CASE STUDY ON DEEP VEIN THROMBOSIS IN AN ATHLETE
Deep vein thrombosis is the formation of a blood clot within deep veins blood clots are formed in both extremities but usually they are formed in deep leg veins.
Deep vein thrombosis (DVT) of the lower extremity is a serious and potentially fatal disorder, thus accurate diagnosis is critical. DVT affects 2 million Americans per year and is the third most common cardiovascular disease after coronary artery disease and stroke.
DVT/PE kills more people than AIDS, breast cancer, water drowning, and Motor vehicle accidents per year. DVT/PE kills approximately 100,000 Americans per year.
DEEP VEIN THROMBOSIS MUST NOT BE MIXED UP WITH MUSCLE INJURY: Physical/muscle injury is one of the most common causes of lower extremity deep vein thrombosis, thus athletes are at great risk of having DVT.
Deep vein thrombosis should not be mixed up with the muscle injury. If DVT is not diagnosed properly in athletes it may have fatal consequences. A DVT can further lead to pulmonary embolism (PE)
A 45-year-old male football player came to the clinic seeking for treatment of the muscle tear in his right leg. Being a football player he had suffered from numerous lower limb injuries over the years. he was recommended by his Physician friend to apply the heat to the affected area on a daily bases. He was also advised to perform stretching exercises. He was also told by his Physician friend that he may return to sports activities once he is feeling better. He followed the Physician’s recommendations but instead of improving his condition, he continued to get worse with the exercises. So, he thought of getting a second opinion from the physical therapist. He told him about his symptoms very sharp, local pain in his upper-middle calf muscle region while he tried to get his bags after a prolonged sitting on an international flight of about nine hours.
He also feels pain when walking on his toes. He explained that he was constantly having discomfort while sitting with his knee in flexion.
After some special tests it was seen that lumbar spine and hips were not affected but only walking on toes was painful. No edema or erythema was present around the painful area. There was great pin-point tenderness locally between the proximal heads of the muscle located on the back portion of the lower leg, one of the major muscles that make up the calf.
The athlete insisted that he is suffering from muscle injury but the physical therapist realized that the signs present were not of typical muscle injury.
In light of the above, he decided to perform a Doppler ultrasonography of the painful leg. The therapist directed him to a local clinic, where a deep vein thrombosis was diagnosed by means of duplex ultrasonography. The patient was immediately hospitalized and anti-coagulants (blood thinner) were started. He was discharged symptom-free two days later, with a recommendation to continue anticoagulant therapy for four months. He was instructed by his physician not to return to sports while on anticoagulant therapy since he is a high risk of bleeding.
So by this case study, it becomes clear that extreme caution must be taken while giving medical advice by phone. DVT is a potentially life-threatening condition, and incorrect advice may lead to very serious circumstances.
It is incorrect to advice patients about aggressive exercise unless conclusive evidence of specific problem becomes available.
But in all cases the use of compression stocking may be helpful.
Some Causes of Deep Vein Thrombosis Are Explained Below:
- Damage to the blood vessel of the lower body due to any reason such as fracture, severe muscle injury or surgery
- Prolonged bed rest or prolonged immobility (long flights, bed rest after surgery or physical injury. pneumonia)
- Heart attack or heart failure
- Pregnancy or recent childbirth
- Use of birth control pills
- Advanced age
- Any medical conditions that affect the vein
SIGNS AND SYMPTOMS OF DEEP VEIN THROMBOSIS ARE EXPLAINED BELOW
- Pain or tenderness in the leg which you may feel only when walking or standing
- Erythema (Redness of specific area) particularly at the back of leg below the knee
- Warm skin in the area of the clot
- Worsening leg pain when bending the foot
- Charley horse (leg cramps occurs especially at night)
- Bluish or whitish discoloration of the skin
BELOW ARE FEW METHODS USED TO DIAGNOSE DVT
- Medical history: Medical history may include the overall health condition of a person, any specific or genetic disease; any prescribed medicines or any recent injury or surgery.
- Physical examination: Physical examination of DVT in leg includes checking for physical signs of DVT such as swelling, tenderness or discoloration of the skin of specific area.
- Diagnostic tests:
- Ultrasound: The most common test for the diagnosis of DVT is ultrasound. A Duplex ultrasound is used to detect DVT in the leg. Duplex ultrasound is a combination of a traditional ultrasound and Doppler ultrasound. A Traditional ultrasound uses sound waves that are bounced off internal tissues and make echoes. The patterns of these echoes from an image, which is then shown on the screen of the ultrasound machine. Doppler ultrasound is used to detect any abnormalities in blood flow. Sound waves are bounced off the blood within a vein. Flowing blood changes the sound waves by the “Doppler effect.” The ultrasound machine can identify these changes and verify whether blood within a vein is flowing normally. The absence of blood flow confirms the presence of blood clot.
- Venography, MRI and CT scanning: If the ultrasound report does not provide a clear diagnosis and there are signs and symptoms of DVT, Venography method is used to detect a blood clot. Contrast dye(usually an iodine dye) dye is injected into a vein, and an X-ray is done. The dye makes the vein visible on X-ray which shows blood flow. If blood flow is slow it indicates the presence of a blood clot. As venography can be painful and invasive it is now replaced by MR venography or CT scanning.
- D-Dimer test: Almost all the people who develop severe deep vein thrombosis have a raised level of a substance called D-Dimer in the blood. It is very sensitive but not very specific since it can be positive for many other reasons.
HOW TO TREAT DVT?
Anticoagulants: (Blood thinners) are the most common drugs used to treat DVT.
- These drugs can be taken as pills or can be injected. Most of the time treatment starts to work right away.
- Thrombolytic drugs (Clot busters): If a patient has severe DVT, or if other medications aren’t working, then the doctor may prescribe drugs that break up clots quickly, called clot busters. These drugs are given intravenously in the Hospital setting.
- MedShoola SCD Pump and Compression stockings: SCD pump and Compression stocking are used to prevent DVT and PE. It should not be used if the patient already has been diagnosed with DVT/PE. It is contraindicated if someone has an acute blood clot in the legs since it can cause the clot to break off and travel to the lungs.
- Inferior Vena Cava Filters: They are small devices that are placed into a large vein (The Vena Cava). The filter trap blood clots. Blood clots in the veins of the legs and pelvis usually travel to the lungs where they may cause a pulmonary embolism or blockage. IVC filters help lower the risk of pulmonary embolism by trapping large clots and preventing them from reaching to the heart and lungs.