Did you think that, by flying on an airplane, your only risk was bad food or the plane going down? There are, in fact, two vascular diseases that happen to one out of every 1000 Americans each year that has, as their major risk factors, flying economy class on a long airplane ride.
These two diseases are deep vein thrombosis or DVT and pulmonary embolism or PE. These diseases happen in patients who fly long haul airplane flights without the ability to get up and circulate blood in their lower legs. It can also happen to people who are bedridden for a long time, such as postoperative patients in a hospital wing who have had back, leg or pelvic surgery.
The DVT usually comes first and is generally considered to be the cause of a secondary PE. A DVT happens when blood clots within the deep veins of the lower legs. The clots begin near the ankle and grow by traveling upward toward the upper thigh, pelvis and lower abdomen. The larger the DVT, the greater is the risk of having pieces of the clot in the leg break off, travel through the venous system and into the lungs, interfering with oxygenation.
When the clot has broken off and has entered the lungs or has become settled across the opening of both lungs, this is called a PE. A PE can have catastrophic consequences. While only 15 percent of DVTs go on to become PEs, a PE is still a very dangerous situation. Up to three percent of all situations of sudden death are actually cases of a catastrophic PE.
The DVT requires at least one of three factors in order to form. One needs to be in a situation of low blood flow to the lower legs, such as not being able to move your legs around. This increases the risk of clotting. One also might have prior damage to the lining of the deep veins, perhaps due to a prior history of vein leakage and edema. Finally, one might have a condition or might be taking a medication that increases the risk of having a DVT.
Those individuals at higher risk of clotting include cancer patients, who create biochemical proteins that increase the clotting ability, women who take estrogen-containing birth control pills or who take estrogen replacement therapy, women who are pregnant, and people who are elderly or obese. There are also those who have inherited a familial trait for increased coagulation who are at the highest risk for clotting.
The person with a DVT may experience no obvious symptoms but many will have pain in the back of the calf, increased duskiness or redness and warmth to the leg, and an increase in the thickness of the calf when compared to the opposite calf.
The doctor can attempt to elicit a positive Homan’s sign from the patient. He or she does this by pushing the patient’s toes upward toward the patient’s head. If the patient has a positive Homan’s sign, he or she will demonstrate this by showing increased pain in the back portion of the calf.
The doctor then might order a d-dimer test in order to increase the suspicion of a DVT. This is a test of the blood that measures the by-products of clotting. Imaging studies include a deep vein venogram of the leg, which can outline the contour of the deep veins, showing the clot directly using x-rays and IV contrast dye. A better test, however, is the Doppler ultrasound of the lower leg. This is a test that measures the flow of blood in the deep veins NHS Medical Compensation Solicitors.
When the doctor is satisfied that a DVT exists, he or she can place a filter inside the patient’s vena cava in order to block the free passage of clots to the lungs. TPA or tissue plasminogen activator can be used in severe cases of DVT. TPA works by dissolving clots. Blood thinners do not dissolve clots but tip the balance in favor of the breakdown of clots. Two common blood thinners are Coumadin and heparin.
Usually, oral Coumadin and intravenous heparin are given together in order to thin the blood. The heparin works immediately and the Coumadin takes up to 3-4 days to become therapeutic. When the Coumadin reaches therapeutic levels, the heparin is stopped and the patient stays on Coumadin for a minimum of three months.
If a DVT is not treated in time, pieces of the clot break off and travel to the lungs to cause a PE. If the patient survives the PE event, it is probably because several small clots have broken off and have traveled to only a portion of the lungs. The patient will experience shortness of breath, anxiety and pain on deep inspiration.
The doctor may hear a friction rub with a stethoscope when listening to the lungs. He or she may also notice by blood gases or oximetry testing that the patient’s blood oxygen level is low. A d-dimer test can be run as in cases of a DVT but the test will not reveal the extent of the problem.
One can confirm the presence of a PE by doing one of two imaging tests. The first is the CT scan of the chest with IV contrast. It cannot be done in cases where the patient has an allergy to contrast dye. In such cases, an MRI of the chest can be performed.
If a PE is confirmed, the doctor can choose to remove the clot by means of a procedure called a pulmonary embolectomy. The doctor will often choose to use TPA in order to break up the clot(s) quickly. IV heparin and oral Coumadin are also used in nearly the same way as they are used in the treatment of a DVT.
People who have multiple DVTs or multiple PEs will automatically have a permanent filter placed in their vena cava. They will also remain on Coumadin for the remainder of their lives. People with genetic coagulation problems will also be on Coumadin indefinitely. For More Info http://www.drmsolicitors.co.uk/