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29 Teves 5761 - January 24, 2001 | Mordecai Plaut, director Published Weekly
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Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Sometimes the lungs are affected by diseases that have little to do with them. One of the most feared diseases is pulmonary embolism. Embolism is a medical word describing the sending of a clot or other solid material from one place in the body to another, where it could cause havoc. We have described such a case with the heart and atrial fibrillation where clots in the heart can reach the brain and cause a stroke.

If there is a clot in the legs, the legs will usually puff up and get red. It can look almost like an infection. Should a piece of this clot break off and reach the major vessels of the lungs it could stop up the vessel and create a situation where little blood reaches the lung and death can occur.

The problem is that this clot in the legs, which is called DVT, can be hard to notice or it may be hard to say it is a clot and not an infection. A pulmonary embolus, that is a clot to the lung, may be really hard to pick up and no test is that close to 100%. It simply causes shortness of breath and a negative x- ray.

When one has a tough disease like this, we start to depend on risk factors. These include cancer, especially a new one and this may be the first sign; prolonged immobilization (this is why one should walk around in a plane and make frequent stops to walk around while on a long drive); recent surgery, especially pelvic surgery or fractures of the pelvis or the hip; clotting disorders, and pregnancy. A swollen leg or shortness of breath with one of these risk factors should raise a red flag.

The treatment is prolonged anticoagulants, that is blood thinners. During therapy, one must be very careful about falls or other things that cause bleeding; and have the thinning be monitored by blood tests.

Other things can embolize to the lungs but are a lot rarer. Two of these of note are amniotic fluid embolism, where some of the fluid surrounding the baby escapes into the mother's blood stream and blocks up a vessel, and fat embolism, where a break in a major bone causes the fat in the bone to also get into a vessel. These conditions are both rare and dangerous.

This is all scary, but like everything else, being aware and cautious may save your life. Write me in care of the Yated. (A special hello to the Rabins from Kiryat Sefer who met me in the supermarket and said such nice things about this column. I appreciate your comments!)

A message from Glaxo, the sponsor of this column. Cold sores hurt. Valtrex can help. Shingles can cause excruciating pain. Valtrex can help. If you develop any of these painful conditions, ask your physician about Valtrex.

 

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