The answer to yesterday’s mystery is … Deep Vein Thrombosis (DVT)! Many readers were able to guess the diagnosis: O’B1, Priscilla, Erin, John P, Erin Morelli, lucky u, EBG, On my way to be a pa, Lilly, American Girl Mommy, R, Rich S, kr, Jill, Tony Siracusa, ColorMaven, Sally, Nicole, Phung, Theresa, Amanda, Lealorali, Clarisa, DG, GetAClue, Melissa, Hospice RN from VA, palmtree435, Joan, and JP. And I’ll give partial credit to those who had the right idea: Peaceable Traveller, Mary, Kimberly Helton, colleen with a little c, mub, Martha, Meg, Katie, Michelle, and JR. I guess this one was too easy for y’all!
DVT occurs when a blood clot forms inside of a vein, usually in the legs or arms. The clots tend to form if a person is immobilized for a long time (for example, on a long airplane ride or after a surgery), or if the person is predisposed to clotting (from certain drugs or their genetics). The most feared complication of a DVT is called a Pulmonary Embolism. This is when the clots sitting in the deep veins travel back to the heart, and then lodge within the pulmonary arteries. If the pulmonary arteries are blocked off, the blood flow to the lungs is decreased, and the body will not be able to get oxygen to its tissues.
Our patient has all of the classic signs and symptoms of a DVT. Because blood flow from the leg back to the heart is decreased and blood gets backed up into the leg, the patient’s leg becomes swollen. The clot causes an inflammatory process within the vein, so it becomes tender, red, and warm. Our patient also has two risk factors for developing a DVT: birth control pills and cigarette smoking. Oral contraceptives that contain both estrogen and progesterone very slightly increase your risk of forming a clot. Smoking cigarettes also increases this risk. It is considered unsafe to take birth control pills if you are over 35 years old and you smoke more than 15 cigarettes per day.
The doctor would want to treat the patient with anti-coagulation (a blood thinner) as many of you said. She would first receive a type of heparin such as lovenox, and then be transitioned to warfarin (coumadin) for three months. Of course, she would be counseled to stop smoking and provided with an alternate form of birth control.
Let me know if you have any questions about the case. Thanks for playing!