Do I Have a Blood Clot or DVT? Signs & Symptoms

[Music] wow [Music] hi welcome to another episode of talking with docs i'm dr brad weaning and i'm dr paul zalzel today's topic really important topic paul do i have a blood clot serious topic it's yeah potentially life-threatening actually can be fatal and relates to a lot of stuff so not only to our jobs as orthopedic surgeons but also more recently with some of the conversations about the vaccine so we're going to talk generically about blood clots we're going to talk talk on the vaccine stuff too maybe a little bit okay okay so blood clot what's a blood clot well blood's supposed to clot right if you cut yourself you bleed yeah and then you eventually clot to stop the bleeding so it's called hemostasis right right and there's a lot of mechanisms inside the blood that enable it to clot intrinsic extrinsic factors within the blood that allow it to clot so you don't bleed to death when you get a bleeding nose it's going back to med school there's a lot of pathways that i remember learning we're done yeah yes we had a hematologist here we go into great detail but it's actually not particularly important for what's happening today in our conversation so we're talking about more pathological or abnormal formations of a blood clot that have potentially serious consequences so we're not talking about blood clot on your skin we're talking about a blood clot in your vessels there are really two kinds of vessels so there are arteries and veins and clots in the arteries and veins cause really different problems absolutely okay where do you want to start i think the most the thing that pertains to us most is the blood clot that occurs in the deep veins of the leg okay and those those blood clots are called thrombosis okay and uh in the deep veins of the leg it's called the deep vein thrombosis or a dvt yes common layman term for a blood clot in your leg dvt so and is a dvt a big deal if you get a blood clot and you're like in the veins of your leg so i'd say generally speaking actually dbt is not a big deal so can cause some local pain could cause some swelling but the dvt becomes a more a serious problem when it becomes mobile yeah so if i always tell patients like if a piece breaks off and goes and the veins uh go go back to your heart and from your heart they go to your lungs right and if you get a piece of that thrombosis goes to the lungs then it's called a pulmonary embolus yeah and which is potentially life-threatening um so let's back it up a little bit so when blood leaves your heart it goes down through arteries so theoretically you get a clot in your artery and that leads to things like heart attacks and strokes and we talked about that in our cardiology series with dr heffernan yeah we explained that so as then as the blood goes out through your whole body and distributes oxygen and nutrients to your tissues then as the oxygen is extracted it puts carbon dioxide back into your blood and then it comes back all these veins but it goes to your to the left to the right side of your heart story and then to your lungs a lot of people like well if i get a blood clot does it actually go into my heart well usually it can it can't get through the filter of your lungs that's why it gets stuck in your lungs and that's why you get a pulmonary it wants to pass through on the right side to get to the lungs exactly um but yeah you get you get a pulmonary embolus or a pe okay so who gets blood clots well blood clots they can happen anybody can have it it can happen to you know there is an incidence of it that occurs and the common population is that one in one to two in a thousand it's actually very common just walking around yeah you can get a blood clot uh and then there are things that can put you at risk for a blood clot uh so you can think of them as things that keep you immobilized for a while yep uh so postoperatively surgery that's the big one for us because i tell everybody if i'm consenting someone for surgery i say well you are at risk for getting a blood clot after okay so surgery and we give you often some form of blood thinner either mechanical or pharmaceutical to try and reduce the risk of a blood clot but a post-operative course is definitely one of the bigger risk factors uh for a blood clot yep long flights long flights very complain very common people always like am i gonna get a blood clot i'm like you could get a blood clot you could get a blood clot in a plane and the two things about being in a plane is one you're immobile in a tight seat i don't get to fly first class often so i'm really cramped in there back in the day when we used to fly not so much now but hopefully we'll get back to that one day and the other thing is when you're up in a plane the cabin pressure is a little bit lower than atmospheric pressure so the veins in your leg therefore dilate and blood pools in there a little bit more and that's why if you take your shoes off on the plane sometimes all of a sudden you're like you can't give a shoe back on swelled up yeah it's welled up so and that's right next year's thinking please put your feet back on and that's why some people wear compression stockings on the plane to help reduce the swelling and reduce the risk of a blood clot there you go um okay so those are two uh controllable kind of things that they cause blood clots and then you can you can be predisposed to it because of some abnormal mechanism in your hemostasis pathway if you have some sort of clotting disorder that makes you clot more frequently then you are an increased risk as well and the only way to know that is if you've had maybe a close family member that's had a history of blood clots or if you're actually tested so unfortunately for some of those people the first time you realize you have that is when you get a blood clot and they say well that's weird you had no other risk factors let's do some tests yeah um cancer is another one unfortunately that some people with certain types of cancers certainly can be hypercoagulable where they have a higher chance of forming blood clots which is a risk as well uh yeah and then there's uh smoking is that puts you at increased risk and certain medications yeah the birth control pill oral contraceptive pill can also put you at increased risk for a blood clot and that's a bad combo oral contraceptive pill and smoking on a plane after you've had surgery you get the idea yes um okay so what do you do well how do they present so so someone's just sitting home like i think i might have a blood clot what are they why would they think that well if it's in your leg one thing we always talk about calf tenderness yep okay soreness in the calf very tender and abnormal amount of swelling which is tricky because you do get swelling after surgery in your leg if you had a hip knit replacement or a knee replacement but kind of an abnormal amount of tense swelling can be an education nova if you look at how does the leg look any different um no no it's hard to tell by looking at usually i usually just examine the calf and palpate it and see if it hurts when i squeeze the calf maybe a little bit red but that's certainly not you could have a normal looking normal looking skin and you might not be able to tell and if it has gone to your lung now you've got some symptoms yeah so what do you so those people where are they showing up with they're showing up with some chest pain yep shortness of breath yeah rapid heart rate rapid heart rate right um okay so you have some of these symptoms and you may have a history or something that's predisposing you so you're worried that you have a blood clot what should you do get to the emergency room yeah or your doctor or urgent care center somewhere particularly on the lung side so if you have the chest being shortness of breath fast heart rate definitely that's probably more of an er vision 9-1-1 even if yeah maybe 9-1-1 if you have a sore calf and a little bit of swelling that might be a family doctor visit but again that would have to be determined by you and the severity of your situation so you get there so you get to the er you explain your symptoms and your story what's a doctor going to do after they take a history of physical i'm going to do a history and physical examination we always say that and then of course if there's been some history of trauma or something they might do an x-ray as well but the key for the diagnosis of the dvt or the deep vein thrombosis is an ultrasound investigation of that limb right an ultrasound is just a test that allows us to assess the amount of flow through a tube like one of your veins and if it shows that that vein is obstructed with something there typically a clot that's how it becomes diagnostic yeah and the way they do it is they look for compressibility of the vein if you push on it does the vein compress because compress the walls of a vein are are very soft a vein will squish easily because the pressure in the vein is very low so you see if it compresses if it doesn't compress that means there's there could be a blood clot in there and then as dr weining said you can also look for flow and the only way we can use ultrasound to look for flow is using uh doppler ultrasound special kind doppler is just uh we're gonna go back to physics here now doppler hands christian doppler austrian physicist found that the frequency shift in sound waves is proportional to the velocity of the thing that the sound bounced off of so it bounces off the blood vessels it bounces off the blood vessel wall and it bounces off the red blood cells and they can they can see flow from ultrasound by looking at a frequency shift in the ultrasound signal they sent out and bounce back did you like that i apologize for dr zelda being an engineer he just went back into engineering mode i love that stuff yeah it's pretty cool flows flow is an important part of engineering and physics for sure reminds us of when our kids are doing physics homework um okay so you got the ultrasound are there any other tests say you're higher on the pe worry we're worried about a blood clot gone to your lungs okay yeah well on this on the investigation side of things you can get some imaging uh fancy imaging of the lungs and that is a so a ct angio or a special type of ct scan of your chest or a spiral ct sometimes they can do it more quickly ct angiogram is just a ct that looks at the blood vessels around an area and spiral ct is just a very high high resolution ct so we used to do vq skins i don't think they do them anymore which it was a test where they looked at the amount of blood that perfused the lung and essentially what happens is if you get a clot that goes to your lung it's kind of like that part of the lung gets blocked off so it doesn't have proper blood flow remember we used to do those all the time yeah but i think it's because ct was not readily available and now even the smallest hospitals often have a ct now so i think it's it's faster and i think it's more forgot about the vqs yeah old school yeah but a history of medicine there you go okay so now you have a p.e wait one more time you can do blood tests there's all these tests you can do okay d-dimer a d-dimer blood test is that a good test paul i think it's not very uh specific maybe sensitive but it's not very specific you gotta pull it together with the story and the exam and all the tests that can help lean you one way the post-operative period i think your d-dimer is going to be up because it's just showing like products of blood clots and things and obviously you've got blood clots going on where you're supposed to have them around a surgical incision right so a d-dimer might throw you off okay there you go so you're positive for a dvt or a pe now what okay uh send you on home yeah good luck with your book lot yeah here here here now you know you got a blood clot well now we got to treat it in some way right so the mainstay of treatment is some sort of pharmacologic agent that thins the blood uh we say you're not gonna you're not gonna burst this clot for me you're not gonna give me a medication to burst it no no it really burst the vein clots right we just and we don't we can't really to be honest to cure them or get rid of them but we want to stop it from progressing right so it's yeah it's some sort of what we call blood thinners i mean uh it's not really thinning the blood but it's really making the blood less uh able to clot right because you don't want that clot that's blocking a small vessel to block a bigger vein and become keep it growing yeah keep growing and keep growing okay so you go a blood thinner so we're taught there's many different categories from aspirin up to very very strong medications do i take this for like a couple days you're going to be on that for a while that's going to be and that you're going to determine with your family doc internal medicine doc or even your hematologist in some centers and it's going to be in the order of months now that you're gonna be taking that yeah like certainly three to six and potentially a year depending on if you've had it before or the severe the clot or your symptoms or whatever especially if you had a pe i'm pretty sure it's minimum six months yeah and if you have some underlying condition that predisposes you to it you may be on it for life yeah people don't love that or if you get them without any predisposing factors yeah uh frequently and even though you haven't had identified sort of anything in your system that causes them then you might be on them for life as well right but they're usually oral medications so it's not it's better than it used to be because we used to have to inject everybody and then injected themselves and the people didn't like that either um so now you're on medication anything else that you do after uh well you try and modify those risk factors you know definitely if you're smoking you're going to quit smoking uh and uh a level of mobility after surgery if you're in the post-operative period or trauma too we didn't really mention that as a potential cause but yeah if you break your ankle break your leg even if you're cast sort of that immobile leg which is a big part of our practice yeah um those people are potentially at risk depending on the location and the duration of your immobility so that's also something to consider um so modifying those what are your thoughts on compression stoppings i think compression starting is a reasonable option especially if someone has some venous insufficiency so the veins in their legs aren't working as well as they should be right um compression stockings just try and reduce the amount of blood pooling that can occur right because veins have one-way valves that slowly start to work less effectively over time so as that pools that compression stock can work almost like the muscles that are surrounding all of your veins that push that blood back to your back to your heart all right we we did mention we're gonna talk about vaccines yeah so this is a really really hot topic obviously for some of the vaccines more than others we don't have to well we will name them you know what we didn't so there's evidence to show that astrazeneca vaccine and the jnj vaccine have a slightly higher risk of potentially being related to blood clots and this is in the order of so normally like we talked about one to two people in a thousand are just walking around are gonna get a blood clot so that's the incidence just in the community and it goes to about what the incidents with the vaccines about one in thirty thousand or one in forty thousand so very small right and it makes it hard to find when if you have one in forty thousand and of that forty thousand you probably already have forty people that have blood clots yeah but there definitely is some association much less frequently with the mrna vaccines um and they don't exactly know why it's a different kind of blood clot it they label it v-i-t-t where you actually have a clot that's related to thrombosis having less platelets than normal which is odd um but there's not much that you can do about it um and some people say well is this enough of a reason for me not to get the vaccine well we always look at risk benefit ratios when we decide on a medical treatment and for the vaccine in specific for the vast majority of people the risk benefit ratio favors getting the vaccine i'm sorry if there are some people here against vaccines and you don't like hearing that but definitely the risk benefit ratio for the majority of people uh uh if you look at a cross-section of society it benefits uh getting the vaccine because the risk is so small and that's what the hematologists say so so yes obviously if you had a specific risk factor or had a family history then you have to discuss that with your family doctor hematologist to weigh the risk specifically for you and kind of categorize them but generally speaking yes the risk of getting a blood clot a in the community is higher and b the risk once you get cove it actually goes up eight times so covet itself can lead to blood clots so in general um saying that you don't want to get the vaccine because of a blood clot despite being normal to be afraid of blood clots is not really backed by science yeah but now you've probably you've probably never thought of blood clots before but probably now you may have heard the word more and more because of the vaccines and that and that and that i don't even say controversy that uh reality reality yeah but yeah so definitely just keep in mind if you've had the vaccine or think of getting a vaccine or you're going to get the vaccine your risk of blood clots very very very very small yeah and doctors even said a lot of people have come to the er or to their family doctor concerned about blood clots having said that very very few of them have blood clots and of the people that do get them the vast majority do get better so hopefully this video has helped yes if you like this video please like it subscribe to our channel and remember you are in charge of your own health we'll see you next time

Channel: Talking With Docs

Views: 367,088

Keywords: DVT, Blood clot, Leg swelling

Id: stLaN0iTl4w

Length: 16min 6sec (966 seconds)

Published: Fri Oct 22 2021