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

February is American Heart Heath Month

 

February is American Heart Month. The heart is part of the circulatory system which also includes veins, arteries. The heart is a little powerhouse, about the size of a closed fist and weighs only about 10.5 ounces, yet it is the strongest muscle in the body. It powers the circulatory system by moving 5000 to 6000 quarts of blood through the body each day. It transports oxygen, nutrients, hormones, and cellular waste products throughout the body. At rest the heart easily pumps over 5 liters of blood throughout the body every minute (that is approximately the total volume of blood in the body).

Arteries are blood vessels that carry oxygen rich blood away from the heart. The arteries are in such close proximity to the heart that they do not need valves to keep the blood from back flowing. The veins are blood vessels that carry the oxygen depleted blood back to the heart. Because the arteries use most of the energy from the heart’s contractions, the veins have lower pressure and the walls are thinner, and relay on gravity and movements or contractions of skeletal muscles to push the blood back to the heart. Some veins have valves which keep the blood from “back flowing”. When these valves become damaged, swelling will occur usually in a lower extremity. Apply a compression stocking or compression sock will help the damaged valve to close enabling the blood to continue the journey back to the heart. This takes some of the load off the heart and helps your heart stay healthy. Who would have thought a compression sock or stocking would help your heart stay healthy!

To keep my heart healthy I love to take walks and Sigvaris Sock and Sleeves or any of the Jobst Socks and Stockings (15-20mmHg or greater) will help increase my circulation and help keep my heart healthy. (You do not have to be an athlete to love some of these socks.)

Here’s to a heart healthy journey for all of us,

Vanda
www.supporthoseplus.com