Like the music that goes round and round, your body is designed so that the blood flows from the heart, down the legs and back again.
Unless you have varicose veins, of course.
Usually in the legs and ankles, these veins are near the surface, red, angry and spidery.
"Yes, varicose veins cause pain and swelling, but they are not a deadly issue," says Dr. Prabhjot (Nina) Grewal, a vascular surgeon in Newport Beach, Calif.
But deep vein thrombosis is a vein problem of a different coloration.
DVTs, as they are known, are blood clots with a higher likelihood of breaking away, moving into a lung and causing a pulmonary embolism. And if the clot is large enough, it can kill you, Dr. Grewal says.
Q: How do we develop deep vein thrombosis?
A: Most people get DVTs from sitting, lying or not moving -- as in an airplane. Lack of movement causes the blood to stagnate and not circulate. Even not moving enough after surgery can cause problems, although usually other things are involved, such as a predisposition to clotting.
Q: How do we know we have a DVT?
A: Usually there is swelling in the calf or the entire leg, sometimes accompanied by pain.
Let me explain the venous system:
The veins carry blood up a vertical column -- up our legs -- to the heart. Most of the blood travels up large veins that are deep in the leg. The surface veins -- the ones that turn into varicose veins -- carry little of the blood. Those deep veins join two main points in the groin.
Blood pumps out well from our heart but doesn't suck back well. To suck against gravity, the veins have little check valves that open one way and allow the blood to push up toward the heart and not pool back into the legs.
If the check valves don't work correctly, there is swelling.
A clot that travels -- a deep vein thrombosis -- is life-threatening.
Q: How can we tell if the leg swelling is serious?
A: An ultrasound lets us look and see if the swelling is normal or abnormal.
Q: How do you treat these veins?
A: Compression stockings provide support and often reduce the swelling, although they don't change the anatomy of the veins.
Superficial vein problems -- those just under the skin -- can be treated with vein ablation. We put a catheter into the vein and close it down. It's not working anyway.
These are outpatient procedures and allow the person to resume normal activity immediately. They are covered by insurance.
Q: And a DVT?
A: This involves acute swelling and pain in the leg. A person who has these symptoms should see a doctor immediately.
There are different treatments. If the thrombosis is very severe, medication and hospitalization may be required. At the very least, the patient is put on Coumadin, a medication that keeps the blood thin and therefore prevents clots from forming.
Q: So there are different procedures?
A: Yes. And patients must be educated.
A clot in the leg can harden and cause a long-term obstruction, ulceration, skin discoloration.
If the clot gets to the lung, it can kill you.
Patients with these symptoms should be referred to a vascular surgeon.