GynoFiles

What do you reach for when flying out of bed to workout? Favorite shirt? Leggings? Have you considered support stockings. It's especially smart to wear support stockings during long plane rides, long immobile days at work, and if you have to stand hours on hard concrete, but you can also wear them during work outs as and extra measure to prevent blood clots. Women flying always should wear some compression stockings, especially the compression on the ankles from these stockings helps not only reduce risk of blood clots, but it reduces the risk of ankle swelling. Wearing support hose is one strategy with virtually no side effects! The risk of developing a blood clot that is serious is about 1-5 per 10,000 women; it rises to 3-12/10,000 if you are on a combination hormonal contraceptive, and the risk is between 5-20/10,000 women during pregnancy and that risk remains higher than normal in the post partum period of time. The vaginal ring as a contraceptive would approximately double ...

Well, it takes a lot of the alphabet, and some of the roman numerals to describe the intense physiological magic that goes into clotting and clearing our blood stream! Simplifying an explanation runs the serious risk of being very inaccurate, and yet, we need to talk about all these numbers and letters your gyno throws around when she discusses blood clot risks! To form a clot we have to form what is called a fibrin clot. To form this clot fibrinogen has to be converted to this fibrin stuff that glues together to be the basis of clot. Once that clot starts, it becomes a whole bird’s nest full of whatever’s available to buttress up the walls. Stuff like tissue plasminogen activator, clotting factors, and plasminogen will glom onto the clot. But it all has to begin with fibrin. To generate fibrinogen into fibrin you need a molecule called thrombin to trigger this reaction. Too much clotting is a bit dangerous, so our physiology protects us by having thrombin circulate in the blood strea...

There are many ways of lowering one's risk of blood clots. Exercise, lower cholesterol, support stockings, sitting correctly, and taking medications which actually thin the blood if you are genetically at risk all help. But altering the birth control you take may be one way of lowering your risk as there are low, but increased risks with certain types of pills. A new study on blood clots with the use of Yasmin birth control pil l discusses those risks. To put them in perspective, the study found rates of 3 women out of 10,000 at risk for blood clotting, vs the normal population rate of about 1/10,000 in the control population not on those pills. The increased rate is still lower than the rate of blood clots in pregnancy which is estimated to be about 50 times higher than none pregnant (although some studies put this number much lower at only 4-20 times as more common, which would be lower than the newest rate for Yasmin). Remember that methods such as a ParaGard IUD for women wh...

Pains in your legs may mean that you have deep vein clots. There are physician performed tests, office tests and radiologic studies that can determine whether you have one of these clots. For women who have suffered a clot it's important to understand if you have a medical or genetic condition that could have led to these clots. Many blood factors lead to proper blood clotting, which we need to heal from cuts. But imbalances in some of these factors can predispose us to clot risk. Some factors cause clots: so you don't want to much of them, others prevent clots, you need enough of these factors. Protein C and Protein S are vitamin K dependent regulatory factors that can, if deficient, predispose us to clots. But a woman may be deficient because genetically she cannot produce the right amount or type of these factors.  In fact a woman who is Protein S deficient has about a 50% risk of developing a clot before age 50, but unfortunately, most women with these conditions don't ...

As I write I'm propping my legs. Getting off your feet and getting circulation going to the heart is important. Most of us assume that if we have swollen ankles or bulging veins we were just in the dancing shoes a bit too long and a bit of a prop is all we need. And yes those two extra smores (my homage to Girl Scouts everywhere since it was the first recorded recipe ever for them in the 1927 Handbook! Anyone want to sell me a copy?) I ate couldn't have helped. Who knew chocolate and graham crackers have so much salt! As your gyno I tend to look even deeper for the source of your leg problems: ovarian cysts, constipation, blood clots, enlarged uteri, and cases of torsion or varicosities of the  pelvic veins as well as deep venous disease or blood clots. But eventually if, more commonly, nothing is found but venous insufficiency syndrome and unsightly leg veins, we can talk about the fix. More on that later!

There are many complex ways of figuring out if your leg aching and swelling is an issue. Pain in one leg, not both, is something to watch for. Swelling on one side, not the other is another thing to watch for, so that if one calf is close to an inch bigger than the other calf, measured at the same spot, that's a warning sign. And if you are prego, or on the pill, or on hormone therapy, or on Evista, the osteoporosis therapy, or on Lysteda, the new heavy bleeding medication, all reasons to call the Gyno 911(or your primary care MD)  to check it out!