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.
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 major damage. 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, if
possible) 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.
