Vascular Disease Foundation - Fighting Vascular Disease... Improving Vascular Health.

Interactive Learning : Ask the Doctor


Ask the Doctor Live Chat Transcript - Tuesday, May 5

Heather Gornik, MD

Cleveland Clinic
Member of VDF Board of Directors





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

Bill: Hi, I had a free PVD screening and they said my score was high. My ankle brachial index was right 1.48 and left 1.52. they said maybe calcification or hard artery. What does high score mean? Do I need to do anything about it, other tests? Are there meds to help. I exercise, don’t smoke and take baby aspirin. Not scheduled to see my Dr. for one year. Thanks for any information

Speaker- Dr. Gornik: Hi Bill, thank you for your interest and excellent question. A high-brachial index means that the blood vessels could not be compressed with the ultrasound device. This can happen in diabetes or sometimes if you have larger sized ankles. The bottom line here is that the ABI is not conclusive in this setting to diagnose PAD, and you need a follow-up study. I would recommend a full vascular lab study with measurement of toe-brachial index or Doppler waveforms and tracings.

VDF Moderator: This next question was e-mailed to us ahead of time: I am 45 years old and have been diagnosed by a Pain Management Specialist as having a cluster of blood vessels that formed at the base of my spine, right in my tailbone, or coccyx. I had a procedure done where the Doctor injected me with cortisone while doing an X-ray, and it helped for about a year, but now the pain is back, and it is making life extremely difficult. I can't sleep on my back, or sit too long, or sit in the wrong position at all, or it causes great pain. Have you ever seen anyone with a congenital vascular malformations (CVM) in that location, and if so, what can be done for it?

Speaker- Dr. Gornik: Vascular malformations can happen in almost any location whether there are blood vessels, so it is not impossible that this is a congenital vascular malformation. I would recommend that the patient be evaluated by a vascular specialist with expertise in the diagnosis and management of congenital vascular malformations.

VDF Moderator: This next question was e-mailed to us ahead of time: Dr. told me that I have venous stasis. My legs are painful just above my ankles. swollen, skin is discolored. I have been wearing support stockings with not much help. Is there anything else that I can do?

Speaker- Dr. Gornik: There are a number of treatment options for venous stasis. First of all, it is important to be sure that your compression stockings are the proper strength and are properly fitting. There are actually many different types of compression therapy. Next, it is important to determine the cause of the venous stasis. If it is related to severe varicose veins, there may be options to treat the varicose veins, such as venous ablation or laser therapy. I vascular specialist should be able to address these issues. Good luck!

VDF Moderator: This next question was e-mailed to us ahead of time: I learned what they called my clot it is a trombo phlebitis, not a VTE is it as dangerous? Does it travel to lungs also as VTE?

Speaker- Dr. Gornik: Well, it actually depends on what type of "thrombophlebitis". This is a somewhat old fashioned term used to describe blood clots. There could be a deep vein thrombophlebitis, now called a deep vein thrombosis or DVT, that does have potential to travel to the lungs. However, thrombophlebitis can also be of a superficial vein, usually of a varicose vein that is very superficial in the skin. These are much less likely to break off and travel to the lungs, and are generally treated conservatively unless they are located in an area that is very close to the deep veins of the leg.

Chai: Heart attacks can be caused by many things, including clots. Of all the heart attacks is there any estimate of how many (percent) )are caused by clots? It seems to be a huge issue that is not identified by simply calling it "heart attack"...Thank you.

Speaker- Dr. Gornik: Neat question Chai. You are right. The majority of heart attacks occur when a clot forms after there is a rupture or breaking open of an atherosclerotic plaque in an artery. I still think the term "heart attack" is a very important one, however, because it clinically describes what happens to a patient --- severe symptoms of a cardiac cause.

VDF Moderator: This next question was also e-mail to us ahead of time: Hi I gave blood and then I developed a VTE in my arm, I had to go to the hospital emergency in Canada was given a shot of anticoagulant and med for pain naproxen and statex and swelling but my arm remains very tender to bed swollen and there is a massive blue and purple spot where the clot is. Why did it happen? I always give blood and this never happened before, Am I at risk even after? I am very concerned the clot will break up and travel in my body, should I be taking more anticoagulant to prevent

Speaker- Dr. Gornik: Dear blood donor. This is a great follow-up to the last question on "thrombophlebitis". It sounds as if you developed a superficial thrombophlebitis in one of the superficial arm veins where the needle was placed for the blood donation. This can progress to a deep vein thrombosis, and this sounds as if this what may have happened. Without knowing specifics of your case, I cannot give you a prognosis as to whether this will happen again --- I would recommend seeing a vascular medicine, thrombosis, or internal medicine specialist in your area. Good luck!

Bill: My mom wakes up at night with bad pain in her heels. Any recommendations, should I try ice, heat, Tylenol? Thanks.

Speaker- Dr. Gornik: Dear Bill. Thanks for participating in the chat. I do think it's important to try to figure out what the cause of the heel pain may be, and I think a thorough Dr's examination can help rule out a vascular problem. Other things that could cause heel pain include diabetes, neuropathy, muscle cramps from electrolyte disorders. So, to summarize, I'd start with a doctor's history and physical examination.

Sandy: Are there any natural remedies to help reduce clots?

Speaker- Dr. Gornik: Hi Sandy --- To my knowledge, no known natural remedies for blood clot reduction, however, I would note that the body does make its own natural clot busting substances that can help the body dissolve clot over time.

Chai: A colleague and yoga enthusiast counsels that headstands or inversion tables that elevate the feet well above the head are very good for leg circulation and may be appropriate for individuals with DVT/PAD. Have you an opinion?

Speaker- Dr. Gornik: Hi Chai. Leg elevation is often beneficial to help with swelling in patients with venous disease, but actually for patients with severe arterial disease, gravity helps the most.

Carrie: Hi, I'm very concerned about my varicose veins. I have many I guess they're called spider veins in my left leg and they are taking over! They are dark blue and purple and now spreading into my right leg. I have one very large varicose vein on the inside of my left cafe that is starting to itch. They are not super big and swollen like in some pictures, but it is ugly and I'm concerned about it turning into DVT. I took birth control pills a long time ago and am now over 40 and can't exercise much due to health problems. Any suggestions?

Speaker- Dr. Gornik: Hi Carrie. There are many treatment options for varicose veins, starting with graduated elastic compression stockings and including interventional therapies such as sclerotherapy for small veins, or endovenous laser therapy or ablation therapy for larger varicose veins. A vascular specialist should be able to point you in the right direction.

Carrie: Thank you Dr. Gornik for your reply. Will the compression stocking help to reduce the "growth" of the varicose veins or just minimize symptoms? Is there anything I can do to stop them from growing?

Speaker- Dr. Gornik: Good question Carrie. Compression stocking can actually do both. They'll help your swelling. In addition, they can help treat the high vein pressures in the legs that might lead to new spider vein formation. Compression stockings are first line therapy for venous insufficiency or varicose veins.

Carrie: Oh great, thanks! How do I know which kind to get and do I need a prescription for stockings or can I just buy them? Which would you recommend? Do I wear the stockings all the time or just once in a while?

Speaker- Dr. Gornik: Lower grade elastic compression stockings can be purchased over the counter at a pharmacy or medical supply store. You only need a prescription for higher grade compression stockings. I'd recommend wearing the stockings during the day and remove at night while in bed or "lounging" with your legs up. This should be a good start.

Sandy: Is there a way to enhance your body's own clot busting efforts? (or not thwart them by eating wrong things)?

Speaker- Dr. Gornik: Hi Sandy, No clinical trials in this area, but basic science research suggests that maintaining a healthy body weight, exercise, and nutritious diet might help...

VDF Moderator: This next question was also e-mailed to us ahead of time: I have experienced in the last two months my right thumb tip turning blue and swollen periodically. It does not happen everyday, maybe once a week. I am unsure what it is associated with. My question is can someone have Raynaud’s phenomenon in only one digit?

Speaker- Dr. Gornik: Raynaud’s phenomenon can happen in only one digit, but this is the exception rather than the rule. I would be very, very suspicious that there is "something else going on" in terms of the blood flow to your hand, such as damage to an artery. I would wonder if the questioner has a job where his or her hand is used a lot (such as using the hand as a hammer). I'd definitely recommend seeing a hand specialist and/or a vascular specialist to pursue the work up for this.

Chai: If one is diagnosed with DVT would strenuous exercise be recommended? Is it correct to assume that a clot would "break off" and cause a PE or other damage? Once a clot forms can it be reduced non-surgically or made more flexible so it doesn't fragment?

Speaker- Dr. Gornik: Hi Chai. Good question. We used to recommend bed rest for DVT patients for that reason, but a clinical trial showed that this was not necessary. I generally tell patients with DVT that, once they are on anticoagulation, they can walk and do light aerobic exercise. I generally avoid heavy exercise for at least a few weeks. If patients are on blood thinners, I also recommend against "extreme activities" such as any sports which involve physical contact (boxing, rugby), down hill skiing in most cases, etc. These are situations which increase bleeding risk while on blood thinners.

VDF Moderator: This next question was also e-mail to us ahead of time: I have a collapsed artery in my right leg around the knee area. I'm able to walk starting with some calf pain but improving the longer I walk. I walk about 2 mi a day and do upper body 3 times week. My problem is doing any work using upper body and legs together bending over, pushing lawnmower etc. for about 20min causes major pain in my feet more in the right after resting for about 5min I can then go back to work for another 15mi or so. I'm 69 would a bypass take care of my problem or would I be better off living with it?

Speaker- Dr. Gornik: It sounds as if the patient with the leg discomforts is doing very well with exercise, but there are other treatment options available too. Supervised exercise training may be an option. There are also certain medications available to treat leg pains due to PAD. Finally, there are interventional therapies available --- not just bypass but also less invasive options such as angioplasty and stenting. I would recommend a thorough vascular evaluation with an experienced vascular specialist to sort out all of the options. In addition, since you have PAD, it's important that you are managing all of your risk factors for vascular disease in other areas, such as heart attack and stroke.

VDF Moderator: This next question was also e-mailed to us ahead of time: Lately I am feeling pain and pressure in the stomach/colon area and have a kind of "metallic" taste in my mouth. Also am experiencing back pain. Could it be due to AAA that was just discovered while having ultrasound of my pelvic area? I am 65 years old male.

Speaker- Dr. Gornik: Dear AAA patient. I am not sure how your symptoms relate, and without examining you and knowing how large the abdominal aortic aneurysm is, I would not want to give any specific recommendations. I would definitely recommend evaluation by a vascular specialist.

Chai: Understanding that many / most vascular problems remain undiagnosed, if there were a single symptom/warning sign that could be promoted to the public, what might that be? "Spot the Clot" is one being used, but you can't see one to stop it! I know it's complex and symptoms can be caused by other maladies... just wondering about anything that is unique and distinctive to vascular symptoms?

Speaker- Dr. Gornik: Hi Chai. Good question. Warning symptoms I go over with my patients are those of: Heart attack (chest pain, shortness of breath, fainting), Brain attack/stroke (headache, loss of vision, weakness on one side of the body, slurred speech, Leg attack/DVT or severe PAD (severe pain in the legs, non healing sore, color changes in the legs or feet).

VDF Moderator: This next question was also e-mailed to us ahead of time: have DVT in my right leg and am on 8mg warfarin. The swelling in that leg is tremendous. Can clogs continue to develop in the affected leg even though I’m taking warfarin?

Speaker- Dr. Gornik: Good question regarding warfarin. Therapeutic levels depend on the type of problem for which blood thinners are being given. For most blood clots, the target INR is 2-3. Target can be lower (for example 1.5-2) in certain situations, or even higher, such as 2.5-3.5 in other situations (such as certain heart valves or clotting disorders). The therapeutic range for your Coumadin is determined by your health care team. And as for compression stockings, research has shown that patients with an acute DVT who receive and use compression stockings are less likely to have problems with leg swelling, discoloration, and ulcers in the future. Patients can have clotting while on warfarin, although this is unusual. Need to be sure that your anticoagulation levels have been at the right level. IF you leg swelling is worsening, I would definitely recommend discussing this with your physician ASAP.

VDF Moderator: This next question was also e-mailed to us ahead of time: I am a 73 yr. old female with PAD, have narrowed arteries in both ankles, non diabetic, non smoker, exercise everyday, and the left foot has one artery only (1 cm) and wish to have surgery on a malformed bone in the arch of the left foot. My vascular surgeon said it's not possible. Why can't tiny arteries in the ankle be replaced when they cannot be opened? Any arteries pertaining to the heart can be re-routed, ballooned, stented, etc., however, not ankles! My right leg had the "fem pop" in 2001, it could not be by-passed, therefore, it's still holding, but my legs get very heavy and I would like to be more active. I take pletal and baby aspirin, etc. Thank you kindly if you can give me any answers at all, I would appreciate it!

Speaker- Dr. Gornik: Unfortunately treatment of the very small vessels in the leg and foot remains a challenge in vascular disease. In some cases balloon angioplasty with or without stent placement can be performed, but in other cases, this is just not possible. Unfortunately, we don't have a way to replace arteries at this time. Growing of new blood vessels, also known as "angiogenesis", is an area of active research interest in the U.S. and abroad, but this is experimental treatment and is not available in all areas. I am glad you are on aspirin and also taking Pletal. Be sure to also have your cholesterol evaluated to be sure all of your vascular disease risk factors are being managed as aggressively as possible.

Stephen: Hi, I don't know if this a vascular problem, but I'm having trouble with my heart. I get very out of breath walking and my heart also races. I'm only 40 and don't smoke. Do you have any suggestions for me what this could be? This has been going on for over a year.

Speaker- Dr. Gornik: I am glad you asked your question. This is a worrisome symptom, and I would be worried about heart disease, including heart artery, heart muscle pump, and heart rhythm problems. You need medical attention ASAP. Please call your doctor today.


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