Deep Vein Thrombosis (DVT) Through the Ages

I have addressed Deep Vein Thrombosis (DVT), its causes, how it can be recognized, and treatments many times. I thought we might review the history of treatment of DVT.

The first documented case of DVT occurred more than 700 years ago in the middle ages. A 20 year old Norman cobbler, Raoul, developed unilateral edema in the ankle and calf which the moved up to the thigh. His physician advised him to “wait and see”. Raoul’s symptoms worsened and he developed a leg ulcer. He visited St Eloi’s shrine, without any improvement. Then he visited the tomb of King Saint Louis. He spent some time in prayer to no avail. He then decided to collect the dust he found below the stone that covered tomb. He applied the dust direct to the ulcer. The story reports he was miraculously healed and was still alive 11 years later. After this story of Raoul, there was increased mention of DVT especially in pregnant and postpartum women.

During the Renaissance physicians thought that pregnancy-related DVT (leading or only cause of DVT) was the result of “evil humors”. It was thought that postpartum DVT was caused by retention of unconsumed milk in the legs (‘milk leg’). Therefore in the late 1700’s breast-feeding was encouraged to prevent DVT.

From 1784 – 1920’s treatment was evidence based. In 1676 Wiseman suggested DVT was a consequence of alteration of blood. In 1793 Hunter hypothesized it was a occlusion of a vein by blood clots. In 1784 Hunter performed ligations (ties) above the blood clot to prevent extension of the clot. Because there was no other treatment for Pulmonary Embolism (PE) this became widely used at the end of the 19th century. This could be done at the femoral, common femoral, iliac or inferior vena cava. Used until mid 20th century along with anticoagulants after they became available.

Iron Splints

Since there was great fear of the blood clot migrating and becoming a PE, strict bed rest was prescribed and was the
cornerstone of DVT treatment from the end of the 19th century. Patient’s limbs were set in iron splints to prevent movement and special inclining beds were used to increase venous return.

Inclining Bed

During the 19th century it was thought that DVT was caused by inflammation of the vein wall, fever, postpartum and after septic surgical procedure. Treatment included anti-inflammatory medication and treatment for infection. Blood letting was popular (especially with leeches) as well as cupping, purging, applying ice or prescribed cold bath. These treatments started becoming obsolete in early 1900’s. Prior to 1930’s (before anticoagulant therapy) treatment was bed rest to fix thrombus, elevation and now application of heat with warm compresses to increase collateral circulation and reduce venous spasm. In hospitals Wright describes the preventative measures such as early ambulation, elastic compression, avoidance of dehydration and tightly applied adhesive strapping.

Next week we will continue with the last 100 years. In the meantime, keep wearing your support stockings and support socks!

Vanda
www.supporthoseplus.com

Santa Didn’t Wear His Support Socks

Hello To All,I Wish I Had Worn My Support Socks

Hope your Holiday season has been kinder to you than it was to our dear old friend Santa Clause. Santa forgot to wear his support socks for his whirl wind world trip and see how swollen his feet are!? If you have not been wearing your support socks or support stockings, your feet may look just like Santa’s and you may feel just as tired as Santa.

All kidding aside, when you take your get away this winter or spring be sure to wear your compression socks or compression stockings. The number of travel-related vein conditions is increasing each year. No matter how you travel, blood circulation in the lower extremity is reduced simply because you are sitting in one position. Symptoms such as heavy legs, leg pain, or swollen feet and ankles develop. The reduced circulation in the lower leg can lead to blood clots (DVT) or even worse the blood clots could break loose and travel to the lungs, resulting in a pulmonary embolism (PE) which can be deadly.

Blood clots are more common in the left leg, possibly because the femoral artery in that leg passes anterior to the vein, and may compress the vein. Symptoms do not usually develop immediately after travel, but more likely within three days of arrival at your destination. Symptoms may not manifest themselves for up to two weeks after a long trip. Symptoms include: pain in leg or pelvis, tenderness and swelling of the leg, discoloration of the leg (reddish), areas of the leg or pelvis region that feel warm to touch, or whole leg swelling.

DVT kills more people every year than AIDS, breast cancer, and traffic accidents combined. Don’t be like Santa, wear your support hose or support socks and arrive at your destination ready for a fun time!

Things You Can Do To Prevent DVT When You Travel

  • Wear comfortable, loose clothing
  • Get up and walk once every hour or two
  • Make figure eights and circles with your feet while seated
  • Breathe deeply frequently
  • Drink plenty of water (Avoid excessive alcohol intake – it dehydrates the body)
  • Elevate your feet when possible
  • Wear your support sock and stockings from Support Hose Plus

Just remember to wear support socks or support stockings when you travel and continue to wear them for the next few days after your arrival at your destination to make sure your legs return to normal size. Encourage friends or family who are traveling with you to do the same. (They may not know about the dangers of Travel Related DVT.) They may not have any problems, so a 15-20mmHg compression may be adequate for them.

Ho! Ho! Ho!
Happy Travels to You and Yours,

Vanda