Phlebitis

Phlebitis. If most people know anything at all about this disease, they know only that former President Richard Nixon had it and that it has something to do with the blood vessels in the legs.

Though correct on both counts, those who have suffered with phlebitis know it as much more—as a painful, frightening affliction that can claim a victim's life without warning via a blood clot lodged in the pulmonary veins of the lungs.

Phlebitis is more correctly known as thrombophlebitis. "Thrombo-" is for the blood clot that is its trademark and primary danger. Two basic types of phlebitis exist: deep vein thrombophlebitis, or DVT for short, the more dangerous condition, and superficial phlebitis, the type of affliction we will deal with here.

Michael D. Dake, M.D., a vascular specialist at the Miami Vascular Institute in Florida, explains the difference. "Phlebitis just means inflammation of the veins," he says, "and that can be the superficial veins near the skin or the deep veins of the legs.

"Deep vein thrombophlebitis is something we're always on guard against," he continues, "because those people can develop a moving blood clot that would have direct access to the lungs if it broke loose and traveled through the system. DVT usually requires hospitalization and treatment with anticoagulants. The blockage that occurs in superficial phlebitis, however, tends not to break loose."

For that reason, the tips we offer here are intended for use only by persons who have been diagnosed with superficial phlebitis and are under a doctor's care. These tips are designed to help relieve pain without prescription medication and help reduce the chances of a recurrence.

Get off the Pill. "If you've had a history of phlebitis or blood clots, you definitely shouldn't use oral contraceptives," says Jess R. Young, M.D., chairman of the Department of Vascular Medicine at the Cleveland Clinic Foundation in Ohio. The incidence of deep vein thrombophlebitis in oral contraceptive users is estimated at three to four times higher than in nonusers. Such a relatively high rate of deep vein clotting also puts the superficial phlebitis sufferer at an unacceptably high risk for recurrence.

Give it rest and warmth. "Superficial phlebitis can be treated by elevating the leg and applying warm, moist heat," says Dr. Dake. While it is not necessary to remain in bed, rest, with the leg elevated 6 to 12 inches above the heart, seems to help speed healing. The inflammation of superficial phlebitis usually disappears in a week to ten days, though it may take three to six weeks to completely subside.

Know your risks. Once you've had phlebitis, you're at increased risk of getting it again. How much risk may depend largely on things you may or may not be able to control. "In general," says Dr. Young, "you have to be put in a situation where you're at increased risk for it, such as surgery or prolonged bed rest."

While you might not be able to prevent prolonged bed rest following an injury or serious illness, certain types of risks, such as elective surgery, can be avoided if you're an older individual prone to clotting disorders. Consult your doctor for specific risk factors, but keep in mind that getting up and around can help reduce the risks of developing phlebitis after surgery.

Investigate aspirin. Some studies have suggested that the blood-thinning properties of aspirin may help reduce phlebitis by preventing rapid clot formation in persons prone to the disease. These studies advise that you take aspirin before prolonged periods of bed rest, travel, or surgery, all of which tend to make circulation sluggish and increase the possibility of clotting. While such a simple recommendation sounds enticing, some doctors hedge on its effectiveness. "I'm not sure aspirin will be that protective against clotting," says Dr. Dake. Even if you do opt for aspirin, this is a medical treatment—see your doctor first.

Walk when you have to ride. Planning a long trip by car? If you've had phlebitis in the past, then make sure your wheels aren't the only thing in motion. "The main thing is to stop frequently and exercise when you stop," says Dr. Dake. "And don't just stop one time during the day and walk a mile, but rather, stop four or five times and walk shorter distances."

What you're trying to do, he says, is prevent the circulation from becoming sluggish as a result of sitting motionless for long periods of time. "Your circulation enters a low-flow state under those conditions and that can lead to a clot," says Dr. Dake.

Add another reason to quit. "If you get recurring cases of phlebitis and your doctor can't find any reason for it," says Dr. Young, "then you should quit smoking. You could have a case of Buerger's disease that just hasn't moved to the arteries yet." Buerger's disease is characterized by severe pain and blood clots, usually in the legs. It is directly related to smoking, and the only cure is to give up all forms of tobacco. "Occasionally, Buerger's will start out as phlebitis," Dr. Young explains. It's possible that Buerger's could be misdiagnosed as phlebitis, in which case continued smoking would be very hazardous to your health.

That's a long shot, Dr. Young admits, but worth considering if your doctor hasn't been able to explain recurring bouts of phlebitis. "Otherwise, there doesn't seem to be any connection between smoking and phlebitis," he says.

Get some exercise. "Exercise—primarily walking—tends to keep the veins emptied," says Robert Ginsburg, M.D., director of the Center for Interventional Vascular Therapy at Stanford University Hospital in California.

Keeping the veins emptied as much as possible is a good way to prevent a recurrence of phlebitis, he says. "The veins are a low-pressure system, and if the valves that keep blood from flowing backward in the legs aren't working properly, such as in varicose veins, the only way you're going to prevent blood from pooling is by walking."

Put your feet up when you're laid up. "If you've had phlebitis and you're going to be bedridden for any length of time," says Dr. Young, "elevate the foot of the bed several inches to increase blood flow through the veins."

He also suggests you exercise your legs as much as you can while in bed. "You can take aspirin if you want," he adds, "though there have been no good studies that show it prevents a recurrence."

Wear support stockings for relief. Some physicians advise the wearing of support stockings to prevent a recurrence of phlebitis, while others don't. While there's no documented evidence showing that support stockings do any good in preventing phlebitis, they do seem to relieve pain and make some people feel better. The best advice? Wear support stockings if they make you feel better. If they make you feel worse, though, don't think you must continue wearing them in order to prevent a recurrence.

Beware the friendly skies. The scientific literature is filled with reports of people being stricken with deep vein thrombosis following a long airplane flight. While nobody seems to be quite sure why this happens (cabin pressure, lack of motion, alcohol intake, etc.), the condition is so common that it is now known as "Economy Class Syndrome," because it rarely seems to strike those passengers seated in roomy, first-class seats.

"Long plane rides or car trips, or really any long period of inactivity, can increase the risk of thrombosis," says Dr. Young. "But on airplanes you tend to be confined to your seat a lot more than when traveling by car. So if you have phlebitis, this is a case where you ought to put on your elastic stockings before boarding, then get out of your seat and walk up and down the aisle every 30 minutes or so after taking off."

To help maintain good relations with your neighbors, he says, "It might be good to request an aisle seat."

PANEL OF ADVISERS

Michael D. Dake, M.D., is a vascular specialist at the Miami Vascular Institute in Florida.

Robert Ginsburg, M.D., is director of the Center for Interventional Vascular Therapy at Stanford University Hospital in California.

Jess R. Young, M.D., is chairman of the Department of Vascular Medicine at the Cleveland Clinic Foundation in Ohio.