Avoid Painful or Fatal DVT During This Air Travel Season

Getting a DVT can be life-threatening especially for elderly travelers. Please share this article with your friends and relatives and enjoy your holiday visits, not visiting a hospital.

It is that time of the year when a lot of us visit friends and families often with long inter-continental and overseas flights. The immobility associated with long flights/drives is associated with an increased risk for developing a deep vein thrombosis (DVT).

Part of our business involves photographing the calf swelling and discoloration often associated with DVTs for documentation and easier communication. We specialize in mobile medical photography integrated with the electronic health record (EHR) without risking patient health information leaks. So helping diagnose a DVT is right up our alley!

A photo of a DVT patient with a swollen left calf (via Wikimedia).

A photo of a DVT patient with a swollen left calf (via Wikimedia).

Like you can see here, photos of DVT conditions are valuable because a DVT patients will show

  • Asymmetrical swelling of the calf/foot where one leg becomes larger than the other. Photos document the subtle changes in size and extent of edema and are valuable for tracking over time by other medical specialists.

  • Depending on the extent of the DVT the skin in the calf and/or foot may get a bluish discoloration or become red. Photos are useful to see the extent of color changes over time.

So I asked my co-founder and also our own vascular surgeon, Dr. Aalami to tell us about what is DVT and how we can avoid them.

So, what is DVT?

DVT stands for Deep Vein Thrombosis. This is when a blood clot forms in one of the deep veins. The most common site for DVTs to occur is in the calf and leg veins. They can start small but propagate (get longer/larger) over time. We are taught about Virchow’s Triad when thinking about what increases the risk for DVTs.

This is when you have,

An ultrasound echo imaging will be used to show the location of the DVT located deep in your body.

An ultrasound echo imaging will be used to show the location of the DVT located deep in your body.

  1. Blood flow stasis (slow flow),

  2. A hypercoagulable condition (a reason for blood to be thicker), and

  3. Vein injury (often to the inner-most lining of the vein- the intima). One frequent cause of this is to sit on one position, notably in aircrafts or long drives. We care about DVTs because of the life-threatening pulmonary embolisms (PEs) they may cause. This is when a piece of the clot breaks off and goes to the heart and lungs and cuts of circulation. It is important to note that the signs and symptoms of this are chest pain and shortness of breath.

How Would I Know I Have a DVT?

• Swelling of leg (or other affected areas)

• Red or blue skins on the leg

• Pain in the leg or especially when you try to walk or dorsiflex your foot (point your toes towards your head)

• Chest pain and shortness of breath could be a sign of PE from a DVT

Simple Steps Can Prevent a DVT

There are simple steps one can take to help prevent a DVT, especially when you know you will be immobile for long periods of time on a flight or long drive.

Check out this FINAVIA airline website for more information on in-seat exercises to avoid DVT. There are also many good flight tips.

Check out this FINAVIA airline website for more information on in-seat exercises to avoid DVT. There are also many good flight tips.

  1. Wear Compression Socks: The simplest approach is to wear compression socks that go up to the knee. For prevention the low-medium compression grade (~15 mmHg-20 mmHg range) will suffice. These now come in stylish contemporary colors or designs (like Sockwell or Comrad or Many Others), so you don’t have to be embarrassed about your style being crimped.

  2. Wigle and Move Around: Blood has to fight gravity to work its way back up to the heart. The normal pressure in veins is quite low, 0-5 mmHg. Our body uses the “Calf Pump” to pump the blood back to the heart. We also have valves in our veins to help keep the blood from working its way right back to our feet. Something easy to do when sitting on a flight or in a car is to simply activate this calf pump by pointing your toe to your head and back down 15 times every hour. This will keep the blood moving. I like FINAVIA airlines’ [1] web page describing simple exercise steps.

  3. Ask for and Drink Lots of Water: According to Vein Association of Texas [2], Dehydration is also the leading cause of DVT (thickening of blood in Virchow’s Triad).

    Also, according to the World Health Organization (WHO) [3] the humidity in passenger aircraft is significantly lower (20% or less) providing a much drier environment facilitating dehydration. And while many of do like alcohol services in the cabin, it is also the source of dehydration—just ask for water with your orders.

    So always drink sufficient water in flights and do your bathroom break more often too to get out of your seats and get your leg circulation going!

  4. Taking Anticoagulants: If you are on anticoagulant medication, take them as advised by your doctor. Some doctors recommend taking a baby aspirin (81mg) before your trip but there is no solid research evidence that it can prevent blood clots in veins. Many still take it because of how effective aspirin is at preventing clots in arteries.

Don’t let DVT ruin your holiday visits.

Please share this article.

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  1. Easy in-flight exercises to prevent deep vein thrombosis https://www.finavia.fi/en/newsroom/2017/easy-flight-exercises-prevent-deep-vein-thrombosis

  2. Dehydration and Blood Clots https://texasveins.com/dehydration-blood-clots/

  3. Cabin humidity and dehydration, World Health Organization https://www.who.int/ith/mode_of_travel/chad/en/

Photo Attributions (in the order of appearance)

  1. Economy class interior of B-5972, N509FZ [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons

  2. Deep vein thrombosis of the right leg.jpg, James Heilman, MD [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Deep_vein_thrombosis_of_the_right_leg.jpg

  3. Ultrasonography of deep vein thrombosis of the femoral vein -annotated.jpg: Mikael Häggström [CC0], from Wikimedia Commons, https://commons.wikimedia.org/wiki/File:Ultrasonography_of_deep_vein_thrombosis_of_the_femoral_vein_-annotated.jpg

  4. Easy in-flight exercises to prevent deep vein thrombosis, A company Blog of FINAVIA airlines. https://www.finavia.fi/en/newsroom/2017/easy-flight-exercises-prevent-deep-vein-thrombosis

Encounters and Orders World Mismatch, Our Experience

Encounters and Orders World Mismatch, Our Experience

Our product ZenSnap had a humble start, with a vascular surgeon wanting to coordinate his pre-and-post care and developing compliant mobile photo collaboration tool such as Slack to fix the HIPAA issues inherent in social media photo and video apps.

Efficient and accurate care coordination requires a lot of visual elements, including tracking the wound healing process, or checking case planning worksheets to make appropriate pre-operative decisions as a team.

As those images accumulate, other clinical users have started to ask why not share some of these images and videos in their PACS/VNAs or EHRs. We’ve found that similar workflows were largely shared by Pediatrics, Orthopedics, Sports Medicine, Dermatology, Wound Care, Podiatry and even Dentistry.

In traditional clinical imaging scenarios, an image acquisition device is considered as a modality (like CTs and Ultrasound). So, to use those devices, an order is made, and radiologists read the images and create reports. There is an excellent and very detailed article published on this topic in the Journal of Digital Imaging in 2016. But as a standard it is neither implemented or widely in use yet.

In our development, a few things became very clear:

1.      All those images are centered around an encounter and episode of care.

2.      Not every image is relevant in being associated with medical records, but “exporting” select images to PACS/VNA and EHR provides great benefits.

3.      For PACS/VNA imaging orders are typically needed.

This has been the typical clinical integration “impedance mismatch” and has been the subject of many concerns in our own customer discussions.

In this article, we would like to share how we are approaching our solution today to address this impedance mismatch.

Every Study by Default Starts with an Anonymous Encounter

When a clinician launches (or resumes) the ZenSnap app, the user is asked whether it is a New Encounter or a continuation of the on-going encounter. In both cases, it does not require a patient name, MRN or order to proceed. The user can proceed to take photos and chat with other users to discuss cases immediately.

Traditional Modality Worklist Starting Point is also Possible

A user is also given a choice to go to open the “Patient List” and select the appropriate patient from the Modality Worklist.

Unified Patient List Mode

If a unified patient/order search* strategy is used in combination with ZenSnap, it is also possible to present the unified patient list from the amalgamation of MWL, Prior Studies, and admission events from the EHR feeds.

If appending of a new series to an existing imaging order is permitted, we can “push” selected images into an existing imaging accession.

Automated Order/Accession Generation

Auto order generation and routing strategy* is an option if a patient has already been established and accession generation scheme can be implemented with the customer.

In addition, it is possible to push images to EHRs as an unsolicited order/report and store the image in their “media tab” without an order.

After-The-Fact Push

Any anonymous encounter will “park” on our the ZenSnap’s secure server. A user will be able to associate anonymous encounters when a patient or order is established.

Image uploaded from iOS.jpg

OCR to the Rescue

We have an OCR engine** plus a bit of AI and so the encounter has a photo of wrist band, bar-code, QR code, association of anonymous studies and “after the fact” push will be automated. This does not have to be the very first image.

In Conclusion

We have found that a surprising number of clinical users rely on photos to orchestrate efficient and accurate care coordination. We’ve explored many ways to match the encounter based and order based visual imaging workflow and clinical users can have effective choices in realizing both worlds to interoperate. We are hoping better recognition of the encounter based scenarios in medical informatics industries will provide even better support in the coming months.

*WinguMD has tested with DICOM System’s Unifier to realize these functionalities.

** We have integrated with medical grade OCR from EDCO

Show a Video of an Injury Scene to Your Doctor Instead of a Few Photos

If you have just witnessed an injury like a fall from a bike ride, use the video feature on your phone to capture the whole scene as soon as possible before moving the patient. If that's possible. 

A few photos are great, but you are not a trained specialist, and it does not tell the whole story of the injury. 

  • Take a video of the whole scene. If you or someone happened to capture the actual fall, that's even better and a lot of people do like to capture a trick maneuver etc. They want to piece together the sequence of events leading to the injury rather than the injury itself. This will aid in people to check other areas of impacts that could be missed.

  • If you are videoing the injured area, also try to cover from all different angles. For example, if there is just a photo of a broken skin, they would not know left or right side of the body. 

  • The video will capture the time of occurrence, which is important for them to know the amount of time passed before the patient was brought into the care facility.

Providers using products like WinguMD can import your videos to their EHRs for future reference.

Statistical Facts About mHealth

1,085,783 Doctors

The total number of doctors registered in the US (Source: Statista.com)

2,857,180 Registered Nurses

The total number of registered nurses in the US in 2016 (Source: Statista.com)

90% Doctors Admit

Nearly a 90% of doctors used their personal mobile phones in clinical use.

Source: Chan N, Charette J, Dumestre DO, Fraulin FO. Should 'smart phones' be used for patient photography?. Plast Surg (Oakv). 2016;24(1):32-4.

Poor Communications Cost 1M/Yr/Hospital

Nearly $1 million could be saved per hospital per year by replacing pagers with secure messging for clinical communications during three critical workflows: patient admissions, coordinating emergency response teams and patient transfers. (Source: Imprivata)

93% Doctors Believe mHealth will Improve Health

74% of Hospitals Think Mobile Make Them Efficient

The How and Why of DICOMWeb and RESTful API

Part 1: The RESTful API Revolution

With Apple’s recent entry into the EHR market, interoperability in healthcare is attracting more attention.

When it comes to medical imaging integration, interoperability has always had a high bar to entry.

Historically, developers had to rely on the DICOM protocol, which was defined by the American College of Radiology and National Electronic Manufacturing Association. Since hitting the scene in 1983, it is the de-facto protocol built into CT scanners, ultrasound machines, and other digital radiology equipment. Using DICOM requires a very detailed understanding of how it works from the network level to the data structure. The entire standard, if printed, would require a decent size suitcase to carry. If a developer was tasked to use this standard, it required hiring a DICOM consultant to work and acquire a DICOM toolkit program; both very costly and time-consuming propositions.

Fortunately, the DICOM committee started to solve this, first with XML access, then in February 2013, nearly thirty years after the first DICOM standard, RESTful access was formalized. This is now commonly called “DICOMWeb.”

RESTful API has taken the world by storm. Accessing services running on Facebook, Google, Amazon, Azure, Watson or IoT devices means all we need to know is their RESTful API specifications, and use JSON as the language of communication. With these changes, developers no longer require the expense of a DICOM toolkit program or the need to hire specialists.

RESTful API, A Breakthrough in Communication

While fully utilizing, for example, a CT image, would require additional knowledge of the CT itself, for the most part, exchanging and especially retrieving patient and visit information, plus getting images as JPEG or video as MP4 has become very as simple as downloading a photo. DICOM servers can do the conversion work for developers.


An example of a DICOM RESTful API Study Query by date range

An example of a DICOM RESTful API Study Query by date range

In the world of medical imaging, DICOMWeb is still relatively new, but products like DICOM System’s Unifier can promote the interoperability of be added into the existing hospital’s imaging network and instantly activate DICOMWeb capabilities over the secure encrypted HTTPS access. As a bonus, the Unifier’s smart routing and proxying allows developers to access many different imaging systems in a hospital network from a single access point.

Now, there is no excuse for not being able to integrate your mobile or cloud app to imaging systems. WinguMD has also switched to DICOMweb to integrate mobile medical photography. We  have switched to DICOMweb primarily for the speed and simplicity of implementing interoperability. Quick implementation means users can start improving productivity in just a few days.

In Part 2, I will dive a bit deeper into the API and services available. 

Test drive Body Map Snap today by contacting us for a free demo

Attending HIMSS18 in Las Vegas? Receive an in-person demo at the Dicom Systems Booth 11649, Hall Gwhere WinguMD founders will be available.

About WinguMD

WinguMD designs, develops and markets Visual Mobile Medical Collaboration and Integration Solutions to enhance care delivery workflow for physicians, suppliers, payers and patients. As a Dicom Systems partner, WinguMD is able to integrate with PACS, EMR, RIS and other vendor platforms as part of your Enterprise Imaging solution.