Calf Pain: It can be serious


Calf Pain is something we don’t ignore in Cardiac Rehabilitation programs. It can be a symptom of a number of things life threatening, severe or minor. So what are we looking for?

Symptoms of blood clot in leg

This is called Deep Vein Thrombosis  or DVT

Only about half of the people who have DVT have signs and symptoms. These signs and symptoms occur in the leg affected by the deep vein clot. They include:

  • Swelling of the leg or along a vein in the leg
  • Pain or tenderness in the leg, which you may feel only when standing or walking
  • Increased warmth in the area of the leg that’s swollen or painful
  • Red or discolored skin on the leg

Pulmonary Embolism

Some people aren’t aware of a deep vein clot until they have signs and symptoms of PE. Signs and symptoms of PE include:

  • Unexplained shortness of breath
  • Pain with deep breathing
  • Coughing up blood

Rapid breathing and a fast heart rate also may be signs of PE.

Blood clots occur when blood thickens and clumps together. Most deep vein blood clots occur in the lower leg or thigh. They also can occur in other parts of the body. A blood clot in a deep vein can break off and travel through the bloodstream. The loose clot is called an embolus. It can travel to an artery in the lungs and block blood flow. This condition is called Pulmonary Embolism or PE.

PE is a very serious condition. It can damage the lungs and other organs in the body and cause death. It’s fatal in up to 26% of cases.

Blood clots can form in your body’s deep veins if:

  • A vein’s inner lining is damaged. Injuries caused by physical, chemical, or biological factors can damage the veins. Such factors include surgery, serious injuries, inflammation, and immune responses.
  • Blood flow is sluggish or slow. Lack of motion can cause sluggish or slow blood flow. This may occur after surgery, if you’re ill and in bed for a long time, or if you’re traveling for a long time.
  • Your blood is thicker or more likely to clot than normal. Some inherited conditions (such as factor V Leiden) increase the risk of blood clotting. Hormone therapy or birth control pills also can increase the risk of clotting.

For Prevention measures to avoid blood clots click here

Symptoms of Peripheral Artery Disease

Peripheral Artery Disease is the most common reason for amputations of toes, feet and legs. The risk factors that cause heart disease also cause poor blood flow to other areas of the body. Calf pain while walking is a warning sign for 50% who have blockages in the legs. If peripheral artery disease is an issue it needs to be closely monitored.

Signs and symptoms of P.A.D. include:

  • Weak or absent pulses in the legs or feet
  • Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
  • A pale or bluish color to the skin
  • A lower temperature in one leg compared to the other leg
  • Poor nail growth on the toes and decreased hair growth on the legs
  • Erectile dysfunction, especially among men who have diabetes
  • Pain with walking or climbing stairs

People who have P.A.D. may have calf or leg pain, numbness, aching, or heaviness in the leg muscles pain or discomfort when walking or climbing stairs.  You might also feel include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. This discomfort may ease after resting.  About 10 percent of people who have P.A.D. have claudication. This symptom is more likely in people who also have blockages or atherosclerosis  in other arteries.

During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won’t get enough blood, which will lead to symptoms. When resting, the muscles need less blood flow, so the symptoms will go away.

Learn more about Peripheral Artery Disease

Overuse Symptoms

A calf strain is an injury to the muscle.  When a muscle is strained, the muscle is stretched too far.  So stretching it isn’t going to make if feel better. Less severe strains pull the muscle beyond its normal excursion.  These often are seen when people are doing more walking than they are used to, such as walking treadmills – especially when the grade is elevated. Also these are seen from poor footwear. People who haven’t exercised in years may have poor footwear. I have seen patients come in wearing slippers, heels, broken down shoes that have no shock absorption.  More severe strains tear the muscle fibers and can even cause a complete tear of the muscle. Most commonly, calf strains are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.

old shoes

The amount of discomfort helps to determine the severity of the injury. Calf strains are usually graded as follows:

  • Grade I Calf Strain: Mild discomfort, often minimal disability. Usually minimal or no limits to activity.
  • Grade II Calf Strain: Moderate discomfort with walking, and limited ability to perform activities, such as running and jumping; may have swelling and bruising associated.
  • Grade III Calf Strain: Severe injury that can cause inability to walk. Often patients complain of muscle spasm, swelling and significant bruising.

Muscle Cramping

A muscle cramp is a sudden, uncontrolled contraction of a muscle. This type of pain is most commonly  called a “charley horse.”

Leg cramps occur when the muscle suddenly and forcefully contracts.

Leg cramps usually last less than one minute, but may last several minutes before the contraction subsides. In some patients, the leg cramps occur primarily at night, and can awaken the patient from sleep. When the muscle cramp is severe or long lasting the muscles will be sore for a day or two following.

What causes a leg cramp?
The exact cause of a leg cramp is not well understood, but there are some risk factors that are thought to contribute to this condition:

  • Muscle fatigue
  • Heavy exercising
  • Dehydration
  • High weight (not necessarily obesity)
  • Electrolyte imbalances
  • Medications (statins, prednisone, lasix…)

The most common cause that is typically seen in patients who develop leg cramps is exercising in an unusual way, meaning either more activity or a different exercise. Leg cramps are more common in older patients. Patients who weigh more are more prone to developing leg cramps. Also, some medications can cause side effects of leg cramping. Cramping is something that should be brought to the attention of your health care provider as soon as possible

Sources: National Heart Lung and Blood Institute

http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/

Vitamin K and Coumadin

A common concern many heart patients first share is their diet concern following a cardiac event. Blood thinners are very commonly prescribed for heart conditions such as atrial fibrillation, or post valve replacements. Many are told to be careful about leafy green vegetables. What the heck does be careful mean? Many take it to mean they can’t eat green vegetables, but then question how they are to eat a healthy diet. This is a very common misconception. It is important to get vitamin K in the diet, and the goal if taking coumadin/warfarin is to get the approximate same intake each day. This is very difficult to do, thus INR levels are fluctuate greatly and this creates health issues if not closely monitored. Most doctors aim to keep INR around 2.5-3.5.

Vitamin K can help prevent Cardio Vascular Disease. Good sources from cabbage, cauliflower, spinach, and other green leafy veg.

http://www.cc.nih.gov/ccc/patient_education/drug_nutrient/coumadin1.pdf

Important Drug and Food Information

From the National Institutes of Health Clinical Center
Drug-Nutrient Interaction Task Force

Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K

The food you eat can affect how your medicine works. It is important to learn about
possible drug-nutrient interactions for any medicines you take.

Why was warfarin (Coumadin) prescribed for you?
Warfarin (Coumadin) is a medicine prescribed for people at increased risk of forming
blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.

How does warfarin work?
Blood clots are formed through a series of chemical reactions in your body. Vitamin K is
essential for those reactions. Warfarin (Coumadin) works by decreasing the activity of
vitamin K; lengthening the time it takes for a clot to form.
International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test
values obtained from measurements of the time it takes blood to clot. Individuals at
risk for developing blood clots take warfarin (Coumadin) to lengthen the usual time it
takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the
INR/PT every month in patients taking warfarin (Coumadin) to make sure it stays in the
desired range.

What can help keep INR/PT in the desired range?
To help warfarin (Coumadin) work effectively, it is important to keep your vitamin K
intake as consistent as possible. Sudden increases in vitamin K intake may decrease
the effect of warfarin (Coumadin). On the other hand, greatly lowering your vitamin K
intake could increase the effect of warfarin (Coumadin).
To keep INR/PT stable and within the recommended range, it is important to:
• Take your medicine exactly as your doctor directed.
• Have your INR/PT checked regularly.
• Keep your vitamin K intake consistent from day to day.

How do I keep my vitamin K intake consistent?
Keep your intake of foods rich in vitamin K about the same each day. For
example, you may plan to eat only ½ cup of these foods per day. If you like
these foods and eat them often, you can eat more, but be consistent. 

  • Eat no more than 1 serving of food that contains 200%-600% DV of vitamin K
  • Eat no more than 3 servings of foods that contain 60-200% DV of vitamin K
  • Eliminate alcohol if you can, or limit yourself to no more than 3 drinks a day
  • Take no more than 800IU of vitamin E supplements
  • Avoid cranberries and cranberry juice as they can raise INR and risk of bleeding
  • Limit or avoid grapefruit and grapefruit juice
  • Work with your doctor when taking CoQ10 as it can hamper the effectiveness of Warfarin
  • Many natural supplements affect PT/INR levels, so it is best to avoid them unless your doctor advises otherwise. The following supplements definitely affect PT/INR levels: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, gingko, horse chestnut, insositol hexaphosphate, licorice, melilot(sweet clover), pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.
  • To find foods low in vitamin K, see the article on low vitamin K foods, check the nutrition facts for a particular food, or use the nutrient ranking tool to find low vitamin K foods in a particular food group.

Source: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf