Pregnancy and DVT

Pregnancy brings many joys into the life of the expectant mother. However pregnancy may also bring spider veins and varicose veins. 33% of women pregnant for the first time and 55% of women who have had two or more full term pregnancies develop varicose veins.

There are several causes of varicose veins in pregnancy.

  • Heredity is a major contributing factor.
  • Hormone (estrogen and progesterone) levels rise during pregnancy which causes the wall of the veins to stretch and weaken.
  • The blood volume doubles to supply both the mother and fetus with an adequate amount of blood.
  • As the fetus grows in the uterus, more pressure is exerted on the inferior vena cava; this increases pressure on the leg veins.
  • Carrying the extra weight of the fetus and standing for long periods of time make it more likely to develop varicose veins.
  • Crossing your legs while sitting increases your risk of varicose veins.
  • There may be a decrease in physical activity.EnlargedVeinAndDamagedVein

All of these factors cause extra pressure on the leg veins causing them to dilate and expand. This weakens the vein walls and damages the valves in the veins. Due to the downward pressure, the blood flow back to the heart is slowed, spider veins appear and the already compromised veins bulge more.

Varicose veins tend to get worse with each pregnancy. They many go away after delivery. However, they may reappear later in life for no apparent reason. The damage done to the valves in the veins during pregnancy is permanent. These problems can be avoided if compression therapy is prescribed during pregnancy. We urge women with a history of venous disease in their family or who experience swelling or pain in their legs to discuss this with their physician.

maternityThere are some things you can do to improve your leg health while pregnant:

  • Keep your weight within the recommended range for your stage of pregnancy.
  • Exercise daily, including walking. The calf muscles act as a secondary pump to move the blood back to the heart.
  • Elevate your feet and legs whenever possible.
  • Don’t sit or stand for long periods without taking a break. If you will be sitting for extended periods of time, use a stool or box to elevate your feet. If you find yourself in a situation where you will be standing for an extended period of time, place one foot on a stool and alternate every 5 to 10 minutes.
  • Sleep on the left side with a pillow between your legs and behind your back will help increase the venous flow back to the heart.
  • Don’t wear clothing that is binding around the tops of your legs, waist or ankles.
  • Wear medical grade compression stockings. You may want to put them on before getting out of bed to prevent blood from pooling in the legs.

According to The New England Journal of Medicine Deep Vein Thrombosis (DVT) is the leading cause of mortality and morbidity during and after childbirth. A DVT can develop if you have certain medical conditions that affect how your blood clots. DVT can also happen if you don’t move for a long time or have surgery. DVT is a serious condition because blood clots in your veins can break loose, travel through your bloodstream and lodge in you lungs, blocking blood flow. This is a life threatening occurrence called pulmonary embolism. A DVT is more common before 20 weeks of gestation and during the first six weeks postpartum. Compression stockings should also be worn postpartum to help prevent DVT. In warmer weather they may seem hot, but will keep your legs healthy!

Here’s to happy, healthy moms and babies,

Vanda Lancour
http://www.supporthoseplus.com

 

 

 

Guard Agains Varicose Veins and DVT

June is Men’s Health Month.  It is the goal of Support Hose Plus to heighten the awareness of preventable leg health problems for men and to encourage men to wear their support socks to prevent leg health problems.

Most men think varicose veins are just a cosmetic problem (a woman thing), however varicose veins are just as detrimental to men’s leg health as women’s leg health.

Here are some reasons men should choose to wear support socks or support thigh highs:

  • Tired achy legs
  • Heavy legs
  • Swollen legs
  • Leg pain from prolonged sitting or standing
  • Dull, aching pain in legs
  • Tingling, numbness, burning or cramping in the legs and feet
  • Legs “fall asleep” often
  • Spider veins
  • Varicose veins
  • Reddish discoloration of the skin
  • Hardened skin on the lower leg
  • Patches of dry skin on the lower leg
  • Open sores on the lower leg that do not heal
  • Family history of venous disease
  • Travel (to prevent a deadly Deep Vein Thrombosis)
  • Surgery (to prevent a deadly Deep Vein Thrombosis)
  • Orthostatic Hypotension ( a form of low that happens when you stand up from sitting or lying down…dizzy spell)
  • Injury

Men seem to be very self-conscious of wearing support socks, but many professional athletes know the value of wearing a compression sock. Can you imagine if one of the valued players of the NBA got a DVT because he did not wear compression when he traveled or had an injury to his leg? Not only would he be on out of the game, but his whole team would be put at disadvantage.

Think of the professional athlete…ProBasketballAthlete

  • As he travels long distances to compete, he wears compression socks. He definitely does not want to arrive at an event for which he has been training to be knocked out of competition by a blood clot (deep vein thrombosis).
  • During his competition he wants to be at his best. Performance athletic socks increase arterial flow, reduce muscle strain, decreases exertion, and reduces skin temperature.
  • After he has completed his competition he wants a speedy recovery, so he wears his recovery socks to help get the lactic acid out of the muscle so there is less muscle soreness.

weekendwarriorsYou may be a “week-end warrior” not a professional athlete, but you can also appreciate what support socks can do for your sporting activities as well as your everyday living. Why should the you not have the same advantages as the athlete? By taking action to wear an appropriate compression garment, you could prevent more serious problems which ultimately could affect your quality of life as well as your family.

weekendwarrior

It is not just the week-end warriors that need the support socks. All males can use compression socks to increase circulation and guard against varicose veins and DVT everyday. I want the best for the males in my life. They are just as important to me as the valued NBA player is to his team. So lets encourage all the men we know to visit with their physician if they have any problems listed above and wear their support socks faithfully.  Remember, you can always call one of the SupportHosePlus.com Certified Fitters on our toll-free number, 1-844-472-8807, for assistance with the selection of a garment.

Hope all of our loved ones have healthy legs,

Vanda Lancour

Compression, Physical Fitness and Sports

athletic3May is Physical Fitness and Sports Month. I would like to direct this news letter to our athletes. You would think young, athletic people would have no problems with their legs, but that is not correct. Sports activities which add more weight to the legs (weightlifting, skiing, backpacking) and repetitive motion sports (running, cycling, and tennis) put a lot of stress on the veins in the legs and can damage the delicate valves in the veins and exacerbate venous insufficiency in the athlete.

When athletes are exercising, their muscles require more oxygen. The arteries transport the oxygen rich blood and the active muscles help the veins return the oxygen poor blood to the heart. Once the exercise has ended, there is no calf muscle pump to help the veins return the blood. So the legs of the athlete with varicose veins may begin to ache, throb and feel heavy. If the legs are elevated, this will help the body defy gravity and return the oxygen poor blood to the heart. This is exactly how compression socks or support socks will help the athlete and may in the long run help prevent deep vein thrombosis. Performance socks use science to help professional athletes as well as the week-end warrior maximize performance as well as recovery.

A deep vein thrombosis (DVT) is the formation of a blood clot within a deep vein, usually in the legs. A pulmonary embolism (PE) is blockage caused by a blood clot in one of the pulmonary arteries in your lungs. It usually originates from a blood clot in the legs (DVT).  You would think the athlete less likely to develop blood clots than the elderly. But that is the problem. Health care  providers think the same way so when an athlete presents with Deep Vein Thrombosis (DVT) symptoms, they interpret the symptoms as “muscle tear, “Charlie horse”, “twisted ankle”, or “shin splints”.  Chest symptoms from an athlete with a Pulmonary Emboli (PE) are often interpreted as pulled muscle, inflammation of the joint between ribs and breast bone, bronchitis, asthma, or a touch of pneumonia.

Being an athlete and being apparently healthy does not guarantee they will not get blood clots. There are several risk factors that put the athlete as well as the non-athlete at increased risk for DVT and PE…

  • Traveling long distances to and from sports events. It does not matter if it is by plane, bus, or car
  •  Dehydration (during and after a sport activity)
  •  Significant trauma
  •  Immobilization (wearing a brace or cast)
  •  Bone fracture or major surgery
  •  Birth control pills and patch, pregnancy, hormone replacement therapy
  •  Family history of DVT or PE
  •  Presence of inherited or acquired clotting disorder (Factor V Leiden, prothrombin 20210 mutation, antiphospholipid antibodies, and other clotting defects or deviancies
  •  Presence of a congenital abnormal formation of the veins
  •  May-Thurner Syndrome (narrowing of the major left pelvic vein)
  •  Narrowing or absence of the inferior vena cava (the main vein in the abdomen
  •  Cervical rib causing thoracic outlet obstruction

Built to performWhen an athlete works out, the muscles of the body act as a secondary pump to help move the blood back to the heart. The athlete also has a slower heart rate than the average person. During performance that is wonderful, but at times, that can be detrimental. After a work out or when the athlete travels the heart does not move the blood through the circulatory system as quickly as when the athlete is exercising. This is when a sock of at least 15-20mmHg is extremely important. It keeps the blood from pooling in the deep veins and forming a DVT.

Call one of the SupportHosePlus.com Certified Fitters on our toll-free number, 1-844-472-8807, for assistance with the selection of performance and/or recovery socks to enhance performance or prevent DVT and PE.

Enjoy your day!

Vanda Lancour

Deep Vein Thrombosis (DVT) Through the Ages Continued

Last week we began studying the history of DVT. The most important advances in the field of DVT therapy occurred during the first half of the 20th century. However, numerous other therapeutic options, sometimes surprising, were tried during this period and later abandoned because of insufficient efficacy.

Even though the mechanisms of venous thrombosis (blood clots) had been discovered by the middle of the 19th century, it was closer to the 1920’s that a consensus appeared regarding the three factors contributing to thrombosis: stasis, vessel wall alteration, and hypercoagulability (abnormality of blood coagulation that increases the risk of blood clots in the blood vessels).

During the late 19th century and early 20th century, there were a number of breakthroughs that have changed DVT treatment. Many of these were discovered by accident.

1884 – Hirudin first isolated anticoagulant. It was extracted from the saliva of leaches. Hirudin could not be used as a powerful anticoagulant until production by genetic engineering in 1986.

1916 – Heparin first anticoagulant that could be effectively used for the treatment of DVT. A medical student, who was doing research to find products which would promote coagulation of blood, noticed some extracts became anticoagulant after prolonged exposure to air. Four years late he discovered true heparin.

1933 – Pure crystalline heparin was produced allowing its use in humans in 1935. The use of heparin became widespread (when available) because of its efficacy. It was administered for 7-10 days and cut the mortality from Pulmonary Embolism among inpatients with symptomatic DVT from 18% to 0.4%.

1941 – Vitamin K antagonists (VKAs) allowed anticoagulant therapy to be extended. Vitamin K is required for the correct production of certain proteins necessary in the blood clotting process. They are structurally similar to vitamin K and act as competitive inhibitors. The action of this class of anticoagulants may be reversed by administering vitamin K until there is no more VKA in the body. Vitamin K antagonists include coumarins which include, but are not limited to warfarin, coumatetralyl, phenprocoumon, acenocoumarol, dicoumarol, and non-coumarin VKAs such as fluindione and phenindione. All can be reversed by administering vitamin K.

1950 – Heparin was still the choice treatment for DVT, but surgical procedures were used for severe cases of DVT. The surgical procedures did not provide substantial clinical improvement.

1958 – First intraluminal “harpgrip” filter showed promise in preventing Pulmonary Embolisms. The filter could block movement of blood clot without significantly affecting the venous system; however it required major surgery and anesthesia for placement.

HarpgripMobbinUddinGreenfieldFilters

1967-1970 – The problem of a filter requiring major surgery and anesthesia for insertion was solved with the Mobin–Uddin umbrella. It could be inserted with a simple catheter under local anesthesia. Besides the potential for migration, this filter could cause gradual obstruction of the inferior vena cava. This was partially prevented by coating the filter with heparin.

1981 – Greenfield developed the first true percutaneous filter, which did not necessitate any surgical opening of a vein. However, truly retrievable filters (without a catheter and without persisting venous access) became available for clinical use only two decades ago. Therapeutic trials are currently underway.

Blood Clot

1970 – Venography (developed in 1923) became standardized and widely used for confirmation of DVT; physicians no longer treat clinically suspected DVT. This enabled physicians to diagnose and treat DVT while clinically asymptomatic and simplified DVT treatment with anticoagulants, ended bed-rest as a treatment, and allowed home treatment.

1980 – Development of low-molecular-weight heparin (LMWH) was the most significant step in the simplification of anticoagulant therapy. In most cases, it does not require monitoring. Was introduced in Europe and in 10 years was widely used.

1996 – Was demonstrated that LMWH given at home was safe and effective as unfractionated heparin administered in the hospital.

1996 – Evidence that early ambulation with compression stockings lessened pain and counteracted swelling without an increased risk of Pulmonary Embolism. This became widespread treatment and is now recommended treatment.

1997 – The usefulness of compression bandages in preventing post-Thrombotic Syndrome (long-term complications of DVT) shown. Even though Hippocrates prescribed compression bandages to treat leg ulcers, it was not until the late 19th century, after observing that superficial vein clots disappeared rapidly after application of compression bandages, physicians started prescribing compression bandages to their patients with DVT. Compression bandages started to be more widely used when anticoagulants became available. They were usually prescribed at the end of heparin treatment, once ambulation was authorized.

1938 – First Thrombectomy (blood clot removal). Twenty years later this procedure was improved and anticoagulant was added to prevent more blood clots from forming. Surgical thrombectomy is not recommended for routine treatment today. Early blood clot removal has been achieved using pharmacological thrombic agents. (Anticoagulation therapy for some patients is not a choice because of bleeding problems.)

1953 – Plasmin (also produced in the body) used to treat acute blood clots (including isolated DVTs) by dissolving them through intravascular infusion. In the same year streptokinase was also used for the same purpose. Streptokinase causes extra production of plasmin in the body.

It will be many years before the appropriate indications and contraindications are carefully defined about the use of thrombolytic agents, and the optimal approach (catheter directed vs. systemic administration) of the use of these agents to blood clots is identified, allowing the selection of the population at highest risk of Post Thrombotic Syndrome and lowest risk of bleeding. Nevertheless, it is likely that the long-term results, despite being promising, will not dramatically modify the routine management of DVT.

I hope you keep wearing your support socks and support stockings so you are less likely to have to deal with a DVT and DVT treatment!

Vanda
www.supporthoseplus.com

More Answers To Your Questions

Many of our customers have submitted more questions they would like answered. I would like to share these questions with you as well as my answers.

I purchased my compression socks from a sports store. I have spider veins and am on my feet many hours. When I remove my socks I have indentions and red marks where my knee highs end. Are they too tight?
How to Measure

Without having all the facts, it is very difficult to say. The socks may not have a good release built in the top of the socks. They may be helping you and move your swelling up, but cannot move any further because the socks end. You may need a thigh high garment instead of a knee high. They may be an incorrect size. Why don’t you take your measurements 1st thing when you get up and call one of our Certified Fitters on our toll-free number, 1-844-472-8807, and let us assist in a garment that is appropriate for you?
Here is how to take your measurements:

Measurements should be taken upon arising when your legs are at their smallest.
  • Using a measuring tape measure around the smallest part of the ankle. This will be above the round bones (malleoli) on both sides of the ankle.
  • Next measure around the fullest part of your calf.
  • For thigh length styles also measure around the fullest part of the thigh.
  • *The measurement from the crease in the bend of the knee straight to the floor will also be needed.

For thigh high stockings you will need a length measurement from the glutial fold straight to the floor.

I was told by my OBGYN that thigh high stockings were not appropriate during pregnancy, because they could cut off the circulation in the groin area.

I do not feel properly fit thigh high stockings will cut off the circulation in the groin area. If you have a lot of swelling, they could move the swelling into to the vulva area. Maternity pantyhose are my garment of choice for pregnancy, because the tummy panel will give some support to the fetus and lift it off of the veins. Most maternity pantyhose have elastic in the waist band which can be adjusted or completely removed. That being said, I do have many customers who are pregnant wear thigh high stockings successfully.

I have a group of veins on one leg that always hurts, but especially when I go up and down stairs. What should I do?

Varicose veins usually do not hurt. If you are in that much pain, you should find a good vein specialist and have a complete evaluation. It may not be your varicose veins which are hurting. It could be something else and only a full evaluation can determine the true cause.

My doctor told me I have orthostatic hypotension and I should wear compression stockings. There is so many choices, what stocking should I choose.

As you know, when people have orthostatic hypotension and stand, their blood pressure drops and they may pass out. Compression stocking can help with this. The garment of choice is pantyhose, but many people are able to manage with a thigh high garment. A knee high garment is really not appropriate. The compression usually varies with the severity of orthostatic hypotension. At least at 20-30mmHg is used for this disorder, but sometimes a 30-40mmHg is required.

I have a DVT (deep vein thrombosis) should I wear my stockings 24/7 or just during the day?

You get the most benefit from your stockings when you are standing or sitting (vertical position). They are less helpful when you are sleeping (in a horizontal position). That being said, it depends on the severity of the DVT. It is very important for you start walking and getting exercise as soon as possible. If you are in doubt, consult your physician.

I have been diagnosed with lymphedema. I wear 20-30mmHg compression stockings, but I keep swelling more and more. Help! What should I do?

First you need to find a good lymphedema therapist. Your physician may give you a referral to a lymphedema therapist. The therapist will evaluate your swelling and probably wrap your extremity with layers of bandages to reduce your swelling as well as teach you some special massages you can do yourself later on. Once your swelling is reduced as much as possible, the therapist will recommend garments for you to wear each and every day. Remember you may need to go back into bandages occasionally  for a “tune up”. Lymphedema may not be currently curable, but is controllable if you follow your therapist instructions.

If you have more questions or comments, please scroll to the bottom of the blog entry to leave a comment or ask a question.

Thanks so much to those who submitted these questions,

Vanda


http://www.supporthoseplus.com

What You Can Do When You Travel That Can Save Your Life

Last week we discussed wearing support hose and support socks to protect you against your enemies DVT (Deep Vein Thrombosis) and PE (Pulmonary Embolism) when traveling (“Who Looks After The Security Of Your Legs“). Well, you are finally preparing for that trip of a lifetime (one that lasts more than 5 hours). If you have ever had a DVT or have a family history of DVT, a trip to your physician might be in order. Discuss with your physician if a preventative dose of asprin or low-molecular-weight heparin would be appropriate for you. Once this is done, be sure you have a good pair of knee high or thigh high support socks or support hose. Be sure and wear them for your trip and for three days after you arrive at your destination. The support socks or support hose do you no good if they are in your bag!

If you are flying choose an isle seat so you can get up and move around easily. If you are traveling by other means, be sure when you stop for gas or bathroom break to take a few extra minutes to walk around and keep your circulation moving. Don’t just sit there – do something. If you are traveling by plane and the “Fasten Seatbelt” sign is lit, here are some exercises you can do (some of these are from Boston Magazine):

Figure Eights
With your toes pointed, lift right leg off the floor and make circle eights with your foot: repeat with left leg. Repeat both several times.

Simulate Walking
Place heel on floor and rotate to toes to simulate walking. Do this at least 8 to 10 times with each foot. This activates the calf muscle pump to increase circulation.

Neck Rolls
Sit up tall and put your hands on your knees.  Nod your chin down, then roll your head to the right, then back to the left until you have completed a full circle. Do 8 to 10 neck rolls each direction.

Upper Stretch
In your seat, place the back of your hand on the small of your back. Then turn your head left and look down. You will feel a deep stretch on the right side of your neck. Hold for 10 to 15 seconds and then repeat on the other side. Do up to 3 to 5 reps on each side.

Seated Cat Stretch
Begin in a tall seated position with hands on your knees. Bring upper body towards your lap, rounding your back shoulders and neck and hold for 1 to 3 seconds. Then lift your chest and your neck, arch your back and hold. Repeat 8 to 10 times.

Quad Pulses
In your seat, hold your mid-thigh so that your thumbs are against your inner leg. Squeeze your legs so you can feel them press against your hands, hold for 3 to 5 seconds and then release. Repeat 8 to 10 times.

When the “Fasten Seatbelt” sign is off:

Standing Calf Raises
Stand up and slowly lift your heels off the floor for a three count, and then slowly lower them back down: repeat 10 times.

Hip Circles
Stand with your feet hip distance apart and place your hands on your hips. Press hour hips forward, to the right, then back, and complete a circle. Do the 8 to 10 times in each direction. Try this while waiting for the bathroom.

Sort-of Side Lunges
Stand with feet a little wider than hip-width, and shift your weight to your right leg, then lightly bend you right knee. Then shift back to the left leg and bend the left knee. Continue alternating 8 to 10 times.
 
You may feel a little awkward…don’t worry these exercises are much more subtle than the person doing yoga in the seat beside you! Drink lots of water (avoid alcohol and caffeine which dehydrate you), choose healthy snacks, and get up in move around frequently. It is up to you to be proactive to make sure your legs arrive safely.

Here’s to a wonderful journey,

Vanda
www.supporthosplus.com

Who Looks Out For The Security of Your Legs

Spring has officially arrived here in the Northern Hemisphere or has it. A couple who are friends have returned to their home on the Upper Peninsula (UP) of Michigan after a lengthy vacation traveling the nice warm southern United States and are questioning their decision to return at this time. They shared on Facebook that they woke up to snow on the deck, the bay is still frozen and it was 35 degrees. For the rest of us the spring time weather like here in Amarillo, Texas gives us the travel bug.

If you are flying, airport security will be looking out for your safe flight by checking for bombs in shoes, explosives in hats, and (oh, of course) the .357 magnum that someone “forgot” to take out of their carry on bag. But what are you doing to make sure you arrive at your destination safely and are not attacked by enemies of a differ kind, Deep Vein Thrombosis (DVT) or the even more deadly Pulmonary Embolism (PA).  Either one can ruin a wonderful vacation. It is not just flying that can create these enemies… any travel by car, bus, or train that lasts 5 hours or longer is a candidate for creating these vacation ruining enemies. 

Air travel has been put on the most wanted poster more times because you are sandwiched between two other travelers, you are sitting, and sitting, and sitting in very dry, low-pressure air with lower than normal oxygen levels. Your legs are bent in the same position for hours and the seat you are sitting in for your safety is constructed with a fairly rigid  metal frame which is cutting into the back of your legs compressing the popliteal vein and slowing down the blood returning to your heart. It is at this point that you become a great candidate for a DVT. As I said, you do not have to be on a plane for this to occur…all you have to do is travel for long distances in the same position. Sitting can be dangerous for your health!

Lets make your journey one you remember because of the wonderful time you have and not because you encountered your enemies DVT and PA. Begin by choosing support socks (knee high will usually be appropriate) that will aid in returning the blood in your lower extremity back to your heart. If you have no swelling in your legs, no predisposition for developing a DVT then a 15-20mmHg compression will probably be adequate.  

Following is a list of factors that increase the risk of developing DVT:

  • Injury to a vein, often caused by:
    • Fractures
    • Severe muscle injury
    • Major surgery (especially of the abdomen, pelvis, hip, or legs)
  • Slow blood flow, often caused by:
    • Confinement to bed (possibly due to a medical condition or after surgery)
    • Limited movement (a cast on an extremity to help heal a injured bone)
    • Sitting for a long time, especially with crossed legs
    • Paralysis
    • Sedate lifestyle
  • Increased estrogen:
    • Birth control pills
    • Hormone replacement therapy, sometimes used after menopause
    • Pregnancy, for up to 6 weeks after giving birth
  • Certain Chronic medical illnesses:
    • Heart disease
    • Lung disease
    • Cancer and its treatment
    • Inflammatory bowl disease (Crohn’s disease or ulcerative colitis)
  • Other facts that increase the risk of DVT include:
    • Previous DVT or PE
    • Family history of DVT or PE
    • Age (risk increases as age increases)
    • Obesity
    • A catheter located in a central vein
    • Inherited clotting disorders
    • Varicose veins

If you swell when you are not traveling or are predisposed to developing a DVT, you should choose a 20-30mmHg compression or discuss this with your physician. It is up to you to be proactive to make sure your legs arrive safely.

Here’s to a wonderful journey and thanks for shopping SupportHosePlus.com,

Vanda

PS: Next week things you can do when you travel that can save your life.