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

A Support Hose Story

One of our very good customers sent us a letter the other day that we would like to share with you.  She expressed what we have been telling our clients for a very long time.  What a difference support hose can make in a person’s life!  ….. Vanda

Untreated Stasis Dermatitis can lead to venous ulcerations

Untreated Stasis Dermatitis can lead to venous ulcerations (from Support Hose Plus)

“If I had just one piece of advice to give those who have extreme swelling in the lower limbs, it would be this – wear compression stockings and keep yourself and your loved ones out of wound care!

We always thought my husband had big legs.  Little did we know that his legs were simply swollen from lack of proper circulation.  It took 4 different doctors until we finally found one who took one look at his legs and diagnosed Venous Stasis Dermatitis as the cause for his dryness and swelling.  We didn’t know what this meant.  That doctor suggested my husband wear compression socks to rid his legs of the excess fluids, which, she said, would rid him of his Stasis Dermatitis.  So, to the Internet I went.

What I learned was this – whatever the cause, and there are many – if we did not get the swelling down quickly, we were looking at months of wound debridement and possible infections that would not be easily treated.  We searched and searched for the right compression socks, pharmacies, local health care dealers.  The first socks we bought were a diabetic sock, which is a great sock, but we soon found these did not have the proper compression to help my husband.  Within a few weeks, we noticed a wound that would not heal, just a few inches above his ankle on his left leg.  We were referred to the wound care center.

What followed were several months of compression wrapping and debridement (scraping) of his wound.  Nightly wound dressing and morning re-dressing is what we had in store for us for the next few months.

When we finally found the correct compression hose, 30-40mmHg, and found someone who would properly explain to us how to put them on, we were absolutely shocked to find that after wearing them daily for three weeks, my husband’s legs were not only NOT big, but were almost svelte.

I am a firm believer in these garments!  Almost a year later he has graduated into a lower compression garment, 20-30mmHg, and does not go one day without wearing them.  His overall health has gotten so much better as well.

Wear your stockings!  Don’t just think a water pill will be the only answer!  Compression is necessary because of the way we were all made.  Our valves in our veins are one-way only, and when they do not work properly, we must force them.

Do yourselves a favor – size your stockings correctly, wear the right compression, and do not go a day without them.  You will be surprised at how quickly and effectively compression socks work!

We are so very thankful to the good people at Support Hose Plus!  Without them, I shudder to think what would have happened to my husband’s legs!  Thank you Rod and Vanda.”