"How do People Die?"

The following is the speech I presesnted this morning -Dr A said it was the "most well-written outline he'd ever EVER had!" Yippeee! Now, if I could only present as well as I write! Ugh. Totally went over the time limit and had a couple of visual aid malfunctions- only scored an 84% but, it's OVER! I do have to present it again (in a longer format) as a lecture for Life-Fitness Concepts later this week... at least it's DONE and needs nothing else to be done!

I'm exhausted and going to take a nap. If you read this whole thing- you'll be taking a snooze, too!

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HENDERSON STATE UNIVERISTY
ORAL COMMUNICATIONS
SUMMER II- July 16, 2007

Title: Deep Vein Thrombosis (DVT) OR "How Do People Die?"

GENERAL PURPOSE: To inform of the silent killer: DVT

SPECIFIC PURPOSE: To inform of the risk and management of DVT

CENTRAL IDEA: Causes of hyper coagulability leading to the risks of Deep-Vein Thrombosis (DVT) and/or Pulmonary Embolisms (PE) occurance, diagnosis and treatment, and to raise general public awareness.

SUPPORTING MATERIALS:
1. Factor V Leiden/thrombophilia Support Site: http://www.fvleiden.org/
2. DVT Prevention site: https://www.preventdvt.org/
3. Pulmonary Embolism (PE)
http://www.merck.com/mmhe/sec04/ch046/ch046a.html
4. Venous Thromboembolism: http://www.clevelandclinicmeded.com
5. National Library of Medicine and Health http://www.ncbi.nlm.nih.gov
6. http://ask.yahoo.com/20051128.html, National Vital Statistics Report, 2006
7. http://www.genome.gov/15015167


I. INTRODUCTION

200,000 Americans will die throughout the year from deep-vein thrombosis (DVT) and/or pulmonary embolism (PE); more than from drunk drivers, AIDS, breast cancer or homicide.

DVTs are treated in 2 milllion Americans each year. Of those patients developing a first-time diagnosis of DVT- 75% were not aware of the risk- factors prior to the event and were unaware that there are preventative measures.

I have had multiple episodes of DVT since 1987 and suffer from resultant chronic post-thrombotic syndrome (PTS).

II. Risk Factors
A. Inherited or acquired predisposition to thrombophilia.

Thrombophilia is the tendency to clot or a blood-disorder. As a child I was fascinated with the Queen Victoria and her descendants- one in particular was Prince Alexei of Russia, a hemophiliac, whose mother's reliance on Rasputin to treat his bleeding helped bring about the end of Imperial Russia. Other than that- I had never heard of blood-disorders and to be honest- I found their murders much more fascinating.

1. it wasn’t until 1998 that there even existed a test to determine the most predominant clotting disorder, Factor V Leiden. Before that time, many folks died of clots not knowing why they had clotted.

I was diagnosed with Factor V Leiden heterozygous (one of two mutated genes) in Spring of 2007. The tests haven’t been performed yet to determine the presence of Proteins CNS and can only be drawn when I am off of blood-thinner, a risk in and of itself.

2. Five% of Caucasian Americans and 1% of African-Americans have FVL.

B. Cancer, Trauma, Advanced Age or Unhealthy Life Habits or Situations

Autoimmune disorders such as lupus, acute medical illness with restricted mobility, and certain heart or respiratory diseases can cause blood-clots or pulmonary embolism.

1. 60% of patients undergoing major surgery, such as hip replacement, who remain immobile in bed after operations without preventive treatment may develop clots

2. Age, smoking and obesity contribute greatly in the episodes of DVT.

3. Airline passengers on long-haul flights call it “economy class syndrome” and office workers that remain seated at their computers for extended periods of time without taking breaks (often called “desk jockeys”) account for 34% of DVT/PE.

C. Women’s Issues
Women are at a higher risk for DVT. Birth-control pills, Pregnancy and Hormone Replacement Therapy (HRT) are all contributing factors.

1. Healthy women taking oral contraceptives have a three- to fourfold increased risk of developing a DVT or PE compared with women who do not take birth control. Women with factor V Leiden who take OCPs have about a 35-fold increased risk of developing a DVT

2. PE is the leading cause of maternal death associated with childbirth. A woman’s risk of developing VTE is six times greater when she is pregnant.

My first known episode of DVT was at age 24 during childbirth, with repeating and devastating occurances in two additional pregnancies.

While doing family genealogy it was discovered that one great-grandmother died not long after pregnancy. If you are researching family medical history- In the “old days” it was often called “milk leg”.

III. Symptoms

Often called the “Silent Killer” because as many as half of all DVT episodes
produce minimal symptoms. A number of other conditions display similar symptoms and mask the true culprit until the misdiagnosis can be corrected or results in death.

1. Leg pain, swelling (called edema), tenderness, discoloration or redness of the affected area and skin that is warm to the touch are the most significant of DVT presentations.

2. PE events are characterized by chest pain, shortness of breath, heart
racing or pounding, passing out or sudden death. These episodes can be a result of a fragment of clot breaking loose from the vein wall and traveling to the lung or a clot forming directly in the lung.

3. Symptoms frequently misdiagnosed include: charley horse, muscle sprain, twisted ankle, sore or achy muscles.

4. PTS or post-thrombotic syndrome occurs in 20-50% of patients after a dvt-event and usually is established within the first 2 years after the acute thrombotic episode. It is a disabling chronic condition consisting of leg pain, swelling, hardening or calcification of veins and skin and ulcers.

IV. Diagnosis

While there is a blood-test to determine if the blood is too thick- only x-rays or ultrasound are thorough in their conclusion.

1. Venous ultrasound is the least invasive of the tests.

2. Contrast Venograms are x-rays that display the clots by injecting radiographic material into a superficial vein.

3. EKG, Chest x-rays, arterial blood-gas and lung scintigraphy for PE’s.


V. Treatment
Treatment for DVT, PE and PTS are limited - all medications increase the risk of bleeding, allowing for bruising and are one of the hardest drugs to manage with interactive medications.

A. For clots caught early in development- clot busters (tPA) may be administered.
B. Blood thinners take a while to regulate and require rigid prothrombin monitoring. Foods rich in vitamin K (leafy green vegetables), soybean, green tea and a a variety of herbal supplements are to be avoided.
1. Heparin injections may be given through IV or injections.
2. Lovenox injections must be given subcutaneously (in the belly).
3. Coumadin or the generic , warfarin is commonly called rat-poison.
C. Leg elevation with compressive therapy and/or extremity pump.
D. Compression stockings or TED hose are the mainstay of therapy- many times the extremity must be custom fit which takes additional time, is expensive, and not covered by many insurance's companies including the Medicare system.

VI. Famous celebrities having DVT or PE.

A. Survivors
1. Vice-President Dick Cheney
2. former Vice-President Dan Quayle
3. HIllary Clinton, former first-lady and NY senator
4. Lainie Kazan, actress “My Big Fat Greek Wedding”
5. Terry Francona, Manager Boston Red Sox
6. Victoria Principal, actress “Dallas”
7. Ian Anderson, lead singer & flutist for “Jethro Tull”
8. Bonnie Bernstein, sports-journalist ABC-Sports and ESPN

B. Deaths due to blood-clots or related events.

1. David Bloom, NBC journalist, FVL
2. Shawntinice Polk, University of Arizona basketball player
3. Tammy Wynette, Country singing star
4. Harry Agganis, aka “the Golden Greek” Boston Red Sox
5. Dan Blocker, actor of “Bonanza” fame
6. Cesar Romero, actor played the Joker in TV-series “Batman” aka “The Latin Lover” and “Cisco Kid”

CONCLUSION: Deep Vein Thrombosis (DVT) is a common but elusive illness that can result in suffering and death if not recognized and treated effectively. You can prevent DVT- Don’t smoke! Exercise regularly! Be aware of subtle symptoms if sitting for long periods of time.