Aims and MethodAll patients attending the local supervised drug consumption clinics were surveyed over a month. They were asked via a questionnaire to list the risks of injecting drugs, particularly the symptoms and consequences of deep vein thrombosis (DVT). Of 69 patients surveyed, 46 agreed to take part.ResultsOnly 9 patients (20%) had never injected drugs, whereas 16 (43%) of those injecting had injected into the groin; 10 patients (22%) had experienced a venous thrombosis themselves, and 35 (76%) knew of someone who had. Only 30 (65%) knew what a clot or thrombosis was. Pain and swelling were the most commonly reported symptoms, but few drug misusers knew of other symptoms. The best informed were those who had experienced thrombosis themselves recently.Clinical ImplicationsThe results indicate an apparent lack of basic knowledge about the risks of DVT in this sample of drug misusers, and a need for some new initiatives to address health education in this area for all drug misusers.

The interaction of several serious illnesses presents considerable difficulty for both clinicians and patients, no matter what the coexisting diseases are. This results in huge anxiety for patients and worsens the difficulties understanding the risks and benefits of the treatment of each disorder. The authors present the clinical scenario where dialysis was commenced while sodium valproate was being taken for bipolar affective disorder, demonstrating the interface between bipolar affective disorder and renal failure and how their treatments caused deterioration in the comorbid condition. This case challenges accepted wisdom regarding the effects of dialysis on the sodium valproate levels in the body and discusses key clinical management issues.