Blood Clots: What to look for and what to do

BLOOD CLOTS: WHAT TO LOOK FOR AND WHAT TO DO

The topic of this article is Deep Vein Thrombosis.

Deep Vein Thrombosis (DVT) is a blood clot in a deep vein. It can be caused by variety of reasons; one of them is a recent surgery, such as a knee replacement.  It can also be caused by prolonged immobility, especially during long flights or driving. Sometimes it’s symptomless. More often there is redness, swelling, and pain. Frequently, it occurs in the lower leg. DVT can go away naturally, but the most serious complication is when a thrombosis dislodges (embolizes) and travels to the lungs to become a life-threatening pulmonary embolism.

During my career as a physical therapist I have seen quite a few cases of DVT. Most frequently it happened to patients after an orthopedic surgery, such as knee replacement or hip replacement.  First time I saw it was when I just started to work at Columbia Presbyterian Hospital. I went to a room to see a patient who had had total knee replacement several days before. The patient complained that her calf was hurting. The calf muscle was hard and the lower leg appeared swollen and was much warmer and darker in color than the other leg. 

I performed a special test, which came out positive and confirmed my initial impression.  I immediately notified the patient’s doctor who ordered the ultrasound test. The test confirmed the diagnosis and the patient was saved.

Since then I don’t hesitate when I see symptoms that could indicate DVT. At Free Motion we have sent about 10 patients to the emergency room or to their doctor with symptoms that we found suspicious. Out of 10, five were found positive for DVT and thanked us for saving their lives. Five were negative and that was fine by us! We would rather be safe then sorry.

How can DVT be prevented? One way is to take blood-thinning medications and that’s what being done after surgeries. Another important measure is to make sure that there is good circulation in the legs. Exercises like “ankle pumps” (moving the ankles up and down) and starting walking soon after the surgery will help to minimize the risk of blood clots. 

Being checked regularly by your doctor and physical therapist and being alert to the symptoms will go a long way to ensure fast recovery and greatly reduce the risk of life-threatening complications.

When traveling on a plane or sitting for a long time it’s very important to take frequent walks and move your feet and ankles while sitting.

Have you had an experience with DVT? Do you know someone who has? Share your thoughts with me and let me know what other topics you’d like to see me write about.

Stay healthy!

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center

KNEE PAIN: GET HELP OR DO IT ON YOUR OWN?

KNEE PAIN: GET HELP OR DO IT ON YOUR OWN?

Recently one of my patients asked me why one has to come for therapy instead of doing 

exercises on their own and if there are studies done on benefits of therapy versus home exercise program. So I did some research and found several articles. One of them is called “Physical Therapy Treatment Effectiveness for Osteoarthritis of the Knee: A Randomized Comparison of Supervised Clinical Exercise and Manual Therapy Procedures Versus a Home Exercise Program”

It was published in the vol. 85 of the Journal of American Physical Therapy Association in December of 2005. The researches had assigned their subjects into two groups one of which received supervised exercise, individualized manual therapy, and a home exercise program over a 4-week period. The other group received the same home exercise program initially, reinforced at a clinic visit 2 weeks later. Here is the direct quote from the conclusion of the research article:

“A clinical physical therapy program of manual therapy to the lower quarter combined with supervised exercise applied by skilled physical therapists was compared with a home exercise program for improving function and decreasing stiffness and pain in subjects with OA of the knee. The comprehensive clinical treatment program resulted in large improvements, reproducing the results previously reported for the same therapeutic regimen. After 1 month of treatment, the average improvement in pain, stiffness, and function seen in the clinic treatment group was twice the magnitude of the improvement observed in the home exercise group.

One year after withdrawing the clinical intervention and further patient contact, this difference between groups was no longer evident. Both groups remained substantially improved over baseline measurements. Subjects in the clinic treatment group appeared less likely to be taking medications for their arthritis and were more satisfied with the overall outcome of their rehabilitative treatment at 1 year compared with subjects in the home exercise group.”

I took the liberty of highlighting couple of sentences above to stress the point and also to point out another issue: recent developments in the administration of health care show us that to save costs insurance companies will discourage their clients from getting certain treatments. It’s true not just for physical therapy but for other healthcare specialties. Patients are being forced to cut corners and accept less treatment or possibly pay more out of pocket for their care.  While it is certainly good for the patients to accept responsibility for their well-being, self-treatment can lead to longer recovery and to the necessity for more dramatic interventions, such as surgery, in the future.  In my experience, timely intervention and properly done physical therapy can help you feel better much faster and may prevent unnecessary complications in the future.

What are your thoughts on the subject? Please share your questions and concerns with me.

All the best,

Michael Sheynin, P.T., Co-owner of Free Motion Rehabilitation Center.