THE recent sad death of a young woman who apparently suffered from deep venous thrombosis, without it being diagnosed at two hospitals, throws the spotlight once more on this dangerous condition.
Deep venous thrombosis, or DVT as it is usually called, is when blood clots in one of the deep internal veins of the body.
The most common site is in the calf, but other areas can be affected also. The clot prevents blood circulating and, as thes
e veins carry large quantities of blood, there is soon a build up behind the blockage. Tissues become swollen, tense and painful.
All that is bad enough, but worse may be to come. Out of the estimated 10,000 people a year in Scotland who experience DVT of a lower limb, a smaller proportion go on to have a much more serious complication.
A vein is not much more than a very smooth walled tube and the clot has little to attach it. As time goes by, the clot may become loosened and move through the system until it reaches the lungs. Here it sticks again but this time preventing the lung from working properly. This complication is called pulmonary embolism.
A small pulmonary embolus may just cause symptoms rather similar to pneumonia except that this happens very suddenly. There is sharp chest pain, made worse by taking a breath, shortage of breath and a little blood may be coughed up. But a massive embolism may choke off both lungs leading to suffocation and sudden death. That is why early diagnosis of DVT is so important.
So why does it happen? There seem to be several causes. Some people have blood that is slightly stickier than normal, so it's more likely to clot.
A lot of publicity has been given to a slightly increased risk of having a DVT as a result of a long journey by air, probably because the ability to move around and keep the blood circulation flowing is reduced. Pregnancy, too, increases slightly the risk of having a DVT, probably due to a combination of pressure from the enlarging womb and hormone changes in the bloodstream.
An older person having a DVT should be examined further lest it be due to disease elsewhere.
If there is any doubt a doctor should be consulted. Tests to measure blood flow can usually sort things out. Treatment involves taking medication called anti-coagulants to thin the blood and reduces the risk of serious consequences, although this treatment itself is not free from risk.
You can reduce the risk of getting DVT by taking regular exercise, keeping your weight down and stopping smoking. When flying, drink plenty of water, avoid excess alcohol and walk around every two hours. Most airlines also show you a video detailing simple exercises that you can perform while in your seat. Some people wear compression stockings to increase the speed of the flow of blood in the deeper veins but I think that this is only necessary if you are at greater than average risk of having a DVT.
Recent investigations have shown that selective use of anti-coagulants in those with a high risk of developing a DVT can prevent one occurring.
None of this guarantees your safety, of course, as recent experience has sadly shown us, but careful organisation of diagnostic and treatment services for DVT can save many lives. That is the good news about this serious condition.
Q: I have this severe pain around my eyes and my doctor tells me it is due to sinusitis. What exactly is this? A: The sinuses are tiny caves in the bones surrounding your nose. They are lined with the same sort of tissue that lines the breathing passages. When they become inflamed in the condition called sinusitis, fluid builds up causing painful pressure. Often this becomes infected, making you feel very unwell. Decongestants and painkillers help, also an antibiotic if an infection is suspected.
Q: Please can you settle an argument I have had with my cousin, does high blood pressure give you a headache? I say it doesn't. A: Severely raised blood pressure can give someone a headache but in the majority of cases you are right. As a general rule high blood pressure is a disease without any symptoms. It is also dangerous if left untreated, this is why we recommend everyone should have their blood pressure taken from time to time.
Dr Ian McKee is an Edinburgh-based GP. If you have a medical query, e-mail
mckee@blueyonder.co.uk. Dr McKee cannot reply personally
