Deep Vein Thrombosis
Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog- Deep Vein Thrombosis. In Beyond Primary Care blogs we highlight healthcare news, advice for medical conditions, and how membership for care works! Beyond Primary Care is an insurance free, membership based family medicine clinic. Beyond Primary Care is the highest rated Direct Primary Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne counties giving families and employers peace of mind about healthcare costs by providing affordable and accessible primary care services.
The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being.
In this blog post, I wanted to educate my patients and any prospective patients about:
Deep Vein Thrombosis
A deep vein thrombosis (DVT) is a blood clot that develops inside the veins of your legs or pelvis- but also can occur in your arms. DVT can happen in anyone but is treatable if discovered early. Much like a frozen pipe in your kitchen during a Michigan winter, the obstruction prevents flow, result in increased pressure in the system, and lead to further problems if not addressed in a timely manner.
Like the frozen pipe, blood clots typically occur because of inactivity. As we walk or run around, the leg muscles (eg- glutes, quads, hammies, calf) squeeze your veins and keep the blood flowing back to your heart. However, if you are inactive for many hours, blood flow in the veins may slow enough that a clot forms.
Blood clots can be painful but the more serious complication is when a piece of that clot breaks away and moves through the blood stream to the lungs. If the clot blocks the blood vessels in the lungs, it’s called a pulmonary embolism (PE).
Value of Direct Primary Care
Availability, access, and affordability. These are the main tenets of healthcare that I believe in at Beyond Primary Care. Recently, we had a young female patient of ours text us at Beyond Primary Care for a same-day appointment on a Friday because she was experiencing leg pain. We promptly responded that we could offer her a same-day 30 minute appointment. During the visit, she relayed a history of a recent trip across the country and a remote history of a prior pulmonary embolism (>10 years ago) following the birth of a child. Other than the leg discomfort, she felt totally fine.
Following our exam, we immediately called around to our local independent imaging centers and were able to secure a same day appointment for a vascular ultrasound of her lower extremity. She had no insurance and we able to get this done for less than $200. The radiologist called us within 1 hour to say she indeed had a blood clot. Again, the patient stated she felt fine other than leg pain.
Instead of sending her to the Emergency Room, we immediately contacted a local pharmacy to start her on a $60 blood thinner medication from the comfort of her own home. The cost without using insurance: $250, results as fast as the ER without the accompanying $20,000 bill.
Risk Factors for DVTs
Some people are more likely to get blood clots. These people include:
People with medical problems such as inherited abnormalities of the blood-clotting body response
People on certain medications, such as birth control or hormone therapy
Pregnant women
People who are very overweight
People who sustain an injury to a vein, often caused by fractures or major surgeries (like stomach, pelvis, or legs)
People who have slowed blood flow, often caused by confinement to a bed (eg- hospitalization), and limited movement (eg- sitting for a long time)
People with chronic medical conditions such as cancer, heart disease, lung disease
People with a previous history of DVT or PE
Symptoms, Diagnosis, and Treatment of Blood Clots
It is possible to have a blood clot and not have any symptoms. However, when blood clots involve larger veins, symptoms may include:
Leg pain
Swelling
Redness of the skin
When there is reasonable suspicion of blood clots, an ultrasound is done to look at the blood flow in the veins. For the vast majority of cases, physical examination alone is insufficient to accurately diagnose a blood clot.
Once a blood clot is determined to have formed, your physician may suggest additional testing depending on your symptoms. Again, the more dangerous consequence is the blood clot traveling to become a pulmonary embolism which would necessitate hospitalization.
Treatment for a DVT outside of hospital systems is typically Warfarin (coumadin) or a newer blood thinner medication that doesn’t require blood monitoring. These medications work on proteins in the blood to prevent new clot formation and also help unwanted clots get smaller.
Affordable and Accessible Healthcare
Deep vein thrombosis and pulmonary embolism are serious, life threatening medical conditions that require immediate attention and prompt action. Yet, many outpatient physicians still want virtually no part in DVT management, even in simple non-life threatening scenarios and will often send their patients to the emergency rooms. While every person is unique and escalated levels of care are sometimes necessary, it is also a physician’s responsibility not to simply recognize or diagnose medical conditions anymore.
Instead, the modern physician’s training must be eclectic to recognize and seek out for affordable diagnosis and affordable management when possible. As detailed by the Beyond Primary Care patient example above, health insurance does not mean access to healthcare nor does it mean affordable healthcare. This is the direct primary care difference and an opportunity to discuss meaningful change about the future of healthcare in Michigan and across the country.
Thank you for reading.
Dr. Jeff O’Boyle with Beyond Primary Care
