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Doctors' Answers to "Frequently Asked Questions" - Blood Clots

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Hemotoma [posted 1/13/99]
Question: What is the treatment I should be having for a hemotoma? My doctor just looked at it and said it was a "design fault" - i.e. because humans are bipedal the blood collects there. She did not recommend any treatment, but I am a bit concerned about it to say the least.

Answer: Treatment for a hemotoma is usually heat to absorb the blood in the damaged tissue. As to a design fault, hemotoma is a medical name for a bruise. I'm not sure I'm answering your question.

Blood Clots and Birth Control [posted 1/8/99]
Question: I was hoping to find someone who could answer a question for me on blood clots and the pill. Do you know where I could look?

Answer: I can give you some information, but the companies that produce them have tons.

Possibly Post Phlebitic Syndrome [posted 1/6/99]
Question: If I still have a blood clot in my calf, and my doctor takes me off of coumadin, what are my chances the blood clot will go o my lungs? If it is Post Phlebitic Syndrome, what can I do to relieve the pain I have in my calf and foot? Is there a medication I could try to alleviate this? Also is this going to be with me for the rest of my life? Will it ever get any better.

Answer: Clots below the calf may embolize, but rarely, if ever, cause symptoms. This is probably due to the size of the clot and the low risk of embolization. However, they can and do cause chronic pain after the clot referred to as Post Phlebitic Syndrome. This is distension and inflammation of the veins in the leg is due to damage to the venous valve structure of the leg. This tends to be permanent since the cause is incompetent valves, which leak blood back to the leg causing chronic distension and pain. Relief centers on compression stocking, aspirin on a daily basis, elevation of the painful calf (above the heart) and heat.

In Need of a Natural Blood Clot Medication [posted 12/10/98]
Question: I am a veterinary technician. My rabbit has just been diagnosed with blood clots. The veterinarian does not want to put her on any human blood thinners, due to the fact that she feels that they will not be safe for my rabbit. I was informed that there may be natural remedies that may help thin the blood. I was wondering if you would have any information? Thank you for your time,

Answer: Aspirin comes from elm bark, is this natural enough?

Blood Clots [posted 10/13/98]
Question: My husband,26, has had three clots in his lower leg in the past two years. They are all injury related. He takes an aspirin a day but clots each time he receives a hard hit to the leg. The doctors have tested him for any factors that may cause this. They turned up nothing. Could these clots over time cause more serious problems for his legs?

Answer: Yes, especially if in the deep venous system-has he been tested for Factor V Leiden activity? A newer and very common cause of clotting disorders.

Blood Clots [posted 8/11/98]
Question: My brother recently had a pulmonary embolism due to a blood clot discovered in his leg. His trouble breathing started after scuba diving in December. Could this have cased the blood clot?

Answer: Possible, but unlikely. If he is young, he should have a work-up by a good internist or hematologist for the familial causes of hypercoagulability. This is important because it can prevent further problems in the rest of the family if found.

Blood Clots
Question: My husband was in a motorcycle accident 5 yrs. ago. He has post concussion syndrome and is currently seeing a psychologist as he has difficulty relaxing. Last year he had bluetoe or a blood clot in his little toe. At this time he had his collarbone rebroke and a steelplate added. He also, during the same time, had die injected and a scope put in his vein. Just recently he had bluetoe again. They did another scope and also put in a shunt. This helped the blood pressure in his hip; however, he now has bluetoe again. He is having a difficult time quitting smoking, even if they may have to amputate. His mother had phlebitis, and heart problems run in his family. Is there anything he can do to correct the blood coagulation?

Answer: The physical problems caused by the accident are probably contributing to his problem but are probably not the cause. He needs to stop smoking. Occasionally, use of a drug like procardia will help peripheral vasodilation sufficiently to stop the problem.

Blood Clots
Question: I need to know information with regards to blood clots in the legs associated with chemotherapy and also the need to amputate any part of the leg after clots have been operated on.

Answer: There are two possible types of clots in the legs - arterial and venous. Arterial clots are usually due to emboli from the heart. However, some patients experience hypercoagulability with different types of cancers and can form arterial clots in different parts of the body. Few chemotherapy agents would cause this problem, and usually the reverse. Venous clots usually form in the leg and can go to the lung in severe cases. These are due to low flow in the legs or else the hypercoagable state I mentioned with different cancers. Venous clots do not usually require amputation. Arterial occasionally due if not correctable rapidly.

Blood clots
Question: I'm a 28 year old that got a blood clot about 2 years ago, supposedly from lifting weights. The clot is in my main vein of my left arm. Collateral veins have since grown around the clotted off spot and provide for full functions on the arm. When the clot occurred I had it successfully dissolved, (heprin, veniogram and angioplasty) but several days after I returned home from the hospital the clot returned. This time my doctor wanted to try a rib resection to relieve the pressure on the vein. This was done about 2 weeks after the clot had returned and was followed by another attempt to remove the clot using veniograms and eurokinates (sic). However, this was not successful. The doctor says that once a clot becomes hard it is almost impossible to remove and even if it were removed the vein may become injured and another clot occur. I was released from the hospital and am not on any kind of medication, nor make regular visits to my doctor. Supposedly, a hardened blood clot is not much to worry about and it will slowly dissolve itself over time. If it did break loose, I was told I would probably survive it. A major problem for me is that my unclotted right arm is missing 5 fingers due to a birth defect, so I am somewhat reliant on the clotted arm. Does what I just said fit into the standard medical blood clot treatment that you may advocate?
Do you recommend continuing my active lifestyle? (exercise, an occasional triathlon, occasionally fight wildland forest fires, lift weights, etc...)
What are the signs that my clot is breaking loose (embolism?) and what are the chances of this happening?
What could I do to help myself as I await medical help? (lie quietly, rush to hospital, take medications, etc....)

Answer: When blood clots occur in young people the question is why? Birth control pills, steroids trauma, inactivity and some inherited disorders could be the initiator of a clot. So, first ensure your physician has screened you for Protein C, Protein S, Lupus coagulants Antithrombin III and checked your platelet count, etc. If the above are normal, I'd recommend an aspirin a day to avoid any further clots. The damage to your arm is of no consequence. The arm has several pathways to return blood other than that one vein. Emboli from the arm are rare and never cause majorage. Continue exercising. Signs of a blood clot in the lung are either chest pain (usually pleuritic), hemoptsis (spitting up blood), or shortness of breath, but unless you develop a clot in the leg you are at minimal or no risk.

Blood clots
Question: Is there any treatment for severe venous occlusion of the legs (inferior vena cava, both iliacs and messentaric)? A greenfield filter is in place. I am on Coumadin but I have severe pain in both my legs.

Answer: Your problem is called post-phlebitic syndrome. It occurs after damage and scarring to the venous structure of your legs caused by the clots. The best treatment is to dissolve the clot as soon as possible after it occurs with any of several drugs. Unfortunately, once the clot has been present more than a couple of days or the damage present, there is no effective treatment. Treatment centers on pressure stockings for your legs and elevation of the legs several times a day. Occasionally, anti-inflammatories (after decreasing the coumadin, ifpossible) are helpful. This is a tough problem to improve because the treatment options are very limited.

Poor blood flow
Question: I have recently developed muscle cramps in my calf muscles, which tighten over short periods of walking and are pronounced when I add weight (carrying an object of some 40-50 pounds). Is there a medication that will ease or substantially eliminate the symptom?

I am also curious about what may be available to permit a senior citizen of advanced years to resume sexual activity that is denied because of a lack of ability to sustain an erection of sufficient firmness. I am 72 years old and an inveterate smoker (2-4 packs a day).

Answer: This is called claudication. There are several possibilities, but generally in smokers it is due to lack of blood flow to the legs. With your decreased erections I suspect you have a major league blockage of the iliac and/or femoral arteries. Your physician will need to get arterial studies to check this. The other possibility is spinal stenosis. This is caused by pressure on the spinal cord in the lower back due to a congenitally small opening in the spinal canal. Regarding your erections, have your blood supply to your legs checked first. The lack of erections are probably due to a similar problem.

Clots In Legs
Question: Why would a man in his late thirties experience two different blood clots in his leg?

Answer: There are several reasons that a person forms clots in his/her legs. The most common reason is trauma or inactivity. Clots following a fractured leg or immobilization of the leg for any reason are relatively common. In a thirty year old there are also several syndromes which are inherited in families. A complete evaluation by a physician will be necessary to check the blood for the known causes of inherited tendencies to clot. Also, once a person has one clot-the damage caused to the venous system will markedly increase the tendency for a second clot.

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