The Rules of Good Health

What is Health?

World health organization believes that health is not merely absence of diseases but a state of physical mental, psychological, social & spiritual well being.

Why this generation in 21st century needs to follow the life style changes and participate in wellness activities?

Over the centuries the cause of death has changed. In early civilization the major cause of death was violence due to natural calamities and war with dawn of civilization man began to live in communities and due to poor sanitation and living conditions the major killer become infectious disease such as cholera, plague etc with advent of antibiotics we have reached a situation where most communicable diseases are eradicated.

With the 21st century a new spectrum of death become epidemic and the major killer is not natural calamities, war and infection, the major killer is modern lifestyle accounting for almost 80% of deaths world wide today, obesity; lack of physical activity and exercise; mental stresses and tension, pollution, alcohol and smoking are the major culprits, which manifest themselves innocently as high blood pressure, diabetes or hyperlipidimia and then without warning strike fatally as heart attack, or cancer.

The first defensive step therefore is not through more hospitals, more physicians more sophisticated and expensive equipments but through prevention and teaching people preventive care it was not so much that people dying; they are killing themselves!

With proper weight, proper diet, proper exercise, controlling blood pressure & cholesterol and eliminating the use of tobacco and use of safety rules we can controlled the risk of heart diseases cancer and HIV etc.




The Rules of Good Health

A. Medical check ups
It is important for all including children to have a medical check up at least once a year. The reason is that the human body is capable of 100% efficiency even with 99% debility and most of the modern ailments such as high blood pressure, diabetes, cholesterol, etc are all silent and have no symptoms. A medical check up helps the individual to identify the current health status and other ailments if treated early can be controlled. If left untreated they can result in heart attack and other killers.

B. Nutrition
The second rule of good health is to eat the right food in the right quantities. We all know that too much sugar is associated with diabetes, too much salt is associated with high blood pressure, too much fat is associated with heart diseases and eating commercially prepared foods is associated with cancer. We all know high fiber diet comprising vegetables and fruits as protective against all these ailments. Accordingly we should eat a balance diet food should be taken in the following ratio
Grain & cereals -40%
Vegetables & fruits -35%
Dairy products -10%
Meats/ Dhal -10%
Other foods -5%

Foods to avoid :
Excess salt, excess sugar and commercially prepared foods. It is also important to eat less(calories ) rather than more and the best way to do is large breakfast, a moderate lunch and dinner will be very light.

C. Exercise
Excess food intake results in obesity which in turn causes blood pressure, diabetes, arthritis, and other ailments and even while it is important to eat moderately, it is equally important that one should do exercise every day in order to keep body healthy and fit. A fit and healthy body ensures that we do not get any ailments like arthritis spondeolosis, back ailments, cardiac ailments etc. the daily exercise programme may be for about an hour and should comprises of (according to age and capacity) aerobic activity like aerobics, walking, jogging to strengthen the heart and lungs, free hand exercises for muscles and joints and for those who knows yoga free hand exercise can be substituted with yoga. Weight training and gym exercise is very important to build the strength and to maintain the optimal efficiency of the body and posture. According to American college of sport medicine exercise should be done 5 days a week, 3 days cardiovascular workouts and two days strength workouts. Cardiovascular work out should be done at our Target hear zone (vo2 max) and 80% of our max weight for strength building.

D. Stress
If physical activities are important for good health, then mental relaxation is also very important. Mental tension and stress cause a whole range of psychosomatic ailments including Headaches, Insomnia, Asthma, Ulcer, Blood pressure, Sexual dysfunctions etc. stress is caused due to problems relating to work, Home, daily routine crisis and even personality. While the effects of stress can be reduced by daily exercise the more acknowledged method of stress management is meditation / yognidra. Sleep is perhaps the most important means of relaxation.

E. Dependencies
The major cause of cancer is smoking. Other causes include an in appropriate diet, excessive alcohol intake, environmental pollution and occupation hazards including dust, radiation, chemicals etc. certainly these must be avoided but giant steps can be taken to reduce cancer by simply managing alcohol to not more than two drinks a day and quitting smoking completely. Avoiding drugs.
F. Safety
Safety is very important factor. Safety compliance such as wearing helmets, using seat belts, keeping with in the speed limits, not utilizing alcohol before driving etc, will go a long way in reducing automobile accidents which is the major killer for the young group. If automobile safety is important than sexual safety is perhaps more important and lack of sexual safety has resulted in spectrum of HIV, which promises to be the biggest killer in future. A.P is second 2nd position in India. In order to contain this menace is important that we adhere to a monogamous sexual relationship and the use of condoms in those situations where we fail to mandatory. Keeping mind that more than 50% commercial sexual workers are HIV positive.



I have identified some simple rules of good health which are, to have a medical check up, to eat the right food in right quantities, to do some exercise, to manage stress, to quit smoking and to adhere to all rules of safety.

S.NADEEMUDDIN
Former International hockey player
Certified Reebok fitness instructor
Certified preventive and promotive health care practitioner
CEO - Active Life Consulting

Cell- 9849345798
nadeem@activelifeglobal.in
www.activelifeglobal.in

The Wonders of the Human Body

10 Ways to Rev Your Metabolism:

Your body is a lean, mean, fat-burning machine just waiting to happen! All you need is the knowledge and determination, and your extra weight will be gone in no time. In fact, you don’t necessarily have to make drastic changes. Try these 10 simple tweaks to your lifestyle, and you will see results.

1. Lift weights. Muscle is the key to a high metabolism. Gals, that doesn’t mean you have to look like a female wrestler. Building lean, sleek muscles ups your calorie-burning. Your resting metabolic rate (RMR) accounts for 60 to 70 percent of your daily calorie expenditure, and it’s closely linked to the amount of muscle you have. Muscle burns more calories than fat… even while you sleep!

2. Get moving with your cardiovascular exercise. When you perform cardio, enzymes are produced that break down fat and enable the body to use it as an energy resource. The average person has 100,000 calories worth of fat stored on their body -- roughly enough to run for 200 hours. For fat to be burned as energy, oxygen needs to be produced. People with a high cardio capacity are able to burn fat very easily because their bodies are efficient at delivering oxygen to muscle cells.

“There’s a fitness term called the ‘after burn’, “This refers to the calories that you burn 24 to 48 hours after your exercise session. What that means to you is a faster metabolism that burns fat at an accelerated rate.”

3. Try interval training. Your body has an amazing ability to adjust to routine. If you don’t change things up, you can get stuck in a rut. Try interval training -- bursts of high-intensity moves -- to boost metabolism. Studies show that people who do interval training twice a week, in addition to cardio, lose twice as much weight as those who do just a regular cardio workout. Just insert a 30-second sprint into your jog every five minutes or add a one-minute incline walk to your treadmill routine.

4. Don't overdo calorie-cutting. If you ingest too many calories, you gain weight, but if you restrict your calorie intake too much, it’s a surefire way to keep the pounds on. That may sound strange, but what your body is doing is entering survival mode. Your body is programmed to defend itself. If you suddenly drop a bunch of calories from your diet, your resting metabolic rate will slow down, because your body makes the assumption that you are starving.

Depending on your level of activity, you can safely lose anywhere from half a pound to two pounds a week. The easiest way to figure out your needs is to multiply your current weight by 22 . So, if you're 70 Kgs , aim for around 1,540 calories a day. Unless you're less than five feet tall, don't let your daily calories dip below 1,200. Research shows that women who consume less than this amount see their resting metabolic rate plummet by as much as 45 percent

5. Eat breakfast. Some of you out there just don’t have an appetite in the morning. Some just don’t have time. But breakfast may just be the most important meal of the day. Your metabolism slows when you’re asleep, and it doesn't rev back up until you eat again. If you skip breakfast, you’re talking upwards of 18-20 hours since your last meal! That’s a recipe for disaster. Start the day with a solid 300-to-400-calorie meal, preferably high in fiber.

6. Space your meals wisely. If you find that you get frequent snack attacks, kick-start your metabolism and curb your appetite by dividing your meals into five to six small, nutritious meals a day instead of three squares. Eat a 200-400 calorie mini-meal every three to four hours. Your body will expend more energy to digest the food and your metabolic rate will increase. If this is too much to handle, revert back to the three meals, but make them slightly smaller and add a couple snacks strategically placed mid-morning and afternoon.

7. Catch some z’s. According to studies, sleep loss may increase hunger and affect the body’s metabolism, which may make it more difficult to lose weight. People who lose sleep may continue to feel hungry despite adequate food intake because sleep loss has been shown to affect the secretion of cortisol, a hormone that regulates appetite. Make sure you get in your eight hours or more of shut-eye every night.

8. Drink water. Researchers in Germany have found that drinking water may increase the rate at which you burn calories. Study participants’ metabolic rates increased by 30 percent after consuming approximately 17 ounces of water. The energy-burning process of metabolism needs water to work effectively. Water also fills you up, curbs your appetite, flushes out your system and rids the body of bloat. Drink at least eight to 10 glasses per day, even more if you’re active.

9. Skip alcohol. Thinking about throwing back a couple before dinner? Not so fast. Several studies show that having a drink before a meal causes people to eat around 200 more calories. Drinking with dinner isn't such a good idea either: Other research has found that the body burns off alcohol first, meaning that the calories in the rest of the meal are more likely to be stored as fat. If you do have a cocktail craving, stick to wine, which packs only 80 calories a glass -- or minimize the calories by drinking a white-wine spritzer (two ounces of wine mixed with two ounces of seltzer).

10. Drink milk. If you’re not lactose intolerant, don’t shy away from low-fat dairy. Women who consumed milk, yogurt and cheese, three to four times a day, lost 70 percent more body fat than women who didn't eat dairy in a study published in the American Society for Nutritional Sciences Journal of Nutrition. The reason: calcium, along with other substances in dairy, actually revs up your metabolism, according to the study. Research shows that women reap the largest fat-burning benefit when they consume three servings of dairy and 1,200 milligrams of calcium a day.

Nadeem

Ceo, Active life consulting

Call us-9849345798, 04023841170

activelifeconsulting@gmail.com

www.activelife.in

InterviewingPeople

RHEUMATIC HEART DISEASE

Rheumatic heart disease is a serious public health problem in India . This disease affects mainly children and young adults. The cause of the disease is rheumatic fever which can affect the joints, heart and nervous system. The effect on the joints is mild but the heart can be seriously damaged leading to deformity of the heart valves. It can produce narrowing as well as leakage of the mitral valve, aortic valve and tricuspid valve.

The basic cause for rheumatic fever is a kind of allergy to a common infection of the throat (pharyngitis) caused by bacteria called "Streptococci". If on a regular basis patient is given inj. Penicillin, the disease can be largely prevented from progressing to a stage of needing surgery of heart

This disease was at one time prevalent all over the world but presently seen largely in the developing countries like India . This is probably due to better standard of living and lesser chance of spread of streptococcal infection. In India this disease is very common and affects children and young adults. It is important to diagnose the disease early so that treatment and preventive measures can be undertaken.

What are the early complaints of the patient with rheumatic fever?
The child usually develops joint pains. There may or may not be history of swelling of the joints. Only some children confirm throat infection. The effect on the heart usually comes a few weeks after the joint pains and can be mild or severe. But it is the long term effects of the rheumatic fever that are of greatest concern and usually produce breathing difficulty, cough, inability to sleep, blood in the sputum and in late cases swelling over the body. By this time usually one or more valves are damaged and need surgery or balloon valvotomy or valve repair.

The various methods of treatment for this condition are out of scope for this article. What is important for the general public to know are:
1. Rheumatic heart disease is largely preventable by diagnosing early case.
2. Any child or teenager complaining of throat pain should be taken seriously and should be taken to a doctor for ruling out streptococcal infection by appropriate tests and if found positive treated with a course penicillin or other appropriate anti-biotic.
3. Established cases of rheumatic fever should be put on long term penicillin prophylaxis which means one injection of Benzathine penicillin once in 3 weeks. These injections have to be given upto a minimum age of 21 years and in many cases much longer.
4. Compliance to the injection of penicillin is the single most important step in preventing this disease from progressing to a life threatening stage.






Dr.K.Sarat chandra,
MD,DM,FICC.
Additional Professor,
Department of Cardiology Unit -I,
Nizam's Institute of Medical Sciences,
Panjagutta,Hyderabad- 500082.
Mobile no. - +91-9848012212
phone no.[Off]- +91-40-23302426
Fax no.[Off.] -+91- 40-23302426
saratkoduganti@yahoo.co.in

DO YOY KNOW WHAT ARE STEM CELLS?

Stem cells are the primal cells of the body. The different cell types within the body are all derived from such cells- and hence the name. Stem cells are undifferentiated, "blank" cells that do not yet have a specific function. Characteristically, stem cells have a high capacity for self-renewal. This feature permits their continuous culture under laboratory conditions.

Stem cells have the unique ability to differentiate into a variety of cells. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function - such as a muscle cell, a red blood cell or a nerve cell.

Self-Renewing

Given the right environment, stem cells can give rise to a number of tissues that constitute the different organs. Also serving as a kind of repair system for the body, stem cells can divide repeatedly and then differentiate and replenish cells within the body. These unique characteristics are the reason why stem cells are considered a breakthrough in regenerative medicine. They have the potential for providing cells and tissues to treat various debilitating, life-threatening diseases.

Stem cells can be derived from various sources such as the bone marrow, embryos obtained by in vitro fertilization, amniotic fluid and umbilical cord blood.
There are three broad categories of stem cells, which can be derived from various sources such as the bone marrow, embryonic tissue, amniotic fluid and umbilical cord blood.

Types of Stem Cells
There are three main types of stem cells, which are usually considered for their potential use in research and medicine. They differ in their ability to self-renew:

Totipotent
These stem cells have the potential to become any kind of cell in the body. After an egg is fertilized, it undergoes a series of divisions to become an embryo and later a fetus. The cells that are formed during these first few divisions are totipotent i.e. they can become any cell in the body. Human cells have this capacity only during the first few divisions of a fertilized egg. After 3 - 4 divisions of totipotent cells, these cells will not be able to differentiate into any cell type.

Pluripotent
This type of stem cell has the ability to become almost any kind of cell in the body-except the cells of the placenta or other supporting tissues of the uterus. Pluripotent stem cells result after totipotent stem cells undergo the first few divisions. Embryonic stem cells at the blastocyst stage and fetal stem cells are pluripotent.

Totipotent and Pluripotent cells are essential for the development of an entirely new organism, which is why they are found in the early stages of development.

Multipotent
These cells can give rise to several other cell types, but those types are limited to mostly cells of the blood, heart, muscle and nerves. These cells function as a repair system for damaged tissue. Adult stem cells are a good example of multipotent stem cells.

Sources of Stem Cells
Stem cells can be harvested from various sources like the bone marrow, embryonic tissue, amniotic fluid or umbilical cord blood. Stem cells are classified according to the source from which they are obtained.

Somatic Stem Cells
Stem cells are found in small numbers in adult tissue such as brain, bone marrow, peripheral blood, blood vessels, skeletal muscle, skin, liver and umbilical cord blood. These cells are also called 'adult stem cells', even though the term 'adult' is incorrect as stem cells also occur in babies and children.

The primary role of stem cells in the body is to maintain and repair the tissues in which they are found, as they are multipotent in nature.

Somatic Stem CellsOf all adult tissue, the bone marrow is an extremely rich source of somatic stem cells. Drawn from the spongy tissue found in the center of bones, the main function of these stem cells is to make blood cells that circulate in our bodies and fight infection. In stem cell therapy, bone marrow was the earliest source of stem cells due to its rich supply.

The other rich source of stem cells is the blood left over in the umbilical cord and placenta of a newborn child. Till recently, this blood was (and continues to be) often discarded as medical waste. However, now that umbilical cord blood is known to be a rich source of stem cells, more people are choosing to bank these cells for its potential future use.

Embryonic Stem Cells (ESCs)
Embryonic Stem Cells (ESCs)These cells are derived from embryos that develop from eggs that have been fertilized in vitro and are donated for research. The embryos from which these cells are derived are four or five days old and are a hollow microscopic ball of cells called the blastocyst. The cells are removed from the blastocyst and treated in a culture dish where they divide into more embryonic stem cells. Because these cells are pluripotent, they are attractive candidates for use in stem cell research and therapy.

Embryonic (or fetal) Germ Cells (EGCs)
Embryonic (or fetal) Germ Cells (EGCs)These pluripotent stem cells are derived from primordial germ cells, which give rise to the gametes (sperm & eggs) in adults. They are found in a 5 to 9 week old embryo/fetus in the area that is destined to become either the testicles or the ovaries. Like the embryonic stem cells, primordial germ cells too are transferred into a specially treated culture dish to form germ cell colonies. Deriving stem cells through this process is controversial since the embryo or the fetuses from which the germ cells are obtained are destroyed. The embryo or the fetuses, even though not fully formed, are considered 'human' in many cultures and hence their destruction leads to ethical dilemmas. Such a dilemma exists even if the embryonic germ cells are derived from a fetus that is obtained as a result of a miscarriage or abortion.

Peripheral Blood Stem Cells
Peripheral Blood Stem CellsStem cells, in limited quantities, can also be found in the peripheral blood circulation. Peripheral blood stem cells are easier to obtain than bone marrow as they can be drawn from blood. Some studies have shown that these stem cells engraft faster than bone marrow stem cells.

Kidney stones

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LifeCell launches Cord Tissue Banking in India

LifeCell International, India’s first & the largest stem cell banking service provider and a pioneer in stem cell research, technology & therapy, announced the launch of Umbilical cord tissue banking service in India, today. The technology to harness the potential of Umbilical Cord Tissue, a rich source of Mesenchymal stem cells was developed in-house at the LifeCell R&D center at Chennai., India. With this launch, LifeCell achieved a considerable technology landmark in the field of Regenerative science & healthcare industry in India.

Mesenchymal Stem Cells (MSCs) from bone marrow have been at the forefront of therapeutic strategies for a number of hitherto incurable ailments like Heart Disease, Type I Diabetes, Crohn’s Disease, GVHD, Osteoarthritis and Stroke. Further, MSCs from Cord tissue showed additional therapeutic potential in animal models to treat Parkinsonism, Skeletal muscle injury, Limb ischemia, Retinal nerve degeneration. Hence, these cord tissue MSCs appear to be superior to bone marrow MSCs and can be a potential substitute for them.

Talking at the occasion, Mr. Mayur Abhaya, President and Executive Director, LifeCell International, said, “We at LifeCell are very excited about this landmark achievement that we have made at our R&D center, by developing the technology to harvest and store Umbilical Cord Tissue in India. With additional service of cord tissue banking, , clinical trials, R&D, therapy solutions we are the only company in India providing comprehensive stem cells solutions. This will give us a competitive edge to tap the potential market. In a country like India with over 40 million births every year, the potential is immense and we see a huge opportunity ahead. We envision a 30% percent growth in our enrolments by 2010. Our revenue for this year is expected to close by Rs.400 Million.”

According to Dr. Ajit, Chief Scientific Officer, LifeCell International, “Previously, after the collection of the umbilical cord blood, the remaining solid cord tissue was normally discarded. However, this cord tissue is a rich source of Mesenchymal stem cells (MSCs) and we have invested two years of time in developing and validating a proprietary technology at our in-house R&D center for collection and storage of the cord tissue. These MSCs from cord tissue are superior to bone marrow MSCs, as these cells are fetal in nature and therefore more robust. Besides, the collection process is non invasive, painless and usually devoid of infection.” Added Dr. Ajit

Over the conversation about the awareness and acceptance of stem cells in India Mr. Mayur added, “Recent success stories of stem cells, daily news on research findings and breakthrough in clinical trials etc., are validating the potential of stem cells thereby increasing the demand for storing the baby’s stem cell for future potential use. The medical fraternity has been playing a vital role in supporting and spreading knowledge and awareness on this concept.”

Customers who want to store their cord tissue have a range of options with LifeCell. They may choose to bank the processed stem cells from the Cord Tissue for a ready use or store the cord tissue which can be used to harvest stem cells later for therapy.

Preserving the cord tissue comes as a package along with cord blood banking service of LifeCell at a cost of Rs.44,600/- for the first year and Rs.3,500/- every year as annual storage fee. However, if the client prefers to process the cord tissue and store the harvested stem cells, the process will cost Rs.63,100/- for the first year and Rs.5,500/- every year as annual storage fee. Both these options include processing and cryo-preserving the cord blood stem cells which is the basic service.

Clients could also go for the option of one-time storage fee of Rs.79,000/- upfront for storing cord blood and cord tissue and Rs.1,17,500 for storing cord blood along with processing of cord tissue.

LifeCell’s key differentiator has been quality and service and with a technology tie-up with the Cryo-Cell International, the world's first stem cell bank, LifeCell has the expertise of technology to maintain the best quality which has also been acknowledged and accredited by AABB. LifeCell offers round-the-clock service and is the only stem cell bank in India offering this service to over 40 centers in India & abroad.

Advantages of Mesenchymal Stemcells:

In a unit population of cells MSCs in the umbilical cord tissue are present in much higher numbers when compared with the bone marrow. These cells have shorter doubling time. Also the HLA ABC antigens are less of an issue with cord MSCs when compared with bone marrow MSCs.

About LifeCell International Pvt. Ltd: .

LifeCell is India’s first & the largest stem cell bank & stem cells solutions provider to bring the revolutionary concept of banking a baby’s umbilical cord blood stem to the country. The company and was incorporated in 2004 in technological collaboration with Cryo-Cell International, USA (the world’s first stem cell bank). LifeCell has established its prominence through a range of services & activities from multi-service banking, research & development, clinical trials, stem cell therapy solutions and technology tie-ups.

LifeCell is accredited by many institutions in India & abroad like AABB, DSIR, ISO and few others by maintaining international quality standards. The company has a large network & client base with over 40 centers in India & abroad and over 20,000 parents have banked their baby’s cord blood stem cells with LifeCell.

Today, LifeCell has consolidated its premium presence in the global stem cell industry as the World’s first and only comprehensive stem cells solutions provider.

DEEP VEIN THROMBOSIS

Arteries have thin muscles within their walls to be able to withstand the pressure of the heart pumping blood to the far reaches of the body. Veins don't have a significant muscle lining, and there is nothing pumping blood back to the heart except physiology. Blood returns to the heart because the body's large muscles squeeze the veins as they contract in their normal activity of moving the body. The normal activities of moving the body returns the blood back to the heart.
There are two types of veins in the leg; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface. Deep veins, as their name implies, are located deep within the muscles of the leg. Blood flows from the superficial veins into the deep venous system through small perforator veins. Superficial and perforator veins have one-way valves within them that allow blood to flow only in the direction of the heart when the veins are squeezed.
A blood clot (thrombus) in the deep venous system of the leg is not dangerous in itself. The situation becomes life-threatening when a piece of the blood clot breaks off (embolus, pleural=emboli), travels downstream through the heart into the pulmonary circulation system, and becomes lodged in the lung. Diagnosis and treatment of a deep venous thrombosis (DVT) is meant to prevent pulmonary embolism.
Clots in the superficial veins do not pose a danger of causing pulmonary emboli because the perforator vein valves act as a sieve to prevent clots from entering the deep venous system. They are usually not at risk of causing pulmonary embolism.

What are the causes of deep vein thrombosis?
Blood is meant to flow; if it becomes stagnant there is a potential for it to clot. The blood in veins is constantly forming microscopic clots that are routinely broken down by the body. If the balance of clot formation and resolution is altered, significant clotting can occur. A thrombus can form if one, or a combination of the following situations is present:
Immobility
* Prolonged travel and sitting, such as long airplane flights ("economy class syndrome"), car, or train travel
* Hospitalization
* Surgery
* Trauma to the lower leg with or without surgery or casting
* Pregnancy, including 6-8 weeks post partum
* Obesity
Hypercoagulability (coagulation of blood faster than usual)
* Medications (for example, birth control pills, estrogen)
* Smoking
* Genetic predisposition
* Polycythemia (increased number of red blood cells)
* Cancer
Trauma to the vein
* Fracture to the leg
* Bruised leg
· Complication of an invasive procedure of the vein

What are the symptoms of deep vein thrombosis?

Superficial thrombophlebitis
Blood clots in the superficial vein system most often occur due to trauma to the vein which causes a small blood clot to form. Inflammation of the vein and surrounding skin causes the symptoms of any other type of inflammation:
* redness,
* warmth,
* tenderness, and
* swelling.
Often the affected vein can be palpated (felt) as a firm, thickened cord. There may be inflammation that follows the course of part of the vein.
Although there is inflammation, there is no infection.
Varicosities can predispose to superficial thrombophlebitis. When the valves of the larger veins in the superficial system fail (the greater and lesser saphenous veins), blood can back up and cause the veins to swell and become distorted or tortuous. The valves fail when veins lose their elasticity and stretch. This can be due to age, prolonged standing, obesity, pregnancy, and genetic factors.
Deep Venous Thrombosis
The symptoms of deep vein thrombosis are related to obstruction of blood returning to the heart and causing a backup of blood in the leg. Classically, they symptoms include:
* pain,
* swelling,
* warmth, and
* redness.

Not all of these symptoms have to occur; one, all, or none may be present with a deep vein thrombosis. The symptoms may mimic an infection or cellulitis of the leg.
Historically, healthcare providers would try to elicit a couple of clinical findings to make a diagnosis. Dorsiflexion of the foot (pulling the toes towards the nose, or Homans' sign) and Pratt's sign (squeezing the calf to produce pain), have not been found effective in making a diagnosis.
When should I seek medical care for deep vein thrombosis?
The diagnosis of a superficial or deep thrombosis often relies on the clinical skill of the healthcare provider. Diagnostic tests need to be tailored to each situation.
Leg swelling, redness, and pain may be indicators of a blood clot and should not be ignored. These symptoms may be due to other causes (for example, cellulitis or infection), but it may be difficult to make the diagnosis without seeking medical advice.
If there is associated chest pain or shortness of breath, then further concern exists that a pulmonary embolus may be the cause. Once again, seeking immediate advice is appropriate.
How is deep vein thrombosis diagnosed?
The diagnosis of superficial thrombophlebitis is made clinically.
Ultrasound is now the standard method of diagnosing the presence of a deep vein thrombosis. The ultrasound technician may be able to determine whether a clot exists, where it is located in the leg, and how large it is. Ultrasounds can be compared over time to see whether a clot has grown or resolved. Ultrasound is better at "seeing" veins above the knee as compared to the veins below it.
Venography, injecting dye into the veins to look for a thrombus, is not usually performed any more and has become more of a historical footnote.
D-dimer is a blood test that may be used as a screening test to determine if a blood clot exists. D-dimer is a chemical that is produced when a blood clot in the body gradually dissolves. The test is used as a positive or negative indicator. If the result is negative, then no blood clot exists. If the D-dimer test is positive, it does not necessarily mean that a deep vein thrombosis is present since many situations will have an expected positive result (for example, from surgery, a fall, or pregnancy). For that reason, D-dimer testing must be used selectively.
Other blood testing may be considered based on the potential cause for the deep vein thrombosis.

What is the treatment for deep vein thrombosis?
Superficial Thrombophlebitis
Treatment for superficial blood clots is symptomatic with:
* warm compresses,
* leg compression, and
* an anti-inflammatory medications like ibuprofen.
If the thrombophlebitis occurs near the groin where the superficial and deep systems join together, there is potential that the thrombus could extend into the deep venous system. These patients may require anticoagulation or blood thinning therapy (see below).


Deep venous thromboses
Deep venous thromboses that occur below the knee tend not to embolize (break loose). They may be observed with serial ultrasounds to make certain they are not extending above the knee. At the same time, the cause of the deep vein thrombosis may need to be addressed.
The treatment for deep venous thrombosis above the knee is anticoagulation, unless a contraindication exists. Contraindications include recent major surgery (since anticoagulation would thin all the blood in the body, not just that in the leg, leading to significant bleeding issues), or abnormal reactions when previously exposed to blood thinner medications.
Anticoagulation prevents further growth of the blood clot and prevents it from forming an embolus that can travel to the lung.
Anticoagulation is a two step process. Warfarin (Coumadin) is the drug of choice for anti-coagulation. It is begun immediately, but unfortunately it may take a week or more for the blood to be appropriately thinned. Therefore, low molecular weight heparin [enoxaparin (Lovenox)] is administered at the same time. It thins the blood via a different mechanism and is used as a bridge therapy until the warfarin has reached its therapeutic level. Enoxaparin injections can be given on an outpatient basis.
For those patients who have contraindications to the use of enoxaparin (for example, kidney failure does not allow the drug to be metabolized), intravenous heparin can be used as the first step. This requires admission to the hospital.
The dosage of warfarin is monitored by blood tests measuring the prothrombin time or INR (international normalized ratio). For an uncomplicated deep vein thrombosis, the recommended length of therapy with warfarin is three to six months.
Some patients may have contraindications for warfarin therapy, for example a patient with bleeding in the brain, major trauma, or recent significant surgery. An alternative may be to place a filter in the inferior vena cava (the major vein that collects blood from both legs) to prevent emboli from reaching the heart and lungs. These filters may be effective but also may be the source of new clot formation.

What are the complications of deep vein thrombosis?
Pulmonary embolism is the major complication of deep vein thrombosis. It can present with chest pain and shortness of breath and is a life-threatening condition. More than 90% of pulmonary emboli arise from the legs.
Post-phlebitic syndrome can occur after a deep vein thrombosis. The affected leg can become chronically swollen and painful with skin color changes and ulcer formation around the foot and ankle.
Can deep vein thrombosis be prevented?
As is the case with most medical illnesses, prevention is of prime importance. Minimizing risk factors is key to deep vein thrombosis prevention.
In the hospital setting, the staff works hard to minimize the potential for clot formation in immobilized patients. Compression stockings are routinely used. Surgery patients are out of bed walking (ambulatory) earlier and low dose heparin or enoxaparin is being used for deep vein thrombosis prophylaxis (measures taken to prevent DVT).
For those who travel, it is recommended that they get up and walk every couple of hours during a long trip.
Compression stockings may be helpful in preventing future deep vein thrombosis formation in patients with a previous history of a clot.


Dr. P C Gupta MS, FICA
Senior Consultant & Chief
Department of Vascular & Endovascular Surgery
Care Hospital – The Institute of Medical Sciences
Road No: 1, Banjara Hills, Hyderabad – 500 034 INDIA
Phone: +91-40-30418888
Fax: +91-40-30418488
Email: pcgupta10@hotmail.com