Your Guide to Compression Stockings

What are Compression Stockings?

Compression stockings are specially designed stockings or socks that apply pressure to your lower legs, helping to maintain blood flow and reduce discomfort and swelling. They may be prescribed by your doctor for conditions that cause poor blood flow in your legs, such as varicose veins (swollen and enlarged veins), venous leg ulcers (a sore, damaged area of skin that takes weeks to heal) and lymphoedema (when your body’s tissues swell up painfully). They are often also prescribed as part of follow-up and ongoing care after diagnosis of DVT to help reduce swelling, increase blood flow and regulate pain.

Why Wear Compression?

Compression therapy is important to recovery from DVT because it helps to slow the progression of vein disease and promotes a stronger circulatory system by supporting weak or wavy (also known as incompetent) veins and valves and accelerating blood flow back to the heart. If you have a DVT, it is recommended that you wear compression stockings for up to two years after your DVT and in some cases, for the rest of your life to promote good circulation and help prevent Post Thrombotic Syndrome (PTS).

Recent studies have indicated that wearing compression may not be as beneficial as once thought in preventing long-term problems after DVT, although many medical professional have concluded that more research is needed.

What Kind of Compression to Get

Medical grade compression stockings come in a variety of compression strengths (known as mmHg), depending on what you need. Be sure to discuss your situation with your doctor to get the right compression for you. The grades include:

  • 15-20 mmHg (Mild) – Generally for mild spider veins, slight varicose veins, achy legs.
  • 20-30 mmHg (Moderate) – Generally for leg fatigue and heaviness, moderate spider veins, pronounced varicose veins.
  • 30-40 mmHG (Firm) – Generally for severe varicose veins, post sclerotherapy and prevention of post-thrombotic syndrome.

Get fitted! Compression stockings have graduated pressure, meaning the pressure is strongest and the ankle and decreases as it goes up the leg. It is really important to get fitted by a professional for the correct size of compression stockings. A Certified Fitter (found at medical supply stores and some pharmacies, call ahead to ask about specifics) measures your calf and ankle sizes and also the length of your leg to make sure you have the right size to maximize compression benefits. Try to get fitted as early in the day as possible before swelling increases.

Compression stockings come in a variety of basic colors including beige, black, navy, sheer and nude. They also come in thigh-high, knee-high, waist-high and open-toed (which I love to wear in the summer!).

Where to Buy Compression
  • Medical Supply Stores (i.e. places where prosthetics, orthotics, wheelchairs, etc. are sold) – Many insurance companies will cover or supplement the cost of compression stockings if they are ordered through a medical supply store so I recommend checking there first. Most, if not all, medical supply dealers require a prescription from your doctor so be sure to ask for one. Also, check with your insurance ahead of time for a list of pre-approved dealers in your area. If insurance does not supplement your stockings, you will most likely pay full price at a medical supply store.
  • Chain Drug Stores/Pharmacies (i.e. CVS, Walgreens, Discount Drug Mart, etc.) – Pharmacies and drug stores are a great option to look for compression stockings because they often offer a less expensive selection of compression stockings.
  • Hospital Pharmacies – Many physicians will prescribe you a pair of stockings before you are discharged. Ask if you can return to the pharmacy to get a new pair in the future.
  • Online – You may be able to purchase compression stockings online (especially novelty ones, like colors and patterns!). Just be sure if you are purchasing from an online retailer, you are still getting the right grade compression for your needs. A quick Google Search should turn up a variety of fashionable compression stockings.
The Cost of Compression

Compression stockings are not cheap. Generally, you can expect to spend anywhere from $29-$110 per pair. Many of the drug store stores offer an “economy brand” of stockings that are in the $29-$40 range. Stockings ordered from medical supply shops range from $60 to upwards of $110. The cost of compression stockings vary depending on the length (thigh-high, knee-high or waist-high); material; brand and whether or not your insurance offers any coverage for compression stockings.

Medical Compression vs. Sport Compression

It is important to note there is a difference between what are known as medical-grade compression stockings and sport or recovery compression stockings. Runners and other athletes sometimes use compression socks to increase blood flow during exercise, which some think may reduce soreness, increase endurance and performance, stabilize joints, activate blood flow and increase coordination, although the research is not conclusive on this stance. Examples of sport compression stockings can be found from CEP and Zensah and range from $40-$60. Athletic compression stockings are not as pressurized as medical grade stockings and may not be suitable for your recovery needs. 

What to Expect

Compression stockings take a little while to get used to and can seem painful or even cause a burning sensation when first wearing them. As with many things dealing with recovery from DVT and PE, give your body a chance to adapt and a chance for them to start working.

Compression stockings may be work on one or both legs. You should expect to replace them every 3-6 months depending on how often you wear each stocking or pair of stockings.

Helpful Hints
  • Wear your compression stockings when you are going to be sitting and/or standing for long periods of time (i.e. at work – sitting or standing).
  • Put your stockings on as soon as you can in the morning when swelling is minimal and they will be easier to put on then.
  • You do not need to wear your compression stockings when you go to bed or if you are going to be lying flat. Blood flow is optimized when you are lying down so they are not needed. Your body actually needs a break from compression at some point and nighttime is the perfect time to take one.
  • Rotate your stockings (if you have more than one pair) for maximum wearability.
  • Be sure to follow the packaging instructions for washing your stockings. Contrary to what you may think, many types actually suggest machine washing and drying to extend the life of the stocking.
  • Many medical supply stores offer additional products to assist you in getting compression stockings on, for example, if you are struggling or do not have a lot of strength to pull them up.
  • Wear compression stockings when you are travelling (a long flight or car ride) to increase blood flow and reduce the risk of DVT.
  • You don’t have to have a DVT to wear compression! People who primarily sit or stand during the day can wear compression as a preventative measure to decrease the risk of DVT.
  • Wearing compression stockings can be damaging to your self-esteem because unless you wear pants and closed-toe shoes, they are not easy to hide. I’ve been wearing them in spite of my self-esteem lately and decided I am proud to show I am a Survivor.

 

Reader Writes In. Do you wear compression stockings? Why or why not? What kind do you wear? Have you noticed that compression stockings help or hurt you?

There is hope for healing and you are not alone,

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Post-Thrombotic Syndrome is Not in Your Head

PTS Not in your Head Cover

In the first days, weeks and even months after being released from the hospital there is a lot to worry about – medications, doctor’s appointments, follow-up care – not to mention an adjustment to a whole new lifestyle, one that might even be filled with pain, new feelings and worry. Experiencing a DVT, PE, or other blood clotting incident changes everything about our lives – right down to the tiniest detail and has far-reaching effects that we might not even notice until months or years down the line. It can be the smallest changes that affect us in big ways.  One of those long-term, and potentially upsetting, effects of DVT is Post-Thrombotic Syndrome (PTS) and it is not in your head.

This week, the reminder that yet another thing may be permanently different came to me in a pair of previously-thought cute pair of winter boots. I did it right. I kept the heel low, got the pair with the calf extender and made sure they weren’t too stiff. I tried them on, walked around the store and wore them at home. Of course, the second day I wore them outside, I realized I couldn’t handle them. Not only could I not handle them, I was afraid of them. I took them off in a fit of panic, actually, and drove home in my socks.  I can no longer stand the feeling of something around my calf, even if it is not tight. I can’t do it. That set me back a little; I got angry (I used to love high boots), I was disheartened and I decided I won’t look cute this winter.

My boot

Even though I am 17 months out from my DVT and resulting PE, I still experience symptoms that are similar to that of the DVT. I have experienced pain, swelling, tenderness, skin discoloration and itching. All are symptoms of PTS and can range from mild to severe. PTS can affect 23-60% of patients in the two years following DVT of the leg. Of those, 10% may go on to develop severe PTS, involving venous ulcers (Wikipedia.com). While some people who have had a DVT recover completely, others may be left with some symptoms in legs (or arms) that may never go away.

Per the National Blood Clot Alliance, an estimated 330,000 people in the United States have the PTS. Typically, the more extensive the DVT, the more severe the symptoms of PTS will be. However, this is not always so: even people who have had very extensive acute DVTs with severe symptoms may recover completely and may not be left with any long-term symptoms.  Approximately 60% of patients will recover from a leg DVT without any residual symptoms, 40% will have some degree of PTS, and 4 % will have severe symptoms. The symptoms of PTS usually occur within the first 6 months, but can occur up 2 years after the clot. If a patient has done well for 1⁄2 – 2 years after the clotting event it is highly unlikely that he or she will develop PTS.  Little is known as to who will develop chronic symptoms, such as skin ulcers, and who will not.

The symptoms of PTS (per the National Blood Clot Alliance) include:

  • Chronic extremity swelling
  • Chronic (or waxing and waning) pain
  • Unspecific discomfort of the extremity
  • Diffuse aching
  • Heaviness, tiredness and cramping of extremity
  • Dark skin pigmentation
  • Bluish discoloration of toes/fingers, foot/hand or diffusely of leg/arm
  • Skin dryness
  • Eczema
  • Hardening of the skin
  • Formation of varicose veins
  • Skin ulcer (stasis ulcer)
  • Atrophie blanche or white atrophy (small areas of white-gray scar tissue)
  • Dermatoliposclerosis (an inflammation of the layer of fat under the epidermis)
You mean it’s not in my head?

No, PTS is not in your head! When a clot forms in a vein, the valves inside the vein can be damaged by the clot or by the surrounding inflammation. The damaged valves (as well as residual clot) block blood returning from the leg veins back to the heart, which results in increased venous pressure in the leg, thus contributing to PTS (Vascular Disease Foundation). The pain you feel weeks, months and even years after your DVT are very real in most cases, stemming from PTS.

I’ve had a DVT, can I prevent PTS?

As with many health ailments, prevention is the key when it comes to PTS. Wearing custom-fitted compression stockings is the best way to prevent PTS. Stockings are often not work because they are uncomfortable, but they should be to help reduce your risk of developing PTS in the long run. They should be worn during the day and while standing. You should not wear them at night. They should be worn for weeks, months, or years to control symptoms. As long as you continue to experience any type of leg swelling, wear compression stockings. 

I’ve had a DVT and now have PTS, can my symptoms be treated?

There are several things you can do to help ease the pain of PTS, including:

  • Elevation of extremity at rest and at night
  • Compression stockings, grade 2, get them fitted by your doctor (although recently research is conflicting on the effectiveness of compression stockings)
  • Weight loss
  • Increased exercise with strengthening of extremity muscles
  • Pain management (medication, visiting a pain clinic)
  • Compression pump (battery-powered device used when stockings fail to work)
  • Vascular interventional radiology procedure: balloon opening and stenting of narrowed vein (procedure to keep the vein open)
I have ulcers, what should I do?

As with any symptoms of PTS, keep your doctor informed of any changed or new experiences. Visits with a vein or wound care specialist may be helpful to get the best care for ulcers.

How do I know I have PTS and not a new blood clot?

Many of the signs of  PTS are the same as those for new blood clots in the leg, so it is very important for you to ask your health care provider to look at your leg. Only a health care provider can tell you if your problems are from a new blood clot or from PTS. Since it can take 3 to 6 months for your blood clot symptoms to get better, it is important to discuss any new or different symptoms with your doctor as soon as possible. PTS pain and swelling symptoms will tend to lessen with rest and elevation, but would not lessen if you are suffering from a blood clot.

Emotionally, I’m a mess, is that part of PTS too?

PTS is a frequent side effect of DVT. Symptoms can come and go over time, but PTS is a chronic, lifelong condition. PTS leads to suffering and disability and is costly to society in terms of treatment. The physical and psychological implications of PTS are very real. If you were very active before PTS or worked a certain occupation, symptoms may make it difficult to return to your previous level of activity. Oftentimes, it is hard to adjust our level of expectations for ourselves while we slowly recover or make adjustments in our activities. In terms of work, some patients are forced to pursue a new line of work or even file a disability application, which can be devastating to the self-esteem, especially if you have been working your whole life. Visiting a social worker, therapist or psychologist may be helpful in facing some of these issues.

Once I have PTS, will it ever go away?

Currently there are no procedures to correct the veins that contribute to PTS. It is typically a lifelong diagnosis that needs continually managed.

Where can I find more information?

Click on the links below for more information about PTS, including symptoms, treatment and care-

Share your story. Are you suffering from PTS? Do you wear compression stockings? How are you dealing with your diagnosis?

There is hope for healing and you are not alone,

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What recovery from a pulmonary embolism looks like

What does recovery from a pe look like

Over the course of my entire life – childhood and adulthood – I had never been hospitalized, and I had never been as sick as I was with my pulmonary embolism. Recovery for me was taking a few days off work to get over a cold or stomach virus or having to stay in bed most of the day and not eat anything with a sore throat. When it came to running, words like recovery meant things like not running for three or four days after a race and taking it easy on my muscles, even icing and massaging, after a big event. I never looked at the time after my mother’s passing as recovery, but as grieving and settling into what became for me, a new normal. Recovery for other people might be time off their feet due to a broken or fractured running bone, but even they always came back within a matter of months. So, recovery was not a very deep word in my vocabulary and I soon found out, that I really had no idea what recovery from a pulmonary embolism looks like.

I vividly remember my first doctor’s appointment with my hematologist after being discharged from the hospital. It was about a week later, and I was feeling bad, beyond what I understood to be tired (I mean, truly feeling fatigue throughout every inch of my body), carting an oxygen tank and convinced my summer was ruined since flip-flops (my warm-weather footwear of choice) could not be worn with my flesh-colored compression stockings. He asked how I was doing and said, “It’s good to have you with us!” I blinked in bewilderment at him and he said, “For as long as I’ve been doing this, you were the sickest I have seen a patient in a very long time. You’re lucky to be here, actually, what you just survived is not something to be taken lightly.” Okay, but I’ll be running and working again in no time, right?

He stopped what he was doing and sat down in front of me. I was perched on the end of the exam table, legs outstretched and not at all comfortable. It was hot, I was hot and I felt like I was suffocating inside the small exam room, not to mention I suddenly just wanted to go home.

“Sara,” he said, “Everything just changed for you. I mean everything. Your body has been through some pretty severe trauma and you aren’t going to be better in a week or a month or even a few months.”

More blinking.

And?

“The recovery we see from this, from people who have been through something like you have, it takes some time. A long time.”

So?

“You are looking at 1-2 years of recovery at this point. We’ll know better after a year what to expect with how things are going to go. You’ll probably be on oxygen for about a month, I would suspect. I don’t want you to stop wearing your stockings everyday for about six months or so from here, well, you need to see me if you think you can stop wearing them daily. And, you’re going to be on blood thinners now.”

What do you mean, like, forever?

“It’s early to say, but you will probably have to manage this illness, to some extent your recovery and yes, blood thinners, for the rest of your life.”

Wait? What? One to two years? As in, YEARS?

He proceeded to talk about how while it was going to take some time, it didn’t mean I wouldn’t find a new normal and probably even go back to activities I enjoyed like running.

Activities I enjoyed? I was tunneling out of the conversation as the projection of my future played out in my mind.

That was just a week shy of one year ago. My doctor and I would have this conversation a minimum of six or seven more times because I couldn’t comprehend at that time why or how I would need that much recovery, what it felt like to be recovering at all and, as I would later find out, I was struggling with cognitive and memory delays that would alter my state of thinking and later contribute to my inability to successfully do the work I needed to for my job.

Still, I was devastated when I left the doctor’s office with my husband that day. Not even convinced I would do everything I could to recover faster, which I later found was impossible too. Just plain devastated. We had planned to stop at Chipotle for lunch and when we pulled up, just on the other side of the building where the doctor’s office was, I couldn’t get out of the car. There was a group of women about my age sitting out front at the picnic table in cute summer dresses and high heels. I was wearing sweats (that were cut-off nonetheless), tennis shoes and carrying an oxygen tank at 29 years old. I wasn’t getting out of that car. My husband finally convinced me we could get it to go and I did get out – after stashing my tank in the back seat – and only made it to the door, with his assistance, before I was gasping for air in the summer humidity. About the same time, I felt a rush of blood down my legs (the first time of many unfortunately over the next year) and I burst into tears. We did not eat Chipotle that day. In fact, I stayed home for the next month, except for appointments.

My reason for sharing this day with you is two-fold. One, I don’t think enough survivors are told what their recovery time will look like. I don’t think they are told to expect months if not years of recovery – that it is normal and to be expected. I don’t think a lot of doctors even know to tell their patients this because maybe no one has gone back to let them know what recovery looks like. This illness/injury isn’t, for many people, a-here’s-your-pill-and-you’ll-be-fine-in-a-couple-of-weeks-once-your-body-adjusts-treatment. This illness/injury

And two, there is hope for healing. I only have myself to compare myself to, but looking at where I was a year ago to today, as I write this post, the improvements I have made are nothing short of amazing. I even feel like a different person now. My mind is more clear, I’m walking again and I can talk about what happened to me.

Some things to keep in mind as you begin recovery:
  • Every person will have a different picture of what recovery looks like. Some people will return to work and normal life in a few days or weeks, some will be in recovery for the remainder of their lives and still others don’t won’t even have the chance to recover because a PE will claim their lives. Recovery and treatment are unique to each of us.
  • This recovery is full of ups and downs and it is not uncommon to continue experiencing symptoms of the PE during recovery. No day is the same and while you may be fine one day, you could be feeling horrible the next. High anxiety about trivial things or a returning clot are not uncommon either. Depression is also a notable symptom of recovery as all of this is very difficult to deal with and understand for some. Make sue you follow up with your doctor if you are struggling with anxiety and/or depression because he or she may be able to prescribe medications to help you.
  • Often the symptoms that diagnosed the embolism are some of the same things that will be experiences during recovery too – swelling and tenderness in the leg and shortness of breath or pain in the chest. Be sure to follow-up with your doctor or emergency room if, at any time, you question what you are feeling to rule out a recurrent clot. My doctor told me, he still sees patients after a couple of years who experience the initial symptoms of their DVT or PE.
  • After a pulmonary embolism the body spends a lot of energy on healing the heart and lungs, even if they were minimally effected. You may feel more tired, more often and be more sick, more often then before your PE. A day of gardening or a bike ride or even a full day of errands or work can leave you ready for bed before dinnertime. This is normal and if your body asks for rest, give it what it needs! It will take time to get back to even a low level of activity.
  • You may come home from the hospital with no physical restrictions, which is confusing after feeling so horrible and being told you have a long recovery ahead of you. My doctor told me I didn’t have any set restrictions on activity because I would know exactly what I could and could not handle and this turned out to be true. I was convinced I could run in a few weeks. I could not, in fact, walk to the mailbox the first month without stopping to turn around halfway down the driveway after taking the step down from my front door. My body simply would not let me move that much. At the same time, exercise helps to decrease your chance of additional clotting, but do not rush this – you will know when it is time to exercise again, if even for a few minutes.

Share your story. How long have you been in recovery? Where you told by your doctors what to expect in terms of recovery? What does your picture of recovery look like?

There is hope for healing and you are not alone,

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