Local Doctor’s Experiences With DVT Prompt Warning, Advice

By John Voket

In his medical practice as a thoracic and vascular surgeon, Newtown resident Dr John DeFrance sees two or three cases of deep vein thrombosis (DVT) every week. But when he talks about the illness he draws from two very personal incidents.

“When I was young, I lost a favorite uncle who was just 28-years-old to deep vein thrombosis,” he recalled during a break from his busy practice at Danbury Hospital. “He was a heavy-set guy and had just completed a surgical procedure for varicose veins. He got through the surgery with flying colors, and had no problem during his nearly weeklong period of recovery in the hospital where he was on almost complete bed rest.”

Then, as Dr DeFrance tells it, his uncle was discharged, arrived home from the hospital, and was dead within a few hours from what was eventually discovered to be a blood clot that had broken free — deep vein thrombosis.

The second case involved a fellow physician. According to Dr DeFrance, the man was the picture of health: relatively young, very physically fit.

“But one summer, he decided to drive cross country,” Dr DeFrance recalled. “And partway through the trip he noticed his leg was becoming all swollen. He quickly learned that he had developed a clot.”

It was another very typical case of deep vein thrombosis.

According to the National Coalition to Prevent Deep Vein Thrombosis, DVT occurs when a blood clot forms in a deep vein, usually in the lower limbs. A complication of DVT, pulmonary embolism, can occur when a fragment of a blood clot breaks loose from the wall of the vein and migrates to the lungs, where it blocks a pulmonary artery or one of its branches.

The American Heart Association reports that about ten percent, or 200,000, of the nearly 2 million people who will develop DVT this year in the United States will not survive the experience. In fact, the little talked about condition takes more lives annually in this country than AIDS and breast cancer combined.

Dr DeFrance said that one of the most common reasons why DVT ends up taking so many lives is because the condition is so often masked by a much more less alarming symptom.

“Unfortunately, many of the patients I see and end up diagnosing with DVT think they’ve simply pulled a muscle or failed to work out a cramp,” he said. “One minute they’re climbing up a flight of stairs, or getting up from an extended period from their desks, and all of a sudden there’s this deep muscle pain in one of their legs.”

The condition can occur in virtually anyone at any time, Dr DeFrance said.

“There are no physical conditions or age groups that are completely immune to DVT,” he said.

However, Dr DeFrance points out a number of factors that can work against an individual, or put that person at greater risk for an incident of deep vein thrombosis.

“People over age 40, especially those overweight, are at a greater risk. Obviously a family history is a strong indicator that you have to be attuned to the warning signs as well,” he explained. “Those taking certain birth control pills, estrogen replacement, and those who work sedentary jobs are also more predisposed for DVT.”

The classic and more widely promoted incidents, however, often occur following long plane flights or periods of driving where a person may be forced in to a somewhat tight, seated position for several hours at a time.

“Early on in my practice, as I was becoming more familiar with the condition, I could never quite understand why there was such a high incidence of DVT in Hawaii,” he said. “But I soon realized it was because so many people were arriving there every day after extended airplane flights.”

Another factor leading more people from seeking a diagnosis for deep vein thrombosis is that the condition is not exclusively limited to the legs. Dr DeFrance said that a fall, hard bump, or hard contact while playing sports can trigger a clot in the arms and upper chest areas.

Individuals who must undergo frequent or specialized IV treatments through their arms are also at higher risk, he said. But there is some good news, and some easy ways to greatly reduce the likelihood one will develop DVT.

“I always advise people taking long car trips or plane rides to get up and move around or stop and get out of the vehicle about every hour or so if possible,” he advised. “Wearing a good pair of support stockings or socks can greatly reduce the risks. And for those who can tolerate it, I believe a daily baby aspirin can offer some slight added protection.”

Medical science and research on DVT has also advanced several means of prevention, as well as treating the condition with minimally invasive procedures, or noninvasive blood thinning medication. In many cases these procedures can be administered in an outpatient situation.

“Those at greater risk, or situations where the clot is larger or positioned in a risky location, will almost always require hospitalization,” Dr DeFrance said. “I’d say today there is about a 50-50 chance that any patient diagnosed with DVT will be hospitalized, even if it’s just to monitor the blood thinning medication.”

And those undergoing long periods of surgery or postsurgical bed rest may often find the staff has applied pumps to one or both patient’s legs to stimulate motion and unobstructed blood flow.

Once discovered, typically through a noninvasive ultrasound procedure called a “Doppler,” the risk of death from DVT can be greatly minimized through a state-of-the art procedure. The arthroscopic activity actually places a tiny filter in one or more of the major upper body veins to block any moving clots, while allowing the blood to flow normally.

“In many cases this is done instead of, or in addition to, anticoagulation therapy with medication, or with patients who can’t tolerate the medication,” Dr DeFrance said.

The Coalition to Prevent DVT offers this information about the signs and symptoms of the condition:

Symptoms of DVT may include pain, swelling, tenderness, discoloration, or redness of the affected area, and skin that is warm to the touch. As many as half of all DVT episodes, however, produce minimal symptoms or are completely “silent.” Because a number of other conditions — including muscle strains, skin infections, and phlebitis (inflammation of veins) — display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests.

If you experience any of these symptoms, Dr DeFrance recommends you seek immediate medical attention. Considering the wide range of successful treatments, there is no reason why you or your loved ones should be put at greater risk by the potentially fatal, but often misidentified medical condition DVT.

For more information on DVT, visit the Coalition to Prevent Deep Vein Thrombosis at www.preventdvt.org. Aventis Pharmaceuticals also hosts an exclusive website with interactive member information for anyone free of charge at www.dvt.net.