Health Because bleeding time is prolonged with the use of these drugs, careful dosing is necessary involving frequent regular blood testing (INR) for those on Coumadin. Bleeding is the most common side-effect and requires immediate attention. Snowbirds requiring this test must continue to take the test even during their winter vacation in order to reduce the risk of a sudden bleeding episode. Xarelto and Eliquis do not require routine blood testing. Symptoms of PE most commonly include chest pain, shortness of breath and cough. Usually, the chest pain comes on suddenly and may seem like a heart attack. It may or may not be associated with leg symptoms suggesting a deep vein thrombosis. The shortness of breath is usually worse with exertion and the cough may produce bloody sputum. In some cases, the individual will feel faint and may experience a rapid heart rate. If any of these symptoms occur, emergency attention is indicated to confirm the diagnosis and allow for the urgent administration of medical treatment. The history is important to the physician, as one or more of the above risk factors may create suspicion that a pulmonary embolism is causing the chest complaint(s). It is especially necessary, as physical examination and even a plain X-ray of the chest may reveal no abnormalities. Suspicion is the key element in this situation in order that the proper special tests are performed in diagnosing embolism. Physical examination may or may not reveal faster respiratory and heart rates, and certain abnormal sounds may be heard on listening by auscultation to the lungs. Examination of the legs is important to detect any sign of a DVT. An electrocardiogram should be done and, if diagnosis is still uncertain, there are several advanced imaging tests of the lungs and legs which may aid in determining whether or not a pulmonary embolism is present. When a diagnosis of pulmonary embolism is made, emergency admission to the hospital is indicated to initiate anticoagulation drugs to prevent extension or further clots, as well as other complications. Once appropriate bleeding times are achieved, oral anticoagulants will be started as the patient’s progress is being monitored. Occasionally, “clot busting” drugs (thrombolytics) may be used in life-threatening cases. In rare severe cases, catheter or surgical removal of a large lung clot may be necessary. In cases where anticoagulants can’t be used or when recurrent release of clots is noted, insertion of a filter into the main vein returning blood to the heart (inferior vena cava) may prevent further clots from travelling to the heart and lungs. Upon discharge from hospital, careful ongoing administration and monitoring of anticoagulants will be necessary − sometimes for years. Snowbirds should be aware of steps which they can take to reduce the risk of DVT and PE. If you travel by plane, maintain some movement of your legs and get up and move about for short periods every hour or so. If travelling by car, stop for some exercise at least every two hours. Keep any other health conditions such as heart disease and diabetes as stable as possible. Lose weight if necessary and keep fit. Walking or other regular exercise most days of the week is important and, if at home in the winter, invest in a treadmill. If you have a problem with swollen lower legs or ankles, consult a physician; but the use of compression stockings and frequent elevation of your legs when resting are generally indicated. If you have any of the known risk factors, be sure to tell your doctor if suffering from new leg pain or chest symptoms. If you are on anticoagulants while out of Canada and require regular blood testing, it is necessary to continue testing, usually monthly. Take a note from your home doctor indicating your diagnosis, the dose of anticoagulant that you take, the need for regular testing and your doctor’s fax or e-mail address. Find a local lab which will co-operate. A telephone call to your doctor a couple of days later may give you needed advice regarding any required dosage change. If this doesn’t work, you will have to get the service from a local physician but, as it is not a sudden and unexpected need, most travel insurance policies will not cover these expenses. Although the chances of getting either of these conditions is low, your knowledge of some of the basic symptoms and facts about DVT and PE may help you recognize these serious conditions − should they occur with you or a loved one − and may result in a more favourable outcome. CSANews | FALL 2021 | 41
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