Pascal Dupuis

Most of the people that read my blog know I love to watch ice hockey, and also know that I especially like the Pittsburgh Penguins.  Today, the Penguins announced that winger Pascal Dupuis has a a "blot clot in his lung."  This is more specifically a pulmonary embolism.   A few months ago, I blogged about how American Idol contestant, Michael Johns, lost his life due to a pulmonary embolism.

The Penguins say that Pascal had chest pain and was evaluated and the embolism was found.  He apparently had a blood clot in his leg (DVT = deep vein thrombosis) that traveled to his lungs.  A DVT in the leg is, in and of itself, not the problem.  However, it can cause very painful leg swelling and inflammation.  The problem is if that blood clot breaks away and travels to the lungs it can be deadly.  Most people would go to the ER if they had trouble breathing, but people need to take sudden painful swelling in the leg just as seriously.  Immobilization after injury, as well as being seated for long periods of time (eg, a long airplane trip), can be a couple of the common causes.

Pascal will be unable to play hockey for at least 6 months as he will need to be on anti-coagulants, or blood thinners, for at least that time to prevent further clots.  As most of you know, hockey is a contact sport and blunt trauma and blood thinners are not a good combination.

The Penguins say that Pascal should be able to return to hockey.  Unfortunately, however, this is his second blood clot.  One has to wonder if he would want to risk coming off anti-coagulation as he is obviously prone to developing thrombi in this body.  I guess time will tell, but either way, he will have to closely watch for developing symptoms for the rest of his life.

Let's Play Hockey!

For a hockey fan like myself it is the greatest time of the year.  (OK, so maybe second greatest if your team makes the playoffs).  The season officially begins tonight and tomorrow my favorite team, the Penguins, and the local team, the Lightning, begin the season.  Because of this occasion, I feel it is appropriate to post my previous hockey blogs.

http://donaldjadamovdpm.blogspot.com/2013/06/alex-ovechkins-broken-foot.html

http://donaldjadamovdpm.blogspot.com/2013/03/kris-letangs-broken-toe.html

http://donaldjadamovdpm.blogspot.com/2013/02/erik-karlssons-achilles-laceration.html

http://donaldjadamovdpm.blogspot.com/2013/01/ice-hockey-is-back.html

http://donaldjadamovdpm.blogspot.com/2011/11/ice-hockey-and-foot-injuries.html

The Passing of Michael Johns

I was saddened to read that a few days ago, former American Idol contestant, Michael Johns, had passed away due to a blood clot after twisting his ankle.  I do not watch American Idol much anymore, but back in 2008 I rarely missed an episode.  I do remember Michael Johns competing.

At 35 years old this is a tragic loss.  Fortunately, blood clots after twisting an ankle leading to death are very rare.  However, blood clots in the legs are not uncommon.  The clot in the leg is not what is fatal but instead it is the blood clot "breaking off" and traveling to the lungs that can lead to death.  This is called a pulmonary embolism.

How do blood clots form in the legs?  Well, there are large veins in the legs and when a person does not move his or her legs for a long period of time there is no muscular activity to help the blood return to the heart.  This blood can then pool in a vein in the leg causing a deep vein thrombus (DVT).

I am not sure of the facts but it seems that Michael Johns twisted his ankle and it was causing him severe pain.  It was too painful to move and he probably stayed off of it.  A blood clot formed and likely traveled to the singer's lungs.

This could have been possibly prevented if the singer sought medical advice.  A possible sign of a DVT is severe calf pain and swelling.  If this happens seek medical attention right away.  An ultrasound can be done to determine if a DVT is present or a blood test called a D-dimer can be done to see if a clotting process is present.

RIP Michael Johns.  Hopefully, some good can come out of this tragedy by educating people on the dangers of this condition.

New Office Renovation

People are hard at work completing the final touches on the new podiatry building on the campus of Absolute Healthcare.  I am very pleased with the new spacious office.  I find it very welcoming and am excited to start caring for my patients in this beautiful building.

Way to go, Scouts!

I was quite interested in the recent story that Ann Curry was hiking in New York and was "rescued" by a group of boy scouts.  There are two reasons for this interest.  First, as is the topic of this blog, I am a podiatrist treating conditions of the foot and ankle.  The second reason is something not everyone may know about me; I was a boy scout.  In fact, I am an Eagle Scout.

I remember learning how to splint ankles and my first aid training but never had to put it into action like these young men.  I found it even more of a feel good story that most of these guys didn't even know that they were helping a celebrity.  Kudos to these young men!

Osteomyelitis

Since it has been awhile since I have posted on this blog, I wanted to post on a topic that I have seen a lot of patients develop recently.  I decided to talk a little bit about osteomyelitis, or bacterial infection of bone.

Working at the wound care center, I have found that a great deal of patients with chronic ulcerations can develop infection in the bone under the ulcer.  I have also found that a doctor needs to suspect this whenever there is a chronic wound that is not healing.  To say it in simple terms, infected bone can "die" and needs to leave the body and this can often be why a wound will not heal.  If infected bone can not find a way to "exit" the body, this infection can lead to a localized infection or abscess.

Sometimes a simple x-ray is enough to suspect osteomyelitis but often more advanced studies such as a bone scan or MRI are necessary to form a diagnosis.  The only definitive test, however, is a biopsy of the bone.  In my experience, though, MRI / bone scan is pretty reliable and a bone biopsy is often deferred due to its invasive nature.

Treatment for osteomyelitis includes more than 6 weeks of IV antibiotics and / or resection of the infected bone (amputation).  Obviously, amputation is always a last resort.  Medicine has made great advances to treat osteomyelitis.  Hyperbaric oxygen therapy is one such treatment.  The clinician must also assess other issues such as a patient's circulation to heal the infected bone and the patient's nutrition.

If you have a chronic wound that will not heal, do not delay treatment.  See you podiatrist if it is a foot or ankle wound or wound care specialist for any chronic wounds.

Charcot Neuroarthropathy

A recent article just came out that shows there is an increase in the occurrence of "charcot foot."  This condition usually affects diabetic patients who have decreased sensation or "neuropathy."  The process is not completely understood, but essentially the foot starts breaking in the midfoot.  What are supposed to be hard bones can become like mush.  The condition is self limiting and eventually the bone destruction stops.  The bones then will heal.  The problem is not the process causing damage it is when the patient walks on this foot that is breaking.  It can deform the foot and the bones can heal leaving a "rocker bottom" foot that is difficult to walk on.  This can cause sores, or "ulcers."  These ulcers can become infected and patients can have to have an eventual amputation from the problems this condition can cause.

The key to treating "charcot foot" is prevention.  A diabetic patient that usually doesn't have foot pain should be seen as soon as possible as this could be the early start of the condition.  The condition is often misdiagnosed as an infection or gout as the foot can become red and swollen mimicking these conditions.

If caught early, strict immobilization is imperative.  If caught after the deformity has already lead to disfigurement of the foot, wounds often develop and special braces and offloading shoes are needed.  This often becomes a wound care center issue.

I am not writing this to scare people but instead educate them.  This condition is rare but is becoming more common as I am seeing in my practice.  The take home message is to go see your podiatrist as soon as possible if you have any foot pain, especially if you are a diabetic.