention Deficit Hyper
activity Disorder, behavioral problems,
and hearing loss in children. Higher
levels of lead poisoning can result in
coma and even death.
All health departments within the
Coastal Health District have the abil
ity to check children for elevated levels
of lead and treatment is available. But
lead poisoning can be prevented. The
Centers for Disease Control recom
mends the following prevention tips:
• Damp-mop floors and damp-wipe
surfaces.
• Frequently wash a child’s hands,
pacifiers, and toys to reduce exposure
to lead.
• Use only cold water from the tap
for drinking, cooking, and for making
baby formula. Hot water is more likely
to contain higher levels of lead, and
most of the lead in household water
usually comes from the plumbing in
your house, not from the local water
supply.
• Avoid using home remedies (such
as azarcon, greta, pay-loo-ah) and cos
metics (such as kohl, alkohl) that con
tain lead.
Take basic steps to decrease your
exposure to lead (for example, by show
ering and changing clothes after finish
ing the task) if you remodel buildings
built before 1978 or if your work or hob
bies involve working with lead-based
products. For more information, go to
www.cdc.gov/environmental. □
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