Joann Lohr, MD, has been practicing medicine for over twenty years. She received her medical degree from the University of Wisconsin in 1983. She studied internal medicine in residency programs at the University of Colorado and the Marshfield Clinic, and general surgery in a residency program at St. Joseph Mercy Hospital in Pontiac, Michigan. She completed a vascular fellowship in 1992 at Good Samaritan Hospital.
What made you decide to become a doctor?
From the time I was a little person I wanted to be a doctor. The truth is that if Wisconsin had a vet school I would have become a veterinarian. Since there wasn’t, I chose people instead.
What are you presenting on at the VEITHsymposium?
My first talk is on changes in women during pregnancy and how those changes affect the vascular surgeon. There are a lot of changes that people don’t realize. The most common ones are clotting disorders, changes with blood volumes, and thrombophilia. Other changes affect the blood brain barrier, the metalloproteinases (enzymes that involve metal), and the angiotensin-renin system (hormone system that regulates blood pressure and fluid balance). Said more simply, changes that affect blood pressure modulation. Women know that preeclampsia is a common problem for pregnant women, especially for older moms. That’s mediated through a hormone system that is normally in balance and that can be shifted. It changes your brain’s permeability and risk of developing other issues, including clotting and bleeding in your brain. Changes in the artery wall can increase your susceptibility to dissection, or separation of the layers. In addition, things can travel or break off and cause a stroke.
How does this affect patients?
In some patients it can cause a fatal hemorrhage, or a fatal blood clot. Other patients may have a severe headache and be required to be on bed rest and blood pressure medicine, or on magnesium to decrease their seizure risk. These patients may need to be treated for prolonged periods of time in the hospital and may have to be delivered early.
What kinds of things should patients keep in mind? Is there anything they should keep a look out for while pregnant?
Most OB/GYN’s—obstetricians and gynecologists—know what changes to watch for. The baby can cause a compression of the left iliac vein, which is the vein that crosses from the left side behind the uterus. This may cause a stricture, or narrowing of the vein, that can cause swelling or a blood clot in your left leg. Sometimes it requires treatment with a balloon or stent to expand the vein and keep it open and functional. Some women have chronic changes with pelvic pain and congestion, pain with intercourse or menstrual cycles, or develop varicosities on the vuvla, lower pelvis, and abdominal wall.
How should a pregnant woman change their behavior to avoid having these kinds of problems?
Unfortunately a lot of things women can’t change—it’s part of the natural physiology—but if you maintain a good healthy lifestyle, don’t gain a lot of weight, and keep your sugar under control, you can decrease your risk. Not having huge families also helps. Some of the risks increase the more children you have, such as the risk of varicose veins and changes in your legs and pelvis.
How do you think treatments will change in the next five to ten years?
Treatments have changed a lot with the pelvic congestion syndrome. We’re now looking at developing venous stents, which we hadn’t done a lot of before, and are looking at long-term trials to remove clots from the left leg, and then balloon and stent the veins open to prevent further issues. We’ve developed techniques to seal and treat pelvic congestion syndrome where extra pathways open during pregnancy.
What advice do you have for patients?
Be healthy, be happy. Do follow up exams with your physician regularly. Get good prenatal care and postnatal care. If you have symptoms and questions, you should seek someone in your area who has an interest in pelvic venous congestion or in May-Thurner syndrome specifically if you’re having problems with your legs. There are a lot of options for varicose veins and superficial varicosities, so there are a lot of options that can be treated with minimally invasive techniques now.
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