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Tuesday, May 1, 2018

Are Blood Clots Dangerous?

A blood clot in the leg is a serious medical issue. But, often I am asked if it is life threatening. As with many things, the answer is yes and no. A blood clot in the legs is also called a Deep Vein Thrombosis. It is typically found in the deep veins of the legs. They can be found in the calf, behind the knee, and thigh. Clots have also been found in the arms.

The blood clot restricts that flow of blood through the portion of the vein after the clot. Clots are much more likely to be seen in veins. Some immediate symptoms will include pain, leg swelling, skin warmth, tightness of the area, leg cramps, and even some color changes to the skin.
Inflammation is a large reason that many of the symptoms occur. Inflammation happens because of the clot itself and the pressure on the tissue around the clot. Irritation of the skin is noted. This is called: Thrombophlebitis.

Bruising in the leg is often not a symptom of a blood clot

Blood clots in the arm can be caused by IV drug use.

When does a Blood Clot become Life Threatening?

When that clot leaves or "breaks loose" from your legs and travels through the blood system it can end up in the LungsPulmonary Embolism and/or the brain - Stroke.

This process of breaking off is called - Embolism
When the clot then lodges itself in the lungs - it affects the pulmonary arteries. This can lead to shortness of breath, difficulty breathing and even death. This is a Pulmonary Embolism or PR. The degree of blockage (location and severity) will determine significance.
9000,000 people each year are affected by DVT/PE

When the clot lodges in the Brain instead of the lungs - Stroke is often seen. Stroke is about loss of oxygen to a portion of the brain. Where the clot is located can determine the symptoms. Common symptoms include: Vision changes, loss of the ability to speak or slurring of speech, body weakness (usually one sided), and others.

Risk Factors for DVT/PE

1.)  Prolonged sitting
2.)  Immobility
3.)  Pregnancy
4.)  Childbirth
5.)  Recent Surgeries
6.)  Family history of clotting disorders
7.)  Recent trauma to lower extremities
8.)  Heart Attack
9.)  Heart Failure
10.)  Some birth controls - Estrogen
11.)  Estrogen treatment/therapy
12.)  Cancer
13.)  High altitudes
14.)  Advance Age
15.)  Certain heart or respiratory conditions
16.)  Other Genetic Conditions
17.)  Other

How to Diagnosis a DVT or Pulmonary Embolism?

1.)  The first step is physical exam. There are certain tests that can be done in clinic on exam that can increase or decrease the suspicion of DVT.

2.)  A Doppler Ultrasound is essnetial to evaluate the vein of the leg. Other tests include venography, impedance plethysmography, and a CT exam.

3.)  Physical exam is also important in Pulmonary Embolism. Other treatment include CT, Blood work (D-dimer), bronchoscopy, etc.

What is the Treatment of DVT or PE?

Initial treatment is based on symptoms and severity.
Blood thinners are essential to both help the clot (if possible) and prevent new clotting.
Surgery in the leg can be done for large clots if the patient is unable to take blood thinners.

Blood Thinners
-  Warfarin (Coumadin)
-  Enoxaparin (Lovenox)
-  Dalteparin (Fragmin)
-  Rivaroxaban (Xarelto)
-  Apixaban (Eliquis)
-  Dabigatran (Pradaxa)
-  Aspirin

How can you prevent DVT and PE?

Prevention is key to many different things that providers and patients must do. Movement is the key. Move around after surgery, on long flights, during work, and while pregnant.

Weight loss is important because it will help you move around and will help blood flow from the legs back to the heart.

Elevation of legs - after surgery and when immobile. This will decrease the resistance and force required to get blood back to the heart.

Avoid high dose Estrogen pills.

Compression stalking or other compression devices. Some patients with complicated medical problems including edema may require compression stalkings. Some devices after surgery also can help the blood flow.

Sunday, May 26, 2013

Use Nasal Rinses to help treat Allergies, Nasal congestion, and Sinus Problems

Rinsing your sinuses to help treat many things including dry nose, nasal bleeding, and nasal allergies.

Depending on where you live, difficulty breathing and runny nose may be ruining your sleep or allowing you to go outside.

Nasal rinses can be a blessing to relieve symptoms.

Nasal rinse can also be referred to as Nasal irrigation.

According to its advocates, nasal irrigation promotes good sinus and nasal health.

Patients with chronic sinusitis including symptoms of facial pain, headache, halitosis (bad breath), cough, nasal drainage, nasal congestion, and more.

Nasal rinses are often used in conjunction with other medications.

In some cases - no other medications can be used.

But more often, nasal irrigation will decrease your need for allergy medications, nasal steroids, and other adjunctive treatments.

Here are 5 helpful hints:

1.)    Use distilled or sterile saline.

2.)    They are quick and inexpensive

3.)    Can be effective to relieve nasal congestion

4.)    Squeeze bottle or use neti pot

5.)    Irrigate or rinse both nasal passages.

Learn more about Allergies and other treatment options here at Allergy Season Hits Hard

Tuesday, December 13, 2011

Blood work to help diagnosis Ovarian Cancer

Research is looking into the distinct possibility that there may be a tumor marker in the blood of those with ovarian cancer . Early diagnosis of this cancer can be very difficult. As it advances it becomes harder and harder to treat. New research hopes the answers are in the blood.

The research is taking place in Chicago at the Rush University Medical Center. Initial research was intriguing though additional studies are required before anything is certain.

Antibodies, found on the surface of ovarian cancer cells, were found in the blood of most of the women with ovarian cancer. These antibodies were also found with women who had previously known ovarian problems - but not necessarily cancer. Women with normal ovarian function and no ovarian cancer were found to not have this antibody.

Typical treatment of ovarian cancer is to removed the uterus completely. This is usually done because the cancer is in an advanced stage. Single ovary removal along with the fallopian tubes can also be seen. Following surgery chemotherapy is a possibility. Radiation is rarely used as a treatment.

If the cancer is diagnosed early - the fiver year survival is very high. If not, the survival rate is far lower.

Friday, July 22, 2011

Wood stuck in his leg

Photo of the day. The man in the pictured above is Azizulhasni Awang of Malaysa, and this happened to him Monday, February 21st, 2011 after falling at the 2011 UCI Track Cycling World Cup Classics in Manchester, England.

Check out more at: Cyclist finishes race despite 8 inch splinter through leg.

Tuesday, August 17, 2010

Shoulder Pain

This deals with what is referred to as the AC joint of the shoulder or the acromioclavicular joint. The AC joint is located at the far end of the clavicle, towards the end of the shoulder. It can be seen in the picture above. When an AC joint is "separated" it means that it has been injured to some severity.

Types of AC joint injuries:

Are all separated shoulders the same?

No.... Separated shoulders are graded according to the severity of the injury and the position of the displaced bones.

Shoulder separations are graded from type I to IV though some grade it up to VI:

Type I Shoulder Separation:
- Is an injury to the capsule that surrounds the AC joint.
- The bones are not out of position
- The primary symptom is pain.
- Ligaments damage is minimal if any

Type II Shoulder Separation:
- Injury to the AC joint capsule
- Additional injury to the important ligaments that stabilizes the clavicle.
- This ligament, the coracoclavicular ligament is often partially torn.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.

Type III Shoulder Separation:
- Involves the same type of injury as a type II separated shoulder
- In addition the injury is more severe and damaged.
- Ligament tearing is more severe.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.

Type IV Shoulder Separation:
- Involves the same type of injury as a type II and type III separated shoulder
- In addition the injury is more severe and damaged.
- Ligament tearing is more severe and can be complete.
- Symptoms include pain, decrease motion, and a possible small bump over the injury.
- In some rare cases the clavicle is pushed behind the AC joint.
- Other times the clavicle is pushed downward

Treatment -

- Types I and II often require ice, pain medication, shoulder sling, and time
- Types II and III include those for the other types. In addition, surgery, PT and other treatments may be necessary

Shoulder Dislocation

The joint of the shoulder consists of three bones that come together at one place. The arm bone (humerus), the shoulder-blade (scapula), and the collarbone (clavicle) all meet up at the top of the shoulder.

The joint between the humerus and scapula, also called the glenohumeral joint, is a ball-and-socket joint. The ball is on the top of the humerus, and this fits into a socket of the shoulder-blade called the glenoid. This joint is effective and multidimensional as it allows the movement of shoulder though a large arc of motion.

There is no other joint in the body that allows more motion than the glenohumeral joint. Unfortunately, by allowing this wide range of motion, the shoulder is not as stable as other joints. Because of this, shoulder dislocations are not uncommon injuries.


1.) Anterior

95% of all shoulder dislocations are anterior or forward.

2.) Posterior

Posterior dislocations are behind the shoulder. They are possibly due to strength imbalance of the rotator cuff muscles. Other causes include falls, sports injuries, and other. Can occur and go unnoticed in elderly patients.

3.) Inferior

Are the least likely to occur with less than 1%. This can turn into a situation with large amount of complications. Blood vessels, nerves, tendons, and ligaments can be affected.


Reduction - a process to return the shoulder back into the correct joint.

Sling, ICE, Pain Management following Reduction

Post Reduction X-ray to ensure in the right spot

Surgery is necessary in the more severe cases or is considered when chronic shoulder dislocations occur.

Monday, August 2, 2010

Toothache - watch out

Dental pain or toothache can be so detrimental that loss of work, school or daily activity can be seen. Several causes of dental pain are seen. Pain can be in the tooth itself, the gums, surrounding soft tissue or lymph nodes. Pain has been described as constant, sharp, pulsating, deep, or intermittent.


- Dental Cavity is the number one reason for dental pain.
- The second most common cause of pain is gum disease.
- Dental Abscess
- Dental Decay
- Sinus infection
- Temporomandibular Joint Disorder (TMJ)
- Muscle spasms
- Exposed roots

Pain can be encountered when chewing, or sleeping, with hot and/or cold contact.

Other symptoms include: swelling, bleeding, ear pain, neck pain, facial pain, redness of gums, discharge


Often an appointment with a Dentist is essential to determine cause of pain.

X-rays are often essential


- Tylenol
- Topical ointment placed on tooth
- Antibiotics
- Fillings


- Daily brushing of teeth
- Flossing of teeth
- Fluoride
- Limit smoking
- Teeth cleaning [every six months]

Tuesday, June 8, 2010

A Possible Prevention of Kidney Stone

Ever had pain so severe in your sides, flank, or your lower stomach that caused you to your knees or even unable to get out of bed. This pain can be sharp and/or burning. In addition, you may have noticed some blood in your urine. After a few days the pain may have seemed to "pass" and so did the blood.

You may have just been subject to a kidney stone. And it is exactly as it sounds; a stone forms in your kidney and either it remains in the kidney or it passes out in your urine. Many Americans each year suffer from this condition. Some are required to go to the hospital for pain medications and others have kidney stones that are so large that specific procedures are done to break the stone into smaller pieces in order for them to pass.

Kidney stones have been described as equal or worse then pregnancy. If you have never had one it would be hard to believe. But if you have experienced a kidney stone then you know exactly what I am talking about.

Often the future prevention of kidney stones is at the top of the list for discussion by patients and their providers. Often individuals are encouraged to change their diet such as caffeine, sodas, chocolates, and others.

Often discussion about the benefit of fruit juices are in the mix. The hopes is that citrus juices may protect against the formation of calcium oxalate stones. These stones are one type of stones found in kidney stones and are the most common.

But are all juices equal?

It appears that the answer is no.

Often the juice recommended is Lemonade or diluted lemon juice along with dietary changes has been
found to be helpful.

But a study by the "National Institutes of Health" compared lemonade with Orange juice and it found that orange juice decrease levels of stones more efficiently then lemonade.

Other juices such as Apple and Cranberry did well with certain stones and bad for others. These two juices actually raised the risk for calcium stones but helped with the less common brushite stones.

Grapefruit juice appeared to fail completely and raised the risk of all stones.


Therefore a couple essential things have been noted. First, dietary changes are essential. Second, knowing the type of stone can be helpful. Third, try to avoid grapefruit juice if you are at risk for kidney stones.

Lastly, some individuals will only have one stone and they will be done. Others, despite the attempts at modifying diet will always be at risk. Drinking fruit juices my help reduce that risk but it doesn't mean that you won't ever have kidney stones again.