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Fibroids and Deep venous thrombosis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Average Posted in: Women's Health
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2379 Questions

User :   DVT, fibroids and warfarin. advice please
User :   Hi
User :  
May I know your age?
User :   39
User :  
Ok
User :  
Have you consulted the gynec for the same?
User :   Yes. I was told a myomectomy would be sufficient and this is what I prefer. My PCP suggested a complete hysteroctomy.
User :   Ok

User :  
Myomectomy should be fine
User :  
Why is the DVT problem?
User :  
How did it happen?
User :   The doctors said after my second clot that the large fibroids may be contributing towards it.
User :   Ok

User :  
Yes, that is one of the complications

Doctor :   Hi
User :   hello
Doctor :  
Yes
Doctor :  
I was mentioning that DVT could have been related to the fibroid.
Doctor :  
It happens because of clots in the vein,
Doctor :  
The treatment is directed towards prevention of clots from happening.
Doctor :  
That is done by the warfarrin.
Doctor :  
And the second treatment is done by treating the cause for it.
User :   I had an ivc filter inserted last year to prevent any fatal pulmonary embolisms in addition to warfarin treatment. I despise the warfarin and wonder if it is needed if I already have a filter. I can't imagine being on warfarin for life. It is depleting my energy and quite frankly my general health.
Doctor :  
DVT can happen in other vein too.
Doctor :  
The filter would help in preventing clots in the pulmonary veins, but has no effects in the other veins.
Doctor :   May i know since when are you on warfarrin?
Doctor :  
Have you been evaluated if there are any other contributing factors that is causing the DVT?
Doctor :  
Are you there?
User :   I have been on warfarin 3 periods in my life. The first tme, I had an intestinal blockage that was removed. This was about 7 years ago. I suffered an embolism and was put on warfarin for 6 months. I had my first diagnosed dvt 2 years ago and was put on warfarin again for 6 months. This past year (August 2009), I had another dvt episode and have been on warfarin ever since. I am here, I was just answering your other question.
Doctor :  
Ok.
User :   When I was in the hospital last year for the dvt, they did a blood test checking for "markers" for what may have contributed. They sent the results to my primary doctor but I haven't heard anything.
Doctor :  
Ok.
Doctor :  
If the cause had been only the fibroids and if the fibroid have been removed, then you may have chances
Doctor :  
of the doctors withdrawing you from the warfarrin after some period of time.
Doctor :  
But if there has been another contributing factor as that due to problems in the blood or heart, the warfarrin therapy may continue for a long period.
Doctor :  
So it is essential to know those reports.
Doctor :  
The other contributing factors could be one of antiphospholipid syndromes(these are checked by looking at the blood)
Doctor :  
It also can arise from the heart where the heart is not functioning to the normal
Doctor :  
This is checked by an ECHOCARDIOGRAM.
Doctor :  
Hence these tests are essential to decide on the duration of therapy.
Doctor :  
Have you followed?
User :   I have not received any information from my doctor about the reports. My heart and it was said to be normal during hospitalization. I do have an innocent heart murmer though. I figured he would contact me if there was any problem.I know realize I have to get rid of these fibroids. My doctors said in about 6 months from August 09, I should look into having my fibroids removed.
Doctor :  
Have you got it removed?
User :   I have one until February of this year, then I can look into having it removed (it is supposed to be 6 months from August 09)
Doctor :  
Ok.
User :   I meant i have one more month.
Doctor :  
Then you can go ahead with that.
Doctor :  
You need to be on the warfarrin till the surgery.
Doctor :  
the therapy would be stopped for a few days before the surgery and you would be restarted after that.
User :   I know. I also was told I have to be off of it for about 1-2 weeks before any invasive surgery (including dental surgery) and take shots of lovenox.
Doctor :  
If there has been no contributing factors, and if there are no recurrence of DVT episodes after the removal,
Doctor :  
then they may try withdrawing the warfarrin off after that.
Doctor :   So you need to be patient and wait till then.
Doctor :  
Along with that, take care of your hydration too.
User :   I know. I have a tendency towards dehydration (just not drinking enough water) and I think that may be contributing to my problems.
Doctor :  
You need to have sufficient amount of water, atleast one and half litres to two litres of water in a day.
Doctor :  
Dehydration can trigger an episode of DVT.
User :   I didnt know that.
Doctor :  
Hence you need to take care of that too.
Doctor :  
Dehydration is also one among the causes of DVT.
Doctor :  
Have you followed?
User :   I didn't know that at all. That is scary since I have a tendency to go for long periods of time without sufficient food and water. I work a demanding job and now know I have to follow up no matter what.
Doctor :  
Yes, you need to keep your hydration also, apart from your medications.
Doctor :  
This would imply even after the DVT has been resolved completely.
Doctor :  
So do take care of that.
User :   It looks like these lifestyle issues my be a contributing factor to a lot of my problems.
Doctor :  
Have you followed?
Doctor :   Do you smoke?
User :   Yes, I have. I do drink more water.
Doctor :  
Or consume alcohol?
User :   I don't smoke and rarely drink.
Doctor :  
Ok.
Doctor :  
That is good, smoking and alcohol may also contribute to the problem to a lesser aspect.
Doctor :  
Occasional drinking alcohol is allowed.
Doctor :  
But do not over drink.
Doctor :  
They can cause dehydration and liver problems which can also cause to the problem.
User :   I know. Due to the fibroids, I have also been severely anemic. I take iron supplements. How long does it take for iron supplements to alleviate anemia?
Doctor :  
Iron is essential for the production of hemoglobin.'
Doctor :   So you need to be on iron supplements.
Doctor :  
Include iron rich food in your diet too.
Doctor :  
The iron rich food would include red meat, liver.
Doctor :  
They are the main source.
Doctor :  
Apart from these, do include fruits like pomegranate, apple and other fruits too in your diet.
Doctor :  
If you can include these in your diet and if the anaemia and
Doctor :  
if the anaemia is not severe, anaemia can improve without iron supplements.
Doctor :  
Have you followed/
User :   I have always been borderline anemic. I think the fibroids may have contributed to my problem. During my first dvt episode, I was severely anemic. I was treated for the anemia before they could even treat me for the clot. I also had a transfusion. So I do take supplements. The only problem is, I don't take it everyday which I know I have to. Now i make sure I do.
Doctor :  
As i said, if you can include iron rich diet, then it is ok.
Doctor :  
If you skip one or two days of iron supplements.
User :   I have also had bouts of constipation for a lot of my life. Can fibroids make that worse?
Doctor :   FIbroids do not contribute heavily to the constipation.
Doctor :  
It is mainly related to the type of food and to the fact that you do not take enough water.
Doctor :  
Less fluid and less fibres in the diet contribute to the constipation more than fibroid.
Doctor :  
So it is essential that you make sufficient modifications to take care of your hydration.
Doctor :  
Have you followed?
User :   I do drink more water now. I unfortunately have a demanding job that requires a lot of long hours and have not found the right work/life balance to address that.
Doctor :  
Yes, I understand that.
Doctor :  
But it would be good if you can correct your hydration atleast.
User :   I know. I will doc.
Doctor :  
You can probably carry a bottle of water along with you when you are at work
Doctor :  
and take that.
Doctor :   Have you followed?
Doctor :  
Do you have any other query?
User :   What are some good fiber enriched foods to alleviate constipation? And also, are there any products you recommend?
User :   The bloating and the fibroids makes me very uncomfortable.
User :   are you there?
Doctor :  
The fibre content are more in the vegetables.
Doctor :  
Apart from these are the laxatives.
Doctor :  
You can try these if the constipation is severe.
User :   With the warfarin, my doctor has told me that I cannot eat any green or leafy vegetables (which is what i love and always ate to relieve any constipation). Are there any altenatives?
Doctor :  
Yes there are few laxatives you can try.
Doctor :  
But they are not recommended for long term.
User :   What kind of laxatives?
Doctor :  
Hence you need to increase the fluid consumption.
User :   I will try to increase the fluid consumption.
Doctor :   You can try naturolax powder.
User :   Is this available in the U.S?
Doctor :  
This powder has to mixed with a glass of milk and need to be consumed at night.
Doctor :  
Yes, they would be available.
Doctor :   Have you followed?
Doctor :  
Do you have any other query?
User :   I have tried taking Miralax which has actually made it worse. Since then, I just drink more water with more fruits. What can be done to alleviate impacted bowels if that becomes an issue? Is a laxative enough to address that or does something more need to be done.
Doctor :  
Impacted stools are hard to be removed.
Doctor :  
They may need an enema or manual removal.
Doctor :  
This can be done at an hospital or the ER.
User :   How long is a manual removal? I have had intestinal surgery in the past. Would that be a problem?
User :   I have scar tissue there too.
Doctor :  
No, this not a surgical procedure .
User :   Is this similiar to a colonic?
Doctor :  
It is similar to a per rectal examination.
User :   Do I need to see a specialist for that, and which specialists.
Doctor :  
the stools are removed by by doing a per rectal examination.
User :   ok
Doctor :  
A surgeon is the better person to do that.
User :   What kind of surgeon?
Doctor :   Some of the general practioner can also do that.
Doctor :  
A general surgeon is good enough.
Doctor :  
Have you followed?
User :   No, here I may need to find a specialist. A gastroentologist (someone who deals wth stomach ailments may be able to recommend somebody for surgery. It is all about referrals here.
Doctor :   Ok.
Doctor :  
Do you have any other query?
Doctor :  
Are you there?
Doctor :  
Please do fill the feed back form too.
Doctor :  
Are you there?
Doctor :  
Are you there?
Doctor :  
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