
Dehydration is a risk factor for clotting problems.   Assuring clear liquid intake and avoidance of alcohol and caffeine are potent dietary factors in managing dehydration.

<b>Clotting [thromboembolism] is one of the most common causes of death in cancer patients.</b>   Among the thrombotic complications in patients with cancer are disseminated intravascular coagulation [DIC], pulmonary embolism, stroke, and heart attack. Clearly, these complications arise as tumor cells interact with almost all components of the hemostatic system including platelets.   

<b>Most venous clots seem to originate in regions of slow blood flow,</b> like the large venous reservoirs of the calf and thigh or in valve cusp pockets.  Decreased blood flow or even stasis due to lack of the pumping action of the large muscle packages is one of the major factors.  As blood pools, activation products of the clotting system accumulate locally leading potentially to local hypercoagulability.  The activated products of the clotting process [coagulation] can create endothelial damage which in turn leads to further activation of the clotting system. Endothelial damage may also result from distension of the vessel walls by the pooling blood.  Blood flow is further decreased by hyperviscosity [less fluid blood, as happens with dehydration.] 

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*Thromboembolic events are a leading cause of death among cancer patients.
*Cancer patients because of the cancer, have an increased tendency to form clots.
*Surgery, used to treat cancer, increases the tendency to clot.
*Chemotherapy, also used to treat cancer, increases the tendency to clot.
*Infections and sepsis [severe infection] often occurs during cancer treatment, and they increase the tendency to clot.
*Lack of movement: post operatively, or because of feeling ill, or various amputations, also predisposes to clotting.
*A patient's body often reacts to the cancer by causing inflammation, increasing the clotting  tendency.
*Depression has also proved to cause a tendency to clot.  Cancer patients get depressed.
*Dehydration, because of decreased fluid intake due to feeling ill, loss of appetite, or vomiting, is a predisposing factor to clotting.

<b>Of the above, the cancer patient has control over three of the factors.
Depression can be treated by psychotherapy and/or SSRIs [which reverse clotting tendencies]
Leg exercises can be done frequently, even if bedbound.
And Dehydration Can Be Avoided.</b>


<b>Dehydration occurs when not enough free water is taken in by the body, and as a result the blood gets more and more concentrated.</b>  This makes it more difficult to fight off infections; it makes it more difficult to eliminate toxins by the kidneys; and it decreases the fluidity of the blood, so it doesn't flow as freely and favors clot formation.  

Caffeine dehydrates.  Caffeine is a diuretic, which means it makes you pee out more than you drank in.  For each cup of coffee, tea, cola drink, or cocoa, take an extra cup of water.  Likewise be aware of chocolate also requiring extra water.

Alcohol dehydrates as well.  It is also a liver toxin, so shouldn't be used during chemotherapy as well.

Milk does not have free water in it, despite it being a liquid.  It has too high a salt and protein load to be considered free water.  Do not have more than 4 or 5 glasses of milk or servings of dairy daily.

A minimum of 8 glasses of water a day [or two liters] is needed.  You may need more if it is hot, you are active, or you are undergoing treatment.  During chemotherapy I needed 4 liters of fluid a day.  

When traveling, do not drink alcoholic beverages, get up and walk once an hour to enhance circulation and avoid clots, and drink at least one glass of fluid an hour.  Airplane air is very drying, so you may find that your fluid requirements increase.

<b>If someone is having chemotherapy, and is vomiting, take them to the Emergency Room  immediately.  Most chemotherapy regimes nowadays have effective anti-vomiting drugs.  Until the vomiting is controlled, intravenous liquids should be given.  Chemotherapy, cancer, and the dehydration caused by vomiting, create a common situation where clotting does occur.  </b>


<b>Definitions & Conditions:</b>

<b>Thrombosis</b> is the formation, development, or presence of a clot[also called a thrombus].

<b>Disseminated Intravascular Coagulation, or DIC</b>, is a condition in which all of the clotting elements, factors, platelets & etc., all clot, all at the same time.  What happens then is that there are NO clotting agents available because they have been used up, and these people bleed, become covered in bruises and bleed internally as well.  This condition can present catastrophically.  Can easily be fatal.  However, the more usual presentation of DIC in a cancer patient is a low grade clotting tendency, with multiple minor episodes.

<b>Paraneoplastic Syndromes:</b> These are collections of symptoms that occur when people have cancer.  The syndromes differ from person to person and cancer to cancer.  Often Tumor Secretions play a part.  Development of auto-immune disease also occurs.

<b>Auto-Immune disease</b> occurs when people make antibodies to their own tissues.  And try to destroy their own tissues.  When auto-immune antibodies are made to blood vessel walls, either artery walls or vein walls, there will be an increased incidence of clotting in those vessels.

<b>Trousseau's Syndrome</b> is a migratory thrombophlebitis [inflammation of the veins, associated with clotting] associated with cancer and believed to be an autoimmune phenomenon.

<b>Embolus [emboli is plural]</b>: A clot or other plug brought by the blood from another vessel and forced into a smaller one, so as to obstruct the circulation. 

<b>Pulmonary Emboli</b>, the usual cause of which is fragments of clot breaking off from a large clot in the large vein of a leg.  These fragments travel to the heart, and pass into the Pulmonary circulation, where they eventually plug a pulmonary arterial vessel.  This can be a fatal complication.

<b>Thrombocytosis</b>:  High platelet[thrombocyte] counts in the blood.  Many cancer patients have high platelet counts, either heralding lung tumors or as a result of inflammatory conditions.  If the platelet counts get too high [like 1,000], they actually require treatment to prevent clotting problems.

compiled by doctordee
December 2003
