Phlebitis
Phlebitis
It’s been dubbed “economy-class syndrome” by British researchers studying airline travelers, but you may know it by its more common name: phlebitis (an inflammation of veins, usually in the legs). It tends to happen to a lot of healthy people who sit through long flights or travel by car, says Gabriel Goren, M.D. vascular surgeon and director of the Vein Disorders Center in Encino, California.
With little leg room, you certainly can’t kick up your heels. Leg circulation is constricted and that impedes blood flow. “When blood is pooling and stagnating in veins, it can clot,” says Dr. Goren. “The clot triggers the inflammation, and phlebitis is born.”
But you don’t have to fly coach to spark a phlebitis attack. Any period of immobility can trigger an episode, and that includes times when you’re recovering from an injury, illness, or surgery. As you get older, especially during episodes of debilitating diseases, your risk of developing phlebitis increases.
“There are two types of phlebitis: superficial, and deep vein phlebitis (DVT) or thrombosis,” says Dr. Goren. Superficial phlebitis is generally seen in people who have varicose veins. Just beneath the skin of the leg, you may notice a red cordlike vein that feels hard, warm, and painful to the touch and is accompanied by redness of the skin around the affected vein.
In the case of DVT, you may feel an overall heaviness in the leg, mainly in the calf, and occasionally ankle swelling.
An estimated 30 percent of DVT cases go undiagnosed and go away on their own, says J. A. Olivencia, M.D., vascular surgeon and medical director of the Iowa Vein Center in West Des Moines, Iowa. But if the doctor detects this kind of thrombosis, you’re sure to have some kind of treatment.
However your doctor decides to treat the problem, there are some ways to relieve the discomfort of superficial phlebitis and discourage blood clots from occurring.
Try This First
Heal it with heat. Apply moist heat to the affected area to soothe discomfort and speed healing. The heat especially improves circulation, which will help your body absorb the clot faster, says Dr. Olivencia. Cover the inflamed area with a towel that has been dipped in hot water and wrung out. Then cover the towel with a heating pad or hot- water bottle to maintain the temperature. Do this for 20 to 30 minutes at least twice a day.
Other Wise Ways
Rise to the occasion. Elevate the affected leg, which also will promote increased circulation and speed healing, says Dr. Olivencia.
Skip the aspirin. To relieve pain and inflammation, take ibuprofen instead of aspirin. It works better than aspirin in two ways. A more effective pain reliever, ibuprofen helps counteract the inflammatory reaction that generates pain and swelling in the vein, says Dr. Goren. Over-the-counter tablets contain 200 milligrams per pill, which is a relatively small dose. To control the pain and inflammation during an episode of phlebitis, you should take 400 milligrams, or two pills, three times a day after meals.
Put the squeeze on. Compression stockings help reduce the swelling and alleviate some of the discomfort caused by phlebitis, because they squeeze the veins and minimize the buildup of fluid in the leg. If you look on the package of compression stockings sold in pharmacies, you’ll find that the compression is rated from light to extra-strong compression on a scale of one to four. Go with grade two, a moderate level of compression, to relieve superficial phlebitis symptoms, says Dr. Olivencia. “The stockings may be very uncomfortable if you have a clot behind the knee or if you have large legs. If the stockings are too uncomfortable, do not force yourself to wear them.”
Increase your rate of return. To reduce your risk of developing phlebitis, keep your circulation moving whenever you are sitting for more than a few hours, says Dr. Goren. Whether you’re flying coast to coast or taking a long drive in the car, take a stretch break.
Once an hour, walk around for at least three to four minutes to return the blood in your legs back to the heart. While you’re seated, flex the calf muscle every 10 minutes by moving your foot up and down.
Boost your B vitamins. Vascular diseases are more common in people with high levels of the amino acid homocysteine. Research has shown that the B vitamins folate, B6, and B12 can reduce elevated homocysteine levels, says James Finkelstein, M.D., chief of medical service at the Veterans Administration Medical Center and professor of medicine at Howard, George Washington, and Georgetown Universities, all in Washington, D.C.
| Managing Your Meds If you’ve been diagnosed with deep vein phlebitis, your doctor will prescribe an anticoagulant drug treatment, usually warfarin (Coumadin), to thin your blood and prevent additional clots from forming. The level of medication, however, must be carefully monitored. Severe internal and external bleeding can occur unless you have the proper dosage. This explains why most people who go on the medication need a short stay in the hospital while the doctor adjusts the level of medication. The adjustments depend on tests that show how fast your blood is clotting. The initial dosage for adults is generally administered for two to four days. It is then adjusted to a level required by the patient to maintain a proper blood-clotting time. To avoid a potential drug interaction that could cause excessive internal bleeding, keep your doctor informed of all the medications you are taking, says Bernard Mehl, R.Ph., doctor of professional studies and director of the department of pharmacy for Mount Sinai Medical Center in New York City. Of the many types of drugs that can interact with anticoagulants and increase the risk of hemorrhage, there are three commonly used for people over 60, the prescription thyroid drug levothyroxine (Synthroid), nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and aspirin. Some antibiotics such as erythromycin can also increase an anticoagulant’s blood-thinning effect. And over-the-counter drugs such as cimetidine (Tagamet), used to treat heartburn and gastric ulcers, will decrease the activity of warfarin. |
To maintain optimum health of your veins as well as your arteries, Dr. Finkelstein recommends taking supplements of 400 micrograms of folic acid (the synthethic form of folate) and 25 milligrams of B6 daily. Because older people are at risk for vitamin B12 deficiency, they should also take 100 micrograms of B12 daily, he says. Folate-packed food sources include orange juice, spinach, asparagus, lentils, and navy beans. Bananas, lean chicken, potatoes, and watermelons are good sources of vitamin B6. Vitamin B12 is found in animal products such as meat, milk, cheese, and eggs. But because people older than 50 years of age may not adequately absorb this vitamin from food, the National Research Council advises that they take foods fortified with vitamin B12, such as ready-to-eat cereals, or use a supplement.
Note: If you’ve been diagnosed as not having the intrinsic factor, which aids in the absorption of B12, you’ll need to talk to your doctor about getting regular injections of B12.
Improve the flow. Several studies indicate that vitamin E helps protect against clots, according to Joseph Pizzorno Jr., naturopathic physician and president of Bastyr University in Seattle. Vitamin E helps prevent platelets (components of the blood involved in clotting) from sticking to each other and to the walls of the blood vessels. To reduce platelet stickiness, Dr. Pizzorno recommends taking from 200 to 600 international units (IU) a day.
Note: If you are taking anticoagulants, you should not take vitamin E. Although vitamin E is generally sold in doses of 400 IU, one small study showed a possible risk of stroke in dosages higher than 200 IU. Consult with your doctor if you are at high risk for stroke.
