To Your Good Health
DEAR DR. ROACH: I am a 76-year-old man. Some time ago, I had a blood clot in my leg. They removed the blood clot and now the blood flow in my leg is back to normal, but my foot swells up every time I stand on it. But when I put my foot higher than my head, the swelling goes right down and I start all over again.
Two doctors are telling me in time my foot will go back to normal but other people are telling me it may not. Which is the truth? — P.H.C.
ANSWER: Blood clots are common, and always damage the veins in the leg. Over weeks and months, the blood clots “organize” and allow more blood through. Even if the clot is removed quickly, by medication — thrombolytics are medicines that dissolve clots — or by surgery, there is permanent damage to the blood vessel.
When the veins don’t work so well, swelling is the result. As you have discovered, the swelling is usually worst after standing or sitting for a long time, and better after keeping the foot elevated. While the symptoms may improve over the next few months, it is likely that you will always notice at least a little more swelling in the leg that had the blood clot, and you will always be at higher risk for a recurrence of the clot.
Doctors often prescribe a course of anticoagulants after a clot, such as warfarin (Coumadin) or apixaban (Eliquis). These prevent new clots, but they don’t really dissolve clots the way thrombolytics do to reduce the risk of recurrent clotting. People with recurrent clotting or life-threatening clotting will be prescribed lifelong anticoagulation.
“Post-thrombotic syndrome” is used to describe the symptoms after a blood clot. These can include not only swelling, but pain, heaviness, skin changes and ulcers. Treatment depends on severity, but relatively mild cases like yours are often treated with recommendations for regular exercise, compression stockings and intermittent elevation of the leg. More severe cases require intensive therapies, sometimes including surgical treatments.
DEAR DR. ROACH: I have been diagnosed with frozen shoulder after an X-ray by an orthopedic doctor. He sent me to physical therapy, but this is the slowest recovery and the most agonizing pain. No over-the-counter products help, and I do not want surgery. He offered a shot for the pain. I declined. I could go back for it but, I do not want a temporary solution. I’m told this could last one to three years. Any suggestions? — D.E.
ANSWER: A frozen shoulder, also called adhesive capsulitis, is a painful loss of motion of one of the joints in the shoulder — the glenohumeral joint, between the shoulder blade and arm bone.
It can come on by itself, but often, is the result of not treating an injury such as a rotator cuff syndrome early and aggressively. Without treatment, healing could take the one to three years you were warned about.
Physical therapy is crucial for treatment; however, a joint injection is an effective supplementary treatment that you should reconsider. Studies have shown that one or more injections can speed up recovery.
It does only provide temporary relief, but my experience is that physical therapy is more effective when people are in less pain and greater movement because of the injection. The injection can be repeated if necessary.
I have had patients get so much relief with the injection that they never go to physical therapy: That’s a mistake. The PT is the definitive treatment. Without PT, the benefit from the shot goes away and the symptoms return.
Orthopedic surgeons, rheumatologists, and regular doctors like family physicians often give these injections.