DEAR DR. DONOHUE: Nine months ago, our son, 42, had a deep-vein thrombosis. The clot was in the calf and thigh vein. He was given an anticoagulant and the clot was surgically removed, but surgery was only partly successful. Some of the clot remains in his leg veins. He continues to take Coumadin and is told it may take a year for the clot to dissolve. His calf is often swollen and painful. Can you suggest any additional treatment? -- M.T.
ANSWER: For readers unfamiliar with this problem, some definitions are necessary. Thrombophlebitis (THROM-boh-flea-BITE-is) is a clot in a vein. "Thrombo" means "clot," and "phlebitis" is vein inflammation. The leg is the common site for it to happen. A person on bed rest after surgery (especially knee and hip surgery), who is sitting for prolonged times during a car or plane trip, taking birth-control pills or suffering trauma is at risk of getting thrombophlebitis.
Clots in the deep veins of the leg, the ones you cannot see, are the dangerous kind. Bits of those clots can break away from the main clot and be carried in the circulation to the lung, where they can plug a lung blood vessel. That's called a pulmonary embolism, and it can be deadly.
Clots in leg veins cause the overlying skin to turn red and become tender. The leg swells and is painful. Ultrasound examination of the veins establishes the diagnosis.
Anticoagulants are the treatment. They don't dissolve the clot, but they keep it from growing larger and they prevent the chance of a pulmonary embolus. In time, a canal burrows through the clot, and blood flow is re-established or blood finds alternate routes to leave the leg. It takes months for this to occur. Nothing speeds the process. Time is the medicine of choice.
A large number of people develop what's called the post-thrombotic syndrome after thrombophlebitis. The leg remains swollen and painful. Compression stockings and frequent leg elevation minimize this complication.
The peripheral vascular disease booklet discusses this illness, its treatment and outlook. Readers can order a copy by writing: Dr. Donohue -- No. 109W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I am on a diet in which the food portions for each meal are small. We are instructed to drink eight glasses of water a day. My question is: When is a good time to drink the water? -- P.F.
ANSWER: You can drink the water anytime you want. Water or other liquids do not interfere with digestion.