September is National Spinal Cord Injury Awareness month and because of that it is my mission to shout awareness of an issue near and dear to all of us in wheelchairs, Deep Vein Thrombosis (DVTs) or blood clots. We, men and women, are all prone to DVTs by simply sitting most of the day. Unfortunately, due to our spinal cord injuries, we find ourselves in a sedentary position for extensive periods of time. Remaining FIT and FABULOUS is my goal with these articles and this one is no exception. Finding exercises to reposition our lower extremities, even while in a wheelchair is extremely critical in maintaining our health by remaining DVT-free.
DVT is the formation of a blood clot in a deep vein, usually in a calf or thigh muscle. DVTs can form in the arms although that is less common. DVT‘s can partly or completely block blood flow, causing chronic pain and swelling. Pain is the symptom us spinal cord injured friends will not all be able to measure. Because pain cannot be assessed, DVT symptoms should be evaluated with the daily skin assessment.
Signs and symptoms of DVT:
- Swelling in one or both legs (not to be confused with dependent edema caused by sitting)
- Pain or tenderness in one or both legs (difficult to assess)
- Warmth in the skin of the affected leg (easy to assess and notify physician)
- Red or discolored skin in the affected extremity
- Visible surface veins
- Leg fatigue (also difficult to assess)
DVTs are dangerous because symptoms may not be experienced or even noticed. But when a piece of the embolism (blood clot) breaks away and travels toward the lungs it may cause sudden coughing, which may bring up blood; sharp chest pain; rapid breathing or shortness of breath; or severe lightheadedness. This is a medical emergency.
CALL 911 OR GO TO AN EMERGENCY ROOM IMMEDIATELY IF YOU EXPERIENCE ANY OF THE ABOVE SYMPTOMS.
YOU MAY ASK “HOW DO I PREVENT DVTs? I’M IN A WHEELCHAIR.” Great question!!!!
According to Web MD, the following suggestions are recommended to avoid DVTs, but us wheelchair-using individuals must make some deviations to the list and become extremely creative due to our inactivity while in a wheelchair. I listed a few suggestions but I welcome any others that you found work.
To lower your risk and help prevent DVT, take these steps:
- Maintain an active lifestyle and exercise regularly — daily, if possible. Walking, swimming, and bicycling are all great activities, but if we can’t walk or bicycle then creativity comes into play. We should and can still move our legs frequently. Some notable suggestions by the Livestrong.com website: If you can, sit with your ankle on your knee, you can adequately stretch your ankle by pulling your foot up and then down. You can stretch your hamstrings by straightening your knee, placing your foot on your couch or coffee table, and leaning forward. Stretches should be held 15 to 30 seconds on each side for 3 to 5 repetitions daily. Splendid ideas but whatever your exercise of choice, move your extremities every few hours, however you choose. If you cannot move your extremities yourself, have a friend assist you.
- Manage your weight with exercise as well as by eating a healthy diet. This may seem difficult but if you read my earlier articles on fabulous vitamins, eating healthy will be more effortless.
- If you smoke, quit! Nicotine therapy (in patches, gums, or sprays) and support groups can make this task much simpler.
- Have your blood pressure checked regularly; take steps to lower it, if necessary. This goes back to my recent article on concussions…..another justification to obtain a blood pressure cuff and to familiarize yourself with YOUR blood pressure baseline numbers. Know what numbers are elevated and what is normal. Remember 140/90 is elevated. Become very familiar with your own blood pressure. You are the paramount advocate for your health.
- Report any family or personal history of blood-clotting problems to your doctor. While most physician offices have electronic medical records in this day, it is pertinent that your information is in their database for future reference.
- Discuss alternatives to birth control pills or hormone-replacement therapy with your doctor.
- If you are on an airplane for more than 4 hours perform leg stretches in your seat. You may be lucky enough to be seated in the bulkhead seats which allow for additional leg room. Here again, move your extremities somehow (I suggest every 30 minutes to one hour), and drink enough water to stay hydrated and avoid alcohol consumption. I know, staying hydrated may be difficult if you perform intermittent catheterization for the emptying of your bladder. That’s why I alluded earlier to become creative in your care. One suggestion may be to insert a Foley catheter with a large leg bag (900 ml) to utilize during the flights.
- Another great suggestion would be to don the compression hose or stockings we wore after our SCI. I know, I know, we really disliked getting those things on, right? But they worked and the reason they worked was because they compress the limb or the lower extremity by exerting pressure against the legs thus reducing the diameter of distended veins and they can cause an increase in venous blood flow velocity and valve effectiveness. Phew!…so get those “bad boys” back on if you will be sitting for a long period of time or on a long flight.
Let me simplify the explanation as to why DVT’s are so dangerous to us SCI individuals. Walking, running, exercising, whatever we did prior to our SCI moved the blood from our lower extremity quickly back up to our heart to be cleaned and moved back out to our body. Well, now since we don’t or unable to move our lower extremities as we once did, the blood can pool and sit and become sludge and tiny clots can form, thus allowing more and more blood to attach to the clot and form a DVT, deep in your vein. When this clot dislodges then it may travel to your lungs causing a medical emergency. That’s why Deep Vein Thrombosis is so dangerous to us SCI individuals.
I am the queen of creativity in wheelchair nursing…..ask me for helpful hints. I would be happy to come up with ideas that are suitable for you and/or to discuss with your physician.
Diagnosis and treatment of DVT’s are left up to your General Practitioner. One word of major caution: if you find your leg or arm to be warm or any of the above symptoms are present;
DO NOT, I REPEAT, DO NOT MASSAGE YOUR EXTREMITY!!!
Please, please, please find medical attention to be evaluated. I want us all, women and men too, to remain FIT, FABULOUS and oh so DVT-free.
The Rollin RN, Patty Kunze, BSN, RNC
Exercises for seniors in wheelchairs. Obtained August 28, 2014 from http://www.livestrong.com/article/112463-exercises-seniors-wheelchairs/.
Symptoms and diagnosis of DVT (Deep Vein Thrombosis). Obtained August 29, 2014 from http://www.webmd.com/dvt/deep-vein-thrombosis-dvt-symptoms-diagnosis.
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