Every year, more Americans die from preventable blood clots than from breast cancer, AIDS and traffic accidents combined. Many people are not aware of this gigantic health threat. The problem starts when a blood clot forms in a large vein deep inside the body, usually in the calf or, less commonly, in the pelvis or abdomen. This is called a deep vein thrombosis (DVT). It can cause severe pain, swelling and permanent blood vessel damage that make it difficult to walk.

The greater danger: In some cases, part of the DVT breaks off...travels through the veins to the heart...and from there moves into the lungs. This is called a pulmonary embolism (PE). It can impede blood flow to the lungs, sometimes blocking it completely. In about 10% of cases, a PE causes death within one hour.

Risk for a DVT rises with age because valves in the veins, which help keep blood flowing, become less efficient. Primarily because of hormonal factors, some women are at higher risk than men.

A DVT most often forms when two or more of these conditions exist…

  • Damage to the inner lining of the vein, which hinders blood flow.
  • Sluggish blood flow through a deep vein, which allows blood to pool and gives it more time to clot.
  • A genetic disorder that causes excessive clotting.

There are various causes for each of these conditions. The more of the following risk factors you have, the more important it is to take steps to protect yourself…

  • Recent surgery. The more invasive the surgical procedure, the higher the risk for vein damage and the more blood-clotting proteins the body produces in an attempt to heal. Also, the longer a person remains sedentary after surgery, the more sluggish circulation becomes.

Reason: During normal activity, such as walking, leg muscles contract and help pump blood onward. When mobility is curtailed, blood stagnates.

Procedures linked with especially elevated DVT risk include major gynecologic surgery, such as hysterectomy due to cancer...some other cancer surgeries, particularly ovarian and pancreatic...and orthopedic surgery, such as hip or knee replacement.

Self-defense: Before surgery, ask your doctor what precautions will be taken to prevent a DVT. You may be given an anticoagulant (orally or by injection) while recovering in the hospital and perhaps for up to four weeks after discharge. You may wear sequential compression devices-inflatable cuffs placed around the lower legs to improve blood flow-before, during and/or after surgery

Important: Follow instructions on how much and what type of postsurgical physical activity to do.

  • Leg injury. New research reveals that even a slight injury, such as an ankle sprain or a torn muscle, increases DVT risk. Microscopic damage to small blood vessels can cause deep veins to narrow...swollen tissues and inactivity can slow blood flow.

Self-defense: To reduce swelling and promote healing after an injury, elevate the leg and apply an ice pack for 15 minutes every two to three hours for one to three days. After a day or two, with your doctor's okay, do gentle stretches to improve blood flow.

  • Being overweight and/or having a sedentary lifestyle. Excess body weight is linked with leptin, a clot-promoting hormone produced by fat cells. Extra weight may be even more risky for women than for men because women's fat cells contain more estrogen-and this hormone also increases clotting. Lack of physical activity compounds the risk because it contributes to obesity and sluggish blood flow.

Self-defense: Ask your doctor for weightloss and exercise advice.

  • Cardiovascular disease (CVD). Various types of CVD involve blood vessel blockages and/or inflammation that can impair blood flow and increase clotting Heart failure, in which the heart's pumping is insufficient, allows blood to back up in the veins. CVD patients who have a pacemaker or an implantable cardioverter defibrillator are at greater risk for clots because these devices can irritate vein walls.

Self-defense: If necessary, take drugs as prescribed to lower blood pressure and/or cholesterol. Don't smoke it adds to CVD risk.

  • Genetic disorder. Inherited disorders can cause blood to clot excessively. The most common, which affects up to 5% of Americans, is factor V Leiden (the V stands for "five").

Clue: A history of two or more miscarriages because clots in the placenta can block the blood flow that the fetus needs to survive.

Self-defense: Ask your doctor about blood testing if a close relative has a clotting disorder ...you have a history of DVT...or you had multiple miscarriages.

  • Pregnancy...birth control pills or patch... hormone replacement therapy (HRT). Blood tends to clot more during pregnancy, perhaps to minimize bleeding during childbirth. Because estrogen promotes clotting, estrogen-based contraceptives (such as the Pill or patch) or HRT (used to relieve menopausal symptoms) increase DVT risk twofold for the average woman-and tenfold or more for a woman with a clotting disorder.

Self-defense: During pregnancy, stay active and wear knee-high support hose (sold in drug. stores). If you use an oral contraceptive or a patch, ask your doctor if you should switch to a low-dose pill or an estrogen-free contraceptive, such as an intrauterine device (IUD).

If you are considering HRT, first get tested for a clotting disorder if you have a family history of blood clots or meet the testing criteria above. If you're already on HRT, use the lowest effective dose.

  • Air travel or long-distance car trips. Spending hours virtually immobilized in the seat of an airplane or a car slows blood flow.

Self-defense: Wiggle your toes and flex your feet every few minutes. Every two hours, get out of the car or stroll the airplane aisles for several minutes. If you have a history of DVT, walk every half-hour.

Information: Venous Disease Coalition, 303989-0500, www.tenousdiseasecoalition.org.

How to Spot a Clot

Deep vein thrombosis (DVT)-a clot in a deep vein-may appear suddenly or over a few days. See your doctor today if you have any of these symptoms in one leg (or less commonly, in the pelvis or abdomen)...

  • Pain, tenderness, swelling and/or a hardened area over a vein.
  • Red or bluish discoloration of the skin.
  • Unusual warmth in the skin.

Pulmonary embolism (PE-a clot that travels to the lungs can be fatal. Seek emergency care if you have any of the following…

  • Sudden severe coughing (with or without bloody phlegm).
  • Sharp chest pain that worsens with a deep breath.
  • Severe shortness of breath.
  • Racing pulse.
  • Severe light-headedness or fainting.

Better Stroke Recovery

In a new study of 63 patients who had suffered an ischemic stroke (caused by a blood clot), one group received an intravenous (IV) treatment to dissolve blood clots, while the other received the IV treatment and additional therapy, such as angioplasty (inserting a balloon to open a blockage in a coronary artery).

Result: Only 12% of those in the combination therapy group died within 90 days of the stroke, compared with 40% in the IV treatment group.

If a family member suffers an ischemic stroke: Seek immediate treatment at a specialized stroke center, where advanced therapies for acute ischemic stroke are available. To find a stroke center near you, consult the National Stroke Association, 800-787-6537, www.stroke.org.

Vitamin E Lowers Blood Clot Risk by 44%

Blood thinners, such as warfarin (Coumadin), help reduce the formation of blood clots deep inside veins-important because besides the pain, there is the risk of a clot traveling to the lungs or other organs, which can be dangerous, even fatal. However, if you have been clear of blood clots for four to six months, there are natural substances that you can take to help prevent future clots. In a study of nearly 40,000 women conducted by Harvard researchers, those with a history of blood clots who took 600 IU of vitamin E every other day had a 44% lower risk of developing a deep vein clot. Vitamin E has a natural blood-thinning effect, as does nattokinase, an enzyme found in the soy food natto and available as a supplement. Talk with your doctor about managing your condition long-term with natural supplements.

New Study Helps You Recover Faster from Stroke

About 40% of stroke patients eventually develop depression.

New research: In a one-year study, 176 stroke patients received the antidepressant escitalopram (Lexapro), a placebo or problem-solving therapy (a form of talk therapy designed for older adults).

Result: In the placebo group, 22% developed depression versus 12% in the talk therapy group and 8.5% who received escitalopram.

If you have suffered a stroke: Ask your doctor if treatment to prevent depression would benefit you.

Fun Stroke Rehab Program

A virtual reality program makes stroke rehabilitation more fun. Patients wearing goggles see bugs flying nearby. When they successfully "smack" them, the bugs move farther away, improving the patients' range of motion.

Physical Therapy Helps Stroke Patients Improve for Years

Even two to three years after their strokes, patients still can learn to use undamaged areas of the brain to perform tasks, especially if their physical therapy includes long-term, supervised walking on a treadmill. Physical therapy typically is prescribed for only 30 to 60 days following a stroke because, until recently, it was believed that patients could make significant improvements only within that time frame.

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