Maarten Vasbinder lives in Isaan. His profession is general practitioner, a profession that he mainly practiced in Spain. On Thailandblog he answers questions from readers who live in Thailand and writes about medical facts.
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Dear Martin,
At the end of October I got a stabbing pain in my left calf. Almost immediately after that time my lower leg, ankle and foot started to swell. The pain eased as I held my foot up. On October 22, I went to a private clinic, received medication there and this doctor referred me to the hospital.
In the hospital, what they called a small scan was performed on my left leg, where it was found that the blood circulation was disturbed. I was given the drug DAFOMIN 500mg for that. An appointment was made to have a “major scan” done on November 27 by a specialist. Back on December 3 for the results and I was given the drug WARFARIN 3 mg. Take one tablet before going to sleep. On December 24, a check and blood tests showed that the blood value was too high, 5 instead of 2/3.
Received the same medicines, but now a whole tablet for three days and half a tablet for four days. I also received the drug LASIX 40mg for diuresis. On January 4th again for a check-up and now the blood value was good again and the doctor advised to continue with the same medicines. Next check on January 24.
My question to you is, are these the right medicines because I see no improvement? When I get up my leg is normal but an hour later after some effort it swells again. If not, what medicines would you prescribe and are they available in Thailand?
My age is almost 72 years, I have described the complaint and medication. No smoking and no alcohol for three months. Not much at that time. Length 1.84 and 87 kg. Blood pressure measured at home is normal 132-79, considerably higher in the hospital.
Hope this information is enough to form a picture of my ailment. I would like to hear from you if I might be better off switching to another medication.
I ask this because we were told that the doctor I went to the last two times was not a cardiovascular disease doctor but a pulmonologist.
Thanks in advance,
Sincerely,
W.
******
Dear W,
It is almost certain that you have had thrombosis and you now suffer from what we call a thrombosis leg. Your story fits very well with that. The pain in the calf in the and swelling leg rings an alarm bell for every doctor.
The pulmonologist is involved, to see if you have not suffered a pulmonary embolism because a blood clot has been shot from the leg into the lungs. In the Netherlands it would be further handled by an internist, but the country's wise honor.
Instead of the Dafomin you have had, low molecular Heparin injections would probably have been better, for example Enoxiparin. Dosage depending on weight (15 mg per 10 kilos per day). Dafomin is usually used for hemorrhoids, although it has not been proven that it works. You can give those heparin injections yourself under the abdominal skin around the navel. Then an ice cube. That can prevent a bruise. Be careful not to take two drugs at the same time, such as warfarin and heparin. That is dangerous.
You can always start with that, but it's probably too late. I have had sporadic success with long-term heparin treatment (3 months), but those successes are more anecdotal. It was a last resort for a long-standing problem that had gone unrecognized by a specialist.
A disadvantage of Heparin is the possibility that platelets will clot, which is a serious but rare side effect (HIT(T)) syndrome. Luckily never saw it. However, the other drugs also have serious, but rare side effects.
Warfarin treatment is the right follow-up treatment. Pradaxa (Dabigatran) 2x 150 mg per day is also eligible. Then your coagulation does not need to be checked
The Lasix will not heal your leg. However, you run the risk of dehydration, which is another risk factor for thrombosis. So drink a lot, if you keep taking it.
Also have a total check-up done in connection with possible underlying causes.
Walking a lot is good. Stand on your toes several times regularly. The effect of compression stockings is controversial, but it is certain that compression stockings are not very pleasant in the tropics.
Do not change your medication without consulting your doctor.
Minimum treatment duration is 3 months, depending on any underlying causes.
Once again I would like to point out that sufficient alcohol-free fluids are a must in this climate. With this, all kinds of ailments and pains can be avoided.
More information: /www.trombosestichting.nl/thrombosis/wat-is-thrombosis/
Yours faithfully,
Dr. Maarten