Deep Vein Thrombosis Usually Due to Surgery
DEAR DR. ROACH: I am a 47-year-old woman. Five years ago, I developed a blood clot in my left leg after fracturing my ankle and being immobilized for several months. I was put on a blood thinner, and my ankle healed. Recently that leg started swelling again, and I went for an ultrasound. I was told that I have a chronic DVT, but that I don’t need blood thinners. Why do I not need a blood thinner now when I did before? What does “chronic” mean? Why am I getting swelling again five years after the first clot? — L.S.B.
ANSWER: Blood clots can happen in veins or arteries, but the type that happen due to surgery and immobilization are almost always in the vein. That’s the “V” in “DVT,” which stands for “deep vein thrombosis.”
A brand-new blood clot has a high risk of propagating further up the vein, and also of breaking off and traveling through the vein into the heart. Most often, the clot will go on into the lungs, then called a “pulmonary embolus.” But in the rare case, the clot can go through a patent foramen ovale, which is sometimes called a hole in the heart, and cause a stroke.
Because of the risk of life-threatening complications, acute DVTs are treated with anticoagulants, such as warfarin (Coumadin) or apixaban (Eliquis). This stabilizes the clot, and after a week or two the risk of propagation or embolization becomes much lower. Most people are treated for at least three months for maximum benefit. Treatment does not dissolve the clot, and a follow-up ultrasound will detail changes that show the clot is no longer acute, hence “chronic.” The vein itself is scarred and damaged, and never returns to normal.
“Chronic DVT” isn’t the best term, since it confuses many, both patients and physicians alike. I prefer scarred, and some experts use “chronic luminal changes” to differentiate it from an acute clot. Whatever it is called, it may still be symptomatic.
Most people with a history of a large clot on one leg will notice that leg swells more than the other in heat or with a large salt load. Even so, anticoagulant treatment is neither necessary nor helpful.
Effective treatment for swelling associated with previous DVT includes salt restriction, compression stockings and leg elevation several times during the day. People with more severe symptoms that do not respond to conservative management may benefit from more aggressive therapies, such as placement of a metal stent to let the blood flow better through the damaged area.
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DR. ROACH WRITES: I am often asked about screening tests for pancreatic cancer. Despite the promise of new tests, the U.S. Preventive Services Task Force recently re-reviewed the available evidence and continues to recommend against screening in the general population. However, it’s important to recognize that these recommendations do not apply to people at increased risk for pancreatic cancer, such as those with familial pancreatic cancer or with some genetic syndromes, such as Peutz-Jeghers syndrome. However, it does apply to people with other risk factors for pancreatic cancer, including smokers and those with new-onset diabetes or chronic pancreatitis.
With better screening tests, or with improved treatments for pancreatic cancer, the balance of benefits (it’s currently unlikely to find early pancreatic cancer when it can be treated) to harms (false positive results can lead to unnecessary surgery)
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Dr. Roach regrets that he is unable to answer
individual questions, but will incorporate them
in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
© 2021 North America Synd., Inc.
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Inflammation: The Role Diet May Play
When something harmful or irritating affects our body, the body responds with inflammation. There are two types of inflammation—acute and chronic.
Acute inflammation is short-lived inflammation. An example of this would be when you cut a finger or stub a toe. You see and feel the signs of acute inflammation in your body, and tissues become red, swollen, and painful. It is part of the body’s natural healing response to injury or infection.
Chronic inflammation occurs over time. It has been linked to the development of serious chronic diseases, including cancer, heart disease, diabetes, arthritis, and dementia. It can be caused by stress, aging, smoking, excessive alcohol intake, excessive abdominal fat, as well as some foods.
A powerful tool to help fight chronic inflammation comes right from the grocery store!
Choose a variety of foods full of anti-inflammatory phytochemicals. Phytochemicals are compounds produced by plants, which help protect our cells. Foods with these compounds include whole grains, beans, nuts, colorful fruits and vegetables, plant oils, and cold-water fish like albacore tuna, salmon, and mackerel. Tea, onions, and spices such as turmeric and ginger also have compounds with anti-inflammatory effects.
On the other hand, some foods—including processed meats, refined grains, and sugar-sweetened beverages—have been linked with increased inflammation. Saturated fat and trans fat are specific components of food that may trigger inflammation. The key to a healthy diet is variety and moderation with all food!
For more information about the benefits of consuming fruits and vegetables, recommended intake, and strategies for including them in the diet, check out some videos we made!
Feast on Fruits and Vegetables
Academy of Nutrition and Dietetics - What is an Anti-inflammatory Diet? (July 2019)
Today’s Dietitian - Inflammation and Cancer Risk: Can Anti-Inflammatory Diets Help? (Jan2018)
• If your pooch doesn’t like to poop in the snow, here’s a great trick to secure a patch of grass (even if frozen). Lay a square of plywood down on the ground, with a rope secured as a handle. After a snow, pull up the wood to reveal the ground underneath.
• Use mismatched socks to protect glass items when transporting them from place to place, or even in storage.
• Refillable spray bottles work best for cleaners. Refills can be economical, they put less waste in the system, and here’s one more reason: less propellants used, which can be a serious irritant to lungs. Purchase an attractive bottle, and then look up some recipes for eco-friendly cleaners. You might be surprised how well they work and how great they smell!
• “Add some nuts to your morning cereal or smoothie for a nutritious boost. It’s not just for oatmeal or granola. I like to crush a handful of walnuts and sprinkle them across my waffles.” — J.E. in Maine
• Get rid of the smell of burned popcorn in your microwave by setting a bowl of coffee grounds in it overnight. Somehow, when you remove it in the morning, it smells of neither popcorn nor coffee!
• Before removing a splinter, ice the area. There’s less fussing and a wooden splinter might absorb some liquid, causing it to swell enough to pop out a bit more.
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Orlando, FL 32803.
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Green Beans With Lemon and Garlic
The beauty of this basic side dish is that you can cook the beans up to 2 days in advance. Immediately after draining, plunge beans into ice water to stop the cooking process, then store them in the refrigerator in a self-sealing plastic bag until ready to complete the recipe.
2 1/2 pounds green beans, trimmed
2 tablespoons olive oil
2 cloves garlic, crushed with side of chef’s knife
1 1/2 teaspoons freshly grated lemon peel
3/4 teaspoons salt
1/4 teaspoons coarsely ground black pepper
1. In 12-inch skillet, heat 1-inch water and 1 teaspoon salt to boiling over high heat. Add green beans; heat to boiling. Reduce heat to low; simmer, uncovered, 5 to 10 minutes, until beans are tender-crisp; drain. Wipe skillet dry.
2. In same skillet, heat oil and garlic 1 minute over medium heat. Add lemon peel, pepper and 1/2 teaspoon salt, and cook 1 minute longer. Return beans to skillet and cook until beans are hot, about 5 minutes. Makes 12 servings.
• Each serving: About 55 calories, 3g total fat, 7g carbohydrate, 3g fiber, 2g protein, 150mg sodium.
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Somehow, muffins seem to fit the bill for a filling breakfast, a tasty snack and even as an offering for dessert. These muffins are no exception!
1 1/2 cups all-purpose flour
1 cup quick oats
1 cup raisins
Sugar substitute to equal 1/4 cup sugar, suitable for baking
1 teaspoon baking powder
1 teaspoon baking soda
1 teaspoon apple pie spice
1 cup fat-free milk
2 tablespoons fat-free sour cream
1/2 cup unsweetened applesauce
1 egg or equivalent in egg substitute
1. Preheat oven to 375 F. Spray a 12-hole muffin pan with butter-flavored cooking spray or line with paper liners.
2. In large bowl, combine flour, oats, raisins, sugar substitute, baking powder, baking soda and apple pie spice. In a small bowl, combine milk, sour cream, applesauce and egg. Mix well with a fork to combine.
3. Add milk mixture to flour mixture. Mix just until moistened (batter will be lumpy). Evenly divide batter into prepared muffin wells. Bake 18 to 22 minutes or until a toothpick inserted in center of muffin comes out clean.
4. Place pan on a wire rack and let set 5 minutes. Remove muffins from pan and continue cooling on rack. Makes 12 servings.
• Each serving equals: About 129 calories, 1g fat, 4g protein, 26g carb., 140g sodium, 2g fiber; Diabetic Exchanges: 1 Starch, 1 Fruit.
© 2021 King Features Syndicate, Inc.