The Clot Thickens: What You Need to Know About DVT & PE

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Picture this you finally made on a vacation.
You survived a chaos of the airport security.
You powered through the airplane chicken, and after eight hours crammed into economy, you stand to stretch, but instead of just stiff legs, you notice one calf is swollen, sore, and a little warm.
You shrug it off.
It's probably just too much.
Netflix, 30,000 feet.

(00:21):
Fast forward a couple days.
You're lying on the beach p colada in hand.
When suddenly you can't catch your breath.
Your chest feels tight, and you pull the muscle you didn't even know you had.
The next thing you know you're in the ER and the doctor tells you you've had a pulmonary embolism, a blood clot that started in your leg and broke off into your lungs.
That's the scary part about clots.

(00:41):
One moment you're living your best vacation life.
.909090909The next, you're hooked up to oxygen with honors beeping next to you Today on not another medical podcast, we're talking about clots when they're normal and lifesaving. 15 00:00:53,160.909090909 --> 00:00:54,90.909090909 And when they're dangerous.
We'll cover deep vein thrombosis, pulmonary embolism, the red flags you shouldn't ignore, and what you can actually do to prevent them.
'cause let's face it, clot happens, and knowing the signs just may save your life. 18 00:01:44,670.63645455 --> 00:01:47,249.12511668 What's up? Hello? Hello. 19 00:01:49,200.63645455 --> 00:01:50,820.63645455 We haven't, we haven't done this. 20 00:01:51,59.12511668 --> 00:01:52,949.12511668 yeah, it it's been a long time. 21 00:01:53,9.12511668 --> 00:01:56,58.95845001 It, feels like, Or is this, schedule there, guys. 22 00:01:57,423.96978788 --> 00:02:07,693.96978788 Maybe we should, start off by saying to the listeners, if you're avid listeners, we apologize that there was a little gap hiatus in our scheduled release. 23 00:02:09,518.96978788 --> 00:02:13,390.63645455 Uh, the it's been incredibly October Yeah. 24 00:02:14,392.13645455 --> 00:02:16,282.13645455 Somehow we miss dropping an episode. 25 00:02:16,282.13645455 --> 00:02:17,440.63645455 So now that yeah. 26 00:02:17,452.13645455 --> 00:02:18,772.13645455 though is being recorded months later. 27 00:02:19,720.63645455 --> 00:02:20,470.63645455 Yes. 28 00:02:20,617.13645455 --> 00:02:21,317.14779241 still I don't think. 29 00:02:21,337.13645455 --> 00:02:26,922.14779241 the inconvenience That may or may not Listen, I, I don't, our I, I heard from some pod. 30 00:02:26,982.14779241 --> 00:02:27,732.14779241 I don't think you're supposed to. 31 00:02:27,732.14779241 --> 00:02:29,382.14779241 Timestamp Podcast i's supposed to. 32 00:02:29,382.14779241 --> 00:02:32,82.14779241 I think they're just supposed to be like forever. 33 00:02:32,322.14779241 --> 00:02:33,802.14779241 So now there're timestamping. 34 00:02:34,512.14779241 --> 00:02:35,112.14779241 Yeah. 35 00:02:35,232.14779241 --> 00:02:39,942.14779241 This one is not, although that could have been 2023 or 2029. 36 00:02:39,942.14779241 --> 00:02:41,65.63645455 It could have been Yeah. 37 00:02:41,592.14779241 --> 00:02:42,462.14779241 any of those, so. 38 00:02:42,505.63645455 --> 00:02:43,987.14779241 There's, there's some Mm-hmm. 39 00:02:44,212.13645455 --> 00:02:44,502.13645455 yeah. 40 00:02:44,575.63645455 --> 00:02:46,735.63645455 happen at some point in our timeline. 41 00:02:47,95.63645455 --> 00:02:56,922.14779241 Uh, and, uh, you know, we just, uh, took a little bit of hiatus and, you know, we recouped and, uh, There was no, hold on a second. 42 00:02:57,612.14779241 --> 00:02:58,242.14779241 Hold on. 43 00:02:58,242.14779241 --> 00:02:59,532.14779241 There were no mishaps. 44 00:02:59,712.14779241 --> 00:03:02,472.14779241 We were doctoring, we were parenting. 45 00:03:02,947.13645455 --> 00:03:04,277.14779241 James, you're Brody's tried to, to. 46 00:03:04,675.63645455 --> 00:03:06,385.63645455 we, we made a promise. 47 00:03:06,415.63645455 --> 00:03:07,645.63645455 We made a promise. 48 00:03:07,705.63645455 --> 00:03:24,55.63645455 Well, nobody made a promise, but we, we, you know, we have a commitment that, uh, we wanted to Um, uh, you're thinking of your wedding vows, James, this That's another story, the. 49 00:03:24,367.13645455 --> 00:03:24,787.13645455 man. 50 00:03:25,212.14779241 --> 00:03:27,432.14779241 Oh, that took a turn. 51 00:03:28,180.63645455 --> 00:03:28,690.63645455 No, no, no. 52 00:03:28,720.63645455 --> 00:03:31,720.63645455 We're, we're very happy there. 53 00:03:31,800.63645455 --> 00:03:31,980.63645455 Yeah. 54 00:03:31,985.63645455 --> 00:03:33,270.63645455 Well, we're Uh, back. 55 00:03:33,450.63645455 --> 00:03:37,55.64779241 Apologize for any gap that may or may not have ever been noticed, but, yeah. 56 00:03:37,350.63645455 --> 00:03:37,770.63645455 we're here. 57 00:03:37,830.63645455 --> 00:03:38,310.63645455 We're here. 58 00:03:38,490.63645455 --> 00:03:38,730.63645455 So. 59 00:03:39,35.64779241 --> 00:03:41,75.64779241 So, uh, Brody, tell, tell us about life. 60 00:03:41,75.64779241 --> 00:03:48,720.63645455 You have the most interesting life right now yeah, with like, trying to get rid of a, many things, but I, uh, I will say today was kind of a weird day. 61 00:03:48,780.63645455 --> 00:03:50,900.63645455 So it was just, myself, one of my daughters, this afternoon. 62 00:03:50,900.63645455 --> 00:03:53,80.63645455 Anyways, my other one is, Hmm with, with her in-laws. 63 00:03:53,440.63645455 --> 00:03:54,160.63645455 Um. 64 00:03:54,655.63645455 --> 00:03:56,125.63645455 Or my in-law's parents, I guess. 65 00:03:56,185.63645455 --> 00:03:58,795.63645455 Um, and or my wife's parents. 66 00:03:58,795.63645455 --> 00:03:59,605.63645455 My wife's parents. 67 00:03:59,605.63645455 --> 00:04:00,295.63645455 I had a, wow. 68 00:04:00,625.63645455 --> 00:04:08,175.63645455 Anyways, I had my daughter today and we were, hanging out after school and the natural conversation comes up, I'm like, kill a time. 69 00:04:08,175.63645455 --> 00:04:10,324.13645455 Like, what do you want to do? mm-hmm. 70 00:04:10,395.63645455 --> 00:04:11,325.63645455 she wanted get her nails done. 71 00:04:11,415.63645455 --> 00:04:12,225.63645455 So I was like, great. 72 00:04:12,645.63645455 --> 00:04:13,374.13645455 So I Wow. 73 00:04:13,584.13645455 --> 00:04:14,134.13645455 First time. 74 00:04:14,415.63645455 --> 00:04:16,515.63645455 daddy-daughter pedicure. 75 00:04:16,725.64779241 --> 00:04:18,245.64779241 me, show us your nails. 76 00:04:18,815.64779241 --> 00:04:19,595.64779241 Let's see. 77 00:04:20,55.63645455 --> 00:04:21,375.63645455 but it was wonderful. 78 00:04:21,375.63645455 --> 00:04:23,554.13645455 Honestly, we went out, I got Yeah. 79 00:04:23,719.13645455 --> 00:04:24,259.13645455 That's great. 80 00:04:24,285.63645455 --> 00:04:26,655.63645455 foot massage scrub. 81 00:04:26,895.63645455 --> 00:04:27,649.13645455 She got her Yeah. 82 00:04:27,765.63645455 --> 00:04:30,320.64779241 dead, went out for dinner afterwards, had some I. 83 00:04:30,795.63645455 --> 00:04:32,239.13645455 She had some That's fancy. 84 00:04:32,435.64779241 --> 00:04:33,695.64779241 That's awesome. 85 00:04:33,965.64779241 --> 00:04:35,915.64779241 That's solid parenting. 86 00:04:36,49.13645455 --> 00:04:39,559.13645455 that's like, uh, you know, uh, circa 2008 Drake. 87 00:04:39,559.13645455 --> 00:04:40,69.13645455 Fancy. 88 00:04:40,830.63645455 --> 00:04:41,730.63645455 Yeah, exactly. 89 00:04:43,140.63645455 --> 00:04:43,950.63645455 Little take care. 90 00:04:43,950.63645455 --> 00:04:44,460.63645455 Action. 91 00:04:44,460.63645455 --> 00:04:46,20.33373801 It was, That's fantastic. 92 00:04:46,606.84507588 --> 00:04:47,56.84507588 Yeah. 93 00:04:47,56.84507588 --> 00:04:47,956.84507588 That's really awesome. 94 00:04:48,90.33373801 --> 00:04:52,391.83373801 ideas? It was Uh, yeah, the greatest thing is we kinda show up. 95 00:04:52,421.83373801 --> 00:04:53,370.33373801 'cause like I yeah. 96 00:04:53,561.83373801 --> 00:04:55,871.83373801 zero care actual stake in what color she gets. 97 00:04:55,871.83373801 --> 00:04:58,511.83373801 So then like you walk in, there's like a wall of color. 98 00:04:58,511.83373801 --> 00:04:59,10.33373801 I Yeah. 99 00:04:59,100.33373801 --> 00:05:00,660.33373801 There's like low expectations. 100 00:05:00,780.33373801 --> 00:05:00,870.33373801 Yeah. 101 00:05:01,151.83373801 --> 00:05:03,161.83373801 place for a pedicure manicure before. 102 00:05:03,161.83373801 --> 00:05:06,330.33373801 It's like I was following her lead and like she's five Yeah. 103 00:05:06,461.83373801 --> 00:05:07,661.83373801 like, yeah. 104 00:05:07,661.83373801 --> 00:05:09,90.33373801 Like amazing. 105 00:05:09,341.83373801 --> 00:05:11,171.83373801 my color and then sit down. 106 00:05:11,171.83373801 --> 00:05:20,563.51174255 I sat down beside her and then she's like, aren't you gonna get your nails done? Sure See, Brody, you, you think you're teaching her, but she's really teaching you. 107 00:05:20,937.00040468 --> 00:05:21,267.00040468 Yeah. 108 00:05:21,653.50040468 --> 00:05:25,812.00040468 the greatest, like self care advice That's amazing. 109 00:05:26,52.00040468 --> 00:05:28,703.50040468 I'm glad that you, you picked out your, loved it. 110 00:05:28,733.50040468 --> 00:05:29,333.50040468 It was great. 111 00:05:29,412.00040468 --> 00:05:32,232.00040468 And I'm glad that you picked out your true color Barbie pink. 112 00:05:32,442.00040468 --> 00:05:34,482.00040468 You know, it really, Yeah, really fits well with you. 113 00:05:34,902.00040468 --> 00:05:35,352.00040468 Yeah. 114 00:05:35,363.50040468 --> 00:05:35,753.50040468 Thank you. 115 00:05:36,173.50040468 --> 00:05:36,533.50040468 Yeah. 116 00:05:36,593.50040468 --> 00:05:36,743.50040468 Yeah. 117 00:05:36,763.51174255 --> 00:05:41,663.50040468 I was gonna make, I was gonna, camera because like it, this isn't my only fan page, but, you know. 118 00:05:41,963.50040468 --> 00:05:48,743.50040468 Um, although that is a good page, huh? only uh, Yeah. 119 00:05:49,513.51174255 --> 00:05:54,798.11137451 only toes, I, What were you uh, I I'm going to Vegas tomorrow. 120 00:05:54,988.10003664 --> 00:05:56,898.11137451 Oh, really? Yeah. 121 00:05:56,898.11137451 --> 00:05:58,458.11137451 Is that cool? That's pretty cool. 122 00:05:58,658.10003664 --> 00:06:02,328.11137451 Did you get your nails Well, I will get them done in Vegas. 123 00:06:02,538.11137451 --> 00:06:03,48.11137451 Heck yeah. 124 00:06:03,48.11137451 --> 00:06:04,68.11137451 After that story. 125 00:06:04,488.11137451 --> 00:06:04,938.11137451 Yeah. 126 00:06:06,406.60003664 --> 00:06:07,518.11137451 well, Yeah. 127 00:06:07,576.60003664 --> 00:06:11,728.11137451 uh, what, what, what's that for? For work There's a, innovation in medicine conference. 128 00:06:11,788.11137451 --> 00:06:15,478.11137451 It's gonna be super cool and some, fun speakers, cool stuff. 129 00:06:15,508.11137451 --> 00:06:16,798.11137451 Get away for a few days. 130 00:06:17,588.10003664 --> 00:06:18,566.60003664 That's That's great. 131 00:06:19,88.11137451 --> 00:06:19,808.11137451 next week. 132 00:06:19,848.11137451 --> 00:06:22,669.62271238 I'm actually gonna Singapore for of course. 133 00:06:22,699.62271238 --> 00:06:23,569.62271238 Of course. 134 00:06:23,749.62271238 --> 00:06:25,639.62271238 I couldn't, I couldn't have one. 135 00:06:26,479.62271238 --> 00:06:30,559.62271238 I couldn't have one to find James Travel to. 136 00:06:30,588.11137451 --> 00:06:33,258.11137451 I guess, to I, I guess. 137 00:06:34,248.11137451 --> 00:06:37,189.62271238 But, uh, you I'm not, I'm not even, I'm not even going to Vegas. 138 00:06:37,189.62271238 --> 00:06:39,679.62271238 I was just lying to what be cool and it doesn't even matter anymore. 139 00:06:39,738.11137451 --> 00:06:44,198.11137451 you set me up, Maybe but you know, but I. 140 00:06:44,524.61137451 --> 00:06:45,874.61137451 literally always traveling. 141 00:06:46,774.61137451 --> 00:06:48,94.61137451 I go down the street for my nails. 142 00:06:48,94.61137451 --> 00:06:49,504.61137451 Josh gets out of the country. 143 00:06:49,504.61137451 --> 00:06:50,469.62271238 James's like, Hmm. 144 00:06:50,524.61137451 --> 00:06:51,439.61137451 I'm middle of the continent guys. 145 00:06:52,389.62271238 --> 00:06:55,674.62271238 Yeah, I'm going to, I'm going to the mood with Elon. 146 00:06:55,679.61137451 --> 00:07:00,248.11137451 for? I'm doing a, like a keynote speak, uh, you know, no big deal. 147 00:07:00,308.11137451 --> 00:07:01,364.62271238 But, um, Hmm. 148 00:07:01,388.11137451 --> 00:07:06,898.11137451 know, at one of their hospitals and, you know, they've stuff, set up for me. 149 00:07:06,898.11137451 --> 00:07:08,758.11137451 So pretty, happy with that. 150 00:07:08,758.11137451 --> 00:07:13,479.61137451 But I do have a segue, Besides being very humble. 151 00:07:13,479.61137451 --> 00:07:15,293.11137451 I will say, not that Oh, yeah, yeah. 152 00:07:15,459.61137451 --> 00:07:18,369.61137451 but I, I know you're holding back and that's pretty cool. 153 00:07:18,369.61137451 --> 00:07:19,689.61137451 So kudos to you, man. 154 00:07:19,719.61137451 --> 00:07:20,788.11137451 That's Oh, thank you. 155 00:07:20,848.11137451 --> 00:07:21,208.11137451 Thank you. 156 00:07:21,388.11137451 --> 00:07:22,978.11137451 Maybe when I come back from it. 157 00:07:23,19.61137451 --> 00:07:25,108.11137451 sweet pedicure Yes. 158 00:07:25,889.62271238 --> 00:07:27,59.62271238 Well you gotta have some good ones there. 159 00:07:27,309.61137451 --> 00:07:27,759.61137451 speak. 160 00:07:28,324.62271238 --> 00:07:29,693.11137451 I, Wait, wait, wait, wait. 161 00:07:29,698.11137451 --> 00:07:29,968.11137451 Hold on. 162 00:07:30,293.11137451 --> 00:07:32,303.11137451 I think I see where your segue is going. 163 00:07:32,743.12271238 --> 00:07:33,763.12271238 I think I do too. 164 00:07:33,853.12271238 --> 00:07:34,363.12271238 I do too. 165 00:07:34,363.12271238 --> 00:07:34,783.12271238 Yeah. 166 00:07:35,168.11137451 --> 00:07:38,173.12271238 That, this flight that I'm Such nerds. 167 00:07:39,33.11137451 --> 00:07:39,653.11137451 Nailed it. 168 00:07:41,171.61137451 --> 00:07:51,41.61137451 So, I've heard that this may be the longest flight that's available that is nonstop flight. 169 00:07:51,701.61137451 --> 00:07:55,423.11137451 Uh, it is 19 hours from JFK Geez. 170 00:07:55,481.61137451 --> 00:07:56,351.61137451 to Singapore. 171 00:07:57,638.11137451 --> 00:07:58,353.12271238 Is there like a whoa. 172 00:07:59,18.11137451 --> 00:08:04,721.61137451 refuel in it? Like that is crazy to me that you can run a, run an airplane Yeah. 173 00:08:04,898.11137451 --> 00:08:06,128.11137451 hours on one tank. 174 00:08:06,911.61137451 --> 00:08:13,156.61137451 not an expert in aviation, but that sounds, uh, like a, paralytic through some of this, like yeah. 175 00:08:13,211.61137451 --> 00:08:16,181.61137451 Just, just, just a last like three hours. 176 00:08:16,571.61137451 --> 00:08:20,638.12271238 We just get on little, like parachute and just, I don't think I could do it. 177 00:08:21,148.12271238 --> 00:08:21,538.12271238 I would. 178 00:08:21,538.12271238 --> 00:08:22,288.12271238 I would lose it. 179 00:08:22,318.12271238 --> 00:08:23,698.12271238 Like 10 hours in, I'm out. 180 00:08:24,58.12271238 --> 00:08:25,183.12271238 I'm running up and down the aisles. 181 00:08:25,721.61137451 --> 00:08:34,261.61137451 Well, I wanted to ask you guys, and you guys all know where this segue is going to, but when I ask you like, long, let's say 10 plus hours flight. 182 00:08:34,291.61137451 --> 00:08:53,786.60003664 What do you guys bring, or are there things that you do knowing the risks that are associated with long-term flights? Like, are we, uh, risks, but, is there stuff that you, you think about, you do? this is, this is a very, make it this is an evasive, evasive segue here, Yeah, yeah. 183 00:08:53,996.60003664 --> 00:08:54,296.60003664 Hold on. 184 00:08:55,346.60003664 --> 00:08:59,280.10003664 I know, I mean, we, Now you've, I know, I know. 185 00:08:59,516.60003664 --> 00:09:00,206.60003664 the segue. 186 00:09:00,690.10003664 --> 00:09:01,740.10003664 Compression stockings. 187 00:09:02,100.10003664 --> 00:09:08,340.10003664 Why would one bring compression stockings to, long-term flights? I, I think that's what we're talking about here. 188 00:09:08,340.10003664 --> 00:09:11,700.10003664 So, Brody, you brought this topic to us. 189 00:09:11,790.10003664 --> 00:09:16,10.10003664 I think this is such an important topic That a lot of listeners wonder about. 190 00:09:16,80.10003664 --> 00:09:22,490.10003664 You are one of the first people to see patients who present with this, so, love to get your thought on this. 191 00:09:23,301.86874412 --> 00:09:32,591.86874412 The reason why I chose this is, the whole developing a blood clot, while traveling is one of probably the more common risks that we know, and we'll talk about risks later on. 192 00:09:32,741.86874412 --> 00:09:37,151.86874412 But the other thing that I find both fascinating but also a little bit devastating about. 193 00:09:37,556.86874412 --> 00:09:38,96.86874412 Blood clots. 194 00:09:38,96.86874412 --> 00:09:42,476.86874412 And again, we're really talking about deep vein thrombosis and pulmonary embolism, and we'll talk about that as in a minute. 195 00:09:42,776.86874412 --> 00:09:52,856.86874412 But I think these are also things that can be hard to diagnose in the emergency department and can be hard to separate from other people presenting with things like chest pain or shortness of breath. 196 00:09:53,546.86874412 --> 00:10:01,526.86874412 And unfortunately, couple of years there is someone who is college age student who presents to them. 197 00:10:01,556.86874412 --> 00:10:04,475.36874412 The emerge with chest pain or shortness of breath, gets Hmm. 198 00:10:04,796.86874412 --> 00:10:07,136.86874412 gets worked up, gets sent home. 199 00:10:07,556.86874412 --> 00:10:12,56.86874412 And then unfortunately dies, right? Um, and, and, or like they come back a second or third time. 200 00:10:12,86.86874412 --> 00:10:21,686.86874412 And it's just something that, I think because of that, because of the, the risk of if it's missed and it's not caught early, you're not, you know, you're not given those interventions. 201 00:10:21,896.86874412 --> 00:10:25,16.86874412 It really is a life-threatening diagnosis. 202 00:10:25,106.86874412 --> 00:10:29,126.86874412 Um, but doesn't always present in showing up that you're super sick with it. 203 00:10:29,126.86874412 --> 00:10:31,80.36874412 And that's one thing that I find also Mm-hmm. 204 00:10:31,166.86874412 --> 00:10:37,496.86874412 medicine, but really the, variety of which how patients with the same disease can present, right? They can be really sick and not sick. 205 00:10:37,576.86874412 --> 00:10:39,676.86874412 That's what what I found is really interesting about it. 206 00:10:39,676.86874412 --> 00:10:43,486.86874412 Hopefully also what the listeners will find interesting about it. 207 00:10:43,546.88008199 --> 00:10:45,31.86874412 Yeah, Um, yeah. 208 00:10:45,211.88008199 --> 00:10:52,81.88008199 I think it, I think it brings up a good just general concept that most people with most diseases do really, really well. 209 00:10:52,651.88008199 --> 00:10:58,501.88008199 They're diagnosed and honestly, even some of the ones that aren't diagnosed do just fine or don't even know they have an issue and do fine. 210 00:10:59,11.88008199 --> 00:11:03,211.88008199 But we talk about the outliers 'cause those are the ones we really wanna prevent. 211 00:11:03,451.88008199 --> 00:11:06,871.88008199 And this is a perfect, uh, perfect topic to, to get into that. 212 00:11:07,361.86874412 --> 00:11:13,451.88008199 Yeah, So I thought maybe I'd start off with talking about what is a blood clot, and, I think the important thing to remember is. 213 00:11:13,765.21341532 --> 00:11:18,653.71341532 Developing a blood clot or your blood clotting is a totally normal and life-saving Mm-hmm. 214 00:11:18,815.21341532 --> 00:11:24,75.21341532 right? Like you cut Yeah, you want to develop a clot so you don't bleed out from having like a. 215 00:11:24,575.21341532 --> 00:11:29,45.21341532 Nicked your leg or your chin, right? Like, these are things that yeah, that the body does most of the time. 216 00:11:29,355.21341532 --> 00:11:29,655.21341532 Yeah. 217 00:11:29,711.71341532 --> 00:11:42,741.71341532 And one of the ways to think about like what a clot is, is kind of thinking it as like your like emergency road repair crew, right? So you cut yourself and then the crew goes out and it know, what Platelets and clotting uh, on it. 218 00:11:42,741.71341532 --> 00:11:46,191.71341532 But really you are trying to stop whatever bleeding that you have by doing that. 219 00:11:46,521.71341532 --> 00:11:49,191.71341532 And that's helpful when you're sealing a wound. 220 00:11:49,251.71341532 --> 00:11:54,231.71341532 But it's harmful if you're just randomly putting a clot inside of blood vessels right. 221 00:11:54,321.71341532 --> 00:11:56,743.38008199 So kind of the complete. 222 00:11:56,793.38008199 --> 00:12:03,460.04674866 Contrary to blood clot is patients who have hemophilia, you know, it's inability to produce clot. 223 00:12:03,580.04674866 --> 00:12:19,510.04674866 And because of that, if you, get cut while shaving or if you get little, lacerations, difficulty to stop the bleeding, the blood clot is a natural thing that you need to help, stop the bleed and it's very essential like Brody said. 224 00:12:19,850.04674866 --> 00:12:27,603.38008199 So tell us, little bit about, what is a normal and abnormal in terms of deep vein thrombosis and pulmonary embolism. 225 00:12:28,704.88008199 --> 00:12:31,584.88008199 Depending on where you clot in the body, it's all cause different things. 226 00:12:31,584.88008199 --> 00:12:36,84.88008199 If you have a blood clot in your brain, it's a stroke, a blood clots in your arteries of your heart, it's a heart attack., 227 00:12:36,84.88008199 --> 00:12:46,54.88008199 And Maybe, jumping back to this patching potholes theory the normal clotting process is there's some sort of, injury to the blood vessel that you are repairing so you're not bleeding out, and that's a normal process. 228 00:12:46,234.88008199 --> 00:12:54,334.88008199 But when you have abnormal clotting, it's kind of the equivalent of like a road repair crew throwing a bunch of asphalt in the middle of the highway, right? Everyone's gonna slow down. 229 00:12:54,634.88008199 --> 00:12:57,904.88008199 You're gonna have, traffic jams and crash into each other. 230 00:12:57,904.88008199 --> 00:13:00,214.88008199 That's exactly what happens within the blood vessel system as well. 231 00:13:00,214.88008199 --> 00:13:05,34.89141986 And This is, um, otherwise, otherwise known as Toronto, Ontario, Canada. 232 00:13:05,154.89141986 --> 00:13:05,244.89141986 Yeah. 233 00:13:05,404.88008199 --> 00:13:08,974.88008199 So if you have Toronto in your legs, you have, yeah. 234 00:13:09,274.88008199 --> 00:13:13,864.88008199 So what we're talking about today are really two entities of where you develop these blood clots. 235 00:13:13,864.88008199 --> 00:13:16,349.88008199 And so one is called a deep vein thrombosis or a DVT. 236 00:13:17,449.88008199 --> 00:13:22,379.88008199 And this is when you form a blood clot in the deep veins of your extremities. 237 00:13:22,399.88008199 --> 00:13:24,149.88008199 Most of the time we're talking about your leg. 238 00:13:24,149.88008199 --> 00:13:27,259.88008199 So this is a blood clot in the back of the knee or the back of the thigh. 239 00:13:27,479.88008199 --> 00:13:32,539.88008199 Some people can get it in their arms, but for the most part, most of the time we're talking about deep vein thrombosis. 240 00:13:32,539.88008199 --> 00:13:39,189.88008199 We're really talking about in the legs and then the other one that we're talking about is something called the pulmonary embolism or a pe. 241 00:13:39,439.88008199 --> 00:13:44,599.88008199 And most of the time, I would say when people develop a PE it's because there's been a blood clot in the leg. 242 00:13:44,599.88008199 --> 00:13:47,299.88008199 They have a DVT and it gets dislodged. 243 00:13:47,389.88008199 --> 00:13:50,479.88008199 It travels through the, the venous system up into the heart. 244 00:13:50,479.88008199 --> 00:13:54,739.88008199 And then this blood clot launches off and goes to the lungs and that's where it gets stuck. 245 00:13:54,739.88008199 --> 00:13:59,659.88008199 'cause now all of a sudden the, the blood vessels of the arteries are gonna get smaller and smaller to that level. 246 00:13:59,659.88008199 --> 00:14:01,63.38008199 So that's where they get stuck Mm-hmm. 247 00:14:01,69.88008199 --> 00:14:02,959.88008199 And that's a PE or pulmonary embolism. 248 00:14:03,349.88008199 --> 00:14:16,329.88008199 So it's a bit of a two step process, right? So there's a blood clot that has developed in dependent areas of the body where blood stays more static or blood doesn't move too much. 249 00:14:16,389.88008199 --> 00:14:23,379.88008199 And then it is more the, the environment is more conducive to developing clots. 250 00:14:23,859.88008199 --> 00:14:35,979.88008199 And then, eventually, these venous flow come back to the heart and that where the blood is received and first place it goes to is the lungs or the blood vessels in the lungs. 251 00:14:35,979.88008199 --> 00:14:38,319.88008199 And that's when it becomes the pulmonary embolism. 252 00:14:38,769.88008199 --> 00:14:39,566.39141986 So Yep. 253 00:14:39,609.88008199 --> 00:14:46,809.88008199 I think it brings up why I talked about long flight as a segue in a very unsuccessful manner. 254 00:14:47,649.88008199 --> 00:14:52,656.54674866 But, tell us about, what these risk factors are that people develop, DVT. 255 00:14:54,246.54674866 --> 00:14:56,616.54674866 You know, pathophysiologically, why this happens. 256 00:14:57,413.04674866 --> 00:14:57,703.04674866 Yeah. 257 00:14:57,813.04674866 --> 00:14:58,103.04674866 Yeah. 258 00:14:58,963.05808653 --> 00:14:59,888.05808653 And James, thanks. 259 00:14:59,888.05808653 --> 00:15:07,88.05808653 Thanks for, thanks for taking ownership of your, um, what do we call this? Misq? We'll call it a misq. 260 00:15:07,416.54674866 --> 00:15:07,806.54674866 Yeah. 261 00:15:07,926.54674866 --> 00:15:09,861.54674866 I mean, it was a C by the side best. 262 00:15:10,658.05808653 --> 00:15:10,928.05808653 Yeah. 263 00:15:10,983.04674866 --> 00:15:13,733.05808653 and I will allow us to move on and Yeah. 264 00:15:14,133.04674866 --> 00:15:15,393.04674866 keeping that in for the editing. 265 00:15:16,1.54674866 --> 00:15:19,331.54674866 I'm sorry for the, the three minutes that I wasted at the top of the show. 266 00:15:20,258.04674866 --> 00:15:20,468.04674866 Yeah. 267 00:15:20,858.04674866 --> 00:15:25,58.04674866 Oh, we have so many more minutes to apologize to our listeners for, for, for wasting. 268 00:15:25,58.04674866 --> 00:15:26,318.04674866 And that was three minutes, man. 269 00:15:27,883.05808653 --> 00:15:30,373.05808653 How many podcasts, times how many minutes? Yeah. 270 00:15:31,898.04674866 --> 00:15:32,766.54674866 Um, Yeah. 271 00:15:32,768.04674866 --> 00:15:53,83.04674866 yeah, what I always find interesting about really the history of medicine are just like, you know how you like have these, like overachievers, like, yes James, I know you're getting flown across the world for a keynote speaker, and, Yeah, yada, by the president of a country and just like But whatever There's just something, but like those old school, like clinicians from like the 17 hundreds. 272 00:15:53,233.04674866 --> 00:15:57,613.04674866 It just, it's a Usually from Eastern Europe I feel like, And all. 273 00:15:57,613.04674866 --> 00:15:57,883.04674866 Yeah. 274 00:15:58,423.04674866 --> 00:16:04,76.54674866 So of that, uh, Rudolph au uh. 275 00:16:04,153.04674866 --> 00:16:11,628.04674866 was a, a German physician scientist, which among a bunch of things, developed this mechanism,, that he proposed for how. 276 00:16:12,533.04674866 --> 00:16:13,913.04674866 Blood clots essentially. 277 00:16:13,913.04674866 --> 00:16:18,23.04674866 And he came up with, as they did in the day, naming something after themselves. 278 00:16:18,23.04674866 --> 00:16:20,183.04674866 So came up with something called Ver Cows Triad. 279 00:16:20,563.04674866 --> 00:16:25,573.04674866 And this kind of really helps you think about what are your three main risk factors for developing blood clots. 280 00:16:25,793.04674866 --> 00:16:32,213.04674866 Besides that, again, for talking about kinda overachieve achievers, he also came up with the theory that all cells arise from other. 281 00:16:32,603.04674866 --> 00:16:33,863.04674866 Preexisting cells. 282 00:16:34,23.04674866 --> 00:16:38,973.04674866 He was the first person to recognize leukemia and also developed modern day autopsy technique. 283 00:16:38,973.04674866 --> 00:16:40,253.0580865 So again, Yeah. 284 00:16:40,323.0467487 --> 00:16:42,786.5467487 want to talk about someone who did a whole lot Wow. 285 00:16:43,94.5031221 --> 00:16:48,284.5031221 So the, the three things in OSes triad for risk factors for developing blood clots are stasis. 286 00:16:48,284.5031221 --> 00:16:51,254.5031221 So Jamie, you're talking about these are things where you're not moving as well. 287 00:16:51,254.5031221 --> 00:17:04,904.5031221 So things like long flights, you're in bed rest, you're in a cast, and, and again, we think about the reason for that, right? So again, your heart does a really good job for pumping blood to where it needs to go right through your arteries, but let it gets down to your legs. 288 00:17:04,934.5031221 --> 00:17:06,464.5031221 Now it's fighting against gravity. 289 00:17:06,464.5031221 --> 00:17:07,574.5031221 Get back to your heart. 290 00:17:07,964.5031221 --> 00:17:10,913.0031221 And it doesn't actually have enough momentum to do Mm-hmm. 291 00:17:10,964.5031221 --> 00:17:11,564.5031221 its own. 292 00:17:11,854.5031221 --> 00:17:24,514.5031221 So, you know,, your veins have these valves in it and it's really dependent on you moving your muscles and moving around and walking or squeezing your legs and doing all those things that then compresses the veins, shoots it up your blood vessel a little bit and then it can't go back down. 293 00:17:24,544.5031221 --> 00:17:25,834.5031221 'cause there's valves in your veins. 294 00:17:25,934.5031221 --> 00:17:31,334.5031221 And that's why, you know, people over time, if they develop leaking of their veins, might get swelling of their legs as well, for example. 295 00:17:31,334.5031221 --> 00:17:40,394.5031221 So anytime that you have prolonged periods that you're not moving your legs, stretching, walking, using those muscles in your legs, especially again, that blood flow gets impaired. 296 00:17:40,434.5031221 --> 00:17:46,824.5031221 He's at a higher risk though whenever things are just stagnant and not moving around as well, they have a higher risk for then developing a clot. 297 00:17:46,824.5031221 --> 00:17:47,904.5031221 So that's one of them. 298 00:17:48,924.5031221 --> 00:17:50,304.5031221 is vessel injury. 299 00:17:50,304.5031221 --> 00:17:52,764.5031221 And again, I don't think that's a surprise to any of the listeners. 300 00:17:52,764.5031221 --> 00:17:56,4.5031221 You know, we talk about inflammation as being a big cause of. 301 00:17:56,99.5031221 --> 00:18:01,169.5031221 All sorts of different conditions that we have and it's very similar or kind of that like blood vessel level. 302 00:18:01,169.5031221 --> 00:18:13,709.5031221 So if you have surgery, and it doesn't have to just be surgery on your blood vessels themselves, but if you have surgery on the bones nearby, there's gonna be swelling if you have surgery in the general area, there's just gonna be inflammation afterwards. 303 00:18:13,709.5031221 --> 00:18:20,309.5031221 All all of those inflammatory markers and things that go around that again are gonna be then relayed to the blood vessels nearby. 304 00:18:20,519.5031221 --> 00:18:21,238.0031221 And Mm-hmm. 305 00:18:21,269.5031221 --> 00:18:23,159.5031221 trauma, right? Surgery is really, I'd say like. 306 00:18:23,919.5031221 --> 00:18:26,979.5031221 Precision or in intentional trauma. 307 00:18:28,273.0031221 --> 00:18:28,633.0031221 Yeah. 308 00:18:28,663.0031221 --> 00:18:29,353.0031221 Controlled. 309 00:18:30,103.0031221 --> 00:18:30,613.0031221 Hopefully. 310 00:18:30,699.5031221 --> 00:18:32,203.0031221 side of the face, like you Yeah. 311 00:18:32,349.5031221 --> 00:18:33,678.0031221 a car and Yeah. 312 00:18:33,759.5031221 --> 00:18:34,29.5031221 chest. 313 00:18:34,64.51446 --> 00:18:34,334.51446 hmm. 314 00:18:34,479.5031221 --> 00:18:38,204.51446 those are also potentially like, you know, there Intentional trauma. 315 00:18:38,209.51446 --> 00:18:38,449.51446 Yeah. 316 00:18:38,559.5031221 --> 00:18:38,979.5031221 things. 317 00:18:38,979.5031221 --> 00:18:39,279.5031221 Yeah. 318 00:18:39,639.5031221 --> 00:18:40,368.0031221 Like, Mm-hmm. 319 00:18:40,419.5031221 --> 00:18:46,569.5031221 um, so anytime there's, there's an injury to the blood vessel or the, or the vicinity of blood vessels, that's also a risk factor. 320 00:18:47,229.5031221 --> 00:18:52,989.5031221 And the last is, is something called hypercoagulability, which is really just kind of your innate body's. 321 00:18:55,44.5031221 --> 00:18:56,964.5031221 or likelihood of developing clots. 322 00:18:56,964.5031221 --> 00:19:03,114.5031221 And there's certain things that we know that, that are conditions that adjust the proteins in your body that make you more likely to form blood. 323 00:19:03,114.5031221 --> 00:19:04,584.5031221 Clot seed are things like cancer. 324 00:19:04,974.5031221 --> 00:19:09,234.5031221 Sometimes there are genetic conditions people are born with that make them more likely to develop blood clots. 325 00:19:09,384.5031221 --> 00:19:18,684.5031221 And the other one, and this is where again, I kind of think about those examples, kinda college age students, especially female that are presenting with chest pain or difficulty breathing is birth control pills. 326 00:19:18,759.5031221 --> 00:19:19,713.0031221 Like, or Mm-hmm. 327 00:19:20,589.5031221 --> 00:19:24,489.5031221 Again, from a hormonal level, there seems to be something as well that's there. 328 00:19:24,519.5031221 --> 00:19:28,629.5031221 That's, that puts people at a higher risk for developing clots, just being on a birth control pill. 329 00:19:29,13.0031221 --> 00:19:29,433.0031221 Mm-hmm. 330 00:19:29,439.5031221 --> 00:19:32,553.0031221 And so those are kind of the, the three main things that, um, Mm-hmm. 331 00:19:32,559.5031221 --> 00:19:32,769.5031221 about. 332 00:19:34,519.51446 --> 00:19:51,289.51446 What's really interesting is that all these risk factors and this whole Virgos triad thing that you talked about, this was over a hundred years ago, and we are still using it as the mainstay of how this happens, why this happens, and actually how to diagnose it in some cases to use some risks based on that. 333 00:19:51,439.51446 --> 00:19:56,569.51446 It's pretty wild that a hundred plus years, nothing has changed and he got it right back then, which is really impressive. 334 00:19:56,659.51446 --> 00:20:03,573.0031221 'cause that's when they were like using leeches and, I don't know, just he was just putting, to figure out what a cell The bloodletting. 335 00:20:03,903.0031221 --> 00:20:04,233.0031221 Yeah. 336 00:20:04,354.51446 --> 00:20:12,839.5031221 yeah, Um, do you guys know that there's a bit of a, a segue, fun? I I wanna tell a story just briefly, Yes, Ooh, I like story, Yeah. 337 00:20:13,203.0031221 --> 00:20:13,423.0031221 yes. 338 00:20:13,474.51446 --> 00:20:14,854.51446 story time with Brody. 339 00:20:14,854.51446 --> 00:20:15,154.51446 Nolan. 340 00:20:15,209.5031221 --> 00:20:28,969.51446 than to reference a story? Um, so if I say the author, because I'll make it specific, so I'm not grateful with names, but I've seen the author, Margaret Wise Brown, without looking at notes, do you guys know, would you, would you have known who that is if I No, no, I, I Not a chance. 341 00:20:29,123.0031221 --> 00:20:29,343.0031221 no. 342 00:20:29,849.51446 --> 00:20:30,994.51446 I was very surprised. 343 00:20:31,289.5031221 --> 00:20:34,499.5031221 Two dads, do you know the story? Goodnight Moon. 344 00:20:34,584.51446 --> 00:20:35,124.51446 Yes. 345 00:20:35,124.51446 --> 00:20:36,954.51446 And I have it in French and English. 346 00:20:36,954.51446 --> 00:20:39,559.5031221 I, Oh, Okay. 347 00:20:39,849.51446 --> 00:20:41,664.51446 yep, yep, yep. 348 00:20:41,844.51446 --> 00:20:42,714.51446 That's how I roll. 349 00:20:43,309.5031221 --> 00:20:50,24.51446 the author of Goodnight Bois, something I have definitely read, probably combined at least a thousand times for my case, Mm-hmm. 350 00:20:50,539.5031221 --> 00:20:51,219.51446 and was Good. 351 00:20:51,229.5031221 --> 00:20:53,233.0031221 revolutionary novel for the Uhhuh. 352 00:20:53,829.51446 --> 00:20:54,489.51446 Hey, Brody. 353 00:20:54,579.51446 --> 00:20:55,89.51446 Brody. 354 00:20:55,689.51446 --> 00:20:56,79.51446 Good night. 355 00:20:56,79.51446 --> 00:20:56,619.51446 Mittens. 356 00:20:56,744.4308629 --> 00:20:57,674.4308629 goodnight Kittens. 357 00:20:58,352.9308629 --> 00:20:59,991.4308629 Anyways, the, Josh, that's coming to you. 358 00:21:00,62.9308629 --> 00:21:10,557.9422007 that was cool, the time the whole like, and you start is that it's obviously a book about trying to put your kids to bed, which although has some like very questionable and somewhat terrifying, uh, diagrams and illustrations in it from the Yeah. 359 00:21:10,592.9308629 --> 00:21:11,102.9308629 book to the end of the book. 360 00:21:11,102.9308629 --> 00:21:15,2.9308629 The book actually gets it darker so that by the time you're on the last page, it's like clearly nighttime. 361 00:21:15,32.9308629 --> 00:21:16,472.9308629 Anyways, kudos. 362 00:21:16,817.9308629 --> 00:21:22,966.4308629 To Margaret Weis Brown, um, while she was doing, uh, she's actually on a book Hmm. 363 00:21:22,997.9308629 --> 00:21:25,517.9308629 I don't think, for Goodnight Moon, um, in, in France. 364 00:21:25,817.9308629 --> 00:21:28,367.9308629 Um, she's 42 at the time, and she had a ruptured appendix. 365 00:21:29,417.9308629 --> 00:21:36,17.9308629 And went to hospital, as you do when you have her a ruptured appendix and had surgery for her ruptured appendix as you do when you have a ruptured appendix. 366 00:21:36,437.9308629 --> 00:21:41,507.9308629 And, um, according to her autobiography, a few days after she had the surgery, she was feeling so well. 367 00:21:41,507.9308629 --> 00:21:44,601.4308629 The doctor came in to check on her doing the rounds, probably James Mm-hmm. 368 00:21:45,437.9308629 --> 00:21:51,621.4308629 and she did like a CanCan motion, like kicking her leg in the air to show how great she was feeling, and Mm-hmm. 369 00:21:51,887.9308629 --> 00:21:54,407.9308629 off a clot and collapsed and died. 370 00:21:55,67.9308629 --> 00:21:55,697.9308629 Um. 371 00:21:56,422.9422007 --> 00:22:00,202.9422007 Is this real? this is real, like, I'm not, like, We fact, we fact check this. 372 00:22:00,212.9308629 --> 00:22:05,702.9308629 on like D-V-T-P-E and trying to, like, this is like this Well, It is, it is uh, Yeah. 373 00:22:05,872.9422007 --> 00:22:07,972.9422007 believe you and I have a question though, James. 374 00:22:07,972.9422007 --> 00:22:12,992.9308629 How many of your surgical patients do can, can kicks to show you how well they're doing? Yeah. 375 00:22:13,232.9308629 --> 00:22:16,942.9422007 Oh, uh, she, she Hasn't happened yet, but a Yeah. 376 00:22:17,222.9308629 --> 00:22:17,492.9308629 history. 377 00:22:17,492.9308629 --> 00:22:25,113.2641962 If you wanna read more about like her and her life As a surgeon, is there anything that you're giving patients all Yeah. 378 00:22:25,259.7641962 --> 00:22:26,313.2641962 while they're Yeah. 379 00:22:26,433.2641962 --> 00:22:28,698.2641962 What you're talking about, I mean, this is not for everybody. 380 00:22:29,613.2641962 --> 00:22:33,13.2641962 undergoing surgery, for short surgery. 381 00:22:33,13.2641962 --> 00:22:35,983.2641962 And then you expect the patients to be mobile right? Immediately after. 382 00:22:35,983.2641962 --> 00:22:48,3.2641962 We don't give this, but for patients who's gonna have a longer surgery, major surgery, who we expect to be bedridden for some period of time, then we would give some sort of pharmacologic, blood thinner. 383 00:22:48,153.2641962 --> 00:22:54,963.2641962 But on top of them, more importantly, we also do, physical, maneuvers to help them not develop clots. 384 00:22:54,963.2641962 --> 00:22:57,843.2641962 So these are things like sequential compression stockings. 385 00:22:57,893.2641962 --> 00:23:08,513.2641962 So these are compression stockings that we slap onto the calf and kind of give massage and periodic motion so that the blood is flowing to the heart. 386 00:23:08,853.2641962 --> 00:23:11,223.2641962 I would love to have this in my, in my own home. 387 00:23:11,223.2641962 --> 00:23:14,239.7755341 Just for I have, little pedicure them on right now. 388 00:23:14,449.7755341 --> 00:23:14,659.7755341 Yeah. 389 00:23:14,733.2641962 --> 00:23:16,983.2641962 Yeah, yeah, yeah, exactly. 390 00:23:18,259.7755341 --> 00:23:18,979.7755341 That's awesome. 391 00:23:19,353.2641962 --> 00:23:21,349.7755341 motion and Exactly. 392 00:23:21,659.7641962 --> 00:23:22,469.7641962 yeah, yeah. 393 00:23:22,559.7641962 --> 00:23:23,629.7755341 I didn't look into the I. 394 00:23:24,239.7641962 --> 00:23:28,98.2641962 One, to confirm there's a bit of, like, some of the stories say that she died of, of Mm. 395 00:23:28,199.7641962 --> 00:23:30,869.7641962 going to her brain, which would be very weird unless she had a hole in her heart. 396 00:23:30,869.7641962 --> 00:23:31,878.2641962 I'm not Mm-hmm. 397 00:23:32,399.7641962 --> 00:23:40,183.2641962 Um, but, uh, I didn't dive into the medicine practices of the 1940s, whether or not DVT prophylaxis or Mm-hmm. 398 00:23:40,229.7641962 --> 00:23:43,393.2641962 you know, uh, blood thinners routinely in hospital was part of Mm-hmm. 399 00:23:43,589.7641962 --> 00:23:46,199.7641962 anyways, And just, and just to further that, it's. 400 00:23:46,309.7755341 --> 00:23:52,909.7755341 to further that, from what James is saying, the reality is 90 plus percent of patients in hospital are on blood thinners for prophylaxis these days. 401 00:23:53,339.7755341 --> 00:24:03,269.7755341 Most of my patients, unless you are remarkably mobile or you have a bleeding risk or you're going for a surgery or something like that, you're on blood thinners in hospital, it's usually a little injection just in the skin of the belly. 402 00:24:03,689.7755341 --> 00:24:07,19.7755341 Um, and most of the time we forgot to tell you that you're going to be on it. 403 00:24:07,79.7755341 --> 00:24:13,49.7755341 So if you were in hospital and you get a little injection in your, in your skin, in your belly, sorry, we didn't tell you why. 404 00:24:13,524.7641962 --> 00:24:13,764.7641962 Yeah,. 405 00:24:13,954.7641962 --> 00:24:19,264.7641962 We've kind of talked about some treatment stuff, but why do we get into Brody? What does this look like? You're seeing people in the emerge. 406 00:24:19,264.7641962 --> 00:24:21,304.7641962 You're the first line to diagnose these things. 407 00:24:21,874.7641962 --> 00:24:27,705.4444683 How are they presenting? What are you seeing? Yeah, What are you doing? Think of DVT and PE as presenting quite differently. 408 00:24:28,18.7778016 --> 00:24:29,863.7778016 DVT, again, this is a blood clot in the leg. 409 00:24:30,718.7778016 --> 00:24:34,828.7778016 you see things then that are a result of impaired blood flow to the leg. 410 00:24:34,828.7778016 --> 00:24:42,698.7778016 So your leg is gonna be swollen 'cause the blood's not gonna be able to get out through your veins as well as it's because of that, it's often red because you have inflammation. 411 00:24:42,698.7778016 --> 00:24:45,338.7778016 Sometimes you can have a concurrent infection on top of it. 412 00:24:45,758.7778016 --> 00:24:50,588.7778016 And because you have swelling and redness, you will also probably have pain as a way for showing that. 413 00:24:50,588.7778016 --> 00:24:53,258.7778016 So usually, you know, the classic sign for this is something coming in with. 414 00:24:53,918.7778016 --> 00:25:00,128.7778016 single leg that's red and swollen and tender is very rare, not impossible. 415 00:25:00,158.7778016 --> 00:25:03,878.7778016 Very rare to get a blood clot in both of your legs at the same time. 416 00:25:03,878.7778016 --> 00:25:04,677.2778016 That's Mm-hmm. 417 00:25:04,688.7778016 --> 00:25:07,568.7778016 more of like an infection or heart failure. 418 00:25:07,587.2778016 --> 00:25:08,7.2778016 Mm-hmm. 419 00:25:08,108.7778016 --> 00:25:10,378.7891395 might be going on, but that's Or someone. 420 00:25:10,438.7891395 --> 00:25:16,258.7891395 Or someone who has ignored, someone who's ignored one side for long enough that it developed in the other side, which I've seen. 421 00:25:16,408.7891395 --> 00:25:16,618.7891395 Yeah. 422 00:25:17,33.7778016 --> 00:25:19,433.7778016 Um, and then, and then the pulmonary embolism one. 423 00:25:19,433.7778016 --> 00:25:20,723.7778016 Those things are really interesting. 424 00:25:20,903.7778016 --> 00:25:25,17.2778016 'cause I'll be honest, the, the longer I practice the more Yeah. 425 00:25:25,223.7778016 --> 00:25:26,753.7778016 of patients presenting with complaints. 426 00:25:26,753.7778016 --> 00:25:27,177.2778016 So like Mm-hmm. 427 00:25:28,163.7778016 --> 00:25:30,143.7778016 would be someone who has chest pain. 428 00:25:30,443.7778016 --> 00:25:33,623.7778016 And normally we describe this as like a quote unquote pleuritic chest pain. 429 00:25:33,623.7778016 --> 00:25:36,773.7778016 So it's like a, a, a lung inflammation type of chest pain. 430 00:25:36,773.7778016 --> 00:25:40,812.2778016 So this is, it hurts, it's sharp when you take a deep breath Mm-hmm. 431 00:25:40,823.7778016 --> 00:25:43,13.7778016 It doesn't really, you can't really push on it. 432 00:25:43,13.7778016 --> 00:25:43,973.7778016 It doesn't feel better. 433 00:25:43,973.7778016 --> 00:25:47,567.2778016 It isn't necessarily a pain that gets worse when you walk around or Mm-hmm. 434 00:25:47,603.7778016 --> 00:25:57,413.7778016 but again, because you're impairing the flow of oxygen and, and delivery of the, uh, of oxygen to the rest of your body, people do often feel short of breath associated with that. 435 00:25:57,627.2778016 --> 00:25:58,47.2778016 Mm-hmm. 436 00:25:58,433.7778016 --> 00:26:04,553.7778016 in extreme cases, if it's a big enough clot or it's been going on long enough, people present with extreme things like coughing up blood. 437 00:26:04,699.1224609 --> 00:26:07,772.6224609 Or they've collapsed or have passed out, et cetera, Yeah. 438 00:26:07,849.1224609 --> 00:26:10,249.1224609 like they're going to pass out when they kind of exert themselves. 439 00:26:10,529.1224609 --> 00:26:17,489.1224609 And so for me, I think what's really important is I think of,, these young, healthy people that are coming in that have a bit of a risk factor. 440 00:26:17,489.1224609 --> 00:26:18,509.1224609 And honestly for like. 441 00:26:19,344.1224609 --> 00:26:21,804.1224609 women, it might be their only risk factor that they're on birth control. 442 00:26:21,804.1224609 --> 00:26:33,924.1224609 But when I hear the story that I go to the gym or do exercise four or five times a week or more, and I now over the last week, I get shorter breath going up a flight of stairs, I have a little like twinge of pain somewhere. 443 00:26:33,924.1224609 --> 00:26:37,404.1224609 Sometimes my chest, sometimes it's my shoulders or between my shoulder blades. 444 00:26:37,794.1224609 --> 00:26:40,314.1224609 That for me is like immediate kind of red flag. 445 00:26:40,534.1224609 --> 00:26:44,697.6224609 Especially if I see that some of their vital signs are off, if their heart rate's higher than I would expect if their Right. 446 00:26:44,734.1224609 --> 00:26:45,274.1224609 a little bit lower. 447 00:26:45,274.1224609 --> 00:26:47,704.1224609 But those are the, the kind of classic symptoms that we think about. 448 00:26:48,539.1337988 --> 00:26:48,749.1337988 Yeah. 449 00:26:48,809.1337988 --> 00:26:55,879.1337988 And it's come up before in that the textbooks are great,, but they are the average presentation and they're what we have to teach medical students. 450 00:26:55,969.1337988 --> 00:26:58,219.1337988 But the reality is most people don't present like textbooks. 451 00:26:58,429.1337988 --> 00:27:01,969.1337988 So you have to have a really high in index of suspicion for these kinds of things. 452 00:27:02,119.1337988 --> 00:27:08,269.1337988 And we'll probably talk a little bit more about we over test for these things over test is not a bad thing in this case. 453 00:27:08,449.1337988 --> 00:27:09,799.1337988 We'll talk a little bit about that later., 454 00:27:10,19.1337988 --> 00:27:13,259.1337988 Because the textbook is not how people present. 455 00:27:13,739.1337988 --> 00:27:15,972.6224609 Yep, And, I've definitely had and, that are like, yeah. 456 00:27:16,44.1224609 --> 00:27:16,974.1224609 kidney stone. 457 00:27:17,4.1224609 --> 00:27:17,304.1224609 Right. 458 00:27:17,304.1224609 --> 00:27:17,969.1337988 Like they have yep. 459 00:27:17,994.1224609 --> 00:27:18,882.6224609 around their Right. 460 00:27:18,924.1224609 --> 00:27:23,292.6224609 it's, it's a blood clot, right? Like, or they think Yeah, They're coughing up a bunch of stuff and Yeah. 461 00:27:24,114.1337988 --> 00:27:24,404.1337988 yeah. 462 00:27:24,689.1337988 --> 00:27:27,869.1337988 Now again, listeners, most of the time it's, most of the time it's not a blood clot. 463 00:27:28,199.1337988 --> 00:27:32,399.1337988 Most of the time your pain that you don't think his blood clot is not, not the most top of yeah. 464 00:27:32,442.6224609 --> 00:27:33,479.1337988 know, differential Yeah. 465 00:27:33,479.1337988 --> 00:27:33,539.1337988 Yeah. 466 00:27:33,942.6224609 --> 00:27:55,292.6224609 But just to add on, some of the symptoms and signs that you've said, Brody, the deep vein thrombosis, you talked about unilateral or one side leg swelling, and that's different from the other type of leg swelling we talked about in previous episodes, which is both sides, like swelling, pitting, edema that we see from like heart failures, chronic kidney diseases and things like that. 467 00:27:55,682.6224609 --> 00:27:59,342.6224609 Versus this swelling on the one side and the other side is completely fine. 468 00:27:59,372.6224609 --> 00:28:07,442.6224609 And unless there was a trauma associated, you have to kind of raise a suspicion of whether this could be deep vein thrombosis. 469 00:28:07,622.6224609 --> 00:28:09,2.6224609 In the hospital setting. 470 00:28:09,842.6224609 --> 00:28:10,292.6224609 agree. 471 00:28:10,292.6224609 --> 00:28:23,772.6224609 These are the textbook kind of signs and symptoms, but if there's tachycardia or a high heart rate that, you know, sometimes even is enough to raise suspicion of whether there's a blood clot in this patient. 472 00:28:23,772.6224609 --> 00:28:33,132.6224609 So, atypical presentations, and we want to have high suspicions for these because the consequences could be devastating. 473 00:28:33,132.6224609 --> 00:28:38,942.6224609 So tell us about, what we do to diagnose, DVT and pe Brody and, Uh, and Josh. 474 00:28:39,679.1337988 --> 00:28:42,379.1337988 and, and maybe this is, this is gonna get into diagnosis. 475 00:28:42,379.1337988 --> 00:28:47,719.1337988 Do you guys remember in med school that we were taught to measure the calves? Like we actually had a little tape measures. 476 00:28:47,719.1337988 --> 00:28:52,309.1337988 We wrapped around the calves to see if they were as Yeah, this was part of the physical exam when we learned. 477 00:28:52,729.1337988 --> 00:28:52,999.1337988 Yep. 478 00:28:53,149.1337988 --> 00:28:53,539.1337988 Yeah. 479 00:28:53,539.1337988 --> 00:28:53,549.1337988 Yeah. 480 00:28:53,869.1337988 --> 00:28:59,29.1337988 And um, I, I remember I had to, if my brother's listening, sorry, Aaron, um, my brother was worried. 481 00:28:59,29.1337988 --> 00:29:01,489.1337988 He had one of these after a long flight and I was in med school. 482 00:29:01,489.1337988 --> 00:29:02,539.1337988 I didn't know what the hell I was doing. 483 00:29:02,659.1337988 --> 00:29:06,829.1337988 And I measured, I measured his calves and, um, I don't think I've done it since then. 484 00:29:07,97.6224609 --> 00:29:07,367.6224609 them. 485 00:29:07,847.6224609 --> 00:29:08,779.1337988 So No, no. 486 00:29:08,959.1337988 --> 00:29:09,559.1337988 He was fine. 487 00:29:09,767.6224609 --> 00:29:09,797.6224609 okay. 488 00:29:09,949.1337988 --> 00:29:10,969.1337988 Aaron, you were fine. 489 00:29:11,329.1337988 --> 00:29:11,509.1337988 Yeah. 490 00:29:12,529.1337988 --> 00:29:13,369.1337988 Mm-hmm. 491 00:29:13,754.1224609 --> 00:29:13,994.1224609 Yeah. 492 00:29:14,664.1224609 --> 00:29:16,284.1224609 I think that that's also maybe a good point too. 493 00:29:16,284.1224609 --> 00:29:29,805.9557943 I know we often focus a lot on symptoms, right? Like what patients are experiencing, but maybe James, just to get a little bit about what you're talking about, vital signs are vital, but those are also some of the signs that healthcare providers looking for, to raise their suspicion for Mm-hmm. 494 00:29:29,997.4557943 --> 00:29:44,920.9557943 But, I do think it's always worth, especially with chest pain or difficulty breathing, knowing that difference from your baseline is incredibly helpful for raising the concern factor when you're like, you, like you don't understand, like, I'm doing kit workouts four times a week and now like I can't carry a bag of Mm-hmm. 495 00:29:45,477.4557943 --> 00:29:47,397.4557943 um, I digress. 496 00:29:47,547.4557943 --> 00:29:49,567.4557943 Uh, we wanna talk about, diagnosis. 497 00:29:49,567.4557943 --> 00:29:50,520.9557943 I think James Mm-hmm. 498 00:29:50,677.4557943 --> 00:29:54,547.4557943 So how do we kinda do these things? I think the first thing you have to at least suspect it clinically. 499 00:29:54,607.4557943 --> 00:29:55,325.9557943 'cause Mm-hmm. 500 00:29:55,537.4557943 --> 00:29:57,17.4557943 tests that we would routinely Mm-hmm. 501 00:29:57,848.9557943 --> 00:30:01,118.9557943 Or we're thinking about it and there's two main tests that we would order. 502 00:30:01,118.9557943 --> 00:30:03,578.9557943 One that would be for DVT and one that's for pe. 503 00:30:03,838.9557943 --> 00:30:12,388.9557943 And then we have these, these decision rules that help us kind of guide based on their signs and their symptoms and their vital signs and risk factors, whether we need to even kind of go down that route. 504 00:30:12,388.9557943 --> 00:30:22,398.9557943 I won't really dive into that, but just to say that there's often a lot of times we're able to rule these things out based on your risk factors and vital signs, and your history and things like that without having to go down the point of doing some of these tests. 505 00:30:22,698.9557943 --> 00:30:25,838.9557943 But there's really, a blood test, an ultrasound, and a CT scan. 506 00:30:25,838.9557943 --> 00:30:28,808.9557943 So the, this, this blood test that we use is something called a D dimer. 507 00:30:29,148.9557943 --> 00:30:34,367.4557943 And your D dimer is kind of a non-specific marker for blood Mm-hmm. 508 00:30:34,903.9557943 --> 00:30:38,193.9557943 Your DMR is kind of like a, a yes no thing, a positive negative thing. 509 00:30:38,193.9557943 --> 00:30:44,343.9557943 So if your D dimer is positive, it doesn't mean that you have a blood clot, but it means that we need to go on to do some of these other tests. 510 00:30:44,553.9557943 --> 00:30:48,93.9557943 If your D dimer is negative, it means that you probably don't have a blood clot. 511 00:30:48,93.9557943 --> 00:30:51,837.4557943 We can save you the time for doing an ultrasound or the radiation of doing a CT Mm-hmm. 512 00:30:52,143.9557943 --> 00:30:54,873.9557943 there is a lot of utility in doing a D dimer. 513 00:30:54,873.9557943 --> 00:30:55,637.4557943 I think Mm-hmm. 514 00:30:55,803.9557943 --> 00:31:04,113.9557943 in the emergency department and with young patients, we're like, there is concern about exposure to radiation or time for patients for getting ultrasounds and things like that. 515 00:31:04,898.9671321 --> 00:31:05,138.9671321 Yep. 516 00:31:05,228.9671321 --> 00:31:11,378.9671321 And for, for everyone listening a d dimer, if you ever think you have a blood clot, a D dimer is not something you just do. 517 00:31:11,378.9671321 --> 00:31:12,458.9671321 And it's not a yes or no. 518 00:31:12,458.9671321 --> 00:31:15,848.9671321 It's very dependent on the risk factors you have and other things. 519 00:31:16,118.9671321 --> 00:31:20,708.9671321 So it has to be decided, it has to be done in the right context. 520 00:31:20,708.9671321 --> 00:31:24,308.9671321 So don't just, just to say, don't go to your doctor and say, Hey, I want a D dimer. 521 00:31:24,308.9671321 --> 00:31:26,18.9671321 I think I might have a, a blood clot. 522 00:31:26,198.9671321 --> 00:31:27,818.9671321 It's more than just a yes or no. 523 00:31:28,372.4557943 --> 00:31:28,940.6224609 Yeah, Yeah. 524 00:31:28,940.6224609 --> 00:31:38,59.1224609 All, all great points, right? And there, the other thing that's hard about D Dimer is the older you get, the more likely that it is quote yeah, So there's inherent Here's, of that as yeah. 525 00:31:38,239.1224609 --> 00:31:42,49.1224609 And you're more likely to have D-V-T-P-E when you're older in general. 526 00:31:43,265.6337988 --> 00:31:47,345.6337988 and I was gonna preempt James 'cause usually here's where he makes a Josh's old joke. 527 00:31:47,434.1224609 --> 00:31:47,724.1224609 know. 528 00:31:47,975.6337988 --> 00:31:50,555.6337988 uh, he is off his game tonight, so I win. 529 00:31:50,929.1224609 --> 00:31:57,204.1224609 you know, uh, now that I'm also getting older, you know, I have less inclination to make those jokes. 530 00:31:57,945.6224609 --> 00:31:58,245.6224609 Okay. 531 00:31:58,875.6224609 --> 00:32:06,230.6337988 Should we Ah, just off to see who has, who has the lowest D dimer? no, we should not. 532 00:32:08,180.6337988 --> 00:32:10,400.6337988 Sorry, that was No, no, we definitely shouldn't. 533 00:32:10,460.6337988 --> 00:32:10,640.6337988 Yeah. 534 00:32:10,725.6224609 --> 00:32:11,205.6224609 idea. 535 00:32:11,295.6224609 --> 00:32:12,954.1224609 Thank you for being Yeah. 536 00:32:14,120.6337988 --> 00:32:15,110.6337988 Oh man. 537 00:32:15,680.6337988 --> 00:32:20,355.6224609 Now we can measure calves since he was the biggest calves that I'm in for, uh, There we go. 538 00:32:20,445.6224609 --> 00:32:20,745.6224609 Yeah. 539 00:32:21,469.1224609 --> 00:32:24,79.1224609 just gimme four weeks of calf exercise. 540 00:32:25,335.6224609 --> 00:32:26,900.6337988 Shit, unilateral calf word. 541 00:32:26,955.6224609 --> 00:32:27,435.6224609 guys. 542 00:32:30,259.1224609 --> 00:32:30,889.1224609 Just calf. 543 00:32:30,949.1224609 --> 00:32:31,639.1224609 Nothing else. 544 00:32:31,699.1224609 --> 00:32:32,59.1224609 Just calf. 545 00:32:33,320.6337988 --> 00:32:35,0.6337988 This is funny to anyone else but us. 546 00:32:35,0.6337988 --> 00:32:36,170.6337988 It doesn't matter. 547 00:32:37,655.6337988 --> 00:32:37,735.6337988 Hmm. 548 00:32:37,789.1224609 --> 00:32:37,999.1224609 right. 549 00:32:37,999.1224609 --> 00:32:39,379.1224609 So diagnosis. 550 00:32:39,379.1224609 --> 00:32:41,179.1224609 So you said D dimer., 551 00:32:41,229.1224609 --> 00:32:49,70.6224609 But what about like imaging studies? What kind of imaging studies would you do? so again, if your D number is negative, that kinda allows us to stop there. 552 00:32:49,970.6224609 --> 00:32:50,840.6224609 can kind of put that on pause. 553 00:32:50,890.6224609 --> 00:32:55,610.6224609 If your D number is positive or if you're just a high enough risk, then we'll go on and do some imaging studies. 554 00:32:55,610.6224609 --> 00:33:00,350.6224609 So the test to do if you're looking for a deep vein thrombosis is an ultrasound in a leg., 555 00:33:00,530.6224609 --> 00:33:02,210.6224609 And it's honestly really simple test. 556 00:33:02,240.6224609 --> 00:33:03,164.1224609 They literally Mm-hmm. 557 00:33:03,249.1224609 --> 00:33:04,479.1224609 Mm-hmm. 558 00:33:04,790.6224609 --> 00:33:06,339.1224609 it Yeah. 559 00:33:06,380.6224609 --> 00:33:07,269.1224609 the Literally. 560 00:33:07,444.1224609 --> 00:33:07,734.1224609 Yeah. 561 00:33:07,910.6224609 --> 00:33:10,515.6224609 literally, and, and they Yeah, It's squishy. 562 00:33:10,785.6224609 --> 00:33:12,294.1224609 There's no clot in there, and then yeah. 563 00:33:12,315.6224609 --> 00:33:14,295.6224609 up a couple centimeters and squish it again. 564 00:33:15,45.6224609 --> 00:33:18,429.1224609 And the idea being, if you can squish the Yeah. 565 00:33:18,465.6224609 --> 00:33:20,205.6224609 the whole way through vein should be squishy. 566 00:33:20,505.6224609 --> 00:33:22,275.6224609 Um, then there's no blood clot. 567 00:33:22,305.6224609 --> 00:33:26,445.6224609 If you, you So, squish it, there's something huh? probably a blood clot. 568 00:33:27,309.1224609 --> 00:33:30,579.1224609 Okay, so ultrasound, blood clot. 569 00:33:30,579.1224609 --> 00:33:32,229.1224609 So let's say there's blood clot. 570 00:33:32,649.1224609 --> 00:33:43,795.6224609 Then would you like move on to do CT scan or what's your kind of algorithm in your mind? interesting thing is that the treatment for whether you have a blood clot in your leg or blood clot in your lung is the same. 571 00:33:44,104.1224609 --> 00:33:44,524.1224609 Mm-hmm. 572 00:33:44,665.6224609 --> 00:33:45,695.6224609 suspicion just for like. 573 00:33:46,525.6224609 --> 00:33:50,335.6224609 Things I would warn that person about would be much higher if I see a blood clot in the heart. 574 00:33:50,335.6224609 --> 00:33:51,14.1224609 Because Mm-hmm. 575 00:33:51,145.6224609 --> 00:33:55,564.1224609 that the blood clot in the leg on its own is yes, needs treatment but isn't Mm-hmm. 576 00:33:55,585.6224609 --> 00:33:56,935.6224609 threatening on its own. 577 00:33:56,935.6224609 --> 00:33:57,854.1224609 But once it goes Mm-hmm. 578 00:33:57,955.6224609 --> 00:34:02,545.6224609 goes to the lungs, then you, you tend to be a lot more worried about like their chance of death. 579 00:34:02,875.6224609 --> 00:34:07,284.1224609 So not everyone that has a positive Mm-hmm. 580 00:34:07,555.6224609 --> 00:34:10,45.6224609 Of their leg will go on to get a CT scan of their chest. 581 00:34:10,144.1224609 --> 00:34:10,564.1224609 Mm-hmm. 582 00:34:10,645.6224609 --> 00:34:13,170.6337988 really impact your Most, most people won't. 583 00:34:13,710.6337988 --> 00:34:14,520.6337988 Most people won't. 584 00:34:14,620.6224609 --> 00:34:15,120.6337988 that are Yeah. 585 00:34:15,520.6224609 --> 00:34:17,704.1224609 respiratory symptoms Mm-hmm. 586 00:34:17,770.6224609 --> 00:34:28,384.1224609 pain or abnormal vital signs might only because again, it, it just might affect some of that follow up and the type of instructions and things Yeah. 587 00:34:28,750.6224609 --> 00:34:34,240.6224609 look for, um, so what, what that looks like then, or, or the other side is sometimes people actually don't have signs of a DVT. 588 00:34:34,300.6224609 --> 00:34:36,74.1224609 But they've, Mm-hmm. 589 00:34:36,370.6224609 --> 00:34:37,810.6224609 risk factors that I'm worried about. 590 00:34:37,810.6224609 --> 00:34:42,184.1224609 They might have just spontaneously, you know, uh, developed a, a, a Mm-hmm. 591 00:34:42,620.6224609 --> 00:34:45,164.1224609 I'll go straight to a CT scan of their chest, for Yeah. 592 00:34:45,240.6224609 --> 00:34:50,515.6224609 If they have more respiratory symptoms, they don't have any signs of A-T-V-T-I. 593 00:34:50,690.6337988 --> 00:34:53,240.6337988 resource rich settings, the three of us. 594 00:34:53,240.6337988 --> 00:34:54,710.6337988 So we have access to all these things. 595 00:34:54,710.6337988 --> 00:34:58,820.6337988 Very different in rural communities or places without, um, the resources we have. 596 00:34:59,479.1224609 --> 00:34:59,659.1224609 Yeah. 597 00:34:59,659.1224609 --> 00:35:11,359.1224609 So this algorithm that Brody had mentioned, you know, kind of from D dimer to ultrasound, to ct, I mean, unless there are specific, you know, signs and symptoms that direct you to CT scan first. 598 00:35:12,79.1224609 --> 00:35:14,929.1224609 That could defer in various settings. 599 00:35:14,929.1224609 --> 00:35:28,714.1224609 Like for, for us in surgery, D dimer is not reliable like this, so we tend to go straight to CT scan if there are signs like high heart rate, and shortness of breath or difficulty weaning oxygen off. 600 00:35:29,349.1224609 --> 00:35:40,829.1224609 So we may not necessarily do D dimer first, and then ultrasound and then to CT scan is more the CT scan first because you already have a risk factor, meaning you've had an operation. 601 00:35:40,979.1224609 --> 00:35:47,129.1224609 So, you know, that kind of puts you at a higher risk of developing pe, which could be detrimental. 602 00:35:47,129.1224609 --> 00:36:07,990.6337988 So we go straight into a CT scan diagnosis, rather than just going through that algorithm, And I, and I think this actually brings up a really important point that I was alluding to before and this, this could be a whole episode on its own, but it's how often and how much do we test for things that we think are probably not going to be there, but we don't wanna miss them. 603 00:36:08,80.6337988 --> 00:36:13,60.6337988 And PE is a perfect example is, um, Brody and James and I. 604 00:36:13,405.6337988 --> 00:36:23,5.6337988 We'll not order cts only if we think 100% there's a pe we're gonna order a CT if we think there is a 5% chance of a pe, because missing that is detrimental. 605 00:36:23,305.6337988 --> 00:36:29,595.6337988 So majority of our scans that we try to do for, PEs, they're gonna be negative and they should be. 606 00:36:30,175.6337988 --> 00:36:38,5.6337988 And especially in something like surgery, for example, where many people have a high heart rate, many people have chest pain, especially if some surgery up in the belly of the chest. 607 00:36:38,335.6337988 --> 00:36:41,724.1224609 Um, you have to have a really, really low threshold to order a Yeah. 608 00:36:42,175.6337988 --> 00:36:43,945.6337988 to look for pe 'cause you could be missing it. 609 00:36:57,803.1668475 --> 00:36:58,163.1668475 Yeah. 610 00:36:58,313.1668475 --> 00:37:00,473.1668475 Um, yeah, so we see lots who are admitted to hospital with this. 611 00:37:00,473.1668475 --> 00:37:05,753.1668475 We see unfortunately, lots who develop them in hospital because being in hospital is a risk factor on its own. 612 00:37:06,53.1668475 --> 00:37:06,233.1668475 Yeah. 613 00:37:06,233.1668475 --> 00:37:12,593.1668475 So there's a whole range of treatments and the majority of people who have PEs or DVDs, they don't need to be admitted to hospital. 614 00:37:12,833.1668475 --> 00:37:19,493.1668475 Most of them you can be put on blood thinners, and sent home with, with appropriate follow-up. 615 00:37:20,213.1668475 --> 00:37:26,583.1668475 Now, treatments really depend, on how severe you are coming in with it, what caused it. 616 00:37:26,883.1668475 --> 00:37:30,663.1668475 And we talk about things that are called provoked clots. 617 00:37:30,663.1668475 --> 00:37:32,463.1668475 And unprovoked clots. 618 00:37:32,523.1668475 --> 00:37:35,643.1668475 Provoked being you have a major risk factor that we can identify. 619 00:37:35,643.1668475 --> 00:37:40,323.1668475 Like you just had surgery, like you just had a flight to Singapore, um, chains. 620 00:37:40,323.1668475 --> 00:37:41,763.1668475 I hope you don't get a DVT. 621 00:37:42,273.1668475 --> 00:37:45,33.1668475 Um, um, unprovoked. 622 00:37:46,8.1668475 --> 00:37:47,148.1668475 I'm not wishing for anything. 623 00:37:47,148.1668475 --> 00:37:50,478.1668475 I'm just, I'm still a little upset about the segue and I'm sorry. 624 00:37:50,478.1668475 --> 00:37:53,301.6555096 I, I, I really sorry I let you down. 625 00:37:55,188.1668475 --> 00:37:59,598.1668475 um, and then there's the, the unprovoked world where you have a clot and we don't know why. 626 00:38:00,41.6555096 --> 00:38:00,461.6555096 Mm-hmm. 627 00:38:00,798.1668475 --> 00:38:05,208.1668475 And so the upfront treatments, blood thinners almost universally for everyone. 628 00:38:05,208.1668475 --> 00:38:08,448.1668475 Those could be in the form of an injection under their skin. 629 00:38:08,603.1668475 --> 00:38:13,193.1668475 Or an IV or in most people, especially if they're not severe, those can be pill, blood thinners. 630 00:38:13,193.1668475 --> 00:38:18,263.1668475 And we'll probably talk about those in, in many other conditions, for the really, really sick people. 631 00:38:18,263.1668475 --> 00:38:23,3.1668475 On the other end of the scale, um, Brody, this is where you probably come in. 632 00:38:23,33.1668475 --> 00:38:27,413.1668475 There's actually ways to go in and get rid of the clot directly with the procedure. 633 00:38:27,593.1668475 --> 00:38:28,883.1668475 And that's really, really cool. 634 00:38:28,883.1668475 --> 00:38:38,423.1668475 It's not gonna be done in, in, um, resource limited settings, but they can go in and they can inject blood thinners directly around the clot or they can actually suck the clot out. 635 00:38:38,843.1668475 --> 00:38:45,53.1668475 And those are for the sickest patients who the clots affecting the heart, the clots, causing them to go to the ICU, all those kinds of things. 636 00:38:45,413.1668475 --> 00:38:46,823.1668475 So there's a whole range of treatments. 637 00:38:51,676.6555096 --> 00:38:52,96.6555096 Mm-hmm. 638 00:38:52,836.6555096 --> 00:38:53,256.6555096 Mm-hmm. 639 00:38:56,483.1668475 --> 00:38:57,233.1668475 It's wild. 640 00:38:57,386.6555096 --> 00:38:57,806.6555096 Mm-hmm. 641 00:39:00,622.2141086 --> 00:39:00,802.2141086 yeah. 642 00:39:00,802.2141086 --> 00:39:06,722.2141086 So, um, and then, and then as I was talking about provoked and unprovoked, it dictates how long you're going to be on these blood thinners. 643 00:39:06,722.2141086 --> 00:39:09,422.2141086 So let's say you're doing fine, you're outta the hospital, you're on a blood thinner. 644 00:39:09,752.2141086 --> 00:39:19,82.2141086 This is where a hematologist, a blood doctor is going to get involved and say, you're a provoked DVT, let's do at least three months, and then we'll talk about the risks of coming off. 645 00:39:19,412.2141086 --> 00:39:25,442.2141086 Versus if you're an unprovoked, we don't know the cause of it, the risks of it happening again, are much higher if you're off blood thinners. 646 00:39:25,742.2141086 --> 00:39:32,342.2141086 So you're gonna have a big discussion about risk benefit and whether you actually stay on blood thinners for a long time, lifelong or not. 647 00:39:32,595.7027707 --> 00:39:32,955.7027707 Right. 648 00:39:33,765.7027707 --> 00:39:44,595.7027707 I think provoked meaning, you know, there is a reasonable understanding that, you know, something like, uh, know, long flight to Singapore happened and this is why you had it. 649 00:39:44,595.7027707 --> 00:39:48,855.7027707 So if you avoid it, there's a chance that there's a good chance that you're not gonna develop this again. 650 00:39:49,185.7027707 --> 00:40:19,595.7027707 I mm-hmm. 651 00:40:33,295.7027707 --> 00:40:33,715.7027707 Mm-hmm. 652 00:40:41,959.8591754 --> 00:40:43,969.8591754 Like do X Yeah. 653 00:40:49,677.7208529 --> 00:40:50,637.7208529 Apixaban. 654 00:40:50,667.7208529 --> 00:40:51,57.7208529 Yeah. 655 00:40:52,502.7208529 --> 00:40:52,722.7208529 Yep. 656 00:41:07,107.7208529 --> 00:41:07,437.7208529 Mm. 657 00:41:21,902.7208529 --> 00:41:22,322.7208529 Mm-hmm. 658 00:41:34,112.7208529 --> 00:41:34,532.7208529 Mm-hmm. 659 00:41:39,957.7208529 --> 00:41:40,47.7208529 Mm-hmm. 660 00:41:44,519.2321908 --> 00:41:55,612.7208529 Blockbuster, Mm-hmm. 661 00:41:58,947.7208529 --> 00:41:59,277.7208529 Yeah. 662 00:42:00,777.7208529 --> 00:42:01,137.7208529 Yeah. 663 00:42:03,717.7208529 --> 00:42:04,197.7208529 Yeah. 664 00:42:06,934.2321908 --> 00:42:07,54.2321908 I. 665 00:42:10,17.7208529 --> 00:42:10,377.7208529 Right. 666 00:42:10,604.2321908 --> 00:42:21,344.2321908 That's, that's honestly the most common question I get is, so what happens to the blood clot while I'm on this blood thinner? And just like, exactly like you said, the body will either chew it up while we prevent another clot, or the clot getting bigger with the blood thinner. 667 00:42:21,554.2321908 --> 00:42:25,244.2321908 Or the body actually sometimes finds a detour around the clot with other blood vessels. 668 00:42:25,432.7208529 --> 00:42:25,852.7208529 Mm-hmm. 669 00:42:25,994.2321908 --> 00:42:30,184.2321908 people are left with a clot forever and most of the time they're not symptomatic with that. 670 00:42:30,184.2321908 --> 00:42:31,264.2321908 Some of the time they are. 671 00:42:31,634.2321908 --> 00:42:33,614.2321908 But the body's really good at getting rid of these things. 672 00:42:33,614.2321908 --> 00:42:36,74.2321908 We just give it a little extra help with these blood thinners. 673 00:42:36,334.3875196 --> 00:42:36,454.3875196 Yeah. 674 00:42:36,454.3875196 --> 00:42:45,54.3875196 There, there's a very, select patients who do have these kind of chronic, embolism in the pulmonary, system. 675 00:42:45,424.3875196 --> 00:42:52,31.0541863 and, I remember as an intern, I've, assisted or observed in some of the surgeries to get rid of them. 676 00:42:52,31.0541863 --> 00:42:54,651.0541863 These are major operations, to do that. 677 00:42:54,651.0541863 --> 00:42:55,851.0541863 And these are for only select. 678 00:42:56,961.0541863 --> 00:43:03,681.0541863 And surgery isn't really something that we do routinely for patients with blood clots in pulmonary system. 679 00:43:03,741.0541863 --> 00:43:14,451.0541863 But something that we forgot to say is that while all of these is going on, these blood thinning processes going on, the patients may be already quite sick. 680 00:43:15,231.0541863 --> 00:43:19,131.0541863 You know, because their respiratory system is quite compromised. 681 00:43:19,581.0541863 --> 00:43:34,341.0541863 They're having difficulty breathing, delivering oxygen to their important organs, and they may need a trick to intensive care unit, need intubation, mechanical ventilations to help support them go through all this treatment and keeping their organs alive. 682 00:43:34,341.0541863 --> 00:43:43,31.0541863 It's not just targeting the blood clot, it's that we're taking care of your entire system, making sure that you're staying alive and your organs are healthy. 683 00:43:52,716.0541863 --> 00:43:53,136.0541863 Mm-hmm. 684 00:44:09,401.0541863 --> 00:44:09,791.0541863 Mm-hmm. 685 00:44:12,16.0541863 --> 00:44:12,436.0541863 Mm-hmm. 686 00:44:15,16.0541863 --> 00:44:15,436.0541863 Mm-hmm. 687 00:44:24,693.7634987 --> 00:44:24,983.7634987 Yeah. 688 00:44:25,203.7634987 --> 00:44:28,908.7634987 And, and I, I think a couple quick public service announcements. 689 00:44:29,178.7634987 --> 00:44:31,398.7634987 Number one, these meds don't work if you don't take 'em. 690 00:44:32,268.7634987 --> 00:44:36,198.7634987 Um, some of them are once a day, some of them are twice a day if you don't take 'em as prescribed. 691 00:44:36,308.7634987 --> 00:44:39,107.2521609 Breakthrough clots are, are much more, Mm-hmm. 692 00:44:39,818.7634987 --> 00:44:42,438.7634987 likely, number two, they're not perfect medications. 693 00:44:42,438.7634987 --> 00:44:45,318.7634987 You can still get clots while on these. 694 00:44:45,318.7634987 --> 00:44:52,188.7634987 Now we will do a good thorough checkup to see if there's anything else that's causing the clot, but they're not perfect. 695 00:44:52,248.7634987 --> 00:44:58,248.7634987 And things like compression stockings, things like moving around on James' Slight to Singapore, it's actually worked out really well. 696 00:44:58,638.7634987 --> 00:45:01,548.7634987 Um, uh, they're not, they're not a hundred percent. 697 00:45:01,758.7634987 --> 00:45:04,638.7634987 So there's nothing in medicine that prevents everything. 698 00:45:04,668.7634987 --> 00:45:08,388.7634987 And this is one of those, it reduces the risk of developing, but it's not perfect. 699 00:45:10,142.2521609 --> 00:45:10,938.7634987 The other thing that I I. 700 00:45:10,952.2521609 --> 00:45:20,252.2521609 add to this is there are some modifiable factors like, if you're smoking, smoking is a, is a risk factor for developing blood clots. 701 00:45:21,212.2521609 --> 00:45:38,252.2521609 if you're taking hormone replacement therapy or if you're taking, you know, some sort of, uh, form of hormonal therapy that are known to have elevated risk of DVT, you know, those are things that you should talk to the prescribers to make sure that the risks and benefits are well balanced. 702 00:45:38,972.2521609 --> 00:45:42,92.2521609 Um, yeah, so those are really important things. 703 00:45:42,122.2521609 --> 00:45:53,732.2521609 And the other thing is if you do develop this clots and you don't know why, I think it may be a re, you know, and you're of certain age or a certain family risk, you know, you should get screened for cancer as well. 704 00:45:53,762.2521609 --> 00:45:58,712.2521609 You know, these may be some of the, you know, unfortunate first signs of cancer diagnosis. 705 00:45:58,712.2521609 --> 00:46:04,82.2521609 So I think it's, you know, another reason to be, know, vigilant about cancer screening. 706 00:46:04,848.7634987 --> 00:46:05,118.7634987 Yeah. 707 00:46:05,133.7634987 --> 00:46:06,858.7634987 And, and James that's a really good point. 708 00:46:06,918.7634987 --> 00:46:10,848.7634987 And just age related cancer screening is vitally important. 709 00:46:11,268.7634987 --> 00:46:19,188.7634987 Um, the majority of clots are not from cancer, but you should be getting your colonoscopies and your mammograms and, and your pap smears and all that kind of stuff. 710 00:46:19,307.2521609 --> 00:46:30,438.7634987 an Yep, you know, blood clot and you don't know why, then, and you're Yeah, certain age and, you know, risk, you should be considered for cancer screen appropriate cancer screening, fine. 711 00:46:30,438.7634987 --> 00:46:32,88.7634987 James, I'll go for my colonoscopy. 712 00:46:32,88.7634987 --> 00:46:32,628.7634987 I get it. 713 00:46:32,673.7634987 --> 00:46:32,963.7634987 Okay. 714 00:46:34,667.2521609 --> 00:46:35,867.2521609 you know, the fear is away. 715 00:46:45,372.2521609 --> 00:46:45,792.2521609 Mm-hmm. 716 00:46:47,212.2521609 --> 00:46:47,632.2521609 Mm-hmm. 717 00:46:49,373.7634987 --> 00:46:49,453.7634987 Hmm. 718 00:46:50,628.7634987 --> 00:46:50,898.7634987 Hmm. 719 00:46:53,822.2521609 --> 00:46:54,242.2521609 Mm-hmm. 720 00:46:57,372.2521609 --> 00:46:57,662.2521609 Yeah. 721 00:46:57,972.2521609 --> 00:46:58,262.2521609 Yeah. 722 00:47:02,652.2521609 --> 00:47:03,72.2521609 Mm-hmm. 723 00:47:05,122.2521609 --> 00:47:05,542.2521609 Mm-hmm. 724 00:47:08,502.2521609 --> 00:47:08,922.2521609 Mm-hmm. 725 00:47:14,892.2521609 --> 00:47:15,312.2521609 Mm-hmm. 726 00:47:25,712.2521609 --> 00:47:26,132.2521609 Mm-hmm. 727 00:47:34,492.2521609 --> 00:47:34,912.2521609 Mm-hmm. 728 00:47:38,542.2521609 --> 00:47:38,832.2521609 Yeah. 729 00:47:39,933.7634987 --> 00:47:40,653.7634987 That's awesome. 730 00:47:42,183.7634987 --> 00:47:43,563.7634987 You know what I'm excited for guests. 731 00:47:44,477.2521609 --> 00:47:49,533.7634987 Myth We're talking about clot bus sting, but let's talk about myth busting. 732 00:47:49,533.7634987 --> 00:47:49,743.7634987 Ha. 733 00:47:50,703.7634987 --> 00:47:52,173.7634987 That's how you segue. 734 00:47:52,307.2521609 --> 00:47:53,417.2521609 Oh, that's a good segue. 735 00:47:57,797.2521609 --> 00:48:00,317.2521609 Alright, Uh, you're on a roll. 736 00:48:00,317.2521609 --> 00:48:03,17.2521609 So why don't you am I, myth number one. 737 00:48:03,723.7634987 --> 00:48:07,923.7634987 is that, what, is that what we consider a role in this podcast? Oh, God. 738 00:48:07,982.2521609 --> 00:48:10,623.7634987 You put together Uh, all right. 739 00:48:10,982.2521609 --> 00:48:11,967.2521609 You're on a roll, buddy. 740 00:48:13,953.7634987 --> 00:48:14,973.7634987 Oh, that is amazing. 741 00:48:15,543.7634987 --> 00:48:17,493.7634987 All right, so, uh, myth number one. 742 00:48:17,493.7634987 --> 00:48:20,823.7634987 Uh, only elderly people get blood clots. 743 00:48:21,783.7634987 --> 00:48:23,373.7634987 I think we've talked about it already. 744 00:48:23,373.7634987 --> 00:48:24,633.7634987 Absolutely not true. 745 00:48:24,633.7634987 --> 00:48:25,353.7634987 Yes. 746 00:48:25,413.7634987 --> 00:48:31,863.7634987 Um, some risk factors go up as you get older, but there are many, uh, many risk factors in the young as well. 747 00:48:31,863.7634987 --> 00:48:34,653.7634987 And we just talked about hormonal therapy, for example, plus many others. 748 00:48:34,653.7634987 --> 00:48:40,697.2521609 So definitely not just the disease of the elderly I'll, uh, I'll hand the mic over to maybe Brody. 749 00:48:40,757.2521609 --> 00:48:41,687.2521609 Brody, you're next. 750 00:49:13,600.1706219 --> 00:49:16,355.1706219 I, I just wanna, I wanna throw one more, I wanna throw one more thing. 751 00:49:16,355.1706219 --> 00:49:22,595.1706219 Sorry Brody, you mentioned it, but I just wanna highlight it 'cause it's a question I get every day about these is, um, I had a stroke. 752 00:49:22,595.1706219 --> 00:49:31,805.1706219 Is it because of a blood clot? Or I have a blood clot? Am I going to have a stroke? And you said it already in the podcast, but blood clots in the legs, blood clots in the lungs. 753 00:49:32,360.1706219 --> 00:49:37,610.1706219 Do not cause strokes outside of very, very rare issues where there's a hole in the heart. 754 00:49:38,30.1706219 --> 00:49:43,70.1706219 So the blood clot usually stops in the lungs, and that's where the problem occurs. 755 00:49:43,70.1706219 --> 00:49:43,970.1706219 So I'll put it out there. 756 00:49:43,970.1706219 --> 00:49:48,440.1706219 There's much more around that, but I just want, uh, blisters to know that, because that's a question we get all the time. 757 00:49:48,615.1706219 --> 00:49:48,835.1706219 Yep. 758 00:49:48,970.1706219 --> 00:49:50,230.1706219 And we'll do an episode on stroke. 759 00:49:50,590.1706219 --> 00:49:50,890.1706219 Yep. 760 00:49:50,963.659284 --> 00:49:54,208.659284 Time to do, uh, takeaways, right? All right. 761 00:49:54,418.659284 --> 00:49:56,308.659284 Well, so takeaway number one. 762 00:49:56,908.659284 --> 00:50:00,598.659284 Um, I think first is that the clot could happen to everyone. 763 00:50:00,598.659284 --> 00:50:06,448.659284 We kind of talked about this already, you know, blood clo, not just for older individuals. 764 00:50:06,478.659284 --> 00:50:08,308.659284 You know, it can happen to anyone. 765 00:50:08,998.659284 --> 00:50:16,18.659284 You just have to be aware of what the risk factors are and try to avoid them if you can, and be aware of the signs and symptoms. 766 00:50:16,379.7083952 --> 00:50:16,649.7083952 Yep. 767 00:50:17,39.7083952 --> 00:50:19,169.7083952 Now that you take away number two, signs and symptoms. 768 00:50:19,199.7083952 --> 00:50:22,439.7083952 We're talking one leg swelling or one arm swelling. 769 00:50:22,439.7083952 --> 00:50:24,179.7083952 Again, arms are very rare. 770 00:50:24,369.7083952 --> 00:50:30,39.7083952 Or redness or pain in one leg or one arm, and then in the chest, chest pain, especially when you take a nice deep breath in. 771 00:50:30,39.7083952 --> 00:50:32,199.7083952 Trouble breathing out of the ordinary. 772 00:50:32,589.7083952 --> 00:50:34,839.7083952 Um, and then some other things that we're gonna look for in hospitals. 773 00:50:34,839.7083952 --> 00:50:35,919.7083952 So keep an eye out for those. 774 00:50:35,919.7083952 --> 00:50:40,539.7083952 These things are still very rare, but, especially if you have risk factors, keep an eye out for those symptoms. 775 00:51:03,67.9829582 --> 00:51:03,247.9829582 Yeah. 776 00:51:05,281.4716204 --> 00:51:05,571.4716204 Yeah. 777 00:51:05,707.9829582 --> 00:51:05,797.9829582 Yeah. 778 00:51:05,797.9829582 --> 00:51:06,337.9829582 We had fun. 779 00:51:06,921.4716204 --> 00:51:07,211.4716204 Yeah. 780 00:51:07,987.9829582 --> 00:51:08,947.9829582 Take it easy guys. 781 00:51:08,947.9829582 --> 00:51:10,267.9829582 Have a great flight, James. 782 00:51:10,446.4716204 --> 00:51:10,957.9829582 day Yeah. 783 00:51:12,306.4716204 --> 00:51:12,996.4716204 Alright, thank you. 784 00:51:13,986.4716204 --> 00:51:14,946.4716204 Thank you listeners.

All Episodes

Episode Transcript

Popular Podcasts

Stuff You Should Know

The Joe Rogan Experience

Two Guys, Five Rings: Matt, Bowen & The Olympics

.css-15opob5{left:0;position:absolute;top:0.8rem;} All Episodes

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}The Clot Thickens: What You Need to Know About DVT & PE

Episode Transcript

Popular Podcasts

.css-r6mb8g{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:1;overflow:hidden;}Stuff You Should Know

The Joe Rogan Experience

Two Guys, Five Rings: Matt, Bowen & The Olympics

All Episodes

The Clot Thickens: What You Need to Know About DVT & PE

Stuff You Should Know