Dr. Donohue: Leg blood clots can travel to the lungs

Syndicated Columnist
Published Wednesday, October 05, 2005

DEAR DR. DONOHUE: I have phlebitis in my left leg. My question is, Can I ever expect to walk normally? Now I am using a wheelchair, a walker and a cane. -- P. G.

ANSWER: "Phlebitis" (fleh-BITE-us) -- vein inflammation -- is short for "thrombophlebitis" -- vein inflammation with a clot (thrombus) in the vein. Usually the involved vein is a leg vein.

You can expect to walk normally once the inflammation calms down and once blood flow though the leg normalizes.

The involved vein is usually one buried deep in the leg muscles. The skin over that area of vein often turns red and becomes hot and tender. An ultrasound examination of the leg veins is one of the best ways of detecting the problem.

Causes are many. Immobilization of the leg is one of the most common causes. Blood tends to clot in leg veins after surgery, when the legs are held in one position, or even on a long auto or plane trip, when a person sits without moving the legs.

As soon as the diagnosis is made, anti-coagulation -- blood-thinning -- is begun. In the hospital, that's done with intravenous medicine that is soon changed to the oral medicine Coumadin.

The reason for all this is that part of the clot can break loose and be swept in the circulation to the lungs, where it can occlude a lung vessel. That's a pulmonary embolus, and it can be a most serious, even deadly, complication.

Anti-coagulation stops the clot from growing and from breaking apart. In time, a new channel through the clot forms, and circulation resumes as before. Even if the channel doesn't form, other veins can take over the job once done by the clotted vein.

DEAR DR. DONOHUE: I am 70 years of age and have always enjoyed good health. For the past two months, I have had the middle finger of my left hand locking in a closed position. My doctor tells me I have trigger finger and should not worry. However, it is very uncomfortable and is beginning to cause pain. It is much worse at night and in the early morning.

I would appreciate any advice. -- W.W.

ANSWER: If you look and feel for it, I am sure you'll find a little nodule at the base of that middle finger where it joins the hand. The nodule can lock the tendon of that finger in place. When a person bends the finger, it stays bent until a little manipulation gets it to straighten out again. When that happens, there's a sudden snapping sound, like the click of a gun trigger.

There are several things to do for trigger finger. Sometimes a splint, worn for a brief time, stops the triggering. So might a shot of cortisone in the area of the nodule.

The ultimate cure for the condition is surgically freeing the tendon from the strands of scarlike tissue that sprout from the nodule and trap the finger when it is bent.

DEAR DR. DONOHUE: I am a retired farmer, and I would like your opinion on a report mailed to me from a famous clinic. I had an electrocardiogram done there because of skipped beats detected during a physical examination.

The report says: "This ECG shows a normal sinus rhythm along with some voltage criteria for left ventricular hypertrophy. There is no evidence of an abnormal rhythm on this ECG." What caused the skipped beats? They weren't mentioned. -- D.C.

ANSWER: Just about everybody has skipped (also called extra or premature) beats. Their significance lies in how many occur and how healthy the heart is in other respects. Your ECG showed nothing to raise an eyebrow over. Sinus rhythm is normal heart rhythm coming from the heart's natural pacemaker, the sinus node. The voltage criteria for left ventricular hypertrophy -- an enlarged heart -- is not usually a matter of concern either. Your skipped beats went away. Forget them.

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