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Do you know exactly what blood clots are and how they affect your body? Dr. Rajay Seudath from Optum - University explains the symptoms of a blood clot and when to seek medical attention.
Nov. 6, 2024
Podcast transcript
INTROWelcome to Docs in a Pod, presented by WellMed. Over the next half-hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts, Dr. Rajay Seudath and award winning veteran broadcaster Ron Aaron, will share information to improve your health and wellbeing. And now, here are Ron Aaron and Dr. Rajay Seudath.
RON AARON
Well, thank you so much for joining us today on Docs and a Pod, the award winning podcast and radio show available on the radio in Texas and Florida and via podcast wherever you get your podcast. I'm Ron Aaron. Our special guest today is also our co-host, Dr. Rajay Seudath. Dr. Seudath is a board certified family medicine practitioner. He's a Tampa native and a current lead physician for Optum. He's at the university location in Tampa. Dr. Seudath earned his medical degree from the University of South Florida's Morsani College of Medicine, and before his career in medicine, Dr. Seudath worked a whole lot of jobs, but working as an English teacher abroad inspired him to enter the field of family medicine. The topic he chose for today is blood clots, which it turns out, kills about 100,000 people a year, according to the Centers for Disease Control. Dr. Seudath, that's a big number. 100,000 people a year die from blood clots.
DR. RAJAY SEAUDATH
That's absolutely correct. People develop blood clots for many different reasons, and it affects a lot of Americans. Blood clots are one of those things that people hear about, but we don't really have a lot of information in the general public. Not until your mother or a family member or a friend suffers a blood clot. The thing about blood clots is it can affect the relatively young adult age all the way up until we get into our senior years. Blood clots have many different reasons. And that's one of the things that I kind of wanted to talk about initially here is what are the kind of things that cause blood clots? What are some of the things that people hear about? One of the major ones that people often hear about is, I was on a really long drive. I was going from Florida to New York, and I got a real bad pain in my leg after that ride, and the second day, I was in the hospital with a blood clot. So, blood clots develop when our blood is not moving well. So, a long airplane flight, a long ride, being sedentary. having major surgery. Anything that really stops your mobility or decreases your blood flow puts you at risk for a blood clot. So, that's kind of the spark. Those are one of the things that cause blood clots in the legs. Now, there are other ways that blood clots can also form. Blood clots can form inside of the heart as well. So, if a person has a heart rhythm that is not beating, well, they're not doing the normal lub dub, lub dub. They're not having a normal, steady heartbeat. If it's beating out of sync or out of rhythm, that can create turbulence, or the blood flow is erratic in the heart, and that can cause a blood clot.
RON AARON
So, that would be me with AFib.
DR. RAJAY SEAUDATH
Absolutely, sir. So, you know all about what we're going to be talking about in a few minutes, the anticoagulation part, the blood thinner part of blood clots. So, again, when you have AFib, your body can create blood clots. Those blood clots can go to your brain. They can cause a stroke. They can go to your lungs and cause a pulmonary embolism. So, that's typically the, the two major complications of a blood clot and then it kind of goes further than that. After a person has been diagnosed with a blood clot, you can have repercussions of that diagnosis of that disease well on into the rest of your life. If the blood clot develops in your legs, a person can have swelling, discomfort, all of those things, even after the blood clot has been dissolved. And then a person who has a blood clot that goes to their lungs, there's damage to their lungs. They can have areas of the lung that don't quite have good blood flow because of those areas of the lung that has died off. That person now has decreased lung capacity. They get winded. They're not able to have a lot of stamina when doing activities. They're more susceptible to upper respiratory infections, COVID, flu, RSV, those kinds of things. And again, if the blood clot goes to your brain, that's a stroke. We all know that strokes can have long-term, long-lasting effects. Paralysis on the side of a body, difficulty finding words, difficulty comprehending words. So, blood clots have a wide, wide range of effects that they can have on a person's life.
RON AARON
As I understand it, according to the Center for Disease Control, one in four people who have pulmonary embolism, a blood clot in the heart, can die with no warning. Boom. You're dead.
DR. RAJAY SEAUDATH
Absolutely, yes. There's a chance that the blood clot can travel to your lungs. What are the signs and symptoms of when a person is having a blood clot that has gone to their lungs? That person in a very short period of time, hours to a day, they're getting very short of breath. They have a very high heart rate. They're feeling very weak. They're feeling a sharp pain in their chest. Those kinds of symptoms are going to clue in family members, going to clue in the emergency department, your doctor. This person may have a blood clot that has gone to their heart and that needs immediate attention. That's a medical emergency. So, health care providers are trained for when they hear chest pain, they hear shortness of breath, they hear doc, my heart is just beating uncontrollably, that should prick their ears up and this is a person at high risk. We need to get them into the hospital. We need to get them evaluated immediately.
RON AARON
Now, how far have we come in developing so called clot buster drugs? If you've got a clot, can't you just shoot me up with some busting juice?
DR. RAJAY SEAUDATH
Yes and no. We have come a long way. The window is still limited. Within four hours of a person getting a major clot, if it goes to your brain, if it's going to your lungs, there's a limited window and that window can be longer or shorter depending on a person's diseases and what type of clot bluster they're using. Now, some clots that develop whether they're in the legs or whether they're in the lungs, they may need surgical removal, which is called a thrombectomy. A blood clot can go to your lungs, it can go to one lung, it can go to the other lung, or it can go right in the middle of your lungs. That's called a saddle embolism. That almost always needs surgery. Or, if surgery's not possible, they can try to use what's called the clot buster in that.
RON AARON
Let me come right back to you. I want to let folks know who may have just joined us. You're listening to the award winning Docs in a Pod, our podcast available wherever you get your podcasts. We're on the radio in Texas and Florida as well, but on a podcast you can hear us no matter where you are, anywhere in the world, and maybe in the universe. I'm Ron Aaron, along with our co-host, Dr. Rajay Seudeth. We're talking about blood clots and the risk of sudden death and more. We were talking about blood clot busting drugs. You mentioned that window of opportunity. If you think you're having a stroke, is the cause very often a blood clot?
DR. RAJAY SEAUDATH
Again, it's a type of blood clot or a blockage. So again, a blood clot can go to the brain and cause that for strokes. There's sometimes a different pathophysiology, a different mechanism, a different way that is happening where blood flow to the brain is encountering a plaque. The plaque can close off and that can cause a stroke, or a piece of the plaque can break off and further down cause a blockage. So, that can be one of the ways a blood clot itself that's formed in the heart can go to the brain as well and cause a decrease in blood flow, which causes a stroke.
RON AARON
Now, not too many years ago, not every hospital was prepared to deal with blood clots or blood clot busting drugs. Have we gotten better now at access and availability?
DR. RAJAY SEAUDATH
Absolutely. Most major hospitals will have some sort of CAT suite or, or CAT lab that can do delivery of those clot busting drugs. Even if a place does not have clot busters, which, I would say it's ubiquitous now. We've done a very good job of getting those medicines out. There's total-body anticoagulation with heparin or other medicines like that to try and dissolve that clot while it's there.
RON AARON
You mentioned a long trip from Florida to New York. Legs are inactive, sitting in a car, you can develop a clot. What do you recommend about people wearing compression hose when they take trips like that or long air flight?
DR. RAJAY SEAUDATH
Absolutely. Compression hose is one of those things that there's no direct decrease in the amount of clots, but it allows that blood flow a little bit better. What that does is it kind of helps to keep those blood vessels open. Then it's the actual getting up every two hours, walking up and down if you're on a long flight. If you're in the car, doing some foot pump exercises, stopping the car. Stop the car every two hours, walk around the car twice, get back in and start driving. It's funny to say that, but it's absolutely true that that sort of foot pumping, walking and pumping that foot can prevent a blood clot. That's absolutely right. In some instances, if we have patients who are at a higher risk, we may start them on something to prevent a blood clot while they're in that situation. For instance, if they already have had a blood clot before, and they're not on anticoagulation, and we know they're going to go on a trip, we might start anticoagulation. We might tell them to take aspirin when you go on a car ride. When you're on vacation you don't need it, but when you're driving back, take one more before you come back. That's a discussion that needs to be had with a person and their health care provider to see is that's necessary or not.
RON AARON
You mentioned anti-coagulation drugs. I mentioned that I have AFib. I'm on a drug called Eliquis, which is designed to prevent blood clots. The downside is how easily I bruise.
DR. RAJAY SEAUDATH
Absolutely. Eliquis, Xarelto, Pradaxa, these are the newer anticoagulation, the newer blood thinners, and they work differently from older-style blood thinners. You are absolutely right. The wind hits you wrong, and you're going to get a little bit of bruising. Your kids or your grandkids, they squeeze you too tight and you're going to have some bruising on your skin. The nice thing about that though is those kinds of medicines don't need weekly or monthly testing.
RON AARON
Like warfarin, the older drug.
DR. RAJAY SEAUDATH
Like warfarin. Absolutely. Warfarin had a very narrow window of therapy. So, that's called the INR or the PTT. It has to be at a certain range. When you go below that certain range, it doesn't prevent clots. When you go above that range, a person can have bleeding, you know, excess bleeding. You brush your teeth too hard, now you have bleeding in your gums. You blow your nose too hard, now you've got a bloody nose.
RON AARON
Warfarin is really rat poison.
DR. RAJAY SEAUDATH
You hear patients say, doc, you want me to use rat poison? Warfarin? No, I'm not going to use that. And yes, in the rat poison doses, they will bleed out and die.
RON AARON
Yeah, bad for rats.
DR. RAJAY SEAUDATH
Bad for rats. But you know, any medicine is a poison, and any poison at the right dose becomes a medicine. One of the other things about warfarin, Pradaxa, is that they have antidotes. If a person's taking too much of their warfarin, or they take too much of the Pradaxa, there are ways to reverse those. For the newer ones, you don't have to do testing. There aren't any readily available antidotes. So, let's say you're on Eliquis, another patient on Xarelto. They notice they're getting nosebleeds, they're passing blood in their stool. What do I do? Am I going to have a brain hemorrhage? Am I going to bleed into my intestines? What's going to happen to me? In that instance, we can evaluate that person. We can stop the dose. Or if it's an emergency situation, we can give them plasma. We can give them whole blood that has coagulant factors in them.
RON AARON
All right, we're going to come back to that in just a moment. We'll be right back with you, Dr. Rajay Seudath. I'm Ron Aaron. You're listening to the award winning Docs in a Pod. We're talking about blood clots, diagnosis, prevention, and treatment, and we're going to talk a little bit more about treatment and diagnosis right here on Docs in a Pod.
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RON AARON
We are so pleased you are sticking with us right here on the award winning Docs in a Pod, our podcast available wherever you get your podcasts. I'm Ron Aaron, along with Dr. Rajay Seudath. He is our co-host and today our special guest. We're talking about blood clots. Diagnosis, prevention, treatment, and Dr. Seudath, one of the things is education. A week ago, we talked about Breast Cancer Awareness Month. When it comes to blood clots, maybe we need a Blood Clot Awareness Month because people don't really know about them.
DR. RAJAY SEAUDATH
That's an interesting thought process because having a month or even a week dedicated to blood clots, it could be something that could bring awareness to it. Like we said earlier, blood clots can arise for different reasons. Afib, inactivity with your legs. So, it would be interesting to have a blood clot awareness week to spearhead that. Another thing would be to tie that to an exercise or some sort of activity endeavor or some sort of campaign for things like that. Because the idea would be as you're moving, as you're not being sedentary, you're having nitrous oxide, and the chemicals that are released that prevent blood clots.
RON AARON
I love my Apple Watch. If I'm sitting too long, my Apple Watch says, stand up. Which is interesting. I look at it and I say, well, how do you know what I'm doing? The watch is usually right. Stand up.
DR. RAJAY SEAUDATH
It is right. Now, we were talking about treatments before. We talked about warfarin, we talked about the other newer one. One of the nice things, and again, you being on eloquence, you should know, there are very few dietary restrictions on the newer blood thinners. Whereas with warfarin, you had to be very careful with eating greens. You had to be careful with eating grapefruit. Any little thing could make your level of that drug go outside of that window. With Eliquis, with Xarelto, Pradaxa, that's very much not an issue anymore. That's why it's great for people to be on those medications to be able to have things that they can eat because the person has heart failure and they have diabetes and they have this and they have that, you want that person eating as much vegetables as possible. But if they can't have it because of their warfarin, now we're kind of in a catch 22, which disease do I worsen in order to keep you alive?
RON AARON
It's all tradeoffs.
DR. RAJAY SEAUDATH
Yes. The way I talk to my patients, I say, you are a very special snowflake, and we must keep you at a very specific balance to prevent you from melting.
RON AARON
And there you are. Now, when it comes to diagnosing blood clots as a primary care physician, is there a list of questions you automatically will ask a patient to give some awareness on your part to whether they're at risk for blood clots or maybe they have one.
DR. RAJAY SEAUDATH
Right. Absolutely. We typically don't do screening for blood clots. But if a person is having swelling in only one side of their leg. Their leg is reddened. They feel that something is off. They're having pain. They feel a pulsing sensation. That should clue us in, okay, this person needs to get an ultrasound. An ultrasound is typically the first step towards diagnosing a blood clot. When we do an ultrasound, it's typically as a STAT because again, if it's a blood clot, we want to treat it immediately. So, you shouldn't be getting an ultrasound order and sometime next week you'll go and get it done. If I'm thinking there's a blood clot there, I'm trying to persuade my patients to go today, to go tomorrow. Patients say, well, Ive got a really busy weekend. Let me kind of fit this into my schedule. No, if I think you have a blood clot, I need you to go right now. So, that's one of the things that would clue us into that if a person has a history of blood clots in the past. If their parents have had blood clots in the past, certain genetic diseases, overweight, morbid obesity, heart failure and then again, the AFib. If a person has an AFib, that's a blood clot in the heart, but if a person has vascular issues in general, they've had heart attacks in the past, they have low blood flow to their legs from their arteries, that can cause a venous issue. Which again, when we talk about blood clots, we're talking about venous blood clots or a blood clot in the heart.
RON AARON
In doing a little research to talk with you about this topic, I came across a great website called stop blood clots, and on it, there's a list of things that could put you at risk. One that caught my attention because I've had it is knee replacement surgery can put you at risk for blood clot. Why? Why would that be?
DR. RAJAY SEAUDATH
It's going to be putting you at risk for surgery in that post-operative period specifically. When they're doing surgery in that area, it creates a lot of inflammation. So, there's a lot of bleeding in area. The chemicals that cause your body to repair itself, to cause the blood to clot and repair, can leak into the veins and cause a blood clot. Additionally, when a person undergoes a knee replacement, you're walking around less. You're having pain when you're walking, so you say, I'm going to kind of sit down and I'm really going to just kind of take a load off. I'm going to let this thing heal, the physical therapist will come, he'll work with me, but I'm really going to take it easy. It's that decreased level of activity that can cause that person to be doubly at risk for the blood clot. You might have noticed when you had your knee replacement, if it was within the last five years, they had you up on day one.
RON AARON
Yes. At night they had me on a device that squeezed my legs while I slept, which I rather enjoyed.
DR. RAJAY SEAUDATH
Yes, it's like a little massage. The thing is, people think that that massaging of your legs is trying to move the blood flow. In fact, it's the massaging of the legs is releasing a chemical called nitrous oxide. The same kind of nitrous oxide we put in to boost sports cars.
RON AARON
Laughing gas.
DR. RAJAY SEAUDATH
Yes, laughing gas. What that does is it dilates, that opens up the blood vessels and allows the blood flow to be a little better and prevents the blood clots. When you walk, your body naturally releases that nitrous oxide as well. So, it's the mechanical movement of the blood back to your heart as well as the chemical of when your muscles squeeze, it actually releases that chemical. That's another way that your body is trying to prevent blood clots altogether.
RON AARON
Let's take advantage of talking about this topic and bring smoking into it, because I read that smoking, includes vaping, increases your risk for blood clots.
DR. RAJAY SEAUDATH
That's absolutely right. Tobacco smoke especially, it's not just the nicotine, it's also the carbon monoxide in the burning leaves. Both of those together cause vasoconstriction, which is making your blood vessels camp down. We just talked about nitrous oxide opening the blood vessels to prevent blood clots, these cause the blood vessels to close, which makes it more risky for blood clots. Vaping as well. It's a little bit of a different mechanism because there's not carbon monoxide. There isn't burning material. There isn't tobacco nicotine. But again, vaping also can increase the risk of your blood clots through a different mechanism.
RON AARON
It really mainlines nicotine. Vaping, thats what it does.
DR. RAJAY SEAUDATH
Yes.
RON AARON
We have less than a minute left. For folks who are listening, give us the 411 on how to know if you're having a blood clot and what to do.
DR. RAJAY SEAUDATH
So again, if you have pain in one leg, specifically in the calf, it's larger than the other side, it's swollen. You've just been on a long airplane flight, a long car ride. That's an indication you need to seek medical attention.
RON AARON
Don't wait until next week.
DR. RAJAY SEAUDATH
Absolutely.
RON AARON
Thanks for coming on. As always, as a co-host, you do a great job. Dr. Rajay Seudath, always wonderful talking with you. For those of you who have been with us, thank you for joining us today on the award winning Docs in a Pod. I'm Ron Aaron. We'll do it again next time on Docs in a Pod.
OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherise Pendleton. Thank you for listening to Docs in a Pod, presented by WellMed.
Be sure and listen next week to Docs in a Pod, presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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