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

Interactive Learning : Ask the Doctor

 

Ask the Doctor Live Chat Transcript - Wednesday, June 18

 

Dr. Heather Gornik

Department of Cardiovascular Medicine The Cleveland Clinic Foundation Cleveland, OH

Vascular Disease Foundation Board of Directors

 

 

 

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


Chris: My mother just had an endarterechtomy and has substantial blockage in all major peripheral arteries. My father had a stroke two years ago (he had an atrial flutter) and I am 56, wondering how I can best avoid the health problems of my parents. My cholesterol is high (HDL above 100) but I think I can manage this thru diet and exercise.  Can you suggest prevention options I can explore as I prefer not to take a drug if I can beat this through diet/exercise? 

Speaker- Dr. Gornik: Dear Chris-It is great that you are being so proactive about your health. There are definitely things that can be done without medication --- start with exercising on most days of the week for at least 30 minutes.  Maintain a normal body weight. Eat a low fat diet rich in fruits and vegetables. Do not smoke, of course! Make sure your blood pressure is checked regularly, with a goal of < 120/80 mm Hg. In some cases, even with the best of intentions, medication is still needed, but these lifestyle modifications can go far.


Moderator- VDF: This next question was e-mailed to us ahead of time: Recently I have experienced pain in my left leg when it is elevated and when in bed at night. Tonight I had mild chest pain as well. Could these be connected? (All tests to my heart have shown very little plaque in only one artery.) I have had pain in my hip while standing, tingling in my feet, and even my hands at night when I sleep with my elbows bent. I am not diabetic, but do have controlled high blood pressure. I am also overweight. I am an active person, but do not exercise regularly. I have had arthritis since I was 14. I am a 64 year old female. Both my parents had heart disease, and my mother was diabetic. She died at 75 from CHF. My father died at age 88 due to complications of poor circulation. He also had CHF a couple of years before he died.       

Speaker- Dr. Gornik: Hello there. There is definitely a link between heart troubles and artery troubles in the legs. Patients with peripheral arterial disease (PAD) are at increased risk for blockages due to atherosclerosis in the coronary (heart arteries). It sounds like you have many risk factors for vascular disease. I would definitely recommend discussing these symptoms with your doctor. You doctor may recommend an ABI test to diagnose vascular disease in your legs (PAD).      


Moderator- VDF: This next question was also e-mailed to us ahead of time: I have been ill and mostly sedentary for almost four weeks now. In the middle of the night I had sharp pains in a small section of a vein along my inner, lower thigh. When I woke up this morning, that section of the vein (approx. 1.5 inches) appears bruised. The skin itself does not appear inflamed or bruised, just the vein itself appears slightly thicker and has more of a bruised coloration rather than the bluish color usually observed through the skin. Any thoughts on what this might be?        

Speaker- Dr. Gornik: This could be a number of things. A clot can sometimes form in a superficial vein of the leg, causing phlebitis. What you describe could also be a small bleed into the skin related to one of the small veins. This is called a venous hemorrhage. This may occur more commonly if you are on blood thinners. I would definitely recommend discussing these symptoms with your doctor.


Vanessa: I was diagnosed with Upper Extremity DVT 6 months ago (right arm). I am currently taking
Coumadin. I do not have any pain and feel just fine, but my arm is still swollen.  Will it ever go away?

Speaker- Dr. Gornik: Dear Vanessa. There are a number of issues here. It is unusual to have a blood clot in an arm vein, unless there is a clear risk factor, such as an IV line or pacemaker wires. If you do not have either of these, I would strongly recommend seeing a vascular specialist to figure out why such a clot happened. In some cases, there is an anatomic abnormality of how the arm veins exit the chest (thoracic outlet syndrome) that can cause blood clots.  Treating the thoracic outlet syndrome can help prevent arm swelling and another clot. In terms of treating the arm symptoms, an Ace wrap often works, or there are special compression sleeves for the arms.


Diane: Ten days ago I suffered a spontaneous aortic dissection while on vacation. I am now at home and looking for a cardiologist. In the meantime I fell very helpless and uninformed, as I seem to be an anomaly, having no hypertension or any other risk factor for a cardiac event. I would like to know if the tear in the arterial lining heals itself, and how long that takes; what are the risks of scar tissue forming at the site and causing problems later, and what I can do to prevent another occurrence, since I don't know what caused the first one?          

Speaker- Dr. Gornik: Dear Diane. I am so sorry this happened, and I am so glad you are ok. I am also glad you are seeking out more information. I would strongly recommend that you see a cardiovascular specialist with expertise in disorders of the aorta. It would be important to examine you to rule out any underlying causes of aortic dissection, such as heart valve disease, Marfan syndrome, or other connective tissue disorders. You also need a good plan for follow-up of the dissection in the chronic phase and to make sure you do not develop an aneurysm. Your blood pressure, as you know, needs to be very tightly controlled. We have some information on aortic dissection on the VDF Web site. There is also a patient advocacy association for aortic dissection that has a helpful Web site through the John Ritter Foundation which you can find here: http://johnritterfoundation.org.  For help in finding a physician in your area, VDF does have a doctor finder online.        


Moderator- VDF: This next question was also e-mailed to us ahead of time: While taking a shower this morning I had a pain in my lower left leg. When I looked down the vein in the left leg was extremely swollen. By the time I got out of the shower everything was back to normal". Is this anything to be overly concerned about?"

Speaker- Dr. Gornik: This is a strange symptom. Veins do not usually swell and then go back down to normal size within a short period of time. I am afraid I am not sure what this could be, but I do think you should mention this to your primary care physician.


Moderator- VDF: This is a question from a subscriber to our newsletter: I developed varicose veins during pregnancy and now every menstrual cycle experience terrible pain and throbbing. I can push through the pain, but can this have any long term effects or develop into anything else     

Speaker- Dr. Gornik: It is not uncommon for varicose veins to worsen during pregnancy, and I have also heard of patients having worsening leg symptoms during the menstrual cycle due (related to hormonal fluctuations). The first place to start with treatment of varicose veins is wearing appropriately fitted graduated elastic compression stockings. There are also minimally invasive techniques available to treat severe varicose veins, including sclerotherapy or vein ablation procedures. I would recommend that you see a vascular specialist if these veins are very bothersome to you and interfering with your quality of life. Your primary care physician can also prescribe compression stockings.


Moderator- VDF: I had surgery in mid-March and a venous doppler 11 days later revealed that I had developed a few small clots in my lower right leg. A CT was done of my lungs to ensure there were no clots there. I was put on warfarin immediately. A second ultrasound was done about six weeks after I started treatment, both legs were checked this time, and no clots were to be seen. The tech even re-checked the original images before she let me leave. My primary physician said I was to stop the medication immediately, even though I was still feeling the sensation in my leg. 

Speaker- Dr. Gornik: In general, a blood clot in the deep veins of the leg is treated for at least 12 weeks, and even longer. In some cases of very small clots in the veins below the knee, a physician may decide not to treat for this full duration of therapy.  I do worry about the symptoms you are still having. I would discuss this with your primary care physician. In some cases we do repeat another ultrasound. Ultrasound is a wonderful tool for diagnosis of DVT, but it is not perfect. It is also possible that there is another explanation for the symptoms in your legs, other than the blood clots.  


Susan: Hello, I just turned 40 and am concerned about my varicose veins in my left leg. I have two areas that look very ugly and then I have on about 20% of both legs little spider veins that keep growing and growing. I have no pain from these but wondered a couple of things, should I be worried about them turning into something or taking over my legs and also, do you suggest some kind of surgery to get rid of them. They are ugly! Thanks!     

Speaker- Dr. Gornik: Hello Susan. Please see my answer to the question above about varicose veins during menses.  There are many options available now to treat varicose veins. All patients need compression therapy, and some patients with severe vein disease may benefit from a procedure such as a laser or radiofrequency vein ablation or sclerotherapy. I would recommend that you see a certified vascular specialist in your area. 


Moderator- VDF: This next question was also e-mailed to us ahead of time: I have recently had to travel a few back to back trips in a row? I had elective surgery on my left knew last summer (July 2007) and have increased pain in the joint since then. The legs I travel are typically not longer than three hours each.           

Speaker- Dr. Gornik: There are many things that can cause positional leg symptoms as you describe, the most common being irritation of a nerve. There are vascular conditions that can cause positional leg symptoms, such as compression of the arteries or veins to the calf, but this is relatively rare.


Moderator- VDF: This next question was also e-mailed to us ahead of time: I am a 40 year old female living in Georgia. I have been having health issues since January of this year. It started with strange head pains along with nausea. I then began having problems with pain in my extremities along with numbness and the feeling that my arms and legs are going to sleep.  I also have chest pain and numbness around my mouth. I have pain on the sides of my neck (carotid areas) and suffer frequent headaches, dizziness and nausea. I have gone to the ER four times in the last 6 months and also was admitted to the hospital just a few weeks ago. They have tested me with chest x-rays, ekg's, blood test, echo, nuclear stress test and all were fine. I am wondering if this is vascular since all the heart tests have come back fine. The worry for me is great and especially since the chest pain is increasing more and more along with the leg and arm pain.  Could you PLEASE offer some sort of advice ....should I worry since all the above test were fine?!?!       

Speaker- Dr. Gornik: I am sorry you are having such difficulties with so many symptoms. I am afraid I am unable to give you advice regarding potential causes of your problems without fully examining you. I see that you are going to the ER frequently, but would also recommend seeing a primary care physician regularly who can get to know you and your medical issues.  Good luck.    


Moderator- VDF: From another subscriber: Is there any restriction of activities when a calf DVT is present? Is Sequential Compression Device (SCD) contraindicated to use on patients with DVT?

Speaker- Dr. Gornik: We generally do not restrict basic activities for patients with DVT who are being treated with blood thinners. Patients with DVT do not need to be on bed rest. It is my practice to NOT use SCDs in patients with DVT, although I am not sure of the medical literature on this off the top of my head.  


Moderator- VDF: This next question was e-mailed to us ahead of time: Do the pneumatic pumps help or any do any good for arterial diseases?

Speaker- Dr. Gornik: In regarding to the pneumatic compression pumps, there are certain patients with PAD who may benefit, such as those with severe critical limb ischemia and no other treatment options. Some other patients may also benefit.  I would definitely recommend discussion of this with a vascular specialist.


Moderator- VDF: This next question was e-mailed to us ahead of time: I had surgery in mid-March and a venous Doppler 11 days later that revealed I had developed a few small clots in my lower right leg. A CT was done of my lungs to ensure there were no clots there. I was put on warfarin immediately. A second ultrasound was done about 6 weeks after I started treatment, both legs were checked this time, and no clots were to be seen. The tech even re-checked the original images before she let me leave. My primary physician said I was to stop the medication immediately, even though I was still feeling the sensation in my leg. 

Speaker- Dr. Gornik: In general, a blood clot in the deep veins of the leg are treated for at least 12 weeks, and even longer. In some cases of very small clots in the veins below the knee, a physician may decide not to treat for this full duration of therapy.  I do worry about the symptoms you are still having. I would discuss this with your primary care physician. In some cases we do repeat another ultrasound.  Ultrasound is a wonderful tool for diagnosis of DVT, but it is not perfect.  It is also possible that there is another explanation for the symptoms in your legs, other than the blood clots.


Moderator- VDF: This next question was e-mailed to us ahead of time: This one might be too technical and specific: I was wondering if you could tell me if after a 2 hour orthopedic procedure (bilateral quadriceps tendon repair), immobilization for 2 days with PCA and foley cath, on a 60-year old healthy individual, if anticoagulation therapy is the standard of care?  Or would bid dosing of Aspirin 325 mg be enough to prevent PE?     

Speaker- Dr. Gornik: Aspirin is not effective in preventing DVT. For high risk patients, such as the one described, we either use low doses of blood thinners (usually injection) or sequential compression boots to prevent DVT.      

   

Thanks to everyone for logging in today and thanks to Dr. Gornik for her time today! We wish you all a healthy day!      

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