NAIL EXAMINATION – ANOTHER PROF. S.N. CHAKRABORTY’S MASTERCLASS

 

I have, a few weeks back, introduced you to Prof. S.N. Chakraborty, our mercurial Professor of Medicine in King George’s Medical College, Lucknow. If you have somehow missed that blog, please click: https://surajitbrainwaves.blogspot.com/2024/03/remembering-prof-s-n-chakraborty-by-his.html

He was a very kind hearted person, an astute clinician and an outstanding teacher. We, in our Alma mater, knew him as an encyclopedia of Medicine and patients revered him as God’s incarnation. Always smiling, his very presence was reassuring to all patients and relatives, residents and students. Once at 8 AM he walked in our lecture theatre and in his inimitable way asked what we wanted to study that day. Unfortunately, it was only on the day before, we had a dermatology class on nail infections, that left us totally confused, so almost in unison everyone said – “examination of the nail”. And so it was instantly decided that’s what we will be studying.

In his sagacious way the Professor said “your body communicates when something is wrong. The color and state of your fingernails can let you know when something is going awry inside your body. Sometimes they can be minor vitamin deficiencies and other times more serious conditions. These changes can be subtle, or blatant and it’s worth noting any differences because many diseases are reflected on your fingertips. As always these are warning signs and it’s important not to rely solely on your nails for a health check. See the entire patient, and what is more important, listen to his story!”

1. Red nails

If your nails go from a pink shade to a darker red, you might have heart disease. If the redness extends to the sides of your nails and cuticle, this might be a sign of the autoimmune disease Lupus. If one nail fold is red and painful it is paronechoea.

 

2. Unusually white nails

This phenomenon is often called Terry’s nails and has three possible explanations. One is that you have developed a fungal nail infection, often accompanied by reddened or dark fingertips. Another reason could be that your nails have begun to detach from the nail bed and the blood supply is interrupted. Thirdly, this is also a side effect of chemotherapy. Terry’s nails also might indicate that you have a more severe illness like anemia, iron deficiency, diabetes, liver cirrhosis, organ failure or hyperthyroidism.

 

3. Thick or overgrown nails

If the nails are growing thicker and faster than usual, your patient might be suffering from a serious fungal nail infection. You might also notice that the nails have become discolored. These symptoms are common results of having either psoriasis or arthritis.

 

4. Detached from the nail bed

When nails begin to detach from the nail bed without trauma or pressure, you might have a hormonal imbalance. Similarly, if your nails have separated, you might be suffering from hyperthyroidism – a condition where your thyroid gland is releasing too many hormones into your system.

 

5. Dark vertical stripes

Many people ignore stripes on their fingernails because they don’t cause any pain however some can indicate very serious illnesses. If you find that you have dark vertical stripes, known as linear melanonychia. This could be a sign of Subungal Melanoma, an aggressive form of skin cancer that only affects the nail bed.

 

6. Blue nails

If you find your nails suddenly have changed to a blue or purple tinge, it’s likely you have developed hypoxia, a lack of oxygen, often triggered by poor circulation to your feet, ears, and hands. Impaired circulation is easily reversible and is not a serious health issue unless it goes untreated. Blue nail or Cyanosis can be central or peripheral. Central cyanosis is caused by diseases of the heart or lungs or by abnormal haemoglobin types like methemoglobin or sulfhemoglobin etc. This is seen commonly as bluish or purple discoloration of tongue and linings of the mouth. Peripheral cyanosis results from decreased local blood circulation in the peripheral organs, arms and legs. This is commonly seen if the arterial blood stagnates too long in the limbs and loses most of its oxygen. Limbs appear bluish and are usually cold to touch. Peripheral cyanosis is most intense in nail beds. Warming may resolve the cyanosis.

Cyanosis shows up as the levels of deoxygenated blood rises in the small blood vessels of the fingers and toes. This may be seen in heart failure, shock (sluggish or slowing of blood circulation with severe loss of blood pressure), exposure to cold temperatures and diseases of blood circulation. Causes of central cyanosis in new-borns can either be in the heart or in the lungs. In the heart the are termed cyanotic heart diseases which include conditions like Transposition of great arteries, Fallot’s trtralogy, Total anomalous pulmonary venous return, small or hypoplastic left heart, and Truncus arteriosu. In the lungs the causes can be birth injury or asphyxia, respiratory distress syndrome, pneumothorax, pulmonary edema, meconeum aspiration, diaphragmatic hernia, pleural effusion, and trachea-oesophageal fistula. In adults constriction of blood vessels of the limbs, fingers and toes. This could be due to cold exposure, Raynaud’s phenomenon, spasm of the smaller skin capillaries or arteries called acrocyanosis, erythrocyanosis occurring in young women and as side effects of beta blocker drugs taken for high blood pressure.

 

7. Dents or Depressions

If you start seeing dents or depressions on the surface of nails this might be a sign of eczema, psoriasis, or reactive arthritis, a form of arthritis that like Lupus, finds your immune system attacking your joints. More than half of psoriasis sufferers experience nail depressions or dents.

 

8. Discolored nails

Nails should naturally by a healthy pink color and when you notice them altering shades you should take note. If they turn brown, this may indicate that the patient has a thyroid disease or is malnourished. Green nails indicate a severe fungal nail infection, nail psoriasis or even jaundice, tuberculosis, sinusitis, or lympheodema. If your patient is taking prescription drugs like anti-malarial pills, you might find grey tinged nails.

9. Spoon nails

This is called Koilonychia, a condition known for causing nails to become excessively soft and appear scooped out, much like a spoon. This symptom commonly indicates hemochromatosis, a liver condition where there is too much iron being produced in your system. Spoon nails also commonly indicate hypothyroidism. There are other diseases such as heart disease, anemia and impaired blood flow that are associated with this phenomenon.

 

10. Brittle nails

Characterized by thin, frail, crumbling nails this common nail problem often indicates a deficiency in vitamins, with vitamin B7 being the usual culprit. This can be easily reversed with multivitamin supplement. Frail nails are also often associated with nail psoriasis, thyroid disorders, or fungal nail infections. Clinically, there are three types of nail fragility: lamellar onychoschizia, onychorrhexis and superficial granulation of keratin. Lamellar onychoschizia, also known as lamellar dystrophy, is characterized by the presence of fine horizontal layers that crack and peel easily from the free margins. Onychorrhexis is defined as longitudinal splitting and fissuring of the superficial nail plate, often seen in elderly population. Superficial granulation of keratin presents in the distal nail plate. It is characterized by white-yellow discolouration and striations. The keratins in the nail plate undergo an exfoliative process resulting in formation of patches. It may be caused by poor quality nail polish. Dermatological diseases like Psoriasis, Lichens, Eczema, nutritional deficiencies of Vitamins, Iron, Zink and Selenium and medications like anti cancer drugs, arsenic, retinoids are associated with brittle nail syndrome. 

 

11. White stripes

While dark striped nails usually indicate cancerous growth, white stripes are more commonly seen as indicative of a disorder. It usually indicates an imbalanced or a non-nutritious diet, lacking in proteins. This problem can easily be resolved with an increase in proteins rich foods such as fish, quinoa, nuts, seeds, and lean meats.

 

12. Curved nails or Clubbing

This condition is called nail clubbing and involves an unnaturally large nail bed, curving around the tips of the fingers. It is not an overnight condition and can take several years to form. The cause is often hypoxia, a lack of oxygen. This can be seen with cystic fibrosis, congenital cyanotic heart disease, and several other serious diseases like irritable bowel syndrome, liver disease, lung abscess, branchiactesis, AIDS and cardiovascular diseases like SABE, Cirrhosis of liver and Hodgkin’s Lymphoma. The tips of the fingers enlarge and the nails become extremely curved from front to back.

 

13. Loose nails

Loose nails not caused by injury can signify fungal nail infection, nail psoriasis, amyloidosis (excess protein in the blood), hyperthyroidism, sarcoidosis or Raynaud’s disease a.k.a. poor blood circulation. In rarer cases, severe allergies to some antibiotics are known to loosen nails from nail beds.

14. Blue nail base

If you find the nails are a white shade on a blue nail base, this might be a sign of a nutrient deficiency such as a lack of iron. When the nails are extremely white and the base blue or purple, this could denote a problem with the liver or pancreas. It is also a common symptom in the initial stages of diabetes when your body is not able to process and metabolize sugars correctly. 

 

15. Yellow nails

Usually, yellow nails are a sign of an unpleasant fungal infection. Yellow nails can also be indicative of more serious illnesses namely a lung problem, such as pleural effusion and emphysema.

16. Smelly, discoloured and irregular nails

Seen particularly in toe nails in over 50% of adults over 70 years of age and 10% of general population, these irregular, thickened, misshaped, discoloured, brittle, crumbly and foul

smelling nails are of Onychomycosis or fungal infection of nails. It may start as white or yellow spots on nail tips but as the fungal infection goes deeper into the nail it becomes discoloured, thick and brittle. Fungi thrive in damp and dark environment and so people working bare feet in wet conditions or wearing damp and sweaty boots suffer from onychomycosis.  

The Professor concluded with the advice “Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings.”

Friends, as I was trying to salvage this lecture from my three decades and a bit old Medicine notes, the image of Prof Chakraborty, walking to and fro across the lecture hall, approaching the blackboard only to write the sub-headings of discussion and smiling all the time, as he would bring out one point after another, came and went in front of my eyes, as if it was only yesterday's lecture. I have only added the illustrations, to show you how apt his description was, and how easily he could communicate with us who were then near novices!

CHILD PSYCHOLOGY I NEVER KNEW

 

Child Psychology studies how children grow, learn, and develop. Recently I had a patient, who was a child psychologist by profession and talking to her got me interested in how child psychology helps us understand young minds’ thought processes, exploring the mysteries of their thoughts and behaviours. It reveals the unique challenges and experiences children face in the early phases of life i.e. infancy, childhood, and adolescence and understanding child psychology is important for parents and educators to give effective support and guidance to the children. 

Children are like sponges, soaking up everything around them, including the words we use. Although some phrases may seem harmless to adults, they can have unintended consequences when heard by impressionable young minds. Talking to my child psychologist patient was truly revealing, and I have no reason to deny that I got it all wrong. She recommended that we avoid certain phrases when addressing our children, as they can cause confusion for them or muddle the messages we are trying to convey. Honestly speaking, I was stumped, and I am quite sure you will be as well.

 

1. “I’m not going to help you.” “Main tumhari madat nahin karoonga”

Encouraging children to be independent is important, but psychologists advise against using phrasing that might unintentionally discourage them from seeking help later on. Instead of saying, “I’m not going to help you,” experts suggest a more supportive approach: "Give it your best shot, and if you need assistance, I'm here to help you figure it out." This conveys confidence in the child's capabilities while emphasizing the availability of parental support when needed.

 

2. "Great job." “Shabash”

Research shows that using generic terms like ‘Shabash”, "Good girl" or "Way to go" while applauding your child's accomplishments may cause them to rely on your approval rather than their own intrinsic motivation. Instead, parenting experts suggest reserving praise for moments deserving of genuine recognition and providing specific feedback. For instance, rather than a general "Super game," offer targeted praise like, "That was an excellent catch. I appreciate how you quick your reflexes were behind the stumps."

 

3. "Hurry up!" “Jaldi karo”

Using the term "Hurry up!" around children might unintentionally communicate a sense of haste, which can lead to increased stress and anxiety. Children are still developing their time-management abilities and may not completely understand the notion of time restrictions. Constantly hearing "hurry up" might make them feel rushed and stressed, perhaps impairing their ability to focus or complete things successfully. Instead, softly encourage them with a gentler voice, such as, "Let's pick up the pace." This subtly indicates that you are partners in the situation and this is a collective effort.

 

4. “Calm down.” “Chup ho jao”

While it may seem instinctive to tell a loudly upset child to calm down, this strategy is often unhelpful. In most instances, children are not able to find solace in being instructed to suppress their emotions. It is important to acknowledge children's emotions and teaching them effective self-regulation techniques. Instead of commanding them to calm down or stop crying, offering a comforting hug, practicing deep breathing together, or gently redirecting their attention can aid children in managing overwhelming emotions. Often, your calm and consistent presence might give them the reassurance they need.

 

5. “It’s not a big deal.” “Koi baat nahin”

While we might view an issue as trivial, it can hold genuine significance for our children. Such remarks often invalidate the child's emotions, potentially leading them to feel disregarded or that their feelings lack importance. This approach may also prompt a child to doubt themselves and the legitimacy of their emotions or experiences. Rather than dismissing their feelings, consider using an open-ended question, such as, "It seems like this is bothering you—could you tell me more about why you're feeling upset?" Now you have given the child a window of opportunity to reassess the significance of the situation himself/herself.

 

6. "We can't afford that.” “Itne paise nahin hain”

Never go for this approach when your child pleads for the latest toy. This remark can imply a lack of financial responsibility, which may worry children. Instead, use statements such as, "We're allocating our funds for more essential items." If the child persists, this is an excellent opportunity to talk about budgeting and financial literacy. You can teach them to save from their pocket money for a play station or a Lego toy.

 

7. "No dessert unless you finish dinner."

Using this expression may inflate a child's perception of the treat's value, ultimately reducing their enjoyment of the meal. Instead, consider reframing your message to say: "Let's focus on finishing our meal first, and then we can indulge in dessert." This subtle change in wording is likely to have a more favorable impact on your child's perspective.

 

8. “Why didn’t you tell me sooner?” “Hame pahle kyon nahin bataya?”

Child psychologists advise against inadvertently making children feel punished when they express themselves. It's essential to maintain a focus on their emotions and reassure them of our availability to listen. Instead of shifting attention to our own reactions, consider responding with gratitude, such as saying, "Thank you for confiding in me," this will encourage your child to confide in you and appreciate that you might have answers to most of their troubles.

 

Cultural, Social and Socio-economic background

Understanding cultural, social and socioeconomic contexts are crucial as they strongly influence children’s development and behaviours. The Cultural Context refers to the cultural environment in which a child grows up. This includes aspects such as cultural beliefs, traditions, language, and customs that influence a child’s development and identity formation. Social Context refers to a child’s social environment, including family dynamics, peer relationships, and community influences. It examines how social interactions, role models, and societal expectations impact a child’s socialization, emotional development, and behaviour. Finally Socioeconomic Context refers to the economic circumstances in which a child grows up, including family income, access to education, healthcare, and community resources. It examines how socioeconomic factors influence a child’s opportunities, resources, and overall well-being.

 

Child Psychology plays an important role in understanding and shaping children’s behaviours. By studying the role of cognitive, emotional, and social factors, psychologists can identify underlying causes of behaviour.

SEXUAL OBJECTIFICATION OF FEMALE POLITICIANS

 

As the gracious host of the recently concluded G-7 meeting of heads of states, the Italian Prime Minister Ms. Georgia Meloni came out in flying colours but the old fashioned misogyny is refusing to die. We are inundated with jokes and memes about her in the social media, desperately trying to reduce her achievements and turning her into a stereotype dumb blond bimbo. This is a very well planned effort by the male world, which reacts typically in this crass way, when they don't know how to deal with a successful female of their species. The press too exhibits failures in the coverage of women politicians, and instead of their worth and their contributions they end up covering their looks, clothing, weight, tone of voice, attractiveness, and hairs.

 

Even in India, a country which was ruled for a very long time by a strong woman leader Mrs. Indira Gandhi, the Italian P.M' jokes and memes are all over the Internet and her open appreciation of our Prime Minister and his popularity has even resulted in a lot of wink- wink and nudge-nudge among our Desi netizens. It so seems that even if you are a Prime Minister, if you are a woman, you remain an object of ogling through the male prism and 'hot or not' is what only matters.

 

 

The world scenario

Discussing the appearance of female politicians is an evergreen tactic that has been used to delegitimize and diminish them. But objectification does more than just delegitimize. In fact, objectification is a form of dehumanization. Dehumanization involves the denial of essential human traits and qualities. Essentially, to dehumanize someone is to strip them of their attributes and personhood. P.M Meloni is not the first female politician to suffer this fate and surely won't be the last. Age doesn’t matter and young and old all women are fair game, when it comes to female objectification. When Theresa May and Nicola Sturgeon were discussing Brexit and it's fallout in all seriousness the British tabloid were comparing their body parts - "Never mind the Brexit, who won the legs it?" 

 

In 2008 Sarah Palin was doing well as an hands on Alaskan woman on the McCain/Palin ticket for the U.S Vice President’s post but suddenly the focus shifted to her appearance and perceived attractiveness, with Time magazine calling her a “sex symbol.” The American public opinion changed thereafter and so did her electoral fortunes. No more was her achievements taken seriously and the press was discussing her looks, her smile, her outfits and her hairstyle!

 

Last year Finland's former P.M, Sanna Marin was the unfair target of netizens for partying with friends! How can that be wrong? Does becoming a P.M mean not having friends, family and private life? Are male politicians gauged by the same yardstick? New Zealand's former P.M, Jakinda Ardern and Brazil's Dilma Rousseff have faced their own objectification and subsequent witch-hunt. A tabloid photographer even photographed Hilary Clinton's panties while she was changing her sitting posture, and netizens offered their innumerable and priceless opinions about it! You sometimes wonder where is this going to stop.

 

 

The Indian scenario

In our domestic politics our female parliamentarians have been the target of sexist remarks and objectification since ages. Hema Malini, Jayapradha, Jaya Bacchan, Urmila Matondkar,  Smriti Irani, Navneet Rana, Kangra Ranaut all have been easy targets. The perpetrators usually get away without any reprimand or legal action because it is a very accommodative All Boys Club! Gender parity and pluralism are still nascent and uneven in India. Women representation is far less than many other democracies. The few women that are there are from privileged and well connected families, and only recently the not so privileged ones are getting elected to the parliament and the state assemblies. 

 

Mrs. Hema Malini, BJP's three-term MP from Mathura was at the centre of debate in this year’s election with a Congress leader, half her age, made almost casual reference in his speech objectifying her status as a star, wife and as daughter-in-law and corralling her identity. Many years ago, she was the subject of another offensive analogy when RJD chief Lalu Yadav claimed he would make Bihar's road as smooth as her cheeks. In 2019 actor-turned-politician Urmila Matondkar became a target of sexist remarks as BJP's Gopal Shetty said that she had been given a ticket because of her looks. In 2022, police registered a case against Congress leader Ajay Rai for a sexist remark against Union minister Smriti Irani, again a very successful actor.

 

This year it was a television savvy spokesperson and Congresswoman asked BJP’s Kangna Ranaut “Mandi me kya bhav chal raha hai?” (What is the prevailing rate in Mandi?) Mandi is her constituency and she, a National Award winning actor, had played the role of a prostitute in a prize winning film. In 2019 Samajwadi Party leader Azam Khan's crass comment on BJP leader and his former colleague Jaya Prada was even worse. At a campaign rally in Uttar Pradesh's Rampur Khan said, "I brought her to Rampur. You are a witness that I did not allow anyone to touch her body. It took you 17 years to identify her real face but I got to know in 17 days that she wears khaki underwear," this being a reference to Rashtriya Swayam Sewak (RSS), the BJP’s ideological organization.

 

And it's not only between rivals, even inside political parties all women politicians face sexism from their male colleagues. You can ask any woman politician and she will tell you the same. Many women politicians have left Congress and Aam Admi Party because of unapologetic sexual harassment and objectification. In 2013 Congress leader Digvijay Singh, a former Chief Minister, had joined ranks of such politicians by commenting on one of Congress' own member, Meenakshi Natarajan, then-MP from Mandsaur, as "sau taka tunch maal" (100 per cent pure material or totally unblemished), which resulted in criticism from across party lines.

 

Why does this objectification occur?

Sexual objectification occurs when a woman's body, body parts, or sexual functions are isolated from her whole and complex being and treated as objects simply to be looked at, coveted, or touched. The sexual objectification of women by men is the primary mechanism of women’s subordination: men regard women as suitable for sexual use and exercise socially sanctioned control over them so as to make them conform to men’s view of them; in so doing, men make women into objects, wrongly harming them by denying them their humanity. When you read this you will realize that this is exactly what the Taliban is also doing, and we are vilifying them quite rightly for the same, but sub-consciously we are going down the same line……..perhaps just a few steps behind them!

 

This attitude stems from the larger patriarchal order that creates an uneven field for women both in private and public spheres. This is due to lack of proper education, nurture and awareness which results in a perverted perception of male superiority which is not reflected in the real world. We have a liberal political structure but the corresponding development of a liberal society is an ongoing process and that will take time.

 

Women are subject to objectification, and in particular, sexual objectification, at significantly higher rates than men. It is happening in all spheres of life – court rooms, corporate board rooms, hospitals, offices, sports fields, you name it. Women in politics are no exception; since women entered the arena of national politics, they have been subject to objectifying rhetoric and portrayals in a way that men have not. Objectification is just one strategy used to devalue and undermine women in politics.

Self objectification

A constant exposure to objectifying rhetoric and imagery can lead to a phenomenon called 'self-objectification', which occurs when individuals internalize observers’ perspectives of their physical bodies. Women tend to self-objectify at higher rates than men. This is related to the belief that beauty is a type of social “currency,” and that both this belief and self-objectification are negatively related to gender-based political activism. Put simply, women who are high self-objectifiers are more likely to be content with the status quo in terms of gender relations and less likely to engage in efforts to improve the current status of women. These women believe that physical attractiveness is an extremely important asset or “currency,” and is something that will benefit them more than other skills, talents, and other pursuits.

 

How to break the objectification loop?

What do we do to combat objectification in our politics? First, we need to recognize that increasing women’s presence in politics is only one part of the equation. We also need to interrogate the way that women in politics are treated and talked about in the media and in everyday discussions. Sexist scripts that objectify women, whether they are cruel or purported to be positive, need to be called out.

 

Female politicians have to give up self objectification and start calling out the offenders loud. Their warmth and confidence is there for all to see, their contribution to the society is out there in the open. Discussion should be about these things and not looks and appearance. If they start howling a few offenders to the court of law and if our justice system responds promptly, the changes will surely happen. We have a liberal political structure but the corresponding development of a liberal society is an ongoing process and that will take time. It has to start from the family, and then reach the society and then the country and the world. The change has to begin at home and parents will have to do it and teachers should then take over and make the societal change a reality.

DEEP VEIN THROMBOSIS

 

 

Deep Vein Thrombosis (DVT) is a medical condition where a blood clot forms in a deep vein, typically in the legs. This can lead to pain, swelling, and in severe cases, can cause clots to break free and travel to vital organs, such as the lungs, leading to life-threatening complications. Recognizing the factors that increase the risk of DVT and adopting preventive measures is crucial for maintaining vascular health.

Veins are responsible for returning the deoxygenated blood back to the heart so that it can send it to the lungs to get oxygenated once again. There are two sets of veins, the superficial veins that pop up when a tourniquet is applied to take blood samples for pathology investigations and are running just under the skin, and the deep veins, which run in the depth, usually along with the arteries. The two are interconnected at places. The veins have valves which help the blood to flow towards the heart even against the gravity.

DVT should not be confused with Varicose Veins. They are both venous diseases but two very different entities. Varicose veins are are swollen, twisted veins that lie just under the skin. These effect the superficial veins and can, at times, be caused by DVT.

The term venous thromboembolism (VTE) is used to describe two conditions, deep vein thrombosis (DVT) and pulmonary embolism (PE). This term is used because the two conditions are very closely related, and, because their prevention and treatment are also closely related.

 

Symptoms of DVT

These can include:

• Leg swelling
• Leg pain, cramping or soreness that often starts in the calf
• Change in skin color on the leg — such as red or purple, depending on the color of your skin
• A feeling of warmth on the affected leg

Deep vein thrombosis can occur without noticeable symptoms as well.

Phlegmasia cerulea dolens (PCD) is an uncommon but potentially life-threatening complication of acute DVT characterized by marked swelling of the extremities with pain and cyanosis, which in turn may lead to arterial ischemia and ultimately cause gangrene with high amputation and mortality rates.

 

Risk Factors for DVT

Previous Blood Clot: Individuals who have experienced DVT are at a heightened risk of recurrence.

Family History: A genetic predisposition to DVT is significant. The risk is further amplified if both parents have a history of the condition.

Age: The likelihood of DVT increases with age, particularly for those over 40.

Prolonged Immobility: Extended periods of immobility, such as bed rest due to hospitalization or long-duration flights, can significantly increase the risk of DVT. When muscles are not active, blood flow in the deep veins of the legs slows down, making it easier for clots to form. This is why it's crucial to take breaks, move around, and stretch regularly during prolonged sitting or when confined to a bed or chair for extended periods.

Gender and Age: Men aged between 45 and 60 are slightly more susceptible to DVT. However, women's risk may increase during pregnancy due to hormonal changes.

Genetic Factors: Genetic predispositions play a significant role in the risk of developing DVT. Conditions such as Factor V Leiden mutation increase the blood's tendency to clot. While a single genetic factor may not cause DVT on its own, in combination with other risks, it can significantly increase the likelihood of clot formation. Knowing family history and discussing genetic testing with a healthcare provider can help assess and manage this risk.

Pregnancy and Hormone Therapy: Elevated estrogen levels during pregnancy or from hormone-based medications can increase clotting risk. Apart from pregnancy, other conditions and medications that alter hormone levels can also elevate DVT risk. This includes hormone replacement therapy and certain types of birth control. The increased estrogen can make the blood more prone to clotting. It's essential for individuals undergoing these treatments to consult with their healthcare providers about their specific risk and possible preventive measures.

Clotting Disorders: Inherent blood clotting disorders can lead to abnormally thick blood.​

Obesity: Obesity is a significant risk factor for DVT. Excess weight, especially around the abdomen, can exert additional pressure on the veins in the pelvis and legs, impeding blood flow back to the heart. This can lead to blood pooling and clot formation. Furthermore, obesity alters the chemical composition of the blood, increasing its propensity to clot. Managing weight through diet, exercise, and lifestyle changes can help reduce the risk of DVT and improve overall health.

Health Conditions: Diseases like heart disease, lung disease, inflammatory bowel disease, and cancer can elevate DVT risk. Injury or Surgery: Physical trauma, such as a bone fracture or muscle injury, can damage blood vessels and lead to clot formation.

Surgery: Surgeries, particularly those involving the abdomen, pelvis, hip, or legs, can increase the risk of DVT due to immobility during recovery and potential damage to blood vessels. Taking preventive measures, such as using compression stockings or medication for blood thinning as recommended by healthcare providers, can help reduce this risk. We routinely use prophylactic anticoagulation therapy in all surgeries below the level of umbilicus in patients over 40 years of age.

Chronic diseases: Certain chronic conditions, such as heart disease, cancer, and inflammatory bowel disease, can increase the risk of DVT. These diseases can alter blood flow, contribute to inflammation, and affect the blood's ability to clot. For instance, cancer and its treatments can increase clotting factors in the blood, while heart disease can lead to reduced mobility and blood flow. Managing these conditions with the guidance of healthcare professionals is crucial for minimizing DVT risk.

Inflammatory Diseases: Conditions like inflammatory bowel disease (IBD) not only disrupt the digestive tract but also contribute to a systemic inflammatory response. This state of heightened inflammation can increase the risk of blood clot formation. Managing inflammation through appropriate treatments and lifestyle changes is crucial.

 

Strategies to Lower DVT Risk

While some risk factors for DVT cannot be modified, several strategies can help mitigate the risk:

1. Avoid Prolonged Immobility: Stand, stretch, or walk at least every 2 hours. Perform simple leg exercises even while seated. If you work at a desk or engage in activities that require sitting for extended periods, integrate short breaks into your routine. Use a timer as a reminder to stand up or stretch every hour. Even minimal movements, such as ankle circles or foot pumps, can stimulate blood flow in your legs.​

2. Post-Surgery Mobility:  After surgery, particularly operations involving the abdomen, pelvis, hip, or legs, it's crucial to start moving as soon as medically advised. Gentle exercises, like ankle pumps, knee bends, and leg lifts, can be performed even in bed. These movements help in maintaining circulation and preventing blood clots.

3. Medical Consultation: Discuss with your doctor about the potential need for blood thinners or compression stockings if at high risk.

4. Travel Precautions: During long flights or car rides, make it a point to stand or walk around every couple of hours. Choose seats that offer more legroom when possible, and perform seated exercises like foot lifts or knee bends. Wearing loose, comfortable clothing and staying hydrated are essential, while avoiding alcohol and caffeine, which can lead to dehydration.

5. Stay Active: Regular physical activity is beneficial for overall health and plays a key role in preventing DVT. Activities like walking, swimming, or cycling improve circulation and vein health. Aim for at least 30 minutes of moderate exercise most days of the week. Even those with limited mobility can find suitable exercises to keep blood flowing efficiently.

6. Health Management: Addressing obesity, quitting smoking, and managing chronic diseases are crucial steps in reducing DVT risk.

7. Lifestyle Adjustments: For individuals who are overweight, losing weight can significantly reduce the pressure on veins in the legs and improve blood flow. Quitting smoking is also crucial, as smoking affects blood circulation and increases the risk of clotting. Managing chronic conditions such as diabetes, high blood pressure, and heart disease through medication, diet, and exercise is vital in reducing the risk of DVT.

8. Proactive Health Checks: For those with a high risk of DVT, regular check-ups and screenings can be lifesaving. This includes monitoring for any signs of clotting disorders, reviewing medication impacts, and assessing the need for preventive measures like compression garments or anticoagulants.

Pulmonary Embolism (PE).

This is the most dreaded complication of DVT. A pulmonary embolism (PE) occurs when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung. Blood clots most often start in the legs, from where they break loose and travel up through the right side of the heart and into the lungs. The warning signs and symptoms of a pulmonary embolism include:

• Sudden shortness of breath
• Chest pain or discomfort that worsens when you take a deep breath or when you cough
• Feeling lightheaded or dizzy
• Fainting
• Rapid pulse
• Rapid breathing
• Coughing up blood

This is a life threatening condition and needs urgent hospitalization and emergency care.

 

So, DVT is not a casual swelling of the leg, which gets all right on rest and limb elevation every time. It needs medical attention and certain investigations and effective care. At least one of its complication, PE, can be life threatening.