WHERE TREATMENT IS IN VEIN.

Byline: Valerie Kuklenski

Staff Writer

'You know someone who wants some very expensive shoes?" Sidney Mandell asks, only half joking.

The Canoga Park salesman can wear only tennis shoes these days, on and off the court, because of deep vein thrombosis, a circulation problem that makes his calves, ankles and feet swell and leaves him prone to dangerous blood clots that could dislodge and travel to his lungs.

Mandell, 76, has suffered from the condition for about 40 years, saying it began with poor recovery from surgery for a torn left Achilles tendon. Since then, he has worn custom-made compression stockings every day, removing them only at bedtime.

Not everyone with DVT is as fortunate as Mandell, who received a warning in the form of edema. The National Institutes of Health report that about half of those with DVT have no noticeable symptoms.

"It's often silent," notes Dr. Wayne Gradman, a vascular surgeon whose Beverly Hills Vein Center specializes in serious conditions like DVT in addition to cosmetic procedures. "Typical symptoms are swelling and pain, and if they don't have either one or don't recognize the symptoms they have as being deep vein thrombosis, I can't treat them."

During waking hours, blood travels to the feet, aided by both the heart's pumping and gravity. It returns to the lungs for oxygenation with a boost from calf muscles. Inadequate blood return leads to clots, which restrict the blood flow even more.

Inactivity is perhaps the most widely known cause for DVT. Gradman said other causes include predispositions -- among them increased female hormone levels from pregnancy or birth control pills and inherited traits such as Factor V Leiden -- and injuries, which can range from obvious traumas to medically necessary vein punctures.

DVT can be diagnosed with ultrasound and treated, if a specialist prescribes it, with a clot-busting drug such as Activase injected directly into the clot during hospitalization.

Gradman said Medicare is pressing for clot prevention with the use of anticoagulant drugs such as heparin before surgeries, particularly procedures such as hip and knee replacements that are linked to a higher incidence of DVT.

The mitigating concern is that such actions leave patients more vulnerable to post-operative bleeding.

Gradman said, "It's a very measured thing. There's a risk involved, but apparently studies have shown that the benefits outweigh the risks."

Gradman would like to ground the myth that aspirin taken before a long flight will prevent vein clots. "Aspirin affects platelets, and vein clots don't have platelets in them," he explained.

The best prevention, experts say, is to get up and move. "Moving blood does not clot," Gradman said.

Mandell says he makes it a point to pace the aisle every hour or so on a flight. Mandell's attitude may be helpful as well.

"(Dr. Gradman) tells me I have the ugliest looking legs he's ever seen in his life," Mandell says with a chuckle. "But this should be the worst thing that happens to me."

Valerie Kuklenski, [phone]

[e-mail]

CAPTION(S):

photo

Photo:

Sidney Mandell wears stockings for his deep vein thrombosis while he plays tennis and during other daily activities.

Tina Burch/Staff Photographer