Interactive Learning : Ask the Doctor

Ask the Doctor Live Chat Transcript - Tuesday, July 12, 2011

Marjorie King, MD

Helen Hays Hospital
Member of VDF Board of Directors

Moderator- VDF: Thank you for joining us today! I would like to introduce Dr. King who is now ready to take your questions.

Margaret M: Will having a hip replacement put me at risk for a clot since I have PAD?

Speaker- Dr. King: PAD is disease of the arteries and clots that occur after hip replacements are due to blood clots that develop in the veins. The causes are different, probably because the vein side is under lower pressure than the artery side of the blood vessel system. You are not at a higher risk than anyone who has a hip replacement. After the hip replacement you will be on a blood thinner, either Coumadin or an injectable one like Lovenox, to prevent clots in the veins of the legs or pelvis that could travel to the lungs and cause a clot there, called a pulmonary embolus.

Moderator - VDF: Hi Margaret, if you'd like to learn more about DVT please visit our website: http://www.vdf.org/diseaseinfo/dvt/

Margaret M: Thank you, that makes me feel better

Moderator VDF: You are welcome Margaret! You can also learn about blood clots by watching this short 5 minute video called "How Blood Clots Form" http://www.youtube.com/VascularDiseaseFdn#p/a/u/2/ac_om5HCjvg

Moderator VDF: This next question was e-mailed to us ahead of time: What type of pain occurs at rest, when laying down or trying to sleep, not weight bearing or any activity, with CVI?

Speaker- Dr. King: There are many causes of leg discomfort at rest, including muscle spasms, aching from chronic venous insufficiency, or a severe form of PAD called critical limb ischemia. Doctors can differentiate these by checking blood flow studies, examining for color and appearance of the skin, and listening to symptoms. There are no good medications for common rest leg cramps that often occur at night, are benign, and are probably related to muscle spasm.

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Sue: Are there any restrictions on how soon to exercise after a leg DVT? And if you start exercising, do you start slow? How long? How often?

Speaker- Dr. King: Actually, it's important to stay moving after a leg DVT to keep the vein blood flow moving. In the past, we had people stay at bed rest, but we've found that that doesn't make a difference. When you start exercising, just be careful about things that could make you bleed since you're probably on Coumadin. Taking up football without a helmet wouldn't be a good idea. That's an extreme example, but it's what I mean about being careful on a blood thinner.

Moderator VDF: I thought you might also like to read these FAQs about DVT: http://www.keepingincirculation.org/issues/v01i02/d4.php

Sue: What about length of the exercise? It would be ok to begin to jog, or ride a bike? Also, what about sitting in a hot tub? Again, after the leg DVT?

Speaker- Dr. King: How long ago was your DVT?

Sue: It's a friend. But it was about 6 weeks ago. I've read that the clots can break apart and cause blockages in the heart or lungs. So, that was one worry. The other is that I've read that they can stay in the vein forever and even calcify. It is not clear what that will do. Varicose veins?

Speaker- Dr. King: It is fine to start back to jogging or biking, obviously wearing a helmet for biking. She should start gradually, since her cardiovascular system is less efficient compared to before she stopped exercising, but if she listens to her body and gradually increases to her previous level of exercise she'll be fine. Precautions about hot tubs are related to potential low blood pressure when you stand up. That's not an issue with DVT.

Sue: Thanks. And having the blood clot forever in the leg - is that a problem? Will it break loose or calcify?

Moderator VDF: Hi Sue, you might like to take a look at our Vein/Artery Map on our Web site: http://www.vdf.org/interactive/vein-artery-map.php

Sue: One more question for my sister-in-law. She just had a hip replacement. Since then she says her foot is "dead". She has blood flow and feeling in it, but has lost ability to move the muscle in it to walk. She has to wear a brace. Her surgery was 2 weeks ago. I suggested she ask her PT person to work on that as well as the hip. Have you ever heard of such a thing?

Speaker- Dr. King: Clots can break apart and travel, which is why we use medications to keep them from getting bigger while your body repairs them. For the venous system clots, when they travel the danger is if they go to the lungs causing a pulmonary embolus. Artery clots are most dangerous when they go to the heart causing a stroke, which can occur if the artery clots are in the upper arteries like the aorta. Clots in the small arteries that supply the heart with blood (coronary arteries) are not usually from clots traveling but occur in place from injury like smoking, high cholesterol, or high blood pressure.

About varicose veins, they are on the surface of the legs and the clots can't easily travel up to the lungs, so they're not dangerous. They can cause aching, but are not a risk for blood clots traveling to the lungs.

Moderator VDF: I would strongly suggest that you have your sister-in-law your doctor about the hot tub. Some of our docs (based on the individual situation) would not encourage anyone to go in a hot tub with an active DVT. I would suggest she use caution. Sorry Sue, that should be "check with your doctor" about the hot tub!

Speaker- Dr. King: Just to finish the answer to your question about calcium in blood vessels, that's usually related to the arteries. We don't know why some arteries develop lots of calcium and some only softer clots. Calcified clots are not necessarily worse than soft clots and make actually be less likely to cause an abrupt event. There's alot we still don't know about vascular disease.

Sue: OK on the hot tub for my running friend. For my sister-in-law it's the question about the muscles in the foot.

Moderator VDF: I'm confused Sue...if your sister-in-law has DVT she needs to check with her doctor about the hot tub. I would always encourage anyone to check with their doctor before going in a hot tub as the heat can have an adverse reaction on many medical conditions.

Speaker- Dr. King: Concerning the foot muscles, she should ask her surgeon whether there was injury to the nerve to those muscles. That can be a brief injury related to a neuropathy that gets better with time. Sometimes a foot brace is used to help avoid dragging the foot and tripping. The PT may also know what caused it, but that's my best guess from your description.

Sue: OK - THANKS for the answers!

Moderator VDF: Great Sue thanks!

Moderator VDF: Thank you all for joining us today and thanks to Dr. King for her time. Please join us on Tuesday September 13th for our next chat at 4pm EST. We wish you a healthy day!

Disclaimer

The material provided on VDF's Web site and Live Ask the Doctor chat are for educational purposes only and are not to be used as a substitute for professional medical services or advice. For more information, please read VDF's important disclaimer.