(upbeat music) - This is Tom Biernacki and today I'm talking
about an important subject that's been much more popular in the news. You know, because of all the talk about vaccines and medications, a lot more people are
thinking about blood clots. And I'm gonna talk about what this means because I have a lot of patients come in and they're confused
about arterial sclerosis, which can plug the veins, or sorry, I should say the arteries
because arterial sclerosis. And then there's things like blood clots, like deep vein thrombosis. And it's very important to diagnose whether you have ankle
swelling, poor blood flow, really a blood clot cause
these can all look like ankle and leg swelling. And the last thing I would want
about this blood clot video is for it to be in vain. Guys, thank you so much
for watching this video. We appreciate your likes,
your subscribes, your comment. We really love hearing
if this stuff helps. It really makes a big
difference for us, so thank you. (chuckles) Sorry about that tasteless
blood clot vein in vain joke, but let's get to it. So arterial sclerosis
refers to the arteries. So arteries bring blood down to your leg and veins bring blood
flow back up to the heart from the feet. So generally
arteries can narrow. So this is called arterial sclerosis. So things like inflammation, smoking, eating too much cholesterol, they can build up in the wall
and make the walls thicker, less elastic, and it
eventually squeezes down. This can plug your arteries so that poor blood flow
gets down to your toes. This usually results in, you
know, people who have diabetes, who are smokers, who
have some health issues, they have weakness and pain in their toes when they're sleeping, when
they walk for a few minutes, but when they drop their legs
over the edge of the bed, their blood flow starts to improve, their toes start to feel better. So if this is you, the
best thing you can do is come see someone like me, a podiatrist, and we'll perform
non-invasive arterial dopplers to make sure that you're not
having blood flow issues. And I'm gonna talk about treatments for all of these towards the end. Now on the other hand, you can get veins from your feet up to your heart and your lungs. Now what can happen is, this
is if you get hit in the leg, if you get injected by a
needle, if you have surgery, if you're a smoker,
birth control pills, age, history of a prior blood clot, all these things can raise
the risk to form a blood clot in the vein. So in the leg it's not really dangerous, but what would happen is
if that clot breaks free and floats up to the heart or the lungs, it can plug those smaller vessels. And when it plugs those vessels, you know, people can have what's called
the pulmonary embolism, which means it can plug
a part of your lung where you can't breathe or it
can cause other big issues. But the single biggest
concern with a blood clot is not that it's a clot in your leg, but the fact that it can
shoot up to your lungs and give you a pulmonary embolism. Now, I'm not gonna talk
about the clot in your brain because that could cause a stroke, but the ones from the leg will
only shoot up to the lungs. They won't make it through
the lungs and into the brain. That's too far of a journey. But that's really the big thing about a blood clot in the leg. So the thing you should do is
if you have pain in your calf, if one leg compared to the
other is red, hot, and swollen, or if you squeeze your calf muscle. So if I'm squeezing my calf muscle and it's tender only on my right side compared to the left side
and you've had an injection, or you've had some type of surgery, or you've had some trauma, or
you've had a prior blood clot, this is a serious risk. You know, there's a whole host of risks. I'm not trying to blame it
on injections necessarily, but it is a risk factor. But as you add all these
things up in risk factors, your risk for blood clots goes up. That's why it's very important
to get that evaluated. Now there's really only one thing to do is you have to go see a doctor
to get a venous doppler. So a venous doppler is like an ultrasound and they squeeze your veins to make sure that there's not a blood
clot that could come loose. And this would traditionally
be done in the emergency room. So if a patient calls me up and thinks they have a blood clot and it sounds like it
might be a blood clot, straight away into the er, get a venous doppler, get evaluated. From there, the patient would go see a vascular specialist or vascular surgeon. We work with amazing vascular
surgeons who would generally put them on a treatment
plan of blood thinners or something potentially
even more aggressive, but generally that's what happens. If you have repeat blood clots, what will happen in that case is you might need further
treatment like a filter so it doesn't shoot up into your lungs, and I've had patients have
to have that get done. So here's the causes of both. So arterial sclerosis is on the way down, so diabetes, smoking, weight gain, eating fats, and inflammatory lifestyle. So that's just anything that
raises your stress level. So here's how you
control the risk factors. Eat healthy, you know, eat your greens. That's the single biggest improvement. Don't eat fatty cholesterol,
sugary foods, you know, there's a lot of debate
now, sugar versus fat, but realistically just eat healthy, eat your vegetables, that's
the best thing you can do. You know, that kind of
skips the whole debate. Eat as healthy as possible. Exercise is phenomenal for you. You know, if you have
health issues like diabetes, go see your primary care doctor and get evaluated for that kind of stuff. That's gonna be the key. And what happens is if you
truly do have poor blood flow to your toes, like they're
pale, they're white, go to your primary care
doctor and you should, or to your podiatrist like myself, and you can get an arterial gram, which is dye to see if there's a blockage or arterial non-invasive
ankle brachial indexes, which are a cuff around your ankles and legs to see if something's narrowed. That can be very beneficial. Then we'd start you on a health
program or blood thinners. Some patients with narrowed blood vessels, it's almost like a
Roto-Rooter invasive angiogram where they can go and
perform an angioplasty that's dropping off a stent
that would hold the artery open. So, this is something I get help with a lot by vascular surgeons. You can see on the left hand side is progressive arterial sclerosis, so that's inflammatory fatty
tissue building up in the wall. And on the right you go in
with a wire and you expand that and that's called a stent right there. So this is what the video looks like. They would go in under
fluoroscopy, which is live x-ray, and essentially come down
with a collapsible stent and place in the proper
position, then expand it. If they can't come in there,
they would have to do a bypass, which is to create a new blood vessel. So see right here, the blood flow can now go
through that narrowed portion. So a bypass is to actually
create a new synthetic graft. That's kind of when for
your heart or your leg, they harvest the vein from
your leg, then they put it in. So that's called a bypass. That is a much more serious procedure that has a big recovery time. So, on the other hand, a
clot coming up the vein, so that's called the deep vein thrombosis. What you wanna do, same kind of thing, get as healthy as possible,
get your risk factors down, try and get off as many
medications as you can by losing weight and getting healthier because medications can be a big risk for blood clots as well. Now the next thing is studies do show that compression socks can be effective. So this is something
that's not well studied. I did a lot of research
prior to this video, but I found a Dr. Lucas, a
vascular specialist in Baltimore, who says essentially once
the blood clots there, the risk of it breaking
free is not the greatest, although you wanna take your
medications and get evaluated. He would recommend, you know, you don't have to like
worry about sitting still and not moving out of your bed, you can wear compression socks,
although that's gray advice, I wouldn't give that like
a strong recommendation. Always check with your vascular surgeon for your specific scenario. But in general, studies show that as long as you don't
have like an active clot, which is a gray area, although that specific
doctor recommends doing it, what you can do is
where compression socks. So studies do show that after surgery, or high risk patients, those
who wore compression socks had a much, much lower rate
of getting blood clots. So compression socks,
especially if you have swelling in your ankles and your
legs, can be very beneficial. There's different types
of compression socks. So there's the knee high ones
that are over the counter. There's knee high ones
prescribed by a podiatrist, like myself. So they can be 20 millimeters of mercury, 30 millimeters of mercury, or 40 millimeters of mercury, or more. These ones that you buy over the counter are more like 10 millimeters
to 15 millimeters of mercury. But what I would recommend is start off with over the counter stuff. The doctor stuff is hard
to get, and it's so tight, and so uncomfortable
that you can barely move and it might not
necessarily be good for you unless your doctor
specifically recommended it. So as always, I include
some of my favorites, some of the best rated ones, but you don't have to get
anything from me, you know, these are not my products by any means. So check out some of these
compression socks right here. So you could see down
here the different size. They actually do a good job showing you the different colors here, but specifically what you wanna look at, is they're not that expensive. Like eight pairs for $17, I mean come on, that's like $2 per pair of socks, So it's like a dollar per sock
that you can keep re-wearing. So you can kind of see these
are meant to be more athletic. There's some sizing guides, but these are marketed as nursing socks. But what I want you to look at is 15 to 20 millimeters of mercury. This is too low of compression
for insurance to cover. Most adults that have swelling
problems will not be able to get on the 20, to 30, or 40
millimeter compression socks. These are so tight that nobody wears 'em. In my experience,
everybody tries to buy 'em, but maybe like 2% of
people actually wear them. Get something that's low cost. So for like, you know,
a dollar per pair here, that's lower compression. If you find that it's not
enough compression for you, then get something heavier. Don't goof around starting with
the 40 millimeter of mercury trying to get insurance to cover it because you're gonna jump
through a lot of hoops, you're gonna waste a lot of time, and it's gonna cut into your skin, and you're gonna hate it if you're like 98% of the patient's I see. Start with something low
cost and lower compression, see how it works, see how it fits into your routine, and then go up to the higher compression. At the same time, take a look right here, the 20 to 30 millimeter
mercury are like $15. Why would you waste time driving
to like different outlets, wasting gas especially the price it is, trying to exchange
prescriptions from your doctor to the medical supply company
to get something like this when it's so cheap online. It just doesn't make a lot of sense to me, and realistically, you should
go with the lower compression. This for the average person is probably a little bit too high and doesn't provide a ton of benefit. It'll cut into your skin and hurt you more than
it will benefit you. So start with the lower compression rather in the high compression. Down in the show notes
I include my favorites. Sitting for long periods of time. So you've probably heard
like on a train, plane, or automobile, if you're
sitting for one hour or more, you're much more likely
to get a blood clot. So do exercises, you
know, pump your ankle, stand up and down, bend your thighs, do some mini squats in your chair. You know, personally, I like
to use a leg massage device so it's annoying to people around you. But if you're a passenger in a car, a massage gun I like to
use on my thighs, calves, calf muscles, hamstrings,
that makes you feel good. You know, there's no studies
done on a massage gun, but I would think it
gets the blood flowing, plus do some leg pumps, get up, move around as
frequently as possible. I used to think massage
guns were a gimmick, but I love these things
they have great ratings. This is one model, just because I know Bob and
Brad, they're great guys. There are cheaper ones out there. So I'll admit there are
much cheaper ones out there but this is a great one that I enjoy and it has amazing reviews,
great customer service. But what you wanna do is just
start with the rubber ball and in the mornings, or when
you're sitting in a chair, every hour or so, you want
to just massage your thighs, your hamstrings, your
glutes, your big leg muscles, your big butt muscles,
your big calf muscles. So use that soft rubber
ball and massage it. It'll keep that blood flowing, it'll push that blood through that region. Don't use it on an active
clot, it's not tested for that. Which you also can use are
these leg pressure cuffs, you can see I bought that one myself. It was a lot cheaper when I bought it. You know, inflation's getting
everything these days, but grabbing these and putting them around your calf muscles, you can set it to basically massage and push the blood flow
through your calf muscles for 20 minutes at a time. Listen, there's a reason
the hospitals force patients to wear these because this
is significantly proven to reduce blood clots,
get the blood flowing, make people feel better. There's a lot of statistics
I could quote and studies, but the bottom line is a
hospital, if you're laying in bed, will force you to wear one of these because that's how effective
and important they are. So don't goof around wearing
'em on like your arms or your feet. The reality is you want
it on your calf muscle so that it pushes blood up into your body. That's really the goal. It's almost like a fake simulation of you walking while
you're stuck in your chair having to do office work, or watching TV because you're unable
to move from an injury or a problem. Don't use
it on an active clot. Risk factors for a blood clot
in the leg can be injections, smoking, diabetes, weight gain, too much bedrest being stuck
in a hospital or a house, or being lethargic and
not exercising daily, pregnancy, medications,
things like birth control can raise your risk for a blood
clot. Cancer is a big one. Another big one is having a prior clot, that's the single biggest risk factor. If you or your family members
have had clots in the past, consider yourself high risk. Autoimmune disorders, genetics, so if you have inflammatory bowel disease, things like lupus, I feel
like it's a house episode everything's always lupus
or autoimmune disease. If you have heart issues or if you sit for over
two hours at a time, that could be a big risk factor. So symptoms of blood clot, a deep vein thrombosis in the vein, is a red, hot, swollen leg. One side's more sore than the other. If you squeeze it, that's gonna be more painful
on one side then the other, history, or if you had a prior
surgery, if you're a smoker, if you had an injury, if
somebody punched you in the leg, or you took a hit to the leg
and it's not getting better, that could cause a blood clot. For a pulmonary embolism, if
you have a hard time breathing, chest pain, breathing difficulty, if it feels like you've
had a heart attack, that goes without saying
go to the ER immediately and get checked out. So treatment for a deep vein thrombosis are you wanna exercise and
get healthy, lose weight. I'm a big fan of the fasting technique, you know, whenever I start gaining weight, cause I like to have fun on the weekends. Fasting works great for me. I'm gonna link, there's a great doctor, Dr. Jason Fung. He does a
great job. He's a nephrologist. Talks about the benefits of fasting and how this could
rapidly get you healthier. Exercises, stretching,
strengthening your muscles. This is a big cause of ankle swelling that's correctable by exercise. Look at my left foot
compared to my right foot, my left foot can't bend up
as much as my right foot, see that? That's about a 10 degree difference and I'll show that in a second. But see now it has to turn out by not being able to turn up as much and being stiff through my hamstring, through my calf muscle, it
creates that difference. That means my leg will swell and get more sore through
the muscles as I land on it because that muscle and
leg has to work harder. That can explain why one legs
more swollen than the other. So look at this healthy young man right here that's flexible. He's running and his feet
are landing straight. They're not buckling out.
This is normal running. Whereas a condition called overpronation, look at how much that ankle
sags in when this person runs. As people get older and stiffer
through their hamstrings, back, and calf muscles the foot bends out, the muscles have to work harder, and as a result they swell because the muscles are working harder. So take a look at this older gentleman. He doesn't really have
flexibility through his feet, ankles, and hamstrings. His muscles have to work
significantly harder. This is why older people can
sometimes get more swelling and sore muscles. Great shoes, great orthotics
can make a big, big difference. So realistically, wearing
great supportive shoes, something like this with a lot of cushion that has a rocker bottom, puts
less strain on your muscles, lets you walk more, lets
you exercise more pain free. If you're in pain and outta
shape and you're not walking, moving, get a great pair of shoes. You know, the more support,
the more cushion, the better. Hoka, Brooks, Saucony, New Balance, Asics, I love all these brands. If you get these, that
makes a big difference. Mizuno too, (chuckles)
I'm not forgetting you. And orthotics, check this out. Without support, your foot flattens out. Whereas with an orthotic, see that right there as I push down, nothing's crushing down. Whereas without it, that bends, that puts more stress
on your ankle muscles, your calf muscles that
can cause more trauma and more likelihood of a clot. And get a good supportive home slipper, that's a big one too, to reduce
ankle swelling and leg pain. That makes a big difference. So see in my slippers I have orthotics, they're nice and comfy. My favorites are down in the
links in my favorite shoes. As far as slippers goes, I'm a big fan of Vionic
slippers for women. So see for these types, you have pretty nice built-in arches. They're not really expensive, they're like in the 40, $30 range, but you could see the
arch is pretty aggressive in most of these. You can't really go wrong
with a brand like Vionic. So Vionic is excellent. Vionic caters more towards
ladies, I would say, even though they do have some shoes I would recommend don't use 'em for shoes, but kind of like a house slipper
to walk around the house. They are fantastic. There are better shoes you can get though. For men, I would recommend- For men I would recommend
something like a Spenco. So see they're just a
little bit more earth tones. I kind of have this one
up here in the corner that works really well. So
these can work really well. See they make slippers, sandals. My wife uses these. She
loves the Siesta Slide. So these are really good as well. So Spenco and Vionic are great. For shoes inside the house,
if I had to pick just one, go with the Brooks Ghost
that's down in the show notes. So you could see last year's
model's a little bit cheaper at about $109. The new model, the 14 is like 140. These are phenomenal shoes. If you can get an insole
from your podiatrist an over the counter insole, and again, down in the
show notes are my favorite. Get a good Brooks Ghost. Get the insoles we recommend
down in the show notes. It's gonna really make a
big difference for you. I personally, right now, am
wearing a good supportive shoe. Brooks are one of my favorite. So I always wear a good supportive shoe inside the house with orthotics. What this does is a shoe and an orthotic can lower how hard your
muscles have to work. And if your muscles are working less hard, then your swelling less. This is probably the
easiest thing you can do. Getting good slippers at home, getting good orthotics inside your shoes, or wearing shoes at
home can do even better. But it's a little bit more annoying to put on a good supportive
shoe and slipper. If you do anything at all,
get a good supportive slipper. Some of the links are down below. Some of my favorite Spenco,
Vionic are great brands. These really, really get
your swelling down quickly. You know, there's no
real risk to doing this. There's risk to medications, but shoes, orthotics not a real risk. If that's helping, then get
some ankle compression sleeves that are easy and low cost to wear. We're talking like 20 bucks for something that's probably going to help
and pretty easy to get on. So slippers, shoes, orthotics,
ankle compression devices, those work extremely well. And then eat your vegetables, exercise, live a healthy lifestyle, stop
smoking, stop the alcohol. All this type of stuff will make a huge, huge difference in taking
care of your lymph edema, your venous stasis edema, and keep you in great healthy shape. Another thing is go see your podiatrist, because if you're suffering at work, we can write you letters
for sit down, on your chair, you know, less motion, less 12
hours standing all day long. This really does impact
the body in a negative way. When you have a blood
clot that's not the time you should be doing
exercises to prevent it, but massaging your
arch, your calf muscles, this can loosen up your muscles and make them less prone to
stiffness and inflammation. So a frozen water bottle,
a frozen ice ball, like realistically on
the bottom of the foot, that's not great, but
these frozen ice balls are great on the calf. You can do a rubber ball on your foot, so as you're standing, you
can roll your foot there. That will push blood
flow up through your legs so it's not stationary that will loosen up those stiff muscles and get it feeling better. I love massage sticks,
especially if you sit all day. If you're on a plane,
using this on your calf can push the blood through
your foot, through your leg. And I do this every morning.
I use a massage roller stick. Just get the muscle, move
the blood flow through there. And again, don't do this when you actually have a blood clot. This is to prevent a blood clot. You can get the bottom of your
foot, you can use a towel. Work on your flexibility. The more flexible you are,
the stronger your muscles are. The more you exercise 'em, the less likely you are
to develop a blood clot. All things considered equally. So I'm a big fan of massage, then stretch. So calf stretches, hamstring stretches, you could use a towel, or a shirt, when you're stationary for a long time. And when you get up in the
morning, rotate your ankle, move your ankle around, move
your calf muscles around. This can make a big difference
for you in the morning. Just get up, move around,
stand on your tippy toes, stretch as much as possible. Try and touch your toes
as much as possible. Walk around as much as possible. All these exercise make a big difference. But the more flexible,
the more mobile you are, the bigger difference
this all makes for you. This stuff is what really
prevents blood clots. But don't do this when
you actually have one, see your doctor at that time. If that helped and you have foot pain, check out this video. This is for you. Please subscribe. Please
leave us a comment. It makes a big difference and let us know if we suck
or if we need to improve.
