Dear Dr. Roach: My story is hard to believe, but itís true. While golfing, I was hit in the calf with a golf ball. It hurt but I could still walk, and I finished 18 holes.
The next day, my calf was swollen, red and really hurt. My doctor sent me to the hospital for blood tests and an ultrasound.
They showed I had a clot in a vein, and I was admitted. While waiting for a room, I suddenly found I couldnít breathe. The clot had traveled to my lung. I was put on blood thinners immediately.
Itís been a whole month since all this happened, and I have been home for two weeks. Iím still taking blood thinners. How long do I take them? My leg is fine, and my breathing has been good.
Dear C.J.: That golf shot definitely was a stroke of bad luck. The golf ball striking your calf injured the large vein there and inflamed its wall.
The inflammation caused blood platelets to stick to the vein and form a clot. The sequence of events is thrombophlebitis (THROM-boh-flea-BITE-iss) and is potentially quite dangerous.
Injury isnít the only cause. One big cause is immobilization in bed. Itís the setting for thrombophlebitis in hospitals. Birth-control pills and estrogen are other causes.
The clot didnít migrate to your lung. Pieces of it broke loose and traveled in the circulation to your lung, where they blocked lung blood flow. Thatís a pulmonary embolus, and it can kill. Anticoagulation (blood thinning) stops the growth of the clot and prevents pieces of it from making their way to the lungs.
Some authorities on thrombophlebitis have their patients stay on anticoagulants for life. Others feel that three to six months is sufficient time.
I donít know what anticoagulant youíre taking. Newer ones donít require the frequent lab testing that the standard, older one does.
Dear Dr. Roach: My uncle is in his 90s and has been hospitalized with gangrene of a toe. The doctors are going to amputate it.
I always thought gangrene was something that happened to soldiers wounded on a battlefield when the wound became infected. My uncle definitely was not in a situation like that. How did he get gangrene?
Dear L.L.: The definition of gangrene is death of tissues. Your uncle has whatís known as dry gangrene. Itís due to a loss of blood supply to the involved area.
Circulation has been cut off. Itís often a consequence of uncontrolled diabetes, but any process that blocks circulation can lead to it.
The kind of gangrene you mention is gas gangrene. It does happen to wounds infected with a bacterium often found in soil. Gas bubbles form in the infection, which spreads rapidly.
It must be treated quickly, or itís fatal.
Email questions to ToYourGoodHealth@med.cornell.edu.