Muscle tear….or DVT?

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I’ve just done my first Parkrun. For those that don’t know anything about Parkrun, it is a free, community-led international event that happens somewhere near you on a Saturday morning. It is a 5kilometre run, which is timed. It felt like hard work, and I got too hot as I had kept my fleece on, which was obviously a mistake.  I’ll let you know what my time was at the end! Parkrun has turned exercise back into what it should be: done by all, easy to access and free. Here is a link to the Abingdon Parkrun

Anyway, after the run I saw one or two participants stretching their calf muscles with rather pained faces. Presumably they had simply pulled a muscle in the leg. A bit of stretching and a mix of exercise and rest, and they’ll be fine. One of the dilemmas that clinicians have is whether leg pain like this is just a pulled muscle or is a DVT, particularly if the patient has not been doing any exercise that might have injured a muscle. I saw one such patient a couple of weeks ago who had pain in his lower leg. He hadn’t done any vigorous exercise and the leg was a bit swollen. I wondered whether he had a deep venous thrombosis (DVT)?

A DVT is a clot of blood (or thrombus)  in one of the veins. The blood clot prevents blood flowing through the vein, hence the swelling. The worry about a DVT is that some of the thrombus can break off and travel through the heart and then get lodged in one of the pulmonary arteries that carry blood to the lungs, called a pulmonary embolism (PE). This is why you don’t want to massage the leg of someone who possibly has a DVT.   PE can cause shortness of breath and chest pain and is a cause of death. So we do need to know if these patients have a DVT or not. If they do then they need to be treated with an anticoagulant, quite typically apixaban (Eliquis).

The way that we can check to see if someone has a DVT is to use an ultrasound scanner to see whether the vein can be squashed. Arteries have tough walls and should not be squashable with compression. Veins have thin walls and should normally be squashable, a bit like a slightly flat bike tyre. If a vein has thrombus in it, it can’t be squashed, a bit like an overinflated tyre. You can see the arteries  in this video. They can’t be squashed. That’s normal. The veins are just above the arteries and in the video you can see that the vein in the right leg can be squashed. The vein in the left leg can’t be squashed because there is thrombus in it. This patient did have a DVT in his left leg.

The GP was very helpful and put him on apixaban and sent him to the Churchill hospital, where the DVT was confirmed. The anticoagulant will minimise the risk of him dying from a pulmonary embolism. Good result!

I hope that the Parkrunners who had calf muscle twinges all recover quickly. I came 222nd out of a field of 316 and did the run in 30mins 39secs. Not at all fast, but I enjoyed it, and will do it again. But if the weather is mild, I’ll leave my fleece off! There was a great sense of community. Maybe I’ll see you there one day?

#calfmuscle, #DVT, #calfstretching, #deepvenousthrombosis, #pulmonaryembolism, #sportsinjury, #chiropractorabingdon, #parkrun, #parkrunabingdon, #chiropractic, #BCA, #BCAfamily, #POCUS

Be like Jill!

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After the last video about the bladder stone that Jill the guinea-pig had removed, I had people asking after her. She’s doing really well, thank you! For those that didn’t know, Jill is one of the family guinea pigs and we found, by doing an ultrasound scan, that she had a stone in her bladder. This was causing her pain. The stone was surgically removed (thanks to Florena at Larkmead Vets!) and since then Jill the pig has become much happier. She is not in distress when she is being picked up, She is able to eat more, she has gained 300g in weight. She is much more vocal, calling out for food, and she is back to her old tricks of bossing her husband Milo around. She definitely wears the trousers!

So this got me thinking, I wonder how many people’s lives are affected by back pain (a lot, I think….) . Apparently, worldwide  it’s about 7.3% of the population. One study in Spine Journal in 2011 found that antidepressants were the fourth most commonly prescribed medication for low back pain in the US . Just think how much better their lives would be if they weren’t in pain. Perhaps they could do more: go for a walk, play their sport, do things around the house, play with their kids. But even more than that, if they were not in pain, they would probably just be happier.  Jill is such a great example of how much better life is without back pain.

Don’t be unhappy! Be like Jill!

A perfectly ‘armless fall

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Many of you will know that Andrew is doing his diagnostic ultrasound training (it’s a slow process) and  have been very gracious in allowing him to practice on you – thank you! Here is a short video about a case where diagnostic ultrasound was really helpful in deciding whether the patient needed to go to the hospital for further investigation and treatment. Turns out she did! Have a look at this short video and see what happened! (Thanks to the patient for allowing me to use the scan picture – you know who you are)!

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