Traditional Tibetan medicine: therapeutic potential in lung diseases

Swollen Ankles And Blood Clots: How Unhealthy Veins Could Kill You

Whilst many of us do our best to take care of our brain, heart, skin and gut, we often take our veins for granted. Perhaps we think they'll look after themselves. Yet, there are thousands of miles of veins running through our bodies – circulating blood back to our heart and lungs for replenishment and waste removal – and there can be serious consequences if they're unhealthy. Think swollen ankles, leg ulcers, throbbing pain and – in the most severe cases – death.

President Donald Trump was recently diagnosed with chronic venous insufficiency (CVI) – a condition which causes blood to pool in the veins – after noticing "mild swelling" in his lower legs. The White House physician assured reporters that President Trump's condition is "benign". However, if ignored, CVI can lead to serious complications including leg ulcers and pulmonary embolism (PE).

So, what are the common venous diseases, how serious are they and what should we be doing to protect our veins?

Varicose veins

In our veins, there are valves that act as one-way doors, ensuring our blood flows in the correct direction towards the heart. They're particularly important in the legs, where our blood needs to travel against gravity. Varicose veins occur when these valves don't work properly.

The blood builds up and puts pressure on the veins – this is called "venous reflux" – which causes them to swell, twist and bulge. Varicose veins typically appear just under the skin on our legs, feet or ankles. Smaller, web-like veins sometimes form around them and these are called spider veins. These develop in smaller blood vessels, closer to the skin's surface, and tend to be asymptomatic.

"People talk about varicose veins quite dismissively. In the past, they were seen as a purely cosmetic problem, however thanks to a shift in research in the 1980s, we now know that's not the case," says Professor Mark Whiteley, a consultant venous surgeon and founder at The Whiteley Clinic. Whilst they're not a major problem for most people, they can sometimes cause complications such as blood clots or leg ulcers.

Symptoms may include aching, heaviness, itching or burning in the legs, as well as visible bulging veins. You should see a GP if you have varicose veins and these symptoms, or ask for an urgent appointment if they're bleeding.

varicose veins

Chronic venous insufficiency

Similarly, CVI is a condition where the veins in the legs struggle to pump blood back to the heart, "resulting in reverse flow which causes inflammation, typically around the ankles," Whiteley explains. "The trouble is that CVI is a catch-all term which basically means that the valves aren't working. This could be in the superficial veins near the skin surface or in the deep veins which run through your muscles." Varicose veins may be a symptom of CVI.

Risk factors include age, prolonged inactivity and family history. CVI may also occur in people who have previously had deep vein thrombosis (DVT – see more on this condition below) and key symptoms include swollen, discoloured, achy, tired or tingly legs.

"If you have swollen ankles and you think you could have CVI, it's really important to get a scan because the treatments and outcomes are phenomenally different depending on whether you have CVI in the deep or superficial veins," Whiteley explains. "It becomes a very different problem if the deep veins are involved, but fortunately – unless you've had DVT in the past – it's usually superficial and can almost always be properly treated."

Blood clots

When blood clots form in your veins, the condition is called "thrombosis". There are three key reasons why this happens, known as Virchow's triad, Whiteley explains, and these are "changes in the blood, changes in the blood flow, and changes in the blood wall".

Factors that "change your blood" include smoking cigarettes and taking the contraceptive pill, Whiteley says. The nicotine in cigarettes causes blood vessels to constrict, whilst also damaging the inner lining of veins and causing inflammation. Meanwhile, in the pill, oestrogen is known to make blood more "sticky", therefore increasing the risk of clotting.

Damage to the vessel wall can occur because of "inflammation, tumours, radiation, injury, or surgery", whilst abnormal blood flow may occur when "you sit down or don't move for long periods of time," Whiteley explains.

If a blood clot forms below the knee or in a superficial vein (superficial thrombophlebitis), it's not generally considered as dangerous and it may resolve itself, Whiteley says. However, it becomes more concerning if the clot forms in a vein behind the knee or, worse, between your knee and groin or pelvis. This is called a DVT…

Deep vein thrombosis (DVT)

…Which is a serious condition where a blood clot forms in a deep vein. "If a clot forms between your knee and groin, or in your pelvis, there's a chance it travels to the heart, is pumped to the lungs and causes a pulmonary embolism [PE]," Whiteley explains. A PE can lead to serious complications including respiratory distress and cardiovascular issues.

Symptoms of DVT include throbbing pain or swelling in one leg, swollen veins that are hard or sore when you touch them and warm skin around the painful area. You're more likely to get DVT if you're over 60, have varicose veins, are overweight or have had the condition before.

"In the long term, DVT can also damage the deep veins. You can end up with a long-term swollen, discoloured leg, often with ulcers, which is called post-thrombotic syndrome," Whiteley says.

You should ask for an urgent GP appointment if you think you have DVT, or call 999 if you have symptoms such as swelling and breathlessness or chest pain.

Venous leg ulcer

Venous leg ulcers are open and painful sores which usually develop on the inside of the leg, between the knee and the ankle. You may develop a venous leg ulcer if you've previously had DVT, have varicose veins, are older, overweight or have difficulty walking and symptoms include pain, itching and swelling.

"DVT can cause leg ulcers in the long term because the blood clots can damage valves in the veins, leading to inflammation which damages the skin," Whiteley explains, whilst varicose veins also increase inflammation in the leg.

Venous leg ulcers are unlikely to get better on their own and usually require specialist medical treatment to ensure they don't become infected or lead to tissue damage.

How to look after your veins Walk, run and swim

"The best thing you can do for your veins is exercise," Whiteley says. Exercise improves circulation which helps to propel blood through the veins, especially in the legs, back towards the heart. A 2018 study by researchers at Liverpool John Moores University found that training improves vascular function and supports the production of nitric oxide, which helps to relax the smooth muscles in vein walls.

Whiteley says walking, running and swimming are the best exercises for healthy veins. "If you're not able to do these, even sitting in front of the TV and stimulating your legs by elevating or pumping them [flexing your feet up and down] is going to help reduce pressure on your veins. Anything that gets the blood flowing," he explains.

Compression stockings

Whilst they're not the most fashionable accessory, Whiteley recommends graduated compression stockings to support your veins. They are designed to improve blood flow in the legs and improve circulation by applying gentle, graduated pressure – tighter at the ankle and decreasing up the leg.

"If you're not able to move your legs a lot, compression stockings will really help to stimulate the blood flow," Whiteley says. They're particularly useful when you're sitting for a long period of time, for example during a flight. They can also help to prevent or manage varicose veins.

Micro-purified flavonoid fraction (MPFF)

Whilst Whiteley says there aren't any major dietary changes you can make to protect your veins, there is "some evidence" that MPFF can support vein health. It's a medication composed of different flavonoids – primarily diosmin which is found in citrus fruits. A 2019 review in Advances in Therapy says it can help to alleviate leg pain, heaviness, sensations of swelling and cramps.

"It won't reverse damage to your veins but it can take away some of the discomfort, pain and inflammation," Whiteley says. "Most nutritional measures may provide a little bit of help but none of them are curative or preventative."

Drink lots of water

When you're sufficiently hydrated, your blood is thinner which means it's easier for your heart to pump and circulate it through the veins. "When you're dehydrated, your blood constituents change which means you're more likely to get a clot," Whiteley explains.

"The simple way to tell if you're drinking enough is to look at your urine," he says. "If it's a straw colour, you're drinking enough." Whilst drinking enough water doesn't make your valves any stronger or work any better, it ensures that your blood is circulating efficiently.

Avoid smoking

Smoking damages blood vessels and reduces overall circulation. It can also thicken the blood and reduce oxygen levels, increasing the likelihood of blood clots forming in the veins.

One study in the Journal of Thrombosis and Haemostasis found a positive association between smoking and DVT among middle-aged men and women. They discovered that former smokers had the same risk of DVT as those who had never smoked, highlighting the potential benefits of giving up cigarettes.

FAQs What do the colour of your veins mean?

"Your veins are white and completely colourless, so you're actually seeing the blood in them," Whiteley explains.

He says the colour depends on "how much tissue is between the top layer of your skin and the blood in the vein". If it looks red, it means your vein is "very near the surface of the skin and has a very thin wall". If it's a purple or blue colour, your vein is "a bit deeper and the vein wall is a bit thicker" and if it's green, it means that "the vein wall is even thicker and the vein is even deeper".

Does dry brushing help with vein health?

Dry brushing does not help with vein health, Whiteley says. However "it's very good for your lymphatics" which are a network of vessels, organs and tissues that play a vital role in your body's immune system.

"I'm a great advocate of dry brushing for drainage, and to help with lymphoedema and cellulite too. Ensure you brush in the right direction of your lymphatics," Whiteley advises.

Does crossing your legs make varicose veins worse?

"No. This is a myth that originated from hospitals when they thought that patients crossing their legs on the bed gave them DVT," Whiteley says. In fact, it was the patient's operation or illness that caused DVT. The idea that crossing your legs makes varicose veins worse is "completely incorrect," Whiteley concludes.

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Tiny Blood Clots May Make Coronavirus More Deadly, Doctors Say

The COVID-19 coronavirus appears to promote blood clotting throughout the body, which might help explain why it is so much more deadly than other members of its viral family, experts say.

Some people severely ill with COVID-19 develop blood clots in their lungs and other major organs, doctors have observed.

Doctors suspect these small blood clots are one reason why COVID-19 patients struggle for breath, said Dr. Hooman Poor, a pulmonary and critical care doctor with Mount Sinai Beth Israel in New York City.

"We see not just the possibility of blood clots in the lungs," Poor said. In COVID-19 patients who require dialysis because of kidney failure, "their catheters are clotting off every second."

These tiny blood clots could also be responsible for one of the unique symptoms of COVID-19: a sudden loss of smell, said Dr. Jeanne Marrazzo, a professor of infectious diseases with the University of Alabama at Birmingham. It also might explain why patients who seem to be doing well suddenly crash.

Clotting associated with COVID-19 is so pronounced that "some people are beginning to say, 'Look, anybody that comes to the hospital needs to be put on'" blood thinners at the start of their treatment, said Dr. Carlos del Rio, a professor of infectious diseases at Emory University in Atlanta.

Poor recently treated five critically ill COVID-19 patients with tPA, a clot-busting drug normally used on stroke patients, according to a new preliminary case report from the Icahn School of Medicine at Mount Sinai.

The five patients had respiratory failure early in their disease, along with blood oxygen levels and clot-related protein markers that indicated that lung blood clots could be robbing them of breath, Poor and his colleagues noted.

"The first patient I gave it to had a dramatic, immediate response, indicating that blood clots were definitely playing a role in why she was so sick at that time," Poor said.

All five showed immediate improvements in their blood oxygen levels, but ultimately they did not have good outcomes, Poor said.

However, he believes more research is needed before regularly treating COVID-19 patients with either blood-thinning or clot-busting drugs.

"These are both very dangerous medicines," Poor said. "It would be a shame to administer these medicines inappropriately and then have a bad outcome, like a catastrophic bleed."

Poor and his colleagues suspected that blood clots might be contributing to people's acute respiratory distress syndrome (ARDS) because the lungs of COVID-19 patients do not develop the kind of stiffness usually seen in other viruses that hamper breathing.

"When you have these abnormalities in oxygen and carbon dioxide with lungs that are not particularly stiff, the first thing that jumps to mind is there's something wrong with the blood vessels of the lungs," Poor said.

Others have also observed clots with COVID-19. Dutch researchers found that about a third of 184 patients in intensive care with coronavirus had a complication associated with a clot — in the lungs or the legs, or even as severe as a clot-caused stroke or heart attack, according to their report in the April 10 Thrombosis Research.

Lung blood clots usually occur because a large blood clot in the leg — a deep vein thrombosis — breaks free and travels up into the lungs, Marrazzo said.

But it's not unusual for viruses to promote blood clots, del Rio said. For example, HIV can promote clotting in patients.

Why the new coronavirus might promote blood clotting is still up for debate.

Poor and Marrazzo speculated that the virus somehow damages human cells in a way that promotes clotting. Poor noted that COVID-19 patients have elevated levels of D-dimer, a small protein fragment produced by blood clots.

Another recent study in the journal Physiological Reviews noted that people with already high levels of plasmin, a key enzyme that breaks down blood clots, tend to have more severe COVID-19 infection.

Plasmin appears to help the novel coronavirus more readily bind with human cells, said lead researcher Dr. Hong-Long Ji, a professor of cellular and molecular biology at the University of Texas Health Science Center at Tyler.

If this is true, then using clot-busting drugs to treat COVID-19 might backfire by enhancing the patients' infection, Ji said.

"If you give the patient plasmin or other kinds of proteins to remove the clots, then the problem is this patient still has a virus in their body and they also have a problem with bleeding in every kind of important organ," Ji said.

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How Blood Clots In The Lungs Affect Your Health - Rolling Out

Blood clots in the lungs, also known as pulmonary embolisms, can be a serious medical condition that affects your overall health. A pulmonary embolism occurs when a blood clot, typically originating in the deep veins of the legs or other parts of the body, travels to the lungs and blocks one or more arteries. This condition can have severe consequences, including damage to the lungs, reduced oxygen levels in the blood, and even death if not treated promptly. Understanding the causes, symptoms, and treatment options for pulmonary embolisms is crucial for maintaining your health and preventing potential complications.

What causes blood clots in the lungs?

Several factors can contribute to the formation of blood clots that may eventually travel to the lungs. These include:

Deep vein thrombosis (DVT): This is the most common cause of pulmonary embolisms. DVT occurs when blood clots form in the deep veins of the legs or other parts of the body and then dislodge and travel to the lungs.

Immobility: Prolonged periods of inactivity, such as long flights or bed rest, can increase the risk of blood clot formation. When you are immobile, blood flow in the veins slows down, making it easier for clots to form.

Medical conditions: Certain medical conditions, such as cancer, heart disease, and respiratory diseases, can increase the likelihood of developing blood clots. Additionally, some inherited blood disorders make individuals more prone to clotting.

Surgery and trauma: Major surgeries, especially those involving the legs, hips, or abdomen, can lead to blood clot formation. Trauma or injury to blood vessels can also trigger clot development.

Lifestyle factors: Smoking, obesity, and a sedentary lifestyle are significant risk factors for blood clot formation. These factors can contribute to poor circulation and increased clotting tendencies.

Symptoms of blood clots in the lungs

Recognizing the symptoms of a pulmonary embolism is crucial for seeking timely medical intervention. The symptoms can vary depending on the size of the clot and the area of the lung affected. Common symptoms include:

Shortness of breath: This is often the most noticeable symptom and can occur suddenly or gradually. It may worsen with exertion but can also be present at rest.

Chest pain: The pain associated with a pulmonary embolism is usually sharp and stabbing. It may worsen when you breathe deeply, cough, or bend over.

Cough: A persistent cough that may produce bloody or blood-streaked sputum can be a sign of a pulmonary embolism.

Rapid heart rate: An elevated heart rate, known as tachycardia, often accompanies a pulmonary embolism as the heart works harder to pump blood through blocked arteries.

Dizziness or fainting: Reduced oxygen levels in the blood can lead to dizziness, lightheadedness, or fainting spells.

Leg pain or swelling: If the blood clot originated in the deep veins of the legs, you might experience pain, swelling, and tenderness in the affected leg.

Diagnosis and treatment of pulmonary embolism

Diagnosing a pulmonary embolism typically involves a combination of medical history, physical examination, and diagnostic tests. Common diagnostic methods include:

D-dimer test: This blood test measures the presence of clot degradation products in the blood. Elevated levels may indicate the presence of a clot, prompting further testing.

Imaging tests: Imaging techniques such as chest X-rays, CT scans, and pulmonary angiography can help visualize the blood vessels in the lungs and detect any blockages.

Ultrasound: If deep vein thrombosis is suspected as the source of the embolism, an ultrasound of the legs may be performed to identify clots.

Treatment options

The treatment for a pulmonary embolism aims to prevent further clot formation, dissolve existing clots, and manage symptoms. Common treatment options include:

Anticoagulant medications: Also known as blood thinners, these medications help prevent new clots from forming and existing ones from growing larger. Common anticoagulants include warfarin, heparin, and direct oral anticoagulants (DOACs).

Thrombolytic therapy: In severe cases, thrombolytic medications, also known as clot busters, may be administered to dissolve the clot quickly. These drugs are usually reserved for life-threatening situations due to the risk of significant bleeding.

Surgical intervention: In rare cases where medications are not effective or feasible, surgical procedures such as embolectomy (surgical removal of the clot) or placement of a vena cava filter (to prevent clots from reaching the lungs) may be necessary.

Supportive care: Supplemental oxygen therapy and pain management may be required to alleviate symptoms and improve oxygen levels in the blood.

Preventing blood clots in the lungs

Preventive measures can significantly reduce the risk of developing blood clots and subsequent pulmonary embolisms. Key prevention strategies include:

Stay active: Regular physical activity helps promote healthy blood circulation and reduces the risk of clot formation. Avoid prolonged periods of immobility by taking breaks to walk and stretch, especially during long journeys or while recovering from surgery.

Maintain a healthy weight: Obesity is a significant risk factor for blood clots. Achieving and maintaining a healthy weight through a balanced diet and regular exercise can lower your risk.

Quit smoking: Smoking damages blood vessels and increases the likelihood of clot formation. Quitting smoking can improve your overall cardiovascular health and reduce clotting risks.

Manage medical conditions: Proper management of chronic conditions such as heart disease, diabetes, and high blood pressure can help reduce the risk of blood clots.

Follow medical advice: If you have a history of blood clots or are at high risk, follow your healthcare provider's recommendations for preventive measures, including the use of anticoagulant medications if prescribed.

Long-term effects of pulmonary embolism

The long-term effects of a pulmonary embolism can vary depending on the severity of the initial event and the effectiveness of treatment. Potential long-term consequences include:

Chronic thromboembolic pulmonary hypertension (CTEPH): This condition occurs when clots do not fully dissolve and lead to persistent high blood pressure in the lungs' arteries. CTEPH can cause ongoing shortness of breath, fatigue, and heart failure.

Reduced quality of life: Individuals who have experienced a pulmonary embolism may have ongoing symptoms such as shortness of breath, chest pain, and fatigue, affecting their daily activities and overall quality of life.

Recurrence risk: There is a risk of recurrent pulmonary embolisms, especially if the underlying risk factors are not addressed. Long-term anticoagulant therapy may be necessary to prevent future clots.

Post-thrombotic syndrome (PTS): If the initial clot originated in the legs, there is a risk of developing PTS, characterized by chronic pain, swelling, and skin changes in the affected leg.

Conclusion

Blood clots in the lungs are a serious medical condition that can significantly impact your health if not promptly diagnosed and treated. Understanding the causes, recognizing the symptoms, and seeking timely medical intervention are crucial for preventing complications and improving outcomes. By adopting preventive measures and managing underlying risk factors, you can reduce the likelihood of developing pulmonary embolisms and protect your overall health. If you suspect you have a blood clot or experience symptoms of a pulmonary embolism, seek medical attention immediately to ensure the best possible outcome.

This story was created using AI technology.

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