Blood clots—they seem to hit many, many people!
Pregnancy is one time we see blood clots develop in young women. Pregnancy is quite a significant risk factor.
Hate to say it, but if you are not pregnant, or just rolled your ATV, and you just get a blood clot out of the blue–we are going to be looking you over really carefully–it is sometimes the first sign of existant, or soon to be cancer—or a clotting disorder! If you are over 50–it is quite worrisome!
Since a clot in the leg can be fatal if it goes to your lungs–it is really important that testing is done quite quickly to see if you have a clot (typically above the knee is what we are worried about).
If we can get a ‘doppler (way of looking at blood flow) ultrasound’ quickly, that is a great test–but sometimes there is no technician on (you know –that after hours thing), and we have to treat you as if you DO have a blood clot until we can get the test done. This is considered a reasonable approach across North America.
In people who have reasons not to go on a blood thinner–say–you just had brain surgery, or you have a history of bleeding from your stomach–then you need testing done ASAP!
There are risk factors for blood clots:
IMMOBILITY Hey, I know one lady who broke her toe—her toe! She had a foot cast on, and kept working AND walking–but got a clot—she wasn’t moving her FOOT!
I am fanatic about moving when you are traveling—dance in the car(seat dancing), lift your butt, bend your knees, get out and walk around the car and do a few knee bends–MORE THAN EVERY TWO HOURS—do something every 10 minutes!!! I have seen young people in their teens and twenties, who just landed after say a trans-Atlantic plane trip–and get a clot in their leg that goes to their lung!!! That “trip of a lifetime” could cost you your life!
People who are in wheelchairs are also at risk as they are sitting the vast majority of the time. wheeling yourself around with your arms doesn’t prevent a clot forming in your legs!
EPIDURALS on pregnant women
Pregnant women getting epidurals are often forgotten about–yet they can lay immobile for hours and hours—not moving. I order that when blood pressure is checked every 15 minutes, that the patient bend and move her legs and, if she can’t, then order electronic leg stockings that pump up and down to prevent clots!
Any surgery to the pelvis–C. Section, hysterectomy, hip replacement, knee surgery, CANCER surgery (requires weeks of blood thinners post op), any surgery over 30 minutes. Your risk is higher if you have additional risk factors such as smoking, obesity, heart failure, an abnormal clotting gene, history of cancer etc. ASK YOUR DOCTOR IF YOU ARE A CANDIDATE FOR BLOOD THINNER AS A PREVENTION MEASURE.
YOU HAVE A GENE or condition that makes you more likely to clot
oral/ring or patch conraceptive-(birth control )–moreso if you are over 35 and smoke–or if you have a family history of abnormal clotting gene.
INFECTION–particularly if infection gets into the blood stream. There is more and more data suggesting that if you are in the hospital being treated for sepsis (that’s the medical term for bacteria is swimming in your blood stream and you are pretty darn sick!), then you should probably be on a blood thinner too! Speak with your doctor about this.
CANCER –About 20% of cancer patients get a blood clot–and the vast majority know that they have cancer then get a blood clot. If you have just been diagnosed with cancer, ask your doctor about using blood thinners!! A high-risk time is when you actually start chemotherapy.
SO YOU HAVE TO GIVE YOURSELF A NEEDLE EVERY DAY?
I am always seeing people who give themselves daily shots,, and tend to stick to the same spot–nobody has ever told them to ROTATE the injections sites.
I have a lovely patient who agreed to me marking up her belly with a grid–just to show you a way you can do it–or come up with your own design–a spiral, bicycle spoke–whatever–just MOVE AROUND. The same could be said for insulin shots.
That scar you see under her belly button is from where a filter had to be put in her vena cava–the big blood vessel that runs in your belly. This was done to prevent more blood clots going to her lungs and killing her!
So–we are getting more active about putting people on blood thinners when they are having surgery. Pretty well every case over 30 minutes!
If you are pregnant, and have a history of a blood clot you will be on a blood thinner while you are pregnant, and for several weeks after you deliver.
All C. Sections get pumping devices on their legs AND a blood thinner and, if you are quite a bit overweight, this can be done after a VAGINAL birth also! I continue blood clot prevention after the baby is out until you are walking out of the hospital. If your BMIputs you in the fluffy range then ask your doctor about blood thinners after you deliver.
AFTER THE BABY!
Just in case nobody told you–your legs will likely be MORE swollen AFTER the birth than before–so bring some big slippers to go home in!
If you are at home, and you notice that one of your legs is giving you grief–it is aching or hurting–to the point that you are commenting on it–you need to come in and get checked for a blood clot. I don’t want to hear you’re ‘too busy’ or you’ll ‘be in tonight’–get here while the ultrasound tech is working!–before 2 pm–we can quickly check for a clot. Otherwise you’ll be getting a needle and staying overnight to wait for the test.
If you do have a clot–you are started on meds to reduce risk of clot getting bigger or doing damage. Clots in leg can go to your lung–and that is bad news!! I’m talking you can die-bad!!! So if you are worried enough to call –you just need to come into the hospital!
So—that is an overview of blood clots. Pretty well everyone I know knows somebody who has had a blood clot–very common. Don’t hesitate to bring up this topic with your doctor–get involved with your health care.