Back in 1985 I had surgery, a double bunionectomy. A bunionectomy is the surgical correction of a protrusion of the MP joint. Very simply, it is a painful swelling of the bursa of the first joint of the big toe. This deformity makes walking difficult and usually produces a thick callus or ulceration when the bunion makes shoes ill-fitting. In 1985 it was very common to place a cast from the foot up to the knee after this operation (as in my case). Many times following orthopaedic surgery, one can develop what is known as a deep vein thrombosis (DVT) or thrombophlebitis. This condition is a blood clot and most frequently occurs in the legs as a result of slow circulation. It is extremely important to recognize the early signs of thrombosis, as it could lead to the clot breaking loose and traveling through the bloodstream to the heart, lung or brain where serious injury can occur. When I developed my DVT, it did travel to my lung, which is known as a pulmonary embolism (PE) which can be fatal.
In addition to surgery or an injury that can damage your blood vessels, blood clots can also form due to inactivity. For instance, if you are bedridden, paralyzed or must sit while on a long flight or car ride. Cancer can cause blood clots and some people have blood that clots too easily, a problem that could run in families. So, what are the symptoms of this unfortunate diagnosis? Swelling in the leg, warm to touch, tenderness and redness of the skin are the most common symptoms. DO NOT massage the area, as this could lead to the movement of the clot. If the clot does travel to a lung, further symptoms can include difficulty breathing, faster than normal heartbeat, coughing up blood, low blood pressure or lightheadedness or chest pain that worsens with a deep breath or a cough. For me, I experienced all of these signs other than coughing up blood.
Almost anyone can develop a DVT; however, certain factors can increase the risk of developing the condition. The risk increases even more for someone who has more than one risk factor at the same time. Here is a list of the most common factors that increase the risk of developing a DVT:
- Severe muscle injury
- Slow blood flow (often caused by limited movement as mentioned above)
- Major surgery (especially involving the leg, hip, abdomen or pelvis)
- Certain chronic medical illnesses, i.e. heart or lung disease, cancer or inflammatory bowel disease
- Increased estrogen (birth control pills, hormone replacement therapy or pregnancy)
- Family history or previous DVT, obesity, smoking, high blood pressure and age
If your doctor suspects that you have a DVT, he/she will probably start with a duplex ultrasound. This test uses sound waves to evaluate the flow of blood in the veins. You might also receive venography, which is a type of x-ray used to look at the veins. Usually venography is done when the ultrasound is inconclusive. In many cases, MRIs (magnetic resonance imaging) are performed which can provide information that would not show up on an x-ray. This test is being used more frequently to diagnose DVT.
Treatments for this diagnosis consist of taking anticoagulant medications (blood thinners such as Coumadin) and wearing compression stockings. Your doctor will need to check your blood frequently to see how well the medication is working. It may also be recommended that you elevate your leg when possible, use a heating pad and take walks. Follow advice very carefully, as a deep vein thrombosis can easily lead to more serious consequences.