Q&A: Blood Clots; Heart Bypass Surgery; Rheumatoid Arthritis
Q. I’m traveling to Europe soon and facing about a nine-hour flight. I’m concerned about air travel increasing the risk of blood clots. What can I do to prevent this occurring?
A. About one person in 4,500 develops deep vein thrombosis (DVT, or a blood clot) within eight weeks of air travel. Older adults are particularly at risk, as are people who have a personal or family history of DVT, are obese, or smoke. Long periods of sitting impair blood circulation, so keep as mobile as possible on the flight. Walk around the aircraft cabin once or twice each hour, and if you have any layovers stay active before catching your next flight. When sitting in your seat, regularly flex and rotate your ankles, and rise up and down on your toes to promote circulation. Avoid dehydration by drinking plenty of water, and avoid tea, coffee, and alcohol because these worsen dehydration. Ask your doctor if wearing compression hose for your trip might help. DVT typically causes unexplained pain, tenderness, redness and swelling, usually in the leg. If you develop painful and/or swollen calves after your flight, seek medical advice as soon as possible.
Q. My husband is scheduled for heart bypass surgery and is worried he will suffer cognitive decline as a result of the operation. Is he worrying needlessly, or is there real cause for concern?
A. It is true that a significant number of people who undergo coronary artery bypass grafting report changes in mental functioning following their surgery. These changes include delirium, short-term memory loss, slowed responses, trouble concentrating, or emotional instability. These cognitive problems, which are usually temporary and do not affect all patients, have been blamed on the older age of most bypass patients, or possibly the effects of anesthesia, reduced blood flow to the brain during surgery, and/or post-operative depression. If your husband does experience cognitive changes as a result of the surgery, it might be possible to speed his recovery through cognitive rehabilitation. Researchers have found that bypass patients who received training in memory or focusing attention following their surgery showed significant improvements in mental performance. Longer-term cognitive decline that has been identified in some bypass patients may be a result of an underlying blood vessel disease associated with the patient’s cardiovascular condition, rather than the bypass itself. A comparison of coronary-artery disease patients who had bypass surgery with others who were treated with medications, and a third group of healthy subjects showed that all of the heart patients, regardless of their treatment, demonstrated signs of cognitive decline six years later, while healthy subjects did not. These cognitive changes are probably linked to atherosclerosis of brain blood vessels, and can possibly be avoided by lowering cholesterol, maintaining healthy blood pressure and blood sugar levels, and stopping smoking. Your husband might consider discussing his concerns with his surgeon before the surgery, and report any cognitive symptoms after the operation so they can be addressed.
Q. I’ve been having pain in my elbow recently and was diagnosed with rheumatoid arthritis (RA). What I didn’t expect was hard lumps forming around my elbow area. Is this because of the RA, or due to something else?
A. Rheumatoid arthritis (RA) is primarily a disease of the joints, but the disease and many of the medications used to treat it also can affect the skin, including firm lumps of tissue called nodules. About 20 percent of people with RA develop rheumatoid nodules. These typically are about the size of a pea, and may form under the skin over bony areas like the elbow or ankle. Nodules are the most common cutaneous manifestation of RA, and they typically form along pressure points—in this case, over the olecranon process of the elbow. (The olecranon process is the outer bump of the elbow that cups the elbow joint.) Nodules also may occur on the internal organs of the body, such as the lungs or heart. They sometimes appear on the back of the head, lower buttocks, Achilles tendon and vocal chords. You may be able to take disease-modifying anti-rheumatic drugs or injections of corticosteroid medications to help shrink the nodules and to control your RA. Surgery also can remove the nodules if they become infected or painful.
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