lupus nodules

earlier this month i saw a patient who wasreferred to me by his general practitioner with phlebitis. his gp had been treating himwith antibiotics and if anything, his leg was getting worse. now treating phlebitiswith antibiotics is simply wrong and i am going to tell you the truth about phlebitis.phlebitis is simply a medical term indicating that there is inflammation in the vein. mostcommonly it affects the superficial leg veins and it is associated with localised swelling-- a lump- which is red, tender and warm and sometimes the lump actually feels hot andpainful. usually phlebitis comes on out of the blue for no apparent reason but very occasionallyi see phlebitis as a complication of some cancers, intravenous arm catheters used inhospital -- drips - or sometimes as a reaction

to some very irritant intravenous injectionssuch as chemotherapy. i haven't seen a case of phlebitis due to bacteria for years andthat happened in a drug addict who was injecting into a leg vein with dirty needles. the standardusual case of superficial leg vein phlebitis seen by a gp does not need antibiotics. antibioticsmay do more harm than good. now until recently, phlebitis in superficial leg veins was thoughtto be a rather trivial condition and many doctors dismissed phlebitis as being of noreal significance. even the term phlebitis is often misunderstood and misused. many peopleincluding doctors describe any discomfort in their veins as being phlebitis. to absolutelysure that the problem is phlebitis, a duplex ultrasound scan is needed -- the ultrasoundappearance of phlebitis is characteristic

and diagnostic. the vein wall is thickenedand there is a variable amount of clot inside the vein. a scan is the only way of checkingthe vein directly and confirming that the vein is inflamed. ultrasound has also revealedthat a very important group of people with phlebitis either already have a dvt or theyare at risk of developing a deep vein thrombosis. the inflammation in the wall of the veinsaffected by phlebitis activates clotting of the blood inside these veins. this clot canextend or spread from the superficial vein into the deep vein. so this is another veryimportant reason why everyone with phlebitis should have a duplex ultrasound scan. a duplexscan is the only way to correctly identify people who already have a dvt and who needtreatment to prevent that clot leaving the

leg, travelling around the body and lodgingin the lung -- a serious condition -sometimes fatal- called a pulmonary embolism. a duplexscan will also determine whether these people with phlebitis are at risk of a dvt and whoneed preventative treatment. so the first important message is that everyone with phlebitisshould have a duplex ultrasound scan. so how should superficial leg vein phlebitisbe treated? well we can only offer the correct treatment for phlebitis if we know the resultsof the duplex scan. the scan may show that the phlebitis is only in a small area andthat only a limited number of superficial veins are affected. if there is very littleassociated clot in these superficial veins and if this clot is well away from the deepveins, then treatment with aspirin or aspirin-like

medication called non --steroidal inflammatorydrugs and compression stockings may be sufficient. a good medical sock will support the veinwhile it is recovering and the anti-inflammatory tablets or cream will ease the swelling andpain. if the phlebitis is extensive or if the clot in the superficial veins is alreadyclose to the deep veins, a course of blood thinning injections -- anticoagulant heparinmedication- is needed to reduce the significant risk of developing a dvt. of course if thescan shows that a dvt has already formed, full anticoagulant treatment for several monthsis needed. so the correct treatment of phlebitis requires a scan.so in summary, phlebitis is not an infection and antibiotics are not the correct treatment.phlebitis is not a trivial condition, it can

be serious and may cause a deep vein thrombosis.everyone with phlebitis should have a duplex ultrasound scan to confirm the correct diagnosis,to check for dvt and to guide the correct treatment.now, if you are interested in vein problems and you would like to keep up to date, pleaseclick the button above and subscribe. that way you will be among the first to see ournext video. why not leave a question in the box below.i'd love to hear from you and i will do my best to get back to you as soon as possible.thank you for watching.