Most of us at one time or another, have probably either known someone with DVT, or been unfortunate enough to end up with one of those ‘clots from hell’ ourselves. Deep Vein Thrombosis or thrombophlebitis as it is sometimes known, is a painful and serious condition and over the last twenty years in particular, drug users have ended up losing limbs, their health and even their lives because of it.
As the Government continues to skimp on providing access to better alternatives to drug treatments, users continue to shoot up substitute substances, often becoming addicted to those as well. Drug users may also have the added problems of their medical treatment often being, how shall we say, ‘less than satisfactory’ and so may miss out on important, even life saving information. So, what is DVT, what’s the treatment, how do you avoid it and if you’ve got DVT – how can you look after yourself with it. This IS NOT something you can sort out yourself. If you think you may have DVT you must see a doctor and in a moment we’ll tell you why.
What is Deep Vein Thrombosis?
Basically, it means the blockage of a deep vein by a blood clot (called a thrombus or embolus if it is some other foreign material that has caused the blockage), usually localised around the deep veins in the calf but it can extend into the deep veins of the thigh and even beyond, particularly for drug users who inject in the groin. The bigger/more extensive the clot, the more serious the condition becomes. A clot can grow in size and not only block other veins but bits of it can break off and travel or ‘fly’ through the venous system, landing in potentially life threatening areas like the lung, causing difficulty in breathing (becoming fatal if massive) the brain, the blood supply gets cut off and brain cells starve and die producing stokes, the heart causing heart attacks, or even moving towards the spine causing serious infection. It can also occur in the portal vein which conveys blood to the liver. Along with deep veins, the venous system also has superficial or smaller thinner veins which can also become blocked by clots and while this can be associated with DVT, rarely are the two systems blocked at the same time.
Superficial Vein Thrombosis (or SVT) refers to a blood clot in a vein near the skin. Thrombophlebitis (the ‘itis’ means inflamed) means the vein is involved in an inflammatory process; the skin around the vein being red and painful and sometimes swollen as well. There is often inflammation where there is blood clots which is why DVT or SVT are sometimes called deep or superficial Thrombophlebitis.
So What are the Symptoms?
A blood clot in the superficial or deep veins in the leg may result in; pain, sudden swelling of the affected leg, (remember, it doesn’t have to be at the injection site) in the early stages the affected limb can be a pasty white often followed by redness or reddish blue discolouration of the skin, warmth or enlargement of the superficial veins. Unfortunately, DVT can be present with no obvious symptoms. Sometimes the first indication of a pulmonary embolus (clot on the lung) is shortness of breath, a feeling of apprehension, sharp chest pain, rapid pulse, fainting, sweating or spitting up blood. Of course there are other conditions that can cause these symptoms but if you do have any of these problems you must get properly checked out by a doctor – and if you think it may be DVT, make sure you tell your G.P your fears, it could just save your limb or even life. Black Poppy doesn’t want to get everyone hysterical but we’re talking important health issues here…….
Drug Use and DVT
Peter, who has suffered with DVT fairly recently, explains how he realised that there was something seriously wrong with his leg. “The pain in one leg kind of built up gradually, and it was getting harder and harder for me to walk. The leg seemed to be swelling (particularly the thigh) but it wasn’t until someone actually measured it with a tape – and it was 5-6 inches bigger in circumference than my other leg – that I realised something seriously bad was happening”.
Unfortunately, Peter reminds us of the reaction and treatment that drug users can get from hospitals, even when they have such a serious illness. “I had been shooting up in my groin for a while, using a lot of Seconal and quite a few dex as well (Dexedrine). I was looking deathly grey. I ended up spending about 10 days in hospital, they thought that the infection had travelled around to my spine. I really wasn’t told anything about what was happening to me, they all seemed to view me suspiciously and certainly gave me no painkillers at all. On discharge I got not one bit of advice about how I should look after my leg, what was actually wrong with it, or what procedures should be followed” .
“Six months later, after popping into the hospital for blood tests every month, I am still none the wiser. I took the Warfarin medication they gave me and I’m nearly finished the 6 month course, but although my leg seems to be better, they have not tested me to see if the clot has gone or shrunk (and we are talking about a clot that had stretched from my thigh to my calf), and I’m angry that I wasn’t told to look out for the symptoms of pulmonary embolism, if, as could happen, the clot broke off and moved to my heart or lungs.”
He continues “I am supposed to come off my treatment soon and I presume they will check for clots before they stop the Warfarin…. It has been an experience I do not want to repeat”.
Be particularly vigilant for signs of DVT if you shoot up;
…….Drugs like Seconal or other barbiturates such as Tuinol, Sodium Amatol, Amatol, etc as many of these have starch in them that CANNOT be filtered out. If your cranking up Dexedrine, or Physeptone- BE SURE that you filter them properly, they are full of semi soluble excipients – (fillers). ( If you do still get temazapam (egg form) on prescription and/or are injecting them (the egg type are still occasionally available on private prescription) remember to check what’s in them. The ones that have glycerine in them are a bit better than the ones with ‘Gelthix’ in them – which are REALLY DANGEROUS for veins, people have lost limbs, but they are both terrible for encouraging clots and vein blockages. So for God’s sake, don’t use them! (Note – they may no longer be available in the UK).
Methadone linctus injected, or even methadone ampoules which, although they are an injectable preparation, decades of meth injectors will attest to the fact that they are acidic – and contribute to the collapse of veins quickly, leading people to use up their veins fast and damage their remaining ones.
There are other things aside from drug use that may increase the risk of getting DVT.
These ‘risk factors’ include;
* Prevention is the best treatment If you are due to have surgery under general anaesthetic, you should always ask the surgeon and anaesthetist what are the methods they will use to prevent DVT occurring during surgery. Usually they are mechanical (compressive devices) and pharmacological (low dose of subcutaneous injections of Heparin). If they do not intend to use any of these, change both surgeon and anaesthetist! (Yes we know, easier said than done….)
* Recent injury or surgery – (even healthy people who have operations under general anaesthesia have a 25% DVT risk.) Those who are over 40 years of age and/or undergo surgery for hip, cancer, urological procedures or brain and gynaecological surgery, the incidence of post operative DVT is even higher. (see ‘tips for avoiding DVT’)
* Family history of DVT.(concerning problems surrounding blood clotting time and circulation)
Immobility – such as long periods of bedrest, confinement in long car or plane journeys.
* Having DVT previously, makes you prone to end up with it again.
* Birth Control Pills, especially for women that smoke,
What’s the Treatment?
If your doctor suspects that you may have DVT, they will probably advise admission to hospital and one of the first tests doctors perform will be an ultrasound, which examines the blood flow through the veins. There are no needles, injections or special preparations needed for this, just jellied water applied to the skin and an ultrasound probe placed over the areas to be examined. It can be a bit uncomfortable when pressure with the probe is applied over an already sensitive/painful area. If a clot is not found using this device, but is highly suspected, then an x-ray should be done (called an ascending phlebogram).
If your doctor has discovered a clot in a deep vein they will proceed with anticoagulants – such as Heparin which is given and then continued in tablet form after you leave hospital for around 6 months. This helps thin the blood out, preventing it from clotting. These drugs will help keep the clot from increasing in size and help prevent pulmonary embolism. Adjustments are made to the dosage over this time with hospitalisation recommended for a few days to a week while you are monitored through this change. Sometimes, over the ensuing months as the blood clot retracts and gets smaller, daermage can occur to the deep vein valves so they don’t close properly allowing the blood to flow back into the vein, pooling in the low veins, leading in a few years to circulatory problems in the leg that can, if not treated with compression, evolve into skin ulceration.
If left Untreated…
If DVT is left untreated, this pooling of blood occurs faster, leading eventually to gangrene and possibly amputation. Prompt treatment can usually prevent this happening. If the blood continues to clot despite the drug treatment, filters then need to be introduced into the main vein of the abdomen, (the vena cava – the whopping great vein going down the front of your chest) to prevent clots on the lung. The type of treatment will depend on the location of the clot and the likelihood of further complications occurring.
With IV drug users, there can be problems when other veins are also diseased or have limited circulation. This can lead to the anticoagulant drugs not getting through the body quickly enough and doctors may need to put a central line in through the neck for a few days while they administer the drugs you need.
Tips for avoiding DVT now and in the future
With illness or disease that requires a lot of bed rest DVT can be induced simply by calf inactivity (which causes blood to stagnate and then clot). This also goes for long car or plane trips, especially if you are over 40 AND an IV drug user and even more so if you’ve had DVT in the past. The answer is to try and ensure you get some movement into your legs. If confined to bed, try and do heel/toe lifts frequently (this causes the calf muscle to contract and that action will move blood in the veins) and/or get up and walk around as often as permitted. If on a long plane/car journey, make sure you get to stop frequently (or walk up and down the aeroplane aisle) and drink plenty of fluids but not alcohol as dehydrating will increase the tendency for blood to clot. Girls, if you take The Pill, you know it’s much better not to smoke as this increases the chance of DVT.
If there is a history of DVT in your family, then be sure to mention it to your doctor. There are blood tests that can be done to see if you have inherited the problem so ask if you can have one. If you have already had a case of DVT, keep a close eye on yourself for further problems as once you’ve had it, it’s easier to get it again. Make sure you go to your doctor AT THE FIRST SIGN OF A PROBLEM. If you have varicose veins or are pregnant or have had DVT in the past, it may be helpful to wear compression stockings to prevent blood from pooling in the veins in your legs.
Looking after yourself with DVT
DVT is a very serious condition and it’s vital that you look after yourself well if you have it. Bed rest is important as is raising your leg up in bed a foot or so and wearing compression stockings. There are many complicated things that can go wrong when you’re dealing with the circulatory system as well as the fact that your body can end up toxic with poisons because your blood is not moving around properly and oxygen is not being carried to the cells in enough quantities and bacteria begins slowly poisoning you and your limb. As stated before – get medical advice at the first sign of something wrong and if your doctor is being ‘difficult’ then go to a drug project such as the Caravan where a nurse or doctor can advocate or refer you for help. Take care of yourself and if your worried about a mate who may have DVT, be sure to point out the urgency involved.
Taken from BP issue 2