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Smoking, being overweight can increase risk for DVT

Tue., June 22, 2010, midnight

This past month a woman was seen in our clinic with a large blood clot in her leg. Such blood clots – also called DVT (deep venous thrombosis) are not unusual, but this one stuck in my mind because it seemed preventable.

The woman was in her 40s, and she smoked and took birth control pills that contained estrogen. She had recently been on a long plane flight shortly after she had undergone surgery. She came into the clinic with pain and swelling in one leg and shortness of breath.

The shortness of breath turned out to be because part of the blood clot in her leg had traveled to her lungs – this is called a pulmonary embolus (PE – blockage of blood flow to the lungs, which can damage the lungs or even cause death).

Other symptoms of pulmonary embolism can include sharp chest pain worsened by deep breathing, coughing up pink or foamy mucous and rapid heartbeat.

It was a pretty scary experience for her, and she will have to take a blood thinner (like heparin or Coumadin) for at least the next six months.

Surgery, smoking, not moving much after the surgery and during the plane flight, taking estrogen in the birth control pill and being older than 40, all put her at risk for the DVT. Other risk factors for DVT include:

•Cancer, some cancer treatments

•Varicose veins

•Heart attack, stroke, heart failure

•Pregnancy

•Being overweight

•Hormone replacements with estrogen

•Paralysis of a leg or arm

•Chronic swelling in the legs or arms

•A family history of a clotting disorder or blood clots.

This woman’s symptoms were pretty typical for a DVT, but some people do not have such clear symptoms. It is also possible for a DVT to happen in other places besides the legs.

In the area of the body where a person has a DVT, symptoms can include swelling, warmth, pain, tenderness and redness. When there are symptoms, they may only be present when the area is touched or when standing or walking, so DVT can be difficult to detect sometimes.

Some risk factors cannot be controlled. There is nothing anyone can do about being over 40, but there are other risk factors that can be changed.

I try not to tell anyone to stop traveling, but I did advise her that taking her trip so close in time to her surgery had not worked in her favor.

I also advised her to consider a low-estrogen or no-estrogen option for birth control (a good idea if you have other risk factors) and to stop smoking.

You can also reduce your risk of DVT by exercising. Improving the muscle tone in your legs can help to reduce the risk of a DVT by improving the blood flow in the legs.

It helps if you can lower your body mass index (BMI – a measurement based on your weight compared to your height).

Being overweight in the middle of your body can make poor blood flow from your legs even worse and put you at a higher risk for DVT.

If you have risk factors for a DVT, then you might want to take extra precautions when you are going to take a long flight or road trip. You could consider wearing compression stockings – talk with your health care provider about this.

Travelers (whether at risk or not) should try to get up and walk once every hour and while seated try to flex and point the feet every 20 minutes (like it shows you in those cute little videos on the plane). You should also drink lots of water and avoid alcohol and caffeine (which are dehydrating).

So keep planning that summertime family road trip across the country or that long flight to visit faraway relatives, but remember to keep hydrated and take every opportunity to get up and move around.

Now you have an excuse to stop, get out of the car, and see the world’s largest ball of twine that you usually just pass by on your way to Aunt Jenny’s house.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section. Send your questions and comments to drhideg@ghc.org.


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