Deep Vein Thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs (calf or thigh) or the pelvis. Deep vein thrombosis can cause leg pain or swelling but can also have no symptoms. DVT is a serious condition, but the good news is that awareness and simple lifestyle changes can make a big difference in prevention.
The Experts
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 1:42 What is VTE (Venous thromboembolism)?
- 2:06 What happens if a blood clot (DVT) travels to the lungs?
- 3:15 What can cause/increase risk for a DVT?
- 5:08 Early signs/symptoms of a DVT
- 6:11 The dangers of sitting for extended periods of time
- 8:06 Diagnosing/testing for DVT
- 8:45 Survival rates for DVT
- 9:15 DVT care at Stony Brook Medicine (diagnosis and treatment)
- 10:25 Blood thinners and surgical intervention
- 11:30 DVT in the arms
- 12:15 Prevention
- 14:30 Closing Remarks
Full Transcript
00:00 Opening and Introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Timothy Brown
Welcome to HEALTH Yeah!, where we break down important health topics in a way that’s easy to understand and actually useful. Today we’re talking about something that doesn’t always get a lot of attention, but definitely should – and that’s deep vein thrombosis or DVT.
DVT is a serious condition where blood clots form in deep veins, usually in the legs. If left untreated, these clots can break loose and travel to the lungs, causing a life threatening pulmonary embolism.
So whether you sit for long periods at work, travel often or just want to know the signs to look out for, this episode is for you. Joining us today, we have Dr. Matthew Pergamo and Dr. Angela Kokkosis. And I want to start the program with just having each of you introduce yourselves to the audience and telling us a little bit about what you do here at Stony Brook Medicine.
Dr. Kokkosis, since you’re directly to my right, I’ll have you start.
Angela Kokkosis, MD
Absolutely. Thank you for having me here. I am one of the vascular surgeons here in the Division of Vascular and Endovascular surgery. And I’m also the medical director for our DVT, VTE team right now.
Matthew Pergamo, MD
And I’m Dr. Matthew Pergamo. I just started actually in August. I’m also a vascular surgeon here at the Division of Endovascular and Vascular Surgery.
Timothy Brown
So you just started in August. Are you from the area?
Matthew Pergamo, MD
My wife is from Long Island. I actually grew up upstate and I did my fellowship in the city.
1:42 What is VTE (Venous Thromboembolism)?
Timothy Brown
Alright, I was just curious. So let’s talk about DVT and VTE. So we mentioned DVT in the open. What is VTE?
Matthew Pergamo, MD
So VITE stands for venous thromboembolism, and that’s when a blood clot or, you know, what’s a DVT, a deep venous thrombosis, actually travels in the vein to another location. And that can mean a variety of areas.
You know, most commonly when people hear about it, they hear about it going to the lungs and blocking blood flow there.
2:06 What Happens if a Blood Clot (DVT) Travels to the Lungs?
Timothy Brown
And Dr. Kokkosis, when it goes to the lungs, what happens? What does that actually do?
Angela Kokkosis, MD
So typically the initial signs and symptoms are patients may feel chest pain, shortness of breath. Those could be some early signs, but you definitely want to pick up on it as soon as possible because it can be life threatening.
Timothy Brown
Yeah, it’s a serious condition. And, you know, can you tell before it gets to that really serious stage?
Angela Kokkosis, MD
Yeah, absolutely. So it started as a DVT and most commonly DVTs do start in the legs, less commonly in the arms. Essentially, what you may notice is that you have swelling or pain in one leg and that may be the early sign.
3:15 What Can Cause/Increase Risk for a DVT?
Timothy Brown
I actually worked with somebody many, many years ago who died from a DVT. And it was devastating to his family, and two young girls. And he was seated in a vehicle actually in Desert Storm for an extended period of time and developed that. Is that common when you’re seated, when you’re traveling? It seems like we hear about these things on airplanes as well.
Angela Kokkosis, MD
Yeah, absolutely. You know, I would call it the perfect storm, where obviously not everybody who travels on long trips is going to develop a DVT. But let’s just say you’re on a particularly long trip. You don’t move, you’re dehydrated. Those certain events could increase your risk.
And then, of course, if you have some underlying predisposition that you don’t know about, that could add to the risk.
Timothy Brown
And Dr. Pergamo, talk about the dehydration aspect of this. That’s interesting. Why is that such a critical part of this?
Matthew Pergamo, MD
Yeah. So when you’re dehydrated, there’s a few factors that go into that. One of them is that your blood volume is a little bit less so your vessels are a little bit smaller, meaning that there’s a little more stagnant flow throughout them and slower blood flow. Usually your blood pressure is a little bit lower.
The other factor is that, as a result of having less water, the water content of your blood likely goes down a little bit. That makes you a little more prone to being what’s called hypercoagulable, meaning that the factors in your blood that caused the blood clot are more likely to encounter each other, stick together in a weird way, stick to the blood vessel wall or form a blood clot.
Timothy Brown
Interesting. And I would imagine just being seated, it just sounds logical that your blood isn’t moving as much. Your heart’s not pumping as much. You’re not being active. Would that be accurate?
Angela Kokkosis, MD
Yeah. So, you know, the calf muscle pump is such an important part of our body as far as circulation. So if you’re not actually walking or moving, then your calf muscle is not working. And that’s what actually helps eject the blood from your legs and push it up toward the heart.
5:08 Early Signs/Symptoms of a DVT
Timothy Brown
That’s interesting. I had no idea. I always figured your heart muscle was the one that does all of the work, but other areas help. See, I learned something today, so hopefully people at home learn something as well.
So what are some of the early symptoms? And, you know, again, oftentimes I’ll be in my car or sitting at my desk for hours. Is there something that I’l notice?
Matthew Pergamo, MD
So I’d say that the most early symptom is going to be just discomfort. It could be in any part of your body. You know, you can get a DVT in your arm, for example. It’s something that happens with swimmers or pitchers. If they repeatedly use their arm, they can get DVT in their arms. It’s a bit of a different syndrome. But the first thing that I’ve heard patients describe to me is that their limb just felt uncomfortable and not really like their own.
And it’s hard to say because, like, if you’ve been sitting a long time, you know, you’re going to be uncomfortable. So, you know, your legs might just feel awkward when you first get up, but it’s that discomfort that persists, you know, that keeps going on that I think most people first encounter.
6:11 The Dangers of Sitting for Extended Periods of Time
Timothy Brown
You know, I have heard that sitting is kind of the new smoking or, you know, people say that I don’t know if that’s accurate or not, but we’ll throw it out there. First of all, is that accurate? Is it that unhealthy when you sit for an extended period of time? And what should people do?
Angela Kokkosis, MD
I think a lot of the technology that we have in this day and age has made it easier for us to sit. You know, you get home deliveries for everything and most of our work is on computers. So, yeah, I would kind of agree with that statement.
And yes, sitting for extended hours is just overall not good for cardiovascular health. You got to get up, move around. It’s good for your heart, your lungs, your vessels.
Timothy Brown
So every once in a while I’ll even get up and just do a lap through the Health Sciences Center and through the hospital just because you feel like you need to.
So there are people that drive for a living. For example, you mention delivery folks, truck drivers, people like that. I would imagine they’re maybe at a higher risk. Would that be accurate?
Angela Kokkosis, MD
Yeah, if they’re not taking breaks, you know, in between those long haul trips. Absolutely.
Timothy Brown
Is there anything you can do while you’re driving to help or do you just need to stop the car and get out?
Angela Kokkosis, MD
Yeah, I mean, naturally you’re usually using one foot on the pedal. The other foot, you could just, you know, pump your foot up and down, flexing your calf muscle and that mimics the action of walking.
Similarly, when you’re on a long trip on an airplane, you could do the same.
Matthew Pergamo, MD
I would say also for, you know, truck drivers, if you’re on a highway, obviously you want to be safe driving and don’t do anything unsafe. But there’s cruise control and you can take a couple of seconds break, put that on to keep your speed going while you, you know, move your right leg, move your legs around and then, you know, take it off and keep driving.
8:06 Diagnosing/Testing for DVT
Timothy Brown
So the question, and it’s always interesting because we get these questions primarily from folks that are searching online, so it’s always interesting to me to see what the questions are. One of these is how do you test for DVT at home? Can you do that even? And when do you need to see a doctor?
Angela Kokkosis, MD
There’s no real home test per se, but I would say you could do a self exam. Meaning if you feel that your leg is, you know, a little painful, a little swollen, and if you squeeze it and it hurts with squeezing, that could be an early sign.
And then you should seek medical attention.
Timothy Brown
And is it true also that if you’re if your skin gets a little warm in that area, is that another sign?
Angela Kokkosis, MD
Absolutely. Warmth and sometimes discoloration. So patients may notice that their skin looks a little redder or a little purpler.
8:45 Survival Rates for DVT
Timothy Brown
If you feel these symptoms, and you go to see one of you, what is the survival rate for folks that catch it?
Angela Kokkosis, MD
So survival rate for DVT on diagnosis is actually very good. It’s the undiagnosed ones that have the risk to progression for pulmonary embolism. So, I mean, just to give you an example, you know, the opposite of your question. A pulmonary embolism has a 20 percent fatality rate. So that’s pretty high. So you really want to seek attention as early as possible.
9:15 DVT Care at Stony Brook Medicine (Diagnosis and Treatment)
Timothy Brown
And what happens when somebody comes to see one of you, what’s the process that they go through and how do you fix this?
Matthew Pergamo, MD
I mean, the first thing is always a physical exam, right to test. And you usually see some kind of size discrepancy in their legs. There’s, you know, swelling on one side or like I said, if it’s in the upper extremity, you see that one arm is significantly more swollen than the other. And then we do imaging and the main imaging modality for DVT or blood clots is ultrasound looking at the deep veins.
And so that’s a noninvasive test that uses sound waves to look at whether or not there’s blood flow through the veins. And if they detect that, usually trying to push down on the vein, if they can’t collapse it, they’ll know that there’s a blood clot there and that will prove the diagnosis.
Timothy Brown
And then what happens?
Matthew Pergamo, MD
After that, the first thing that happens is usually a patient gets put on blood thinners, and that’s the mainstay of treatment. And for the majority of people, blood thinners is enough to treat their blood clot. It kind of stabilizes things, stops them from getting worse and begins to treat, even if they’ve had a small pulmonary embolism, it starts to treat that.
10:25 Blood Thinners and Surgical Intervention
Timothy Brown
And if it gets to the stage where they need to see a surgeon, does that happen very often or not?
Angela Kokkosis, MD
Not often. You know, in cases of really extensive DVT, where the clot is essentially the entire limb and up into the pelvis area, those are really the cases where they may need a surgical treatment to remove some of the clot.
Reason being those patients may have such severe symptoms of pain and swelling that it would take a long time for them to wait for the clot to dissolve with the blood thinners.
Timothy Brown
And if you are taking the blood thinners, is there a concern that the clot could come loose and cause issues or not and not so much?
Angela Kokkosis, MD
That’s a great question because many people ask just that intuitively. They think, well, the clot is going to become more mobile and it’s going to break off. The risk is actually less because the idea of the blood thinners is it dissolves it and prevents it from getting worse.
11:30 DVT in the Arms
Timothy Brown
So it’s interesting you bring up the DVT in the arms, because I’d never really even thought that much about that. I always thought of the legs. Is that common or is it primarily legs?
Matthew Pergamo, MD
It’s definitely more rare than the legs. But, you know, the reason for it is usually – it’s what’s called the element of obstruction as the cause of it. So usually they have a rib that’s pushing on the vein coming from their arm.
And, you know, in somebody who’s like a pitcher, like I mentioned, or a swimmer, when they overuse that arm and they’re irritating that spot where the vein is going through their rib, it causes a little bit of blood clot, and then that kind of cascades and clots up their arms. So it’s usually in younger patients, in more of a special subset then, you know, most other DVTs in the legs.
12:15 Prevention
Timothy Brown
So I’m not wearing my watch that tells me to stand up right now. It bugs me, I’ll be real honest with you, because every hour you get a little notification, usually in a meeting or something like that. So I turn mine off. Probably not the way to do it.
But every hour, is that a good school of thought for getting up and getting around and trying to prevent things like this from happening?
Angela Kokkosis, MD
Yeah, absolutely. I think that’s healthy. You know, if you can do every hour or you’re in good shape, you know, if it’s 2 hours later, it’s not the worst thing. But yeah, it’s a good habit.
Timothy Brown
So I need to turn that back on my watch, I guess. Okay. And final question, you guys, first of all, have been great. This has been very interesting. I’ve learned multiple new things today, which is always important and good. Hopefully our viewers have as well.
Can DVT be prevented, though, even if you’re one of these long haul drivers, a traveler, sometimes people will fly overseas.
I know we’ve had some tips. Can you really prevent it or sometimes it just happens and you have to be aware?
Matthew Pergamo, MD
I would say for the ones that have a cause from immobility or you know, some mechanical cause like that, I would say that those are, for the most part, preventable as long as you’re moving around and kind of keeping your blood flow going.
I would say for other people who have a genetic predisposition to getting them, you know, they have a family history of blood clots or pulmonary embolism that sometimes, you know, they sit the same amount as another person would and they might put themselves at risk of a blood clot. And there’s not much that they could do to prevent that.
Timothy Brown
And if you do have a family history, I would imagine there are things you could do, blood thinners, things like that.
Angela Kokkosis, MD
Absolutely. And also there’s genetic testing depending on what the inheritance pattern is. There are some genetic mutations that are well known to predispose people to clotting.
Just as an aside I’ll throw out there. Sometimes a DVT can be a harbinger for a cancer, a malignancy. So oftentimes when we work up these patients, we really get an in-depth history to make sure we’ve determined what the exact cause of the DVT is. And if there’s no obvious reason, then we start to look a little more deeper. Blood tests, cancers and things like that.
14:30 Closing Remarks
Timothy Brown
Interesting. Well, there’s another thing I learned today. This is great.
You guys have been very, very helpful. We really appreciate it. All right. That’s it for today’s episode of HEALTH Yeah!. Deep vein thrombosis is serious, but the good news is that awareness and simple lifestyle changes can make a big difference in prevention. I will turn my watch back on.
Thanks for tuning in. If you found this episode helpful, share it with a friend and please make sure you subscribe for more health tips that can keep you educated and empowered. Until next time, stay informed and stay healthy.
Announcer
Stony Brook Medicine is Long Island’s premier academic medical center. We transform lives through scientific discovery, education and care, and we bring together innovative research, advanced education and extraordinary health care expertise to set the standard for how healthy communities thrive. For more information, visit Stony Brook Medicine or follow us on social media.
*DISCLAIMER: The information provided in this podcast is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you think you may have a medical emergency, call your doctor or emergency services immediately.
