Vascular Insights Issued #2

MARCH 2011

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ISSUE 0002

VASCULAR INSIGHTS A QUARTERLY NEWSLETTER OF VASCULAR ASSOCIATES, LLC

DEEP VEIN THROMBOSIS AND LYMPHEDEMA

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Vascular Associates Welcomes a New Face!

IN THIS ISSUE Preventing DVT....................... pg.2

Vascular Associates, LLC, would like to introduce Mrs. Jennifer Clark, PA-C, MPAS to the practice.

Did You Know.......................... pg.3

Jennifer is happily married to Greg Clark, and has two children; 11 year old stepson Griffen and 14 month old daughter Ayla. She grew up in Colorado and Kansas and after almost 11 years in the military they are very much looking forward to planting their roots in Panama City. Jennifer is an avid runner, training in fact for the Seaside half marathon.

She enjoys golfing and spending time with friends and family, and continues to have a passion for supporting our troops at home and abroad. She is a member of the American Academy of Physician Assistants and the Florida Academy of Physician Assistants.

Lymphedema.......................... pg.5

DVT Can Strike Anywhere...... pg.4

DVT is Treatable...................... pg.6

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1836 Florida Avenue, Panama City, FL 32405 Phone: 850-872-8510 • Fax: 850-872-7412 www.ArteryandVeins.com

Famous Faces who have experienced a DVT

Take Steps to prevent

D.V.T. Former Vice-President Dick Cheney March 2007

Preventing deep vein thrombosis, or DVT -- the formation of a blood clot in a deep vein -- is vital.

That’s because the blood clot, which usually forms in a calf or thigh muscle, can partly or completely block blood flow and damage valves in blood vessels. It can also break free and travel through your blood to major organs, such as your lungs -which can be fatal.

DVT Prevention: Healthy Lifestyle and Regular Checkups To lower your risk and help prevent DVT, take these steps:

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• • NBC Journalist David Bloom April 6, 2003 *see article on page 4

• • •

Maintain an active lifestyle and exercise regularly -- daily, if possible. Walking, swimming, and bicycling are all great activities.

Manage your weight with exercise as well as a healthy diet.

If you smoke, quit. Nicotine therapy (in patches, gums, or sprays) and support groups can make this much easier to do.

Get your blood pressure checked regularly; take steps to lower it, if necessary.

Report any family or personal history of blood-clotting problems to your doctor.

Discuss alternatives to birth control pills or hormone-replacement therapy with your doctor.

During pregnancy, ask your doctor what you can do to help prevent DVT.

Preventing DVT After Surgery or While Bedridden

ESPN Reporter Bonnie Bernstein October 2006

2

Your DVT risk may begin with becoming immobile and continue for several months following surgery. However, in some cases, your risk is greatest right after surgery and about 10 days afterward.

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Researchers continue to look at the best ways to prevent DVT after surgery. For example, some studies show that using regional anesthesia instead of general anesthesia, when possible, can decrease your DVT risk.

Here are other measures your doctor may suggest to help prevent DVT:

•

• • • • •

Take any blood thinners (anticoagulants) your doctor prescribes before or right after surgery. These may include aspirin, heparin, or warfarin. You may receive some of these by injection or intravenously (IV).

Wear a sleeve-like device on your legs during surgery to compress your legs and keep blood flowing through your veins.

Wear elastic compression stockings.

These keep blood from pooling in your veins.

Elevate the foot of your bed.

Get up and move as soon as you can after surgery, or after you’ve been ill.

Take pain medicine as prescribed to make it easier to move around.

Also to prevent DVT, do any leg exercises your doctor or other health care provider prescribes.

These may include leg lifts and gentle foot and ankle exercises.

Reference: http://www.webmd.com

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periods ofinactivity, such as sitting on a long haul flight.

Tips for a Safe Flight: When flying, it’s important to take steps to avoid developing Deep Vein Thrombosis, commonly known as DVT, a potentially fatal condition which can occur after long periods of inactivity, like sitting on a long haul flight. In the United States, figures indicate that one in 100 people who develop DVT die, but the good news, DVT can be easy to prevent through simple precautions like wearing compression stockings, exercising during a flight, and drinking plenty of water. Read on to find out more about how to have a safe and healthy flight and prevent DVT.

1. Wear graduated compression socks - Health

professionals recommend that those particularly at risk of developing DVT, such as people with high blood pressure, elderly and overweight people, pregnant women, or people with an illness or a history of DVT, wear stockings with graduated compression to aid with circulation in the legs while flying.

Graduated compression stockings work by exerting pressure around the ankles, and the pressure gradually decreases as it goes up, to get the blood flowing and circulating - they’re very different from ordinary support socks - with even pressure throughout the leg-- , which can actually cut off your circulation.

When choosing compression stockings, get measured properly so that your stockings are the best fit for your legs.

2. Exercise on the plane - You don’t have to run up

with Compression Stockings and down the aisles of the cabin in your compression stockings, because that would be unsafe, but do take a walk to the front or back of the plane every hour or so and do some stretches while you’re waiting for the restroom. While it’s tempting to get as much rest as possible on a long haul flight, it can be dangerous to sit or lie in the same scrunched up position for hours on end, especially if you’re particularly at risk of developing DVT. When you’re in your sitting in your seat, do some exercises - wiggle your feet and toes around, flex your legs, and lift your knees.

3. Wear loose clothing - You don’t just wear compression stockings and loose clothing on long haul flights because it’s comfortable, you wear it to keep your blood circulating. So forget about looking fashionable on your flight and ditch your skinny jeans and cowboy boots in favor of track suits with loose elastic waist bands and put your feet in socks, slippers or lightweight shoes.

4. Drink lots of water

- In addition to wearing compression stockings, it’s important to drink plenty of water and non-alcoholic drinks because dehydration can result in thickening of the blood, which can cause blood vessels to narrow and clot. Avoid tea, coffee and alcohol which can cause dehydration.

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3

DVT Can Strike Anywhere His wife’s response when she was told of his death was not surprising, “What? He died of what?”

Article by Bud Shuler, MD., FACS

In the early spring of 2003, NBC journalist David Bloom accepted a dangerous assignment away from the comfort of the Weekend Today desk where he served as co-anchor, to become an embedded journalist with the U.S. Third Infantry Division as Operation Iraqi Freedom began. Then, suddenly, he died, not as a casualty of the expected wartime threats, but rather due to a deep vein thrombosis (DVT) and a pulmonary embolism (PE).

He was 39 years old and left behind a wife and three daughters.

His wife’s response when she was told of his death was not surprising, “What? He died of what?” Since that time his wife, Melanie Bloom, has become a vocal advocate and a national spokeswoman for the Coalition to Prevent DVT. Like many people, blood clots in the deep veins of the legs, is not often a common Thanksgiving table discussion, but unfortunately DVT’s affect up to 2 million Americans each year. Aside from the swollen painful limb, the possibility of the blood clot leaving the leg and traveling into the lungs (PE) occurs in approximately 600,000 people a year with up to 300,000 dying from the event. And if one happens to survive the blood clot restricting the flow of blood to the lungs, significant breathing and heart problems can lead to a severely disabled life. In addition, 20% people will develop ulcers around their ankles within the first 2 years if not treated properly. Considerably more people die each year from PE than from breast cancer and AIDS combined.

So why the disconnect? David Bloom was vigorous and healthy. He had spent a year training with the Army and led an active life. But Mr. Bloom was cramped in a tank for days, dehydrated in the desert, and was later determined to have an inherited disorder that increase his risk for developing blood clots. He had complained of “leg cramps” for a few days before he died, but he was on the battlefield. Everyone “hurt” somewhere.

DVT and PE are considered a silent epidemic. The diagnosis can be difficult and many people have no symptoms. Although dubbed “economy class syndrome” in the 1970’s, it is non-discriminatory. No one is immune, old or young, male or female, but risk factors can alert one to its possibility and aid in its prevention. Immobility causing stasis of blood in the legs, and damaged veins such as varicose veins can lead to development of clot formation. Obesity, heart failure, and pregnancy also increase the pooling of blood in the legs. In addition, “thickened” blood from an inherited or acquired disorder, medications such as hormone replacement and some birth control pills, cancer, and dehydration also increase the risk. Signs and symptoms of DVT often include swollen, reddened, warm, or painful leg, especially after a prolonged trip, sedentary period, or injury. PE can lead to shortness of breath, chest pain, and 4

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coughing up blood. If you think that you may have symptoms of DVT or PE, you should see your doctor or go to the emergency room.

Diagnosis usually involves an ultrasound, and outpatient treatment without hospitalization is usually possible. However, the key is prevention. This is even more important with the upcoming holidays and season change, due to the long drives to Grandma’s house, the cramped flights and prolonged layovers, and colder weather leading to less outdoor activity. Avoiding immobility with increased exercise, frequent stops during long trips to get out of the car to walk around, walking the aisles on longer flights helps keep the blood from clotting. Drinking plenty of nonalcoholic, non-caffeinated beverages helps to hydrate the body. Using gravity to prevent swelling results from simple elevation of the legs when possible, and the use of knee-high compression stocking/socks will minimize the risks.

In an attempt to turn the tide on this relatively preventable disease, the Surgeon General of the United States, Steven Galson, M.D., M.P.H., in 2008, enacted a “Call to Action” to increase awareness within the medical and lay communities. I also highly recommend visiting the website, www.preventdvt.org, to read more. So spread the word, be active, drink water, and wear compression. Being aware could save your life, or the life of someone you love.

Lymphedema: Article by: Clark Stream, PA-C

The Epidemic that no one Talks About What is lymphedema?

Lymphedema is swelling that is caused by damage to the lymphatic system resulting in an accumulation of fluid in the tissues under the skin. The word lymphedema is broken down into 2 words; Lymph, a colorless to milky colored fluid in your body and Edema, which means swelling. Most often the swelling is in the arm(s) and/or leg(s).

Types of Lymphedema (2 types)

Primary lymphedema occurs without any known precipitating cause, and is due to inadequate or non-functional lymphatic vessels.

Secondary lymphedema is precipitated by an event causing blockage or interruption of the lymphatic vessels. In the United States the most common causes are surgery involving the lymph nodes, radiation therapy, trauma, and cancer. It is most often seen following surgery for cancer of the breast, pelvic area, and resections for lymphomas and melanomas.

Signs and Symptoms of Lymphedema

Extremities with lymphedema develop a chronic inflammatory condition stemming from the accumulation of fluid, resulting in fibrosis (hardening) of the tissues. As lymphedema progresses, mobility can be severely impaired and joint movement often becomes restricted and painful. This unhealthy state often leads to recurrent infections because the high protein lymph fluid is a good growth media for bacteria and fungi. Each subsequent infection can further damage the already impaired lymphatic system

Treatment for lymphedema

The aim of treatment is to increase function by preventing further progression of the swelling. Treatment should begin as soon as lymphedema has been diagnosed by your physician, with a certified lymphedema therapist. Treatment can be effective even for people who have had lymphedema for many years.

Components of treatment:

The best and most effective treatment for lymph edema is Complete Decongestive Therapy (CDT). It involves the following: 1. Manual Lymphatic Drainage (MLD) is a gentle manual technique to move the fluid out of the affected area.

2. Compression Therapy: Compression bandaging is an essential component of lymph edema management to decrease the excess fluid, and help to soften the tissues. After treatment, a compression garment can help maintain results.

3. Exercising according to recommended CDT protocols can help stimulate the lymphatic system and get the fluid moving.

4. Meticulous Skin and Nail Care for the affected limb is crucial to keep skin healthy and protect against infections.

5. Good Nutrition and plenty of water is important. Eat lots of fresh fruits and vegetables. Controlling weight is essential because being overweight can make the condition worse.

The LIVESTRONG foundation started by seven-time Tour de France winner Lance Armstrong announced its endorsement of H.R. 4662, the Lymphedema Diagnosis and Treatment Cost Saving Act of 2010 introduced by Congressman Larry Kissell (NC-08). This bill will require Medicare to offer fair treatment coverage for Americans afflicted with primary and secondary lymphedema. The National Lymphedema Network has called lymphedema “the epidemic no one ta ks about.” For further information you can look online at www.lymphnet.org or search on Facebook, “Lymphedema in the News.”

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5

DVT is Preventable and Treatable Article by Candice Dunlap, RVT

Deep Vein Thrombosis, or DVT, is a life threatening condition that occurs in approximately two million Americans each year. DVT is when a blood clot forms in one of the large veins of the deep venous system, most commonly in the lower limbs. The primary and most dangerous complication of DVT is a pulmonary embolism or PE. A pulmonary embolism (PE) occurs when a segment of clotted blood (most commonly from the lower extremities) breaks loose, and travels toward the heart through the circulatory system. This clot can then become lodged in the artery that carries blood from the heart to the lungs (pulmonary artery), causing a severe dysfunction in respiratory function.

More people die in the United States from a PE than from breast cancer and AIDS combined.

Some of the biggest risk factors for DVT include sitting for long periods of time such as when driving or flying; inheriting a blood-clotting disorder, cancer, Injury or surgery, pregnancy, oral contraceptives or hormone therapy, obesity and smoking.

Symptoms for DVT may include, but are not limited to; swelling, pain, redness, skin discoloration or skin that is warm to the touch. Most healthy, active individuals are at low risk of developing DVT, but it can happen. Be aware of the risk factors and also aware that over time, your risk factors can

change. Assess your risk on a regular basis, and if you observe anything suspicious, speak with your healthcare provider right away.

In the diagnosis of DVT your healthcare provider will take into account your specific symptoms and risk factors, and frequently will order some type of diagnostic or objective testing such as an ultrasound and/or blood work. An ultrasound is a non invasive and painless way to image veins for DVT. A wand-like device (transducer) is placed over the part of your body that is in question. As sound waves travel through your tissue with the help of gel, they will reflect back a moving image on a video screen. An ultrasound technologist can then image the venous system where clot may be visible if the patient is positive for a DVT. Sometimes a series of ultrasounds are done over several days to determine whether a blood clot is extending, and also to be sure a new one hasn’t developed.

The good news is that DVT is preventable and treatable.

DVT treatment options include blood thinners, clot busters, filters and compression stockings. With March being DVT awareness month, we encourage you to stay active and have a conversation with your healthcare professional about reducing your risk for developing a DVT.