HEALTH-DIET-EXERCISE – Page 3

DRUGS IN WORKPLACE – BIGGER CONCERN THAN YOU MIGHT THINK – ARE YOUR COMPANY POLICIES IN PLACE?

Peto DRUGS IN WORKPLACE – ARE YOU TRYING TO SKIRT THE ISSUE?

A month or so ago the Feds released their workplace data regarding use of drugs while on duty in various jobs and employments. These are the newest data compared to previous studies in mid-nineties.

Industries that continue to have high rates of on the job drug use and use of drugs are those industries in general that continue to have high job turnover rates.

Illicit drug usage among the 18-64 year olds working full-time was the highest in food service and accommodation industry, construction work, entertainment and arts, information services, and management support companies.

http://schottremovals.co.uk/testimonials/ The highest rate was 16.9 percent of the food and accommodation employees used illicit drugs in the last month, in the survey.

Construction workers and miners had the highest heavy use alcohol rates at 17.8 percent. Even CEO’s rate was at 8 percent for heavy alcohol usage.

Marijuana continues to lead the pack on illicit drug use for these surveys.

Over 12 percent of the illicit drug users had three or more employers in the past year! Current drug users had twice the rate of missing one or more days in the last month.

Increased rates of illicit drug use were seen in men and lesser paid jobs.

About half of the full-time workers report that their company does pre-placement drug testing. Protective services had the highest rate (76%) of this type of testing, while legal occupations had the lowest (14%) reported in the study.

Only one-third of the workers reported random drug testing policies by their employers.

ONLY one-third of the workers reported they would be less likely to work for companies with random testing programs in place.

NO DIVING IN LAKES OR RIVERS – “FEET FIRST” PRETTY PLEASE

Over the many years as an Emergency Physician working with trauma and teaching, many patients have presented by ambulance and private car with water diving injuries.

This summer there have been injuries related to diving into the lakes and rivers.

Years ago, not sure if it still is going, was a program I believe by the Neurosurgeons College called “Feet First.” This program tried to educate parents and kids on the value of not diving into water in the lakes and rivers.

A few years ago, going up the Spokane River, I heard a boat literally rip its outdrive off by a “deadhead.” Imagine if that boat would have let the occupants dive in that area “to cool off” only hitting the submerged log.

When a person dives into the water, all the force is decelerated, into the skull onto the brain. But more importantly, the cervical spine “the neck” gets flexed or extended quite rapidly and dramatically. Then as the flexion or extension is exaggerated, the force (weight) of the body from the height of the dive is literally driven into the spinal vertebrae. This force is so great it can fracture (break) the neck, rupture the ligaments that hold them in place, and dramatically injure – even push bone fragments into the spinal cord itself. Thus, paraplegia or quadriplegia ensues….never to walk or move again!

Facial injuries of jaw fractures, nasal fractures, lost teeth, eye injures and even skull fractures, as well as lacerations of all of the above-do occur. Head injury is commom.

Risk of drowning is high when these injuries occur. Risk of additional injury is high as “helpers” try to get the victim out of the water…in a “layperson” way…without EMS techniques or even lifeguard techniques.

These are just plain sad cases. So preventable. So life options limiting. So challenging for the victim, their family, their friends, and their doctors. Can you imagine how hard it is to hear, “Your child is paralyzed.”

So castMD says:

NO DIVING IN RIVERS OR LAKES

FEET FIRST IS THE RULE!

HEAD INJURY – WHY NOT WEAR THE HELMET

Recently, during a Fourth of July parade, many bikers, cyclists, gymnasts, cheerleaders, rollerskaters, Shriners’ clowns, speed-skaters, and even horseriders were watched with such intensity…and were applauded for their acts, high flying or racing speed. BUT……..Why not wear a helmet?

Some states have passed and then repealed helmet laws. There has been some emphasis on kids with bicycles to wear helmets, and some push to wear helmets during down-hill skiing. BUT…..Why not wear the helmet always?

Is it a personal right NOT to wear a helmet? Is it a business right then for taxpayers, insurers, employers, disability companies and worker comp programs to refuse coverage retrospectively for such injuries and morbidity when someone does NOT wear a helmet? What about a seat-belt? What about smoking, drinking, obesity, and lack of exercise? Sounds far fetched?

Well, back to the parade…..

The Emergency Departments see generally over 2 million head trauma victims annually in the United States. It is the leading cause of death in persons under 25 years old, with over 50,000 persons dying yearly from head injury.

Head injury crosses all boundaries of socio-economics, ethnicity, financial burden, and coverage. Just ask the attorney that fell from the bus he was watching a parade from…a little too much partying possibly…Ask his wife who was unrecognized by this smart man after hitting his head. Life as it was…over…New rules, new learning, new start – ALL difficult to say the least. Career, family, dreams, and hopes all snuffed due to the head injury.

Some patients have intra-cranial bleeding from their head injury, which is about 5-10%. This means there is bleeding either in the brain itself, or around the brain under the skull. Each of the types of bleeding is extremely serious. Some do not need surgery, while other types of head injury with bleeding inside the skull require immediate life-saving procedures and surgeries.

High risk groups for “closed” (no external injury) head injury that need a CT scan, which now is the standard, are kids under 6 months, elderly, persistent vomiting, neurological or mental changes, alcohol abuse or overuse, prolonged loss of consciousness and those on blood thinners. The medical legal world has driven the doctors to scan more often defensively, even with minor head injury. This has been pushed by successful litigation for what appears minor, only later to be a significant injury.

Even the NFL has now taken up the banner. It is evident now that boxers and football players with repeated or recurrent head injuries have shown brain disability later in life. Most of the athletic associations understand now that head injury, even minor, is not to be taken lightly. Even many of the “rough and tough” rodeo cowboys now wear helmets with the rodeo association. The bronco-busters are leading the pro charge.

So what’s up with the ultimate boxing and cage fighting until loss of consciousness? Should insurers, payors, and hospitals be forced to insure these programs and their victims?

Long term complications of concussion, (which ranges from a confusion with loss of consciousness to complete coma) are many. Memory difficulties exist, and may stay persistent. Dizziness, a general feeling of weakness or lack of energy may continue for months to years. Headache is common, as well as a problem of focusing on projects or things that require intense thought. Amnesia, or ability to remember is certainly a problem many victims of head injury encounter. This retrograde (backwards) memory loss can be devastating. Thus the attorney’s wife….sobbing….and wondering….

Generally there are three classes of initial head injury in evaluation and prognosis. They are: mild, moderate, and severe. This category is really of doctor’s category based on an initial scoring designed by Glascow.

castMD in a previous post discussed more about head injury. Please see the following link if you wish to read more about concussion and sports.

http://www.castmd.com/?p=93

But head injury is a very serious matter…So teach your kids to wear their helmets by wearing yours. Consider the no helmet-no activity rule for this.

As for what the future will bring for insurance coverage for dangerous behavior regarding helmets is still up in the air…..but many insurance companies require a rider or no insurance coverage for trampolines now…..too many broken necks and spinal cord injuries!

I remember the little boy as he was lying there. Absolutely beautiful 4 year old. Unconscious. Comatose. Scheduled for long-term care preparation and surgeries. No sign of external injury. “Just a closed head injury…..”

“SICKO” – WILL IT HELP MAKE THE DIAGNOSIS AND TREATMENT?

AFTER LISTENING THIS PAST FEW DAYS TO SOME NEWS, CASTMD FIGURED THE SYSTEM IS TOO BROKEN NOT TO COMMENT. MIKE MOORE’S DOCUDRAMA OF THE U.S. HEALTHCARE SYSTEM IS AT LEAST A STARTING POINT…AGAIN….

A FRIEND OF MINE SAVED A PATIENT’S LIFE. IN SURGERY, THE PERSON ALMOST DIED. THIS ANESTHESIOLOGIST WANTS TO GET PAID BY THE PATIENT’S INSURANCE COMPANY. SOUNDS SIMPLE?

THE PATIENT HAD TO BE TRANSFERRED FROM THE SMALLER HOSPITAL TO A TERTIARY CENTER (A LARGER TEACHING TYPE HOSPITAL) AND LATER UNDERWENT ANOTHER SURGERY. NOW THE INSURANCE COMPANY WILL NOT PAY THE FIRST HOSPITAL AND THE ANESTHESIOLOGIST. THEY DEMAND MORE PAPERWORK, SAYING IT WAS THE SAME SURGERY. SO THE BATTLE OF HEALTHCARE PAYMENTS GOES ON! GENERALLY, DESPITE THE ONLINE DIRECT SUBMISSION OF BILLING TO MEDICAID, MEDICARE, AND OTHER INSURANCE COMPANIES, PAY IS SLOW.

WHAT HAPPENS THEN, IS THE PATIENT GETS BILLED, THE EXPLANATION OF BENEFITS GOES OUT AND EVERYONE INVOLVED IS SENDING DOCUMENTS AND PHONECALLS TO EVERYONE ELSE. SO IT GOES. SO MUCH LOST EFFORTS, EXPENSES, AND WORK…TO GET PAID.

ALL THAT MONEY COULD BE FOR HEALTH AND WELLNESS AND PREVENTION. INSTEAD YOU HAVE FAMILIES BEING BANKRUPTED BY MEDICAL BILLS. THIS HAS BECOME ANOTHER CREDITOR ATTACKING YOUR CREDIT RATING, YOUR PROPERTY, YOUR LIVELIHOOD, AND YOUR HARD-EARNED DOLLARS. MANY HOSPITALS HAVE LAW FIRMS NOW FILE LITIGATION AND SUE THE PATIENTS FOR PAYMENT.

WE SPEND THE MOST ON HEALTH IN THE INDUSTRIALIZED WORLD, YET WE HAVE HIGH INFANT MORTALITY, A SHORTER LIFE EXPECTANCY, AND NEARLY 45 MILLION KNOWN ABOUT PERSONS WITHOUT ANY INSURANCE COVERAGE TO ADEQUATELY PROTECT THE FAMILY OR THEMSELVES.

THE DIRECTOR OF THE G.A.O. (GENERAL ACCOUNTING OFFICE) WAS ON TV THE OTHER DAY. HE SAID IT IS TOO LATE IF WE DO NOT CHANGE NOW. HE IS IMPORTANT. HE IS THE UNITED STATES’ CPA BASICALLY. HE IS MEETING WITH BUSINESS LEADERS, COMPANIES, AND OFFICIALS TO TRY TO GET THE MOMENTUM UP TO CHANGE HOW WE DO THINGS. HE SAID THAT WITH THE BABY-BOOMERS COMING “ON LINE” IN JANUARY 2008, THE GOVERNMENT HAS CREATED A SYSTEM OF INCOMPATIBLE EXPENSE. WITH MEDICARE, MEDICAID, AND SOCIAL SECURITY FOR THE BOOMERS, THE SYSTEM WILL BUST. SOON! 2020 OR SOONER! WHY? HE HAS GIVEN UP ON CONGRESS !!!

IF YOU ADD ON THE NUMBER OF MANDATED ER CARE OF ILLEGAL IMMIGRANTS GOING TO THE EMERGENCY ROOMS, PLUS THE UNDERINSURED, AND THE UNINSURED – IT IS EASY TO APPRECIATE THE PROBLEM. MANY HOSPITALS’ ERs HAVE CLOSED. SOME HOSPITALS ARE BEING SOLD FROM NOT-FOR-PROFIT TO FOR-PROFIT SYSTEMS.

WHAT ARE YOU DOING TO HELP TALK IT UP ABOUT HEALTH INSURANCE RATES, HEALTH INSURANCE, AND THE COSTS.

NO FAMILY SHOULD BE FORCED INTO BANKRUPTCY BY HEALTH ISSUES……

SQUIRREL ATTACK DURING HIDE N’ GO SEEK FATHER-DAUGHTER’S BONDING STORY

All my daughter’s friends were over for their little party.

These eight or so girls, all about 7 years old were playing crazily. You see wintertime had broken in Minnesota, and the summer was near. But it was one of those days you live for there, vibrant blue sky, gentle breeze, and life’s passions greening up.

Well, the little girls had played on the playground equipment for quite awhile, and in the sand making “things.” They were drawing chalk style hopscotch boards on the sidewalks, and had jumped rope without any bruises. Such a great day, such harmony in family and friends with nature watching.

My daughter and her little friends decided it was time to play “hide n’ go seek." No one better to hide than dad. Their collective eyes leaked with sincerity of request. How could any father turn such princesses and angels down for this next fun event, on such a great day, in such prime weather, in Minnesota ?

The "search and rescue" group of small girls began to count.

ONE. TWO.

Meanwhile, my scurrying about reminded me to tell them to, “Count Loud” and “NO peeking." They, in unison, guaranteed this with giggles and laughter.

THREE. FOUR.

My eye scanned the topography. Where to hide? How long would it be to hide quickly, yet stealth like? Scanning the local yard’s horizon, a brilliant idea now could become reality. Ha ha ha. Those little ones will never see me there.

FIVE.

Quickly, quietly, and with ease my legs jumped up into the tree. This tree was strong. It could hold an adult, even a hidden stealthy adult. Lots of those huge Minnesota leaves that would cover all the color of the “hide n’ go seek” secret agent. So covert.

SIX, SEVEN, EIGHT.

Hurriedly my arms pulled my body into location, in the tree. Knowing how to quickly judge and climb a tree was like riding a bicycle or swimming to me. All those hours building huge tree houses in the skies of tall ash or elm trees now would pay off. All those limb evaluations of size versus strength and caliber were emblazoned in this climber. This was a confident spot.

NINE.

As my arms lifted me into position, with my sitting spot almost prepared, the little girls were starting to rustle. Shifting my seat gently as not to be heard by doing a pull-up on the branch above, suddenly my stealthy world changed.

TEN.

As my pull-up ended, my line of sight was slightly diagonally upward. A loud noise, a squeal. Then heard of buffalo, a covey of quail, and a wild horse stampede came right at me! My ears were frozen on the word, “TEN” that the little princesses had yelled. My eyes were beyond frozen to see eye to eye with it.

Squirrel attack !!!

Yes, man to female animal, face to face, and eye to eye there it was. No time for a counterattack. It was cold. It was heartless. The attack of the mother squirrel was like no other. Brutally shown teeth, larger than a shark – claws drawn, sharper than the griz. Lightening speed, out of no where. An ICBM loaded and launched at the intruder. No early warning system for the unprepared “hide n’ go seeker.” BAM. The war was on. Knowing my face had been hit, a cover was needed. No where to hide now. Too far up to jump, as a youth might attempt. Age and wisdom prevented that action quickly. Swiping away the blood, my fight was limitless but so ill directed. Not once was there a hit on the enemy despite readjusting my coordinates while in the leaves. Retreat was the only option. Cut the losses. Sooner, not later. This mother wasn’t retreating from the nest she had so preciously prepared for the family.

The gaggle of girls was coming down the sidewalk. They too had heard the noisy breach of the stealthy sacred safe place. It was over…almost.

The “hide n’ go seeker” now did what all attacked, retreating, and severely mentally and physically injured “hide n’ go seekers” do. Swing out of the tree. With two great leaps of caliber-calculating swings, my feet hit terra firma. Solid. Looking around quickly, the attack was over.

All the faithful players of the “hide n’ go seek” family game came running. My position was still of a prepared martial arts stance, ready to counter strike as if a secondary push might occur.

“We see you,” they all yelled. The girls approached quickly to prove they had seen me. But as they received their victory in game, they realized what was different. Suddenly, they all began screaming at the top of their choral lungs, high pitched in fear, yelling and running away faster and faster. My daughter said, "Daddy, you have blood,” and she ran away too, to the safety of the flock. Reaching up to my face, it was warm, and slippery. Looking at my hand, realizing my sweat from the environmental battle was not red – it was blood. Wiping away the blood from my hand to my pants, the flow of blood continued. A painted warrior of sorts.

My wife came outside to see how things were going with the “hide n’ go seek” game. She had come around a corner just as the girls were approaching. “My goodness,” she said, “Why did you fly out of that tree…to scare the girls…They were yelling so loud…And YOU looked like a gorilla flying out of the tree… AND you are bleeding!” “What happened?”
Re-living it…worse….

As my eyes close yet to this day, that mother squirrel is in my view forever. Everyone survived. A family moment. A father-daughter memory forever. And now you know why my 20 something daughter sends reminders once in a while, and why she sent me a shirt with a squirrel on it that states the rules: “ADVICE FROM A SQUIRREL.”

WEST NILE VIRUS UPDATE – IDAHO LEADS NATION DISCUSSION CONCERNING PANHANDLE DISTRICT

IDAHO LED THE NATION IN 2006 AND WAS THE HARDEST HIT AREA IN THE USA FOR WEST NILE VIRUS. 996 cases of WNV were diagnosed in 2006 with 171 neuroinvasive type and 825 fever – and 23 deaths. (neuroinvasive = meningitis, encephalitis, neuro complications during and after diagnosis)

As of June 2007, GEM COUNTY has identified the first positive mosquito pool in Idaho.

Hospitals, physicians, health professionals, and labs must report probable and confirmed cases.

PROTECT YOURSELF AND PROTECT YOUR KIDS THIS SUMMER.

The biggest problem in the Northern Idaho region that I talked with Panhandle representatives about is the standing water drainage systems.

It appears that the Planning and Zoning, government maintainence such as roadways, and the health departments are NOT talking to each other. The ground water grassy swales that are imposed are now the breeding grounds for such mosquito populations. This water is stagnant until it filters down through the ground to protect our ground water. The drains typically are set 8 inches above the level of the ground to allow overflow in heavy rains or runoffs, but this is the rub. The swales stay wet. Hopefully all parties will begin to plan for such health disasters at the early stages of future developments. Revising the swales may need to become a priority.

Review WNV and WNV-birdflu-hunting at the these sites:

http://www.castmd.com/?p=35

http://www.castmd.com/?p=45

www.cdc.gov

www.westnile.idaho.gov

AARP article misses the boat – DRUG SAMPLES AND DRUG REPS – MAYBE NOT SO BAD – BUT LIMIT THE DIRECT-TO-CONSUMER ADS and LAWSUITS

A recent article in the AARP Bulletin highlighted an email of a drug company's inside commentary on drug representatives and their impact on physicians' practices. Congress was on this subject of how doctors obtain information years ago, and rather than mandating legislation, the Pharma Industry limited themselves. Now the irony here is that, all the Pharma Industry now advertises the millions and millions of dollars for their new drugs on television, cable and non-cable, radio, and the print media. How many ads of erectile dysfunction have you seen or watched in the last few years? What about allergy drugs? Those ads seem to be everywhere also.

Meanwhile, most doctors get some of their information from drug company representatives. The doctors of yesteryear were wined and dined – alot. But all that has changed. Company meetings for continuing medical information and education are sponsored for cost. However, the rules are tight. No trips to Hawaii have ever been offered to me, in 25 years or so.

Now the medical appliance industry, like the artificial hips, pacemakers, etc., are not included in the Pharma SELF-imposed rules. This industry works like many others. Recently my awareness was stretched when a person told me ALL hundreds of employees of a beer industry were wined and dined, golfed, and brought to a city with alot of casinos! All on the company. And recently a marketing company took hundreds of employees to another city for 3-4 days, for their needs.

Now, most doctors do like to see drug representatives. We do get good and current information from the reps. If the doctor has a brain, he or she will and can challenge the drug rep with his product, his information, and his competition. This is good information.

Literally, thousands of patients through the years have asked for "Any free samples?" Many times we can accomodate some starter paks of medicines that have been given to us by the pharmaceutical representatives. Most clinics get some samples for patients. According to a recent study over 75% of clinics get free samples. Many times the reps will sponsor quick to the point luncheons. Some doctors join company panels to discuss the highlights and controversies of new therapy. So, what is the big deal?

Most pharmaceutical reps are good people. Most earn their living by providing information currently and timely. Most doctors are good people. Most earn their living by providing good patient care. Most patients are good people. Most enjoy and sincerely appreciate a "few samples" to start their drug regimen.

Now, with the costs of drugs so high, and the pressure on the drug companies to limit free samples or starter paks, it would seem to be soon – a policy that will be forced out. This will be a loss for the underinsured, uninsured, family of four parents, and others that look at the costs in general of healthcare and delay or eliminate their prescription all together.

The billions of dollars spent on "direct-consumer-advertising" that is endorsed by the FDA and other federal, state, and societal organizations is the first place to cut drug costs. Those ads drive the physician by patient requests. Get rid of direct to consumer advertising. Next, get rid of the massive class action suits against all the companies. The U.S. has driven the vaccine industry out of the U.S. and the drug making is not far behind. If the vaccine shortage concerns did not awaken some fear in you, this should.

So, soon, patients will say good bye to free samples, free starter cost reduction cards, and reduced up to date physician information.

As for me, trips, rock n' roll collections, and tennis racquets have not crossed my desk….And to say they do is just crazy by a biased author. And some of the doctors will stay "chummy" with professional colleagues in the pharmaceutical representative business. Some might call that professional interaction and ethical education…

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

Stroke and other cardiovascular diseases are linked closely to high blood pressure. In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked. Most of these studies have been a type of case control showing high probable causal relationship. Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue. In the study, persons were given about 2.6 gms or 2.0 gms of salt daily. Another group of placebo was a control also. The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period. This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group.

We have long known this concern of salt and high blood pressure and other cardiovascular diseases. Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day.

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %. In many developing countries however, the personal use is the burden of salt. Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation. More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it. Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products? Dear ol' Mom probably had it right when she said, "Not so much salt!"

So next time you pick up the product, do a salt survey. Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk. The debate appears to be over. Salt can take a toll. Be a wise shopper and a wiser eater.

Salty popcorn with butter anyone? Remember, more fiber, less salt, less trans-fats….Yuk!

DVT – DEEP VEIN THROMBOSIS – POTENTIAL SILENT KILLER – planes, trains, and surgeries

YEARS AGO, MY FATHER RETURNED AFTER SEEING MY GRANDFATHER, FROM THE SMALL HOSPITAL IN THE LITTLE TOWN IN MIN-NEE-SOOO-TAH.

My grandfather had been in the hospital after a minor surgery. Remember years ago, even small procedures were done in the hospital by the general practitioners or early surgeons and patients were held in the hospital for days. Just shortly after my father returned from seeing his father, our telephone rang. I remember seeing his face change and his voice quiver slightly. But dad was a strong man. He said to all of us, a big family, and my mother, that grandpa had "some trouble" and that he needed to go to the hospital right away. Only, not just dad went, but mom went hurriedly along also. Grandpa died that few moments between my dad seeing him, and returning home, about 5-10 minutes. Grandpa died of a pulmonary embolism, a clot in the lungs that travelled from his leg, after that small procedure. Certainly a sudden and quick death, a reality that still exists these days.

Deep vein clot (thrombosis) is a relatively common, and a very serious potential disease. We see those patients in the emergency room, immediate care, and certainly worry about many more. The mortality and further injury (morbidity) from clots in the legs is not in the leg! The risk occurs from associated lung clots (pulmonary embolism) and a rare condition of post-clot syndrom (post-thrombotic syndrome).

There is not one specific symptom or sign that clinches the diagnosis. The elderly have rates of DVTs in the 200/100,000 range while younger people have rates of about 50 per 100K. The clots occur in the higher deep veins of the legs, or from extension of clots in the lower legs – even though this risk is lesser. When clots in the lower leg veins extend, the risk of lung clots goes up. The problem with DVTs creating the lung clot (PE) is that symptoms can range from sudden death to minimal at all symptoms.

In a doctor I knew, his clot formed during a long airplane ride and he lived. In my grandpa's case as told by my father, it was sudden death.

Risks for developing DVTs in the leg veins are:

conditions: cancer, pregnancy, blood disorders, kidney disorders, estrogens, and smoking

stagnant movement: surgery, immobility, paralysis, obesity, extended travel

other: previous DVT or PE increases risk, and trauma increases risk.

If patients have any two or more of these, they really become at risk. Symptoms that patients can feel or see are: swelling of the leg compared to the other side, calf swelling, localized tenderness of the calf or leg, new pain or numbness in the leg. There are other causes of these same symptoms, therefore you should see a doctor without hesitation.

Your doctor will most likely go through the above lists with you. But your doctor will be concerned. Lab tests will be drawn most likely and an ultrasound of your leg will be ordered stat. Usually if both of these are negative, the cause is not a clot. If the ultrasound is positive, you will begin treatment. If the blood test is positive and the ultrasound is negative, you will probably have a repeat ultrasound in about a week.

Treatment consists of starting the pill, warfarin, for "thinning the blood." But this takes days for the body to change. Therefore, almost all patients will need to use injections of a heparin substance that "thins" the blood quickly. Usually, patients will need to be on heparin medicine for 5 days or so, or at least until the pill warfarin reaches a therapeutic level in your bloodstream.

Patients will need to use compression stockings during this time and after the event to minimize risk of recurrence of DVT. These stockings also help prevent the post-thrombotic syndrome of pain, swelling, inflammation that can become a chronic condition.

Risk of recurrence never goes away. That is why proper treatment and post-event planning is so important. Expect to be on medicine for 3-12 months after a DVT or PE. Risk reduction knowledge goes a long way.

TALK WITH YOUR DOCTOR ABOUT CONCERNS AND PREVENTION.