Leg Ulcers can be Prevented After Deep Vein Thrombosis and Post-Thrombotic Syndrome

Kin Coulee Park in Medicine Hat has more than one thing to offer. (Dr. Noorali Bharwani)
Kin Coulee Park in Medicine Hat has more than one thing to offer. (Dr. Noorali Bharwani)

The title of this column suggests three interrelated health issues – deep vein thrombosis, which may lead to post-thrombotic syndrome, and in some cases the individual may end up with chronic leg ulcers.

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, usually in the legs. Post-thrombotic syndrome is a complication of DVT and can affect 23 to 60 per cent of patients in the two years following DVT of the leg. Of those, 10 per cent may go on to develop venous ulcers.

The presentation of DVT and post-thrombotic syndrome may be quite similar. Seventy to 90 per cent of chronic leg ulcers are due to improper functioning of venous valves of the legs. It is important to remember post-thrombotic syndrome is a chronic but preventable condition. Otherwise it leads to limb pain, swelling, skin discolouration, ulceration, and rash after DVT.

An article in the Canadian Medical Association Journal (CMAJ January 7, 2014) describes the risk factors for the post-thrombotic syndrome, which include older age, obesity, male sex, iliofemoral (proximal) DVT, recurrent same side DVT, previous or primary venous insufficiency, and elevated D-dimer levels after withdrawal of anticoagulant agents.

Any individual who has had DVT should be advised regarding the long-term consequences of damaged valves in the deep veins and preventive measures. These include using compression stockings and taking low-molecular-weight heparin for at least three months after DVT is diagnosed.

Compression stockings and exercise therapy are first-line treatments for the symptoms of post-thrombotic syndrome.

A Cochrane review reported that compression stockings (30 to 40 mm Hg) used early after the diagnosis of DVT were associated with a 69 per cent reduction in the odds of post-thrombotic syndrome developing.

A systematic review also showed that long-term treatment with low-molecular weight heparin after DVT resulted in a lower incidence of post-thrombotic syndrome than treatment with anticoagulants administered orally.

The aim of management is to prevent further incidence of DVT and prevent long-term consequence in the form of chronic leg ulcers, which are not easy to treat.

An article in the American School of Laughter Yoga website titled, “Laughter helps leg ulcers heal.” quotes Dr. Andrea Nelson, University of Leeds School of Healthcare saying, “Believe it or not, having a really hearty chuckle can help too (with leg ulcers). This is because laughing gets the diaphragm moving and this plays a vital part in moving blood around the body.”

Once again, remember, more you laugh the better you get and better you feel.

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We Should Not be Afraid to Laugh

My friend Sam - one face with multiple laughs. (Dr. Noorali Bharwani)
My friend Sam - one face with multiple laughs. (Dr. Noorali Bharwani)

“God is a comedian playing to an audience too afraid to laugh,” says Voltaire (1694-1778), a French writer, historian and philosopher. He was famous for his wit.

Why are we so afraid to laugh at ourselves? When a friend made a joke about his illness, people looked at him in amazement. “Has he gone crazy?” people would ask. Who knows, there may be some truth in that. But as long as the jokes are about him, and he is not hurting anybody, what is wrong with that?

Everyday we are faced with new challenges in life. Some challenges are mild and some are horrific. And there are lots in between. One way or the other, we have to deal with them.

Staying positive and taking a good laugh about it is not going to hurt you. It is not going to hurt anybody. It will definitely keep your morale and help you and your family deal with the problem.

Besides laughter you can do more things in life if you can find time. And time you have to find to stay healthy. Time to listen to music, dance if you can and watch comedy shows. Exercise within your physical limits. Most people are busy at work and raising a family. It is not always easy to do everything. Keep doing something.

There are no hard and fast rules about being healthy. Most of it is common sense. Do everything in moderation, without any sense of guilty. Have a long-term strategy. Rome wasn’t built in a day. And it is still a beautiful city. Worth visiting.

OK, enough for today. Stay positive, healthy and happy. Don’t be afraid to laugh. Talk to you soon.

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Research Shows Laughter and Music Good for Your Heart

A group of smiling women. (Goodshoot)
A group of smiling women. (Goodshoot)

In 2009, for the first time, research showed that there is some truth in the good old saying, “Laughter is the best medicine.” But anger and stress, hmm… not so good.

Laughter, along with an active sense of humour, may help protect you against a heart attack, according to the 2009 study by cardiologists at the University of Maryland Medical Center in Baltimore. The study found that people with heart disease were 40 percent less likely to laugh in a variety of situations compared to people of the same age without heart disease. They also displayed more anger and hostility.

The researchers could not explain how laughter protects the heart but they found that mental stress is associated with impairment of the lining of the blood vessels. The damage to the lining is followed by inflammatory reactions that lead to fat and cholesterol build-up in the coronary arteries and ultimately to a heart attack.

Now let us fast forward to 2011. Location: Paris, France. At a session entitled, “Don’t worry, be happy,” a series of research papers were presented at the European Society of Cardiology Congress highlighting the role of laughter, positive thinking (cognitive therapy), anger, and job stress on developing cardiovascular events.

The cardiologists from Baltimore presented their research related to the effects of humorous and stressful movies on the function of the lining of the blood vessels. They found that the blood vessels constricted by as much as 30 to 50 per cent when watching movies which were emotionally stressful. In contrast, blood vessels dilated when investigators measured vascular function in subjects watching the comedies.

Positive or negative effects on blood vessels can last for about an hour. Other researchers have seen the benefits of laughter on vascular function extended to 24 hours. The magnitude of change in the blood vessel is similar to the effects observed with statins and physical activity.

Other studies presented at the Paris conference dealt with the effect of anger, job stress, and depression. A study from University of Helsinki, Finland, observed that public-sector individuals who work more than three hours overtime per day were at an increased risk of coronary heart disease compared with those who worked no overtime.

A study from the Institute of Clinical Physiology in Pisa, Italy, recruited 228 patients with the diagnosis of myocardial infarction (heart attack), 200 of whom were men, and assessed the long-term effects of anger on recurrent cardiovascular outcomes. They found that over the course of 10 years, 78.5 per cent of patients without an angry-personality profile were free from a recurrent infarction compared with 57.4 per cent of patients with angry personalities. People with angry personalities tend to eat more and use alcohol too much to curb stress.

A study from Australia showed at four months, cognitive therapy reduced depression and reduced waist girth, increased good (HDL) cholesterol levels and increased physical activity. Patients were better at managing their anger, depression and anxiety.

A researcher from Germany, believes that classical music offers the ideal therapy for patients with hypertension and increased heart rates. He is now planning a prospective study called “Bach or beta blockers.”

Come to think of it, preventing heart attack is lot of fun. Laugh a lot, listen to music, have a positive attitude, meditate a bit, eat healthy, exercise regularly, have a glass of red wine, have a fulfilling relationship with your partner, go dancing and manage your anger. Easy.

Now, go and have some fun.

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Why do women laugh more than men?

Laughter is a tranquillizer with no side effects.

-Arnold Glasow, American humourist

This is the last segment on our discussion about laughter and how we use it to counterbalance life’s troubles. Laughter makes you emotionally and psychologically strong, makes you physically friendlier and sexually attractive. In this article we will discuss how men and women use laughter for flirtation and long-term commitment. And why women laugh more than men.

“Humour in all its form – sarcastic, witty, anecdotal, ironic, satirical – is as complicated and evolved as language. It can be a weapon used to alienate and a means to communicate interest and intelligence,” says Christie Nicholson, contributing editor of Scientific American in an article in Scientific American Mind (May/June 2010).

Nicholson, in her article The Humour Gap, says that men and women have different sense of humour and appreciation of humour. Men want someone who will appreciate their jokes, and women want someone who makes them laugh. Some researchers believe that this has been an evolutionary process as part of the laws of natural selection.

In 1859, Charles Darwin introduced the term “natural selection.” It is the observation that individual organisms with favorable characteristics are more likely to survive and reproduce than those lacking these traits. Do we use laughter as part of our survival instinct – men and women using laughter in their own way to smooth their relationships and ride over trouble times?

Women find funny men very sexy. Especially in their first meeting. Funny man shows creativity, intelligence, playfulness and openness to experience. Women, consciously or subconsciously, know that humour is a good indicator of intelligence which is a highly prized heritable trait, says Nicholson. Women want their men to make them laugh and have children who are intelligent and funny like their dad. During the time of ovulation, women prefer to be around creative funny men than rich dull guys.

Women are always known to laugh or giggle more than men. You can remember that from your school days. And experiments have confirmed that women laugh so much more when they are speaking to men – and they laugh more than men even when men are doing the talking –suggests that there is some instinct at play, says Nicholson. The instinct may be related to the female role of sexual selector. Nicholson says, “…whatever the roots may be of the female instinct to laugh around men, it works – men find women attractive when they laugh. Perhaps it is because laughter unconsciously signals interest and enjoyment.” It is an invitation to continue.

Studies have shown that laughter is a powerful measurement of the level of attraction between two people. In fact, experiments have shown that female laughter is an accurate predictor of the level of attraction between both partners. A woman laughs a lot when she is attracted to a man or when she senses a man’s interest. More she laughs, more attractive she becomes, indicating that she welcomes his attention.

Nicholson’s article concludes by saying that the deeper purpose of use of humour in our life is to help us connect and bond with one another. She continues, “A genuine laugh is one of the most honest ways to convey: I’m with you.”

So, my dear reader, do not forget to laugh today and every day and make somebody laugh. That means you care. Angry grumpy men should remember, women will like you more if you learn to relax and laugh and make others laugh. And you may produce children who are healthy, funny and intelligent.

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