Cath Lab Digest

Clinicians often are so focused on their patients’ needs and symptoms they overlook their own health. If an elderly, hospitalized, or immobilized patient presented in a healthcare facility, clinicians would automatically check for deep venous thrombosis (DVT) but how frequently would an otherwise healthy, fairly young, busy medical professional acknowledge those symptoms and conduct self-screening? Typically, we are always on the go, giving up meals, exercise, or sleep when duty calls without a second thought. Sometimes, however, a second thought might help preserve our health so we can continue contributing to our patients’ well being. My personal experience with DVT underscores the need for clinicians to be aware and proactive about their own, as well as their patient’s, health.

Personal Experience

I was attending a conference on the West Coast, alternating sitting for extended times and walking long distances in high-heeled shoes. At some point during the conference, my left foot began to hurt. Walking became difficult but the discomfort could be endured. After the conference, I immediately went on a planned vacation. Two weeks after my vacation, I finally had my foot examined; the x-ray revealed a probable stress fracture. Naproxen and crutches eased the pain and my normal gait returned.

I did not have time to slow down — the back-to-back trips meant I had to tackle accumulated work, face looming deadlines, and assimilate the next batch of speaking materials before I left again to address another conference, barely 2 weeks later. During the conference, my foot and calf began to bother me. I awakened with leg cramps during the night. Thinking the pain and cramps were the result of too much walking, I elevated the leg more often.

When I returned to my office a few days later, my foot felt better but pain began to radiate into my knee and thigh. Soon, the calf became grossly swollen and hard. The back of the knee also was swollen and sore. I felt extreme pain in the leg almost instantaneously whenever my leg was not elevated. I called the nurse manager and my doctor; something was wrong.

A history was taken and clinical examination was followed by compression ultrasound that revealed thrombi occluding the saphenous and popliteal veins. Thankfully, I experienced no chest pain nor did the chest x-ray show any signs of pulmonary embolism. But I was stunned. Were my circumstances actually that conducive to DVT? I was traveling frequently (10 flights in 6 weeks), restricting my foot movement, and attending numerous conferences, but I am also a young mother with two preschoolers — wasn’t chasing them around enough to counteract periods of inactivity?

My doctor offered a choice: hospitalization or self-treatment as an outpatient with home health visits for venipuncture. Although outpatient treatment for DVT is not right for everyone, it helped me avoid potential nosocomial infections and maintain a sense of normalcy. I learned how to inject a low molecular weight heparin (LMWH), combining this blood-thinning regimen with oral warfarin. Until the pain medication took effect, I did not realize the extent of my discomfort. I had no choice but to slow down and comply with the imposed bedrest.

Trying to avoid the whiplash from the sudden change in pace was difficult at first but my body seemed to enjoy the new priority: rest. The forced down time allowed me to research DVT and related issues. I discovered why I had become vulnerable to the condition and decided to share my newfound knowledge with the hope that clinicians will be better able to recognize the risks and symptoms of DVT and, in turn, provide the appropriate timely care that can relieve the discomfort and the potential for complications.