BY
RACHEAL NINSIIMA
For weeks, the universe did not seem to make sense to
Musa Mugume who had sustained fractures in his legs and suffered severe
bleeding from a bus accident that had occurred along Masaka road. The illness
appeared not to affect his general physique but he did notice a strange symptom;
that of a swelling in his left leg.
Mustering courage, he let it be massaged every day for
two hours because casts had to be put on his legs. When they finally placed,
pain seemed to surge beneath these fibre tight bone straighteners. However,
after days on end, they were finally removed. When the orthopaedic did an
ultra-scan on his legs, he diagnosed Deep Vein Thrombosis (DVT). Unbeknown to
him, his life would lay motioneless and breathless in just three days. Mugume
died of a deep clot in his blood.
DVT means thrombosis (clotting) of blood in the deep
veins of the legs. It can cause swelling and pain in the leg, but often occurs
without giving any symptoms. Dr Miriam Laker Opwonya-Oketta of the infectious
disease institute says that blood clots may form abnormally when there is a
reduction in the speed of the normal flow of blood in the veins, injury in the
inner walls of the blood vessels and abnormalities in the substances which are
responsible for forming clots.
Dr Miriam says that there are two systems of veins in the
legs - the important deep veins which carry most of the blood up the legs
towards the heart and the superficial veins just under the skin.She adds that a
blood clot/thrombus in the deep venous system is not dangerous but may cause
pain.
“The situation becomes life threatening when a piece of
clot breaks off, travels to the hearts and is pumped into blood vessels of the
lings,” she says.
She adds that all the veins in the leg have valves which
should direct blood flow upwards, towards the heart. The deep veins lie between
the muscles, and muscular activity (moving the legs, walking, or any leg
exercise) helps to pump the blood up these veins.
When the legs are inactive,
and particularly when sitting or standing, blood tends to stagnate in the deep
veins. Stagnation of blood can eventually lead to thrombosis.
Dr Derrick Bengo, a haematologist (blood specialist)at
Mulago hospital explains thatwhen the clot moves up to the lungs, a person
might develop one of these three complications.
Pulmonary
embolism.
A pulmonary embolism happens when a piece of the blood
clot breaks off and travels through your bloodstream to your lungs, where it
blocks one of the blood vessels.Dr Bengo says that small pulmonary emboli may
cause chest pain, and sometimes coughing of blood while the multiple or larger
pulmonary emboli may cause death.
“The thrombosis can get stuck and interfere with the
process of gas exchange resulting into death,” he says.
Post thrombotic syndrome
This
happens if the damage caused by a DVT permanently reduces the ability of your
veins to efficiently return blood from your lower leg and leads to pooling of
fluid. This can eventually lead to long-term pain and swelling. In severe cases
these may lead to boils on your leg.
Limb ischaemia
This is a
rare complication that only happens with a large DVT. The blood clot can cause
the pressure in your vein to become high. “This can block the flow of blood
through your arteries, so less oxygen is carried to your affected leg. This can
be painful and lead to skin boils, infection and even decay,” Dr Bengo says.
Treatment
of DVT
Inthe
medical journal, ‘The Diagnosis of venous
thromboembolism,’Kelly J and Lewis RR in advise thatanticoagulant medicines prevent a blood clot from getting bigger and also
help stop part of the blood clot from breaking off and becoming lodged in
another part of one’s bloodstream. There are two types of anticoagulants used
in treatment of DVT. These are:
Heparins
Heparin is available in two different forms: standard and
low molecular weight heparin (LMWH). Standard heparin can be given as an intravenous injection administered
straight into one of your veins, anintravenous
infusion where a continuous drip of heparin is fed through a narrow tube
into a vein in your arm and a
subcutaneous injection, administered under your skin. LMWH works contains
small molecules that dissolve the clot which means you will not have to stay in
hospital and be monitored.
Warfarin
Warfarin is taken as a tablet. You may need to take it after an initial
heparin treatment to prevent further blood clots occurring.
“When you first start taking warfarin, you may need to
have two to three blood tests a week until your regular dose is decided,” they
write.
In
addition, Dr Bengo advises that individuals with an excessive tendency to form
blood clots, anticoagulant drugs like warfarin can be lifesaving.
Elastic
compression stockings
Patients with a deep vein
thrombosis should wear compression stockings as the rate of post-thrombotic
syndrome may be reduced.These
special stockings are designed to provide "graduated" pressure
starting at the ankle and reducing pressure as the stocking goes up to the calf
or thigh. By providing "graduated" compression with the greatest
pressure at the ankle and reducing pressure as the stocking goes up to the calf
or thigh - medical compression stockings support the weakened vein walls.
In terms of dieting,
vitamin K is best known for its role in healthy blood clotting.In 1929 a Danish scientist discovered thatoften, when a person is known
to have a slow blood clotting time and were given Vitamin K before surgery, it
controlled excess bleeding.
The
use of the letter "K" in the very name of this vitamin originally
came from the German word koagulation.
“Leafy
vegetableslike spinach and amaranathus containVitamin Kanthocyanins – powerful
amino acids that may cut one’s risk of heart disease and stroke by inhibiting
clot formation,”Grace Babughirana an expert nutritionist says.
Babughirana adds that other food sources include beef liver, chicken liver, milk and eggs and liver.
On the Knee guru website,
one post reads:“I had experience with a blood clot after my surgery. It is not
something that you want to mess around with. The discomfort is like a deep
ache. It lessens when you elevate the leg and becomes more uncomfortable when
you are upright. If you continue to be concerned- call your doctor. It's always
better to be safe than sorry.”
Although its symptoms and
signs do not come in handy like other ailments, DVT could be lead to sudden
death like that Mugume faced.
ninsiima@observer.ug
