Most of us at one
time or another, have probably either known someone with DVT, or been
unfortunate enough to end up with one of those 'clots from hell' ourselves.
Deep Vein Thrombosis or thrombophlebitis as it is sometimes known, is
a painful and serious condition and over the last twenty years in particular,
drug users have ended up losing limbs, their health and even their lives
because of it. As the Government continues to skimp on proper drug addiction
treatments, users continue to shoot up substitute substances, often becoming
addicted to those as well. Drug users may also have the added problems
of their medical treatment often being, how shall we say, 'less than satisfactory'
and so may miss out on important, even life saving information. So, what
is it, what's the treatment, how do you avoid it and if you've got DVT
- how can you look after yourself with it. This IS NOT something you can
sort out yourself. If you think you may have DVT you must see a doctor
and in a moment we'll tell you why
What
is Deep Vein Thrombosis?
Basically, it
means the blockage of a deep vein by a blood clot (called a thrombus or
embolus if it is some other foreign material that has caused the blockage),
usually localised around the deep veins in the calf but it can extend
into the deep veins of the thigh and even beyond, particularly for drug
users who inject in the groin. The bigger/more extensive the clot, the
more serious the condition becomes. A clot can grow in size and not only
block other veins but bits of it can break off and travel or 'fly' through
the venous system, landing in potentially life threatening areas like
the lung, causing difficulty in breathing (becoming fatal if massive)
the brain, the blood supply gets cut off and brain cells starve and die
producing stokes, the heart causing heart attacks, or even moving towards
the spine causing serious infection. It can also occur in the portal vein
which conveys blood to the liver. Along with deep veins, the venous system
also has superficial or smaller thinner veins which can also become blocked
by clots and while this can be associated with DVT, rarely are the two
systems blocked at the same time.
Superficial Vein Thrombosis (or SVT) refers to a blood clot in a vein
near the skin. Thrombophlebitis (the 'itis' means inflamed) means the
vein is involved in an inflammatory process; the skin around the vein
being red and painful and sometimes swollen as well. There is often inflammation
where there is blood clots which is why DVT or SVT are sometimes called
deep or superficial Thrombophlebitis.
So What are the Symptoms?
A blood clot
in the superficial or deep veins in the leg may result in; pain, sudden
swelling of the affected leg, (remember, it doesn't have to be at the
injection site) in the early stages the affected limb can be a pasty white
often followed by redness or reddish blue discolouration of the skin,
warmth or enlargement of the superficial veins. Unfortunately, DVT can
be present with no obvious symptoms. Sometimes the first indication of
a pulmonary embolus (clot on the lung) is shortness of breath, a feeling
of apprehension, sharp chest pain, rapid pulse, fainting, sweating or
spitting up blood. Of course there are other conditions that can cause
these symptoms but if you do have any of these problems you must get properly
checked out by a doctor - and if you think it may be DVT, make sure you
tell your G.P your fears, it could just save your limb or even life. Black
Poppy doesn't want to get everyone hysterical but we're talking important
health issues here........
Drug
Use and DVT
Peter, who has
suffered with DVT fairly recently, explains how he realised that there
was something seriously wrong with his leg. "The pain in one leg
kind of built up gradually, and it was getting harder and harder for me
to walk. The leg seemed to be swelling (particularly the thigh) but it
wasn't until someone actually measured it with a tape - and it was 5-6
inches bigger in circumference than my other leg - that I realised something
seriously bad was happening".
Unfortunately, Peter reminds us of the reaction and treatment that drug
users can get from hospitals, even when they have such a serious illness.
"I had been shooting up in my groin for a while, using a lot of Seconal
and quite a few dex as well (Dexedrine). I was looking deathly grey. I
ended up spending about 10 days in hospital, they thought that the infection
had travelled around to my spine. I really wasn't told anything about
what was happening to me, they all seemed to view me suspiciously and
certainly gave me no painkillers at all. On discharge I got not one bit
of advice about how I should look after my leg, what was actually wrong
with it, or what procedures should be followed" .
"Six months
later, after popping into the hospital for blood tests every month, I
am still none the wiser. I took the Warfarin medication they gave me and
I'm nearly finished the 6 month course, but although my leg seems to be
better, they have not tested me to see if the clot has gone or shrunk
(and we are talking about a clot that had stretched from my thigh to my
calf), and I'm angry that I wasn't told to look out for the symptoms of
pulmonary embolism, if, as could happen, the clot broke off and moved
to my heart or lungs.
I am supposed to come off my treatment soon and I presume they will check
for clots before they stop the Warfarin.... It has been an experience
I do not want to repeat".
Be particularly
vigilant for signs of DVT if you shoot up;
.......Drugs like
Seconal or other barbiturates such as Tuinol, Sodium Amatol, Amatol, etc
as many of these have starch in them that CANNOT be filtered out. If your
cranking up Dexedrine - BE SURE that you filter them properly, they are
full of semi soluble excipients - (fillers). ( If you do still get temazapam
(egg form) on prescription and/or are injecting them (the egg type are
still occasionally available on private prescription) remember to check
what's in them. The ones that have glycerine in them are a bit better
than the ones with 'Gelthix' in them - which are REALLY BAD for veins,
but they are both terrible for encouraging clots and vein blockages. So
for God's sake, don't use them!
There are other
things aside from drug use that may increase the risk of getting DVT.
These 'risk factors' include;
What's
the Treatment?
If your doctor suspects
that you may have DVT, they will probably advise admission to hospital
and one of the first tests doctors perform will be an ultrasound, which
examines the blood flow through the veins. There are no needles, injections
or special preparations needed for this, just jellied water applied to
the skin and an ultrasound probe placed over the areas to be examined.
It can be a bit uncomfortable when pressure with the probe is applied
over an already sensitive/painful area. If a clot is not found using this
device, but is highly suspected, then an x-ray should be done (called
an ascending phlebogram).
If your doctor has discovered a clot in a deep
vein they will proceed with anticoagulants - such as Heparin which is
given and then continued in tablet form after you leave hospital for around
6 months. This helps thin the blood out, preventing it from clotting.
These drugs will help keep the clot from increasing in size and help prevent
pulmonary embolism. Adjustments are made to the dosage over this time
with hospitalisation recommended for a few days to a week while you are
monitored through this change. Sometimes, over the ensuing months as the
blood clot retracts and gets smaller, daermage can occur to the deep vein
valves so they don't close properly allowing the blood to flow back into
the vein, pooling in the low veins, leading in a few years to circulatory
problems in the leg that can, if not treated with compression, evolve
into skin ulceration.
If DVT is left untreated, this pooling of blood
occurs faster, leading eventually to gangrene and possibly amputation.
Prompt treatment can usually prevent this happening. If the blood continues
to clot despite the drug treatment, filters then need to be introduced
into the main vein of the abdomen, (the vena cava - the whopping great
vein going down the front of your chest) to prevent clots on the lung.
The type of treatment will depend on the location of the clot and the
likelihood of further complications occurring.
With IV drug users,
there can be problems when other veins are also diseased or have limited
circulation. This can lead to the anticoagulant drugs not getting through
the body quickly enough and doctors may need to put a central line in
through the neck for a few days while they administer the drugs you need
Tips
for avoiding DVT now and in the future
With illness
or disease that requires a lot of bed rest DVT can be induced simply by
calf inactivity (which causes blood to stagnate and then clot). This also
goes for long car or plane trips, especially if you are over 40 AND an
IV drug user and even more so if you've had DVT in the past. The answer
is to try and ensure you get some movement into your legs. If confined
to bed, try and do heel/toe lifts frequently (this causes the calf muscle
to contract and that action will move blood in the veins) and/or get up
and walk around as often as permitted. If on a long plane/car journey,
make sure you get to stop frequently (or walk up and down the aeroplane
aisle) and drink plenty of fluids but not alcohol as dehydrating will
increase the tendency for blood to clot. Girls, if you take The Pill,
you know it's much better not to smoke as this increases the chance of
DVT.
If there is a history of DVT in your family, then be sure to mention it
to your doctor. There are blood tests that can be done to see if you have
inherited the problem so ask if you can have one. If you have already
had a case of DVT, keep a close eye on yourself for further problems as
once you've had it, it's easier to get it again. Make
sure you go to your doctor AT THE FIRST SIGN OF A PROBLEM. If you
have varicose veins or are pregnant or have had DVT in the past, it may
be helpful to wear compression stockings to prevent blood from pooling
in the veins in your legs.
Looking
after yourself with DVT
DVT is a very
serious condition and it's vital that you look after yourself well if
you have it. Bed rest is important as is raising your leg up in bed a
foot or so and wearing compression stockings. There are many complicated
things that can go wrong when you're dealing with the circulatory system
as well as the fact that your body can end up toxic with poisons because
your blood is not moving around properly and oxygen is not being carried
to the cells in enough quantities and bacteria begins slowly poisoning
you and your limb. As stated before - get medical advice at the first
sign of something wrong and if your doctor is being 'difficult' then go
to a drug project such as the Caravan where a nurse or doctor can advocate
or refer you for help. Take care of yourself and if your worried about
a mate who may have DVT, be sure to point out the urgency involved.
BP issue 2