Welcome to ‘Community Health TV’ powered by Community Therapy. DVTs. Do you know what a DVT is or what it stands for? Deep Vein Thrombosis.
Many people have heard about that term in their life or may have suffered a DVT and been treated for it. They are a medical emergency and can result in further complications if the DVT dislodges in your body and that blood clot moves and lodges in lung or brain in particular.
So for our clinicians out in the field, any medical professional, health professional, allied health professional, we’re always on the lookout for things such as DVTs, which we would refer to clinically as red flags. We’re clearing for red flags to then make sure there’s nothing sinister when we’re seeing somebody so we can move on to normal therapy.
When may we see a DVT?
For our team it’s typically a Physiotherapist out in the field, supporting somebody after an acute surgery, often without rehab at home services, post total knee or total hip replacement. We are on the lookout for DVTs. How do we do that as a team? Clinically, we’re looking for things that are predominantly in the lower limb. Distal which means, in medical terms, further away from the centre. So distal to the knees or typically in the lower limb is where we’re looking for swollen, hot, red and painful calves, typically. There are many other symptoms and signs that we look for.
We often refer to something called the Wells Criteria, and you can punch that into Google, or God forbid, you’re using Microsoft Edge… Type that into Wells Criteria and have a look and it gives us a bit of a framework to look through clinically of giving us a score of how much of a risk someone is. Some of the things that looks at are a measurement of left versus right. If there’s greater than a three centimetre difference in calf circumference starts to raise a little bit of a red flag for us in that criteria. That can be a little bit difficult if people have had those limbs operated on, we then may struggle with a correct left versus right difference. But we still take it into factor. Superficial veins showing differently, tenderness through the deep venous system through the body, the lower limbs, pitting oedema.
What does pitting oedema look like?
Typically, it’s in the foot. We call that pedal oedema, so pedal for foot. When you’re pressing into the foot or along, typically, the tibia or the lower limb, and you’ll see an imprint still left that’s telling us that the body isn’t clearing fluid through the lymphatic system. But the venous system also has a very big part to play in fluid dynamics pumping up against gravity. And that’s starting to tell us that there’s compromise possibly in fluid management and that could be from a DVT. Many other things in the wells criteria.
Does a person need further investigation to determine if they have DVT?
We go through all of that, spits out a score to us in combination with our clinical suspicion. We’re able to then determine, is this person high risk of a DVT and should we have an investigation? What sort of investigation? It’s usually an ultrasound, which we refer to as a type of ultrasound being a Doppler to look at the blood flow to then diagnose a clot.
If a clot, a DVT is diagnosed, we need to treat it so that we don’t get that escalation flowing on to possibly that breaking off, lodging in lung, lodging in brain, risk of stroke, etcetera
How to treat Deep Vein Thrombosis
So how is it treated? Usually a blood thinner or what we would call an anticoagulant, sometimes may be hospital admission with IV, sometimes may be then long term use of a medication such as warfarin, a blood thinner. What do we do after that is the next question? I’m glad you asked! It’s typically lifestyle modification for somebody, especially if somebody suffered a DVT in the presence of not an acute event. So if somebody’s had a surgery, there’s often a reason for that to have occurred. But in the presence of nothing, we’re always looking at lifestyle modification as well because it may be related to physical inactivity and dietary intake as well.
The right health care professionals to consider after engaging with primary health care, GP and hospital for management of the DVT, would be looking for a dietitian to review what you’re eating and your whole interaction with food and then physiotherapy, looking at engaging with physical activity to improve strength, improve mobility, and also get the advantage of the other care needs that we can help as physios as well.
Somebody might be an older adult and we might be able to also help you with falls preventions, etcetera. Hopefully, that’s helped with some information about DVT, and you can be on the lookout for that amongst yourself and friends and family. They’re definitely rare, however, across the health care system, we’re always looking out for them.