Medicine Made Simple

Pulse Oximeters : Part 2

2009-10-20T12:34:00.000-07:00

Is a pulse oximeter always reliable?

No, there are times when a Pulse Oximetry is not accurate in the following situations:

1.Individuals in shock who are vasoconstricted and have no
pulse generally cannot be monitored by pulse Oximetry. Other
conditions where the pulse may be absent or very faint include
severe dehydration, heart failure, excessive hemorrhage, peripheral
vascular disease, many collagen vascular disorders and other heart
disorders
2.Occasionally bright white lights in hospital rooms can interfere
with accuracy of the oximeter. The numbers may be amplified.
3.The oximeter is sometimes affected by the use of electrocautery
in the operating room. Other medical equipment that can interfere
with the pulse oximeter includes laser beams, ultrasonic devices
and certain types of electronic hardware.
4.Individuals who are shivering or have a persistent tremor often
give unreliable oximeter reading
5.Nail varnish/polish can also cause erroneously low readings.

What are normal pulse oximeter readings?

In general, pulse oxygen saturation in healthy individuals should be above 95% and above. In patients with lung or heart disease, the oxygen saturation may be lower. When the pulse oximeter reads less than 88%, the individual will definitely show difficulty with breathing and may appear out of breaths.

Are pulse oximeters reliable?

Pulse Oximeters available today are very sensitive and reliable. The degree of accuracy has led to their widespread use not only in the hospital setting, but also for use in emergency rooms, out patients medical centers, ambulatory care medicine, outpatient or walk in clinics and even at home.

What is cost of a pulse oximeter?

Advances in Oximetry have now led to the development of devices which can also measure the levels of carbon dioxide at the skin level. The pulse oximeter had been of a tremendous advance in medicine and serves as a vital tool for monitoring the oxygen status of an individual. The cost of pulse Oximetry device is variable depending on the type one wants. The price ranges from $170-$950

For more on pulse Oximeters, visit www.medexsupply.com

Pulse Oximeters : Part 1

2009-10-20T12:32:00.000-07:00

What is Oximetry?

Oximetry is a simple non invasive medical procedure used to measure the concentration of oxygen in the blood. Oximetry is widely used in the hospital care setting to assess patients who have a variety of lung and heart disorders. The measurement of oxygen is done by an oximeter which is a photoelectric device. The majority of Oximeters are small, portable and reusable. Many home devices can be run on batteries.

Where is a pulse oximeter placed on the body?

The oximeter can be placed on the finger tip, ear lobe or toes. Pulse Oximeters are so called because they react only to pulsations of the blood vessels. If there is no pulse, Oximeters will not pick up the pulsations and oxygen concentration cannot be obtained.

Pulse Oximeters are used in all intensive care units, the neonatal unit, coronary care unit, emergency room and during anesthesia. Portable Oximeters are now widely used on the regular medical floors in hospitals across America. The majority of patients who have emphysema, COPD or congestive heart failure are monitored by pulse Oximetry in the hospital.

How does a pulse oximeter work?

The pulse Oximeters work by transmitting a beam of red and infrared light though a pulsating blood vessel. The ratio of red to infra red blood light transmitted provides a measure of the oxygen saturation of the blood. The oximeter identifies the pulse and then deducts the intensity of color perceived when the pulse is absent. The residual intensity of color corresponds to only the oxygenated red blood. This is shown on the electronic screen as a percentage of oxygen saturation in the blood.

Urine strips for making Diagnosis: Part 3

2009-10-16T10:19:00.000-07:00

Urobilinogen test does provide a clue in patient with hemolytic disorders, live failure, poisoning, resolving hematoma or hepatitis. Sometimes low values may occur when there is failure to produce bile or there is an obstruction for passage of bile. A negative result does not mean there is absence of Urobilinogen. High concentrations of ascorbic acid or sulphonamides can also obscure the color and lead to a false negative test.

The nitrite test pad gives an indirect indication of presence of bacteria. When the pad goes pink it signifies a positive reaction. Abnormal nitrite values may indicate presence of a UTI (usually from gram negative bacteria). While the test is accurate in most cases, false negatives may result if there is ascorbic acid present. To confirm present of a urinary tract infection, send a specimen for bacterial culture. Excessive urination or use of diuretic drugs can often create a false negative test due to dilution. The urine test for nitrite is most accurate when antibiotics have been discontinued for at least 3 days prior to the test

Ketones in urine can readily be identified on a urine strip. Ketones are produced in the body when fat is broken down to generate energy. Ketones are generally seen in

- Diabetic ketoacidosis
- Insulin over dose
- Starvation
- Persistent nausea and vomiting
- Strict dieting
- Stress
- Infections.

When Ketones are detected in urine, the next step is to measure urine glucose. If glucose levels are low, one should immediately seek medical attention.

The urine strip is the most inexpensive method to detect white cells in the urine. While a few cells are always present in urine, more than 20 WBC/ul is considered pathological. WBC in the urine may occur from

- Urinary tract infection
- Kidney abscess
- Bladder infection
- Infected kidney stone

The intensity of the color formed is generally proportional to the number of WBC. Results of the test can be obscured by presence of oxalic acid or oxidizing agents. Other factors that affect the test include high sugar, high protein and presence of certain antibiotics like tetracyclines and cephalosporins.

The urine strip allows at least ten quick clinical measurements in an inexpensive way. The results can then be used to treat or counsel patients for further treatment. To view our urine test kit and prices, please visit www.medexsupply.com

Urine strips for making Diagnosis: Part 2

2009-10-16T10:16:00.000-07:00

Urine glucose is the most frequent diagnosis sought out on a urine strip. Urine strips readily identify glucose in the urine; however, for the result to be reliable one has to ensure that the strip has not expired. If the enzymatic action of enzymes is altered on the pad, then the results may be spurious.

Urine strips are quite sensitive to glucose in the urine and this is one of the fastest and inexpensive ways to check for glucose. Abnormal glucose may be seen in diabetes, pregnancy or after a heavy diet. The sensitivity of urine strip to glucose is decreased when the urine has high specific gravity or ascorbic acid concentration is high

Bilirubin levels on a urine strip are often unreliable. The best way to use urinary bilirubin level is to correlate them with clinical findings and laboratories values.

The occult blood test on a urine strip may detect red blood cells, free hemoglobin or myoglobin. The test is very sensitive and quite useful. Blood may be seen in the urine due to a kidney stone, urinary tract infection, break down of muscle, or red blood cells. When urine has high specific gravity it reduces sensitivity of the strip, while ascorbic acid may cause a falsely negative test.

The protein test pad only gives a rough estimate of protein in the urine. However, false positives may occur if the urine pH is very alkaline. Protein may occur in urine from a variety of conditions including:

- Position
- Strenuous exercise
- Extremes of temperature (too hot or too cold)
- Pregnancy
- Low blood pressure
- Liver cirrhoses
- Renal failure
- Upper respiratory tract infection
- Immune complex disorders
- Sepsis

The urine strip reagent is highly sensitive to albumin and less to globulin

Urine strips for making Diagnosis: Part 1

2009-10-16T10:13:00.000-07:00

Urine strips are widely used in medicine to make a quick diagnosis of numerous medical disorders. The majority of these diagnostic reagent strips are designed only for human use and provide immediate useful information about health. Urine strips are frequently used by physicians and health care professionals in emergency room, outpatient clinics, nursing homes, doctor’s office and mobile ambulatory centers. The majority of urine strips are multipurpose and readily show color changes when an abnormality is identified. Most strips have gradations of color which allows one to judge the severity of the problem. For those who are not familiar with urine strips, the following information is readily available from urine strips:

Specific Gravity: Urine specific gravity is readily obtained from a strip but it only provides a clue to change in urine density. For more accurate testing, one needs to use a calibrated refractometer.

Urine pH is the most widely used property on a urine strip. The test strips are designed to measure pH change values to within 0.5 units. For the most part, urine pH values are okay for emergency use. Abnormal pH levels may be seen in the following conditions:

Alkaline urine

- Urinary tract infection
- Consuming a vegetarian diet
- Systemic alkalosis
- Bowel obstruction- pyloric stenosis
- Excessive vomiting
- Use of alkaline drugs

Acid urine

- Gout
- Fever
- Use of drugs like phenacetin
- Uric acid stones

The test strips are most accurate for pH in the range from 5-9. However, one has to remember that false negatives can occur because the solution may run over from the highly acidic protein test pad to the urine pH pad. Thus, it is important to hold the strip horizontally when evaluating urine for pH. Whenever there is doubt about urine pH, a pH meter can be used to verify your results.

Shoe Covers: Part 2

2009-10-02T11:27:00.000-07:00

Almost all shoes covers available today for health professionals are made from poly lactic acid which is an environmentally friendly fabric that is easy to dispose. It biodegrades into water and carbon dioxide. All shoe covers for hospital use are made in accordance with guidelines from OSHA.

The shoe cover fabric is generally 0.1-0.5 mm in thickness and comes in white or blue colors. Shoe covers are ideal for people who not only work in the health care industry but also for those who process food, do house work, work in hair salons, cook foods or work into pharmaceutical manufacturing industry. Shoe covers available today are very light weight, convenient and easy to use. Most have an elastic band along the edges which helps the cover from falling off.

For individual who have latex allergy, there are even shoe covers which are latex free. Disposable shoe covers are considered to be an investment for hospitals because they limit the spread of diseases. One wears them to protect the environment.
Like disposable gloves shoe covers also are available in mass quantities. The majority of shoe covers available are fire resistant, splash proof and non slippery. Most are non allergenic and are easy to dispose.

For more on shoe covers, please visit www.medexsupply.com

Shoe Covers: Part 1

2009-10-02T11:25:00.000-07:00

Every hospital has difficulty controlling and preventing infections. There is a lot of evidence that a number of infections acquired in hospitals are passed on to patients from other people (both health care professionals and non health professionals). Despite all advances in science, infections still remain a major cause of death. With recent epidemic of swine flu and bird flu, the importance of hand washing has again been re-emphasized. Another aspect of prevention or transmission of infection is wearing of shoe covers. Shoe covers are vital for health care professionals who work in the operating rooms or in areas of the hospital where complete anti sepsis is required.

All of us wear shoes and walk into environments which are dirty and unsanitary. Show covers help materials from shoes from falling inside clean environments.
Besides preventing transmission of dirt and junk from the outside, show covers also prevent contamination of personal clothing like socks and shoes. There are many types of shoe covers but most health care facilities prefer the disposal shoe covers which come in one size fits all.

Shoe covers are made from light paper cloth, which has a stretchable fabric so that the fit is perfect around any type of shoe. Once the shoe cover is worn it stays firm and does not easily slip off irrespective of the circumstances. Most shoe cover fabrics are sturdy and prevent transmission of fluid into the shoe or socks.

Surgical Masks

2009-09-10T08:14:00.000-07:00

Surgical masks have always played an important role in preventive medicine. With the advent of Swine and Bird flu, surgical masks have gained even more significance in the world of medicine. Surgical masks were once only worn in hospitals by health care professional and patients. Surgical masks help protect health care workers from bodily fluids, blood, various lung secretions and reduce spread of microorganisms from patients to health care worker and vice versa.

Since the advent of influenza virus, two other airborne viruses have been discovered that have the potential to cause many deaths. Large-scale pandemics of bird and swine flu viral infections have led to use of surgical masks outside health care facilities. The availability of relatively cheap surgical masks has led to high usage among populations in South East Asia. In many Oriental countries, use of surgical masks is a frequent public site to help avoid spread of the common cold virus.

Since the Bird flu scare several years ago, surgical masks have become popular among the public in many parts of America, including Canada and Mexico. There is abundant clinical evidence indicating that surgical masks play an important role in protecting health care workers from contaminated body fluids and aerosol particles. Surgical masks are primarily worn in hospital to prevent inhalation of aerosolized particles including microorganisms.

Awareness of serious viral and bacterial infections has led to development of guidelines regarding use of surgical masks in many health care facilities. Today, surgical masks are advocated for health care professional by the following institutions:

- American National Standards Institute Practice for
Occupational and Educational Eye and Face Protection
- Association of Perioperative Registered Nurses
- Joint Council on Accreditation of Healthcare Organizations
- National Committee for Quality Assurance
- National Institute for Occupational Safety and Health
- Occupational Safety and Health Administration
- The Food and Drug Administration

For more on surgical masks, please visit www.medexsupply.com

Eye Protection in health care facilities: Part 2

2009-09-10T04:02:00.000-07:00

What types of safety eye wear is available for hospital workers?

The presently available safety eyewear include:

- non prescription eye glasses
- prescription safety glasses
- goggles
- Face shields that are combined with a surgical mask

Eye goggles are easy to use and do provide an important protective function. Before buying a pair of eye goggles one should look for the following features:

- are the goggles lightweight
- are the goggles easy to wear and comfortable
- Do the goggles protect against fluid splatter
- Do the goggles easily fog up?
- Are the lenses strong?
- Are the goggles resistant to chemicals and fluids?
- Are the goggles scratchproof?

It is highly recommended that one wear eye protection if there is any potential for eye injury. Today, OSHA standards require that all health care facilities make available to their staff appropriate eye protection. To be useful, the eyewear must be of the correct type for the risk encountered and correctly fitted.

Eye protection devices must be maintained if one wants them to last. The lenses should be regularly cleaned – dented, scratched or and soiled lenses can diminish vision and may be a factor in causing injury

For more on eye protection devices, please visit www.medexsupply.com

Eye Protection in health care facilities: Part 1

2009-09-10T03:52:00.000-07:00

Protection of the eye is very important in health care facilities. Each year thousands of health care workers are exposed to sick patients, contaminated aerosolized environments, infected body fluids, and blood. Surgeons especially are always at risk from flying fragments and body fluids during surgery. Despite protection from prescription glasses, a number of health care workers develop various types of eye injuries. Moreover, besides direct injury to the eye, there is always a potential for coming into contact with infectious organisms or blood.

When the eye is injured or infected, one has to miss work. This adds to loss of manpower and adds more stress on the already overworked workman’s compensation program. There is no dollar figure that can entirely replicate the personal toll these injuries take on injured health professionals.

Eye experts indicate that proper eye protection can significantly reduce incidence of eye injuries in hospitals and related facilities.

What are common causes of eye injuries in a hospital setting?

- Flying objects especially during surgery (blood particles,
bone chips, metal particles)
- Chemicals
- Aerosolized particles
- Fumes
- Laser beams

How can one prevent eye injury at work?

Eye injuries can be very serious and thus a preventive approach is ideal. All individuals who work in a hospital environment should know the following:
- location of nearest emergency eye wash basin
- be aware of all potential causes of eye injuries in
the working environment
- wear proper eye protection
- be familiar with use of eye goggles

If there is any chance that the eye may be injured at work, one should wear eye goggles. There are many types of protective eyewear available today and most work well. The choice of eye goggles is strictly personal.

HPV vaccine: Part 3

2009-06-11T08:32:00.000-07:00

Finally the cost of HPV vaccine

Medicine is foremost a business and nothing is free. A single dose of Gardasil costs $120-$140. Each individual requires three doses over a 6-month period. Further, many physicians are also charging for a consultation fee, cost of syringe and office time. Thus, the average cost for the entire series of HPV vaccine amounts to about $500-$600 plus.

Not all health insurance plans cover Gardasil. Moreover, some insurance plans only cover the vaccine for females in-between the ages of 9-26, the age where the vaccine has been FDA approved. At present, there is no legislation mandating that insurance plans cover the cost of the vaccine.

The pharmaceutical giant, Merck now has released data that the vaccine is also useful in women up to the age of 45. If there is FDA approval for the vaccine for this older group of individuals, perhaps some insurance companies may cover the cost.

At the moment, Gardasil is covered under a federal program for those who have no insurance and to Medicaid eligible children under the age of 18. For those individuals who lack medical insurance, one can check with the physician or the local health clinic to determine if there is program to get the vaccine free.

HPV vaccine: Part 2

2009-06-11T08:31:00.000-07:00

The one reason why Gardasil is not recommended for women over the age of 25 is that by this time it appears many women have already been exposed to HPV. However, there are studies that have documented safety of this vaccine in the older age group. At present, Gardasil is believed to be effective for at least 5 years after injection. Current research is trying to determine if a booster shot at the end of 5 years will extent protection from the vaccine.

All consumers should understand that getting the HPV vaccine does not eliminate the need for future doctor visits. Pap smears are highly recommended in all females when they become sexually active.

As far as side effects are concerned, both vaccines have proven to be quite safe. From the recent clinical trials, the most common side effects observed were redness and pain at the injection site. These transient side effects last for a few days.

Neither Gardasil nor Cervarix is recommended for pregnant women. Once injected with the HPV vaccine, more than 95-98 percent of women are protected from developing cervical cancer

What is all the fuss about the human papillomavirus (HPV) vaccine?

2009-06-11T08:18:00.000-07:00

Cervical cancer is quite common all over the world. The tragedy of cervical cancer is that it affects young females. Current estimates indicate that in America, approximately 11,000 women develop cervical cancer and there are about 3,000 deaths each year. Over the years, a strong link between the human papilloma virus (HPV) and cervical cancer has been established. Furthermore, HPV has also been linked to cancers of the mouth, vulva, anus, and penis. With more people engaging in sexual activities at an earlier age, a vaccine would be a great way to prevent these cancers associated with HPV.

At present two vaccines have been developed to prevent infection from HPV. Both vaccines are administered by an injection in three divided doses. The current injection guidelines recommend that the first injection be followed by the 2nd and 3rd dose, two and six months, apart.

So far, only one vaccine is currently available in North America. Gardasil is currently available and recommended for all girls and young women between the ages of 9 and 26. In different countries, the age of vaccination is slightly variable. For example in Australia, cervarix is recommended for all females between the ages of 10-45 and for boys in-between the ages of 9-15. Cervarix is currently in the clinical trials stage in North America but data indicate that it is just as effective and safe as Gardasil.

The most important factor with both vaccines is that one gets vaccinated prior to becoming sexually active. Current data indicate that if the vaccine is injected in sexually active individuals, it does not get rid of HPV infection and thus protection against cervical cancer is not a guarantee.

Blood in urine: Part 4

2009-06-08T07:32:00.000-07:00

Treatment

When hematuria occurs, the doctor has to treat the underling cause.

Urinary tract infections are treated with antibiotics and within a few days both the symptoms and hematuria will disappear. In rare cases, one may need long-term treatment with antibiotics

Kidney stones generally pass spontaneously through the ureter when one drinks a lot of water and remains active. If this method fails, then there are several other options to reveal kidney stones. One is non-invasive use of ultrasonic shock waves to break up the stone. Other more invasive methods include Cystoscopy or surgery.

Enlarged prostate does require treatment when the patient has symptoms. There is no ideal treatment for enlarged prostate. Every treatment has some negatives. In general, one is treated with medications and these do work well, but they also have side effects. When medications fail, the other options are use of heat, laser, or ultrasonic waves to shrink the prostate.

Immunological kidney disease does require treatment. The treatment depends on the type of kidney disease.

Cancers of kidney and bladder are generally treated with surgery. These tumors generally do not respond well to radiation or chemotherapy. In most cases, surgery is combined with an assorted variety of chemotherapeutic drugs.

Inherited disorders of the kidney which cause hematuria, do not always require treatment. Some disorders may cause extensive kidney damage and dialysis may be the only alternative.

Prevention of blood in urine

Unfortunately, one cannot not prevent hematuria. Even then, one should lead a healthy life style. Drinking adequate water and urinating right after intercourse does help prevent some urinary tract infections

To decrease the risk of kidney stones drink lots of water, limit salt, excess protein, and foods such as spinach.

To decrease risk of cancer, stop smoking, avoid exposure to heavy metals or chemicals and get regular exams from a physician.

Blood in urine: Part 3

2009-06-08T07:04:00.000-07:00

What are risk factors?

Anyone can develop blood in the urine.

Age: Many men in the 5th decade of life develop and enlarged prostate and have blood in urine

Females generally tend to have hematuria in urine from a UTI

Family history may predispose one to kidney stones which may lead to blood in urine.

Medications like aspirin and penicillin can cause blood in the urine.

Athletes who are long distance runners or joggers often develop hematuria.

Diagnosis

After a complete history and physical examination, hematuria work up depends on the suspected cause.

Urine analysis can determine if there is blood, infection, or a stone. Urine analyses is not specific for diagnosis and some type of radiological study is usually required.

Imaging with CT scan, MRI, or ultrasound can help look at the urinary tract.
Sometimes a long flexible camera (cystoscope) is passed from the penis or vagina into the urethra and up the ureter. The camera can help visualize structures and biopsy can be obtained.

In a few cases the diagnosis of hematuria may not be evident. This may occur if one has had a prior exposure to a drug or an environmental toxin.

In elderly individuals, the cause of hematuria is almost always investigated to rule out a cancer.

Blood in urine: Part 2

2009-06-08T06:54:00.000-07:00

Causes of hematuria

There are a number of structures that make up the urinary tract. Starting with kidney, there are the ureters, bladder and urethra. The kidneys remove waste products and make urine. The urine is then carried by the ureter to the bladder where it is stored. When the bladder is full, the urethra opens and one urinates. blood can originate from any one of these structures.

Urinary tract infections (UTI) are common in women then men. Often some women develop microscopic hematuria during a UTI. This usually clears up once the UTI is treated with an antibiotic. No investigations are needed.

Infections of the kidney is known as pyleonephritis and can also result as microscopic hematuria. The condition is associated with significant flank pain, fever, and difficulty passing urine. The condition is typically treated with antibiotics.

Stones are a common cause of blood in urine. Urinary stones are excruciatingly painful and often cause both gross and microscopic hematuria. Identification of stones is easy with a dye study. When the stone has passed, hematuria usually clears up.

Enlarged prostate is a leading cause of hematuria in man over the age of 50. The prostate is located at the base of the bladder. As men age, the prostate gets bigger and compresses the urethra; often this leads to difficulty in urination. Often the condition is associated with both gross and microscopic hematuria. The condition is easily diagnosed with a rectal exam or an ultrasound.

Kidney disorders; There are many kidney disorders that can cause microscopic hematuria. Most of these disorders are either infections or immune mediated. These disorders also have other organ involvement and need to be worked up. Most of these immunological kidney disorders present much early in life.

Cancer: Gross hematuria is often the first sign of cancer of bladder, kidney or prostate. Unfortunately, when gross hematuria occurs the cancer is generally more advanced.

Trauma is a common cause of hematuria. Individuals into contact sports may see blood in urine after trauma.

Medications like aspirin and blood thinners can also cause blood in urine.

Strenuous exercise can cause gross hematuria. This is most probably related to dehydration, trauma to the bladder or breakdown of red cells. The condition usually improves within a few days.

Why do I have blood in my urine?

2009-06-08T06:49:00.000-07:00

Having blood in urine is not normal. Seeing blood in urine can be a frightening experience for most people. When blood occurs in the urine, the condition is medically known as hematuria. In most cases, having blood in urine is not a cause for alarm. Sometimes participating in strenuous sports can cause blood to appear in urine. Some footballers often see traces of blood in urine after being knocked down on the sports field. Other common causes of blood in urine include kidney stones and drugs. However, in the elderly individual blood in urine may signal the appearance of a cancer.

Blood in the urine is classified as gross or microscopic. When the urine is only slightly red and red blood cells are only seen under a microscope, this is known as microscopic hematuria. When there is frank blood in urine, this is known as gross hematuria.

When gross hematuria occurs, one must always rule out a cancer. When there is microscopic hematuria, the cause may be an infection or a stone.

Hematuria that is caused with exercise or sports trauma usually disappears within a few days and does not require any extensive work up

Symptoms

In many individuals, microscopic hematuria may present as red or pink colored urine. It takes only a few red blood cells to make the urine look red. In most cases, there is no pain associated with blood in urine.

Blood clots:Part 6

2009-06-07T00:13:00.000-07:00

How can I prevent blood clots?

The best methods of preventing blood clots include:

- Being active, walking on a daily basis
- If flying or driving a long distance, walk around
every few hours
- Wear compression stockings
- Lose weight
- Avoid prolonged standing
- If possible, avoid the birth control pill

Are there any home treatments to treat blood clots in the legs?

Yes, once you have been started on a blood thinner, you can do a number of things at home to relieve symptoms:

- Frequently elevate the leg, this will decrease
swelling and pain
- Avoid standing for long periods
- Wear compression stockings
- If it feels warm at the back of the leg where the
blood clot has been identified, apply a warm compress

Final advice

All individuals who are being treated with blood thinning medications should wear a medical bracelet to alert health care workers of their medical problem.

Blood clots: part 5

2009-06-07T00:09:00.000-07:00

Is there a risk from taking these medications?

Yes, all blood thinning medication can cause bleeding. Thus one should avoid activities that can lead to trauma to the body, otherwise severe bleeding can occur.

Can blood clots be dissolved instantly?

Yes, there are medications (thrombolytics) which can rapidly dissolve blood clots. However, there are specific indications for use of these medications and they all carry a higher risk of complications. Their use is only limited to hospital patients.

Is surgery ever used to treat blood clots from the legs?

Yes, in very rare cases surgery (thrombectomy/embolectomy) is sometimes used in the treatment of blood clots. However, this is done for life or limb threatening cases only. There is no role for surgery in the routine treatment of blood clots in the legs. The surgery is hazardous and fraught with complications. However, it is life saving.

What happens if I am unable to tolerate a blood thinning medication?

Today, there are several devices (filters) which can be placed in the vein to prevent blood clots from migrating to lungs. The filter has to be placed before the blood clot has broken off. The filter acts like an umbrella and is quite effective in preventing the blood clot from moving to lung. These devices have an umbrella like appearance and do not dissolve the clot but prevent it from going to lungs. Filters are more commonly used in individuals who can not take blood thinners. There are both permanent and temporary filters available today but they do cost a fortune. Some of the temporary filters cost more than $15, 000.

Blood clots:Part 4

2009-06-07T00:04:00.000-07:00

What is treatment of a blood clot?

If a blood clot is found in the deep veins, you will require admission to hospital for at least 4-7 days. Following some blood work, you will be started on heparin.

What is heparin?

Heparin is a blood thinner that is given intravenously. It does not dissolve the clot but helps to stabilize the clot so that it does not move. After a few days, you will be started on an oral medication called warfarin and then discharged home. Anyone who receives warfarin needs his or her blood assessed on a weekly to monthly basis to ensure that blood thinning is adequate.

How long do I need to take a blood thinner?

For a first time blood clot, you will need to take warfarin for at least 6-9 months. Those with recurrent blood clots will require warfarin for an indefinite time.

Are there any other medications one can take for blood clots?

Yes, the newer medications are called low molecular weight heparins (LMWH). These medications do not require monitoring and can be taken at home. Unfortunately they need to be injected daily and are more expensive.

Blood Clots: part 3

2009-06-07T00:01:00.000-07:00

What causes blood clots in the veins?

There are many reasons why blood clots can form in veins. These include

- Prolonged immobility (after surgery)
- Long airplane ride
- Taking the birth control pill
- Trauma or fractures of leg(s)
- Injury to veins
- Cancer
- Stroke- which has caused one to become bed ridden
- After any surgery- especially hip and knee
- Obesity
- Congestive heart failure
- Pregnancy or just after delivery
- Inherited blood disorders
- Prior blood clot –there is increased chance of a
second clot if one has had a previous blood clot

Are blood clots dangerous?

Most definitely. Any time you have one of the above symptoms; one should go and see a doctor. Blood clots in veins have a high tendency to break off and migrate to the lungs where they can cause serious problem’s including death.

How can blood clots in veins be detected?

Your physician will first examine you and order the most appropriate tests. The first test to detect blood clots in all cases is an ultrasound.

Doppler ultrasound is a painless test that takes a few minutes and can easily detect the presence of blood clots in arm and leg veins. However, if blood clots are located in the chest, abdomen or pelvis, Ultrasound is not good enough.

MRI: This non invasive test is also excellent for evaluating presence of blood clots. The test does not use radiation but is slightly more expensive. It is useful for detection of blood clots almost anywhere in the body, but is not the first test of choice.

Venogram: In the old days Venogram was used to look for blood clots. However this test is rarely used to day because of availability of US and MRI. Venogram requires use of a dye and radiation.

CT scan: The newer CT scans can easily identify presence of clots in the lungs. However, CT scans are not routinely used to detect blood clots as the initial test. CT scan requires exposure to radiation and use of an iodinated dye.

blood clots: part 2

2009-06-05T10:05:00.000-07:00

What are veins?

Veins are thin walled vessels which play a role in removing all deoxygenated blood from the tissues and take it back to the lungs for oxygenation. They are numerous veins all over the body; the largest vein is called the inferior vena cava.

Can blood clots occur in veins?

Most definitely, blood clots are far more common in veins than arteries. When clots occur in veins they have a tendency to break off and move to the lungs where they can compromise breathing. Clots can occur in both the arm and leg veins.

Which veins are more prone to blood clots?

The majority of blood clots occur in veins of the leg but they can occur in any vein in the body.

Which blood clots are of importance?

Blood clots can occur in both superficial and deep veins. Only blood clots in deep veins are of concern. Blood clots in superficial veins do not need any treatment except for an aspirin.

What happens when blood clots migrate to lungs?

The lungs are important for gas exchange. When blood clots move into the lungs, they can block blood vessels and impair oxygen transport. If the clots are large, one can have severe difficulty breathing and death is not uncommon.

Are blood clots in veins common?

In the United States, about 2 million people per year develop blood clots. Most of them are aged 40 years or older. Statistics reveal that at least 200,000 patients die each year from blood clots in their lung.

How do I know if I have blood clots?

It depends where the blood clot has formed. In most cases blood clots form in the legs, especially the calf area. You may have some of the following symptoms:

a. heaviness of leg
b. tenderness in calf area
c. swelling in calf area
d. warmth near the calf
e. at least 30% will not have any symptoms

Blood clots 101

2009-06-05T09:48:00.000-07:00

In a healthy human there is a delicate balance between factors that cause blood clots to form and factors that dissolve blood clots. Blood clots form all the time in blood vessels, but the body immediately responds by breaking them up. However, sometimes, the body’s defense mechanisms fail and blood clots form. Blood clots when they initially form look like red jelly. Blood clots are useful because they can help stop bleeding. However, in some cases, blood clots continue to form and can break off can create problems

Where do blood clots generally occur?

Blood clots can occur in arteries and veins of any size. Veins usually take blood back to the heart. Thus, when a blood clot occurs in a vein blood starts to pool and collect in the vessel. The most obvious sign of a blood clot in the leg vein is swelling, pain, and discoloration. Blood clots in small veins like in the feet or hands are not important. However, when blood clots occur in large veins, they are important. These blood clots can break off, go to the lung, and make breathing difficult.

What are arteries?

Arteries are muscular blood vessels which take blood from the heart and supply oxygen to the body. When a blood clot forms in an artery, the body part does not get oxygen. Hence the leg goes blue, feels cold and is painful. Blood clots commonly block off arteries in the leg vessels near the groin.

Can clots occur in arteries?
Yes, blood clots can and do occur in arteries. Since arteries supply oxygen to the body, blood clots formation is usually more serious. Blood clots can deprive the hand or leg of oxygenated blood. This is what happens in a stroke or a heart attack. Blood clots generally tend to occur in arteries that supply the brain, heart, legs, or kidneys. Blood clots formed in leg arteries generally require urgent surgery

Irritable bowel syndrome 101 part 10

2009-05-06T10:50:00.000-07:00

Alternative therapy

The failure of conventional medicine to help individuals with IBS has led many people to seek alternative care. Acupuncture is widely used as a treatment for IBS. While some claim that it works, clinical evidence is scant and limited trials show that is does very little. There are hundreds of people who have tried acupuncture and found to be junk therapy. Acupuncture is a therapy still looking for a medical disorder it can cure.

Other therapies tried out in IBS include use of peppermint to relax the intestine and Probiotics. The data on both these therapies are mixed. Some say it works and others say it does not. As far as clinical evidence is concerned, there is only one study that shows mild benefit of peppermint. Most of the time the effectiveness of these therapies is only in the minds of people who sell these products.

Irritable bowel syndrome 101 part 9

2009-05-06T10:41:00.000-07:00

Can IBS be prevented?

One of the ways to avoid symptoms of IBS is to decrease the triggers. To avoid trigger factors and lessen their effects, one may need to undergo some type of counseling, biofeedback, or alternative therapy.

Coping

The best way to cope with IBS is to find a treatment that works for you. Every individual has his or her own remedy and often this regimen does not work for all individuals. The goal is not to find a temporary solution but a long-term solution that is effective

Fiber. Even though fiber is good for patient with IBS, fiber can also be a real hassle. Fiber can help decrease constipation but it can also produce a lot of gas and cause abdominal cramps. Fiber should be gradually introduced in the diet over a period of weeks and not days. Foods, which contain decent amount of fiber, include whole grains, fruits, vegetables, and beans. Most individuals do not need to consult a dietician for a fiber consult. There is enough free literature on cyberspace that can tell you what to eat and how much fiber to eat. When eating a fiber supplement like Metamucil or Citrucel, introduce these supplements slowly and drink lots of water. This will minimize bloating and gas. If a fiber works for you, stick to that brand and use it on a regular basis.

Avoid “problem” foods. Keep a dairy and make a note of foods that make your symptoms worse. Culprit foods that often worsen IBS include:

- Alcohol
- Chocolate
- Caffeinated beverages (coffee and sodas)
- Medications that contain caffeine
- Dairy products
- Sugar-free sweeteners (sorbitol or mannitol)

Other foods that produce gas and make symptoms worse include beans, cabbage, cauliflower, and broccoli. Fatty or oily foods can also be problematic for others.

Individuals who chew gum, drink through a straw and talk while they are eating can swallow more air and this can also lead to more gas

Eat at regular times

To synchronize your bowel movements, eat at regular times. Do not skip meals and do not eat large meals all the time. Many individuals with diarrhea find that eating several small meals can help reduce symptoms. If you are constipated all the time, add fiber to your diet

Dairy products: Individuals who have problems with lactose should avoid dairy products or eat lactose free products. One can even use an enzyme product called lactaid that can break down lactulose. For some individuals, milk or dairy products may have to be completely eliminated from diet to relieve symptoms. In these individual it is essential to eat other food containing calcium and vitamin B

Drink liquids: Drink lots of fluids. While there are hundreds of beverages, there is nothing better than water. Avoid alcohol or caffeine containing beverages as it can make diarrhea worse.

Exercise regularly: Regular exercise will help you maintain a decent weight, relieve stress, and stimulate your bowels to work better. One does not have to join an exercise club, spend a fortune joining a gym- start with walking, or jog regularly. Nothing beats daily walking.

Avoid excessive use of anti-diarrheal medications and laxatives: Individual who have diarrhea should try and avoid use of excessive anti diarrheal medications. Imodium and kaopectate do work, but one should start with the lowest dose. These medications can rapidly resolve diarrhea but can also worsen constipation.