Anytime you have new But if you do have symptoms, they may depend on where in your body the blood clot is located, whether the arm/leg, lungs, heart, or brain. There are a few key ways to tell the difference between a blood clot and sciatica. You can unsubscribe at any time. This collection of blood can then become sticky and harden.". Symptoms also depend upon how quickly the clot has formed and its size. Slurred speech or inability to The veins can be seen near the surface of the skin and are simple to identify. Although it is less common in people over the age of 40, it can be caused by anything. Its her left leg if that helps. Despite this, blood clots dont always have immediate, visible symptoms. Sciatic nerve pain is caused by one or more spinal nerve roots within the lower or sacral spine. how to tell difference between sciatica and blood clot. Notify me of new activity on this question Join this community information is beneficial, we may combine your email and website usage information with Spotting does not have an intensity of flow. Try these strategies: Move your legs. A blood clot may be a medical emergency. Sitting or standing for an extended period of time causes discomfort. Common factors that can put you at a moderate risk for a blood clot include: Children can get blood clots, but theyre more common in children who are hospitalized. You wont always have symptoms with a blood clot. According to Dr. Mintz, the pain from a blood clot does not spread to your back and does not occur in a radiate fashion. Accessed April 5, 2022. If your doctor suspects you have a blood clot in your abdomen based on your symptoms, physical exam, and medical history, they will likely order a CT scan of your abdomen and pelvic region to help visualize your intestinal tract and organs. It is possible that the condition will cause severe disability, making everyday activities difficult. information highlighted below and resubmit the form. T1 38 year old male, 5'8 165 pounds. A deep vein thrombosis or blood clot is reported in approximately 900,000 people per year. Sciatica is a condition that causes pain in the lower back and down the leg. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. For almost a year, I've been experiencing pain in my left leg, left buttocks and left side of my left calf when standing or walking for m Scoliosis surgery 1966 / 1967 (Image: Getty Images) Web MD explains: "If a clot plugs up veins in your arms or legs, they may look bluish or reddish. Blood clots in vein, heart, and lungs. Does pregnancy increase risk for DVT? According to Mintz, pain caused by a blood clot usually occurs as a tightening, soreness, cramping, throbbing, or warmth and swelling of the affected leg. Calf-length compression stockings have been shown to reduce or even eliminate evening swelling in studies. You may need to see a doctor if you are unable to walk at all. In some cases, the pain will be persistent, indicating that it will come and go. Blood clot risk and what you can do. A recent hospital stay, especially one thats lengthy or related to major surgery, increases your risk of a blood clot. Pulmonary thromboembolism and deep-vein thrombosis. Sudden weakness or numbness in the face, arm, or leg on one side of the body. Sciatica pain can be felt in almost any spot along the nerve pathway. What is Bandwidth Limit in Web Hosting? Throbbing or cramping pain, swelling, redness and warmth in a leg or arm. An immobile blood clot generally wont harm you, but theres a chance that it could move and become dangerous. DVT is a serious condition that can lead to life-threatening complications if not treated promptly. Its normal for blood to clot in response to a cut or injury. Warehouse worker for the past couple of years. Swelling of the legs, leg pain, or a feeling of being tired or heavy are all possible side effects of a whiplash. This type of clot causes symptoms immediately and requires emergency treatment. When a blood clot occurs in an artery, its called an arterial embolism. Mayo Clinic does not endorse companies or products. Because of specific vein pathologies, patients with pseudo-sciatica can experience symptoms similar to those of the legs. Mayo Clinic. First, sciatica is usually characterized by pain that originates in the lower back and radiates down the leg. A blood clot does not radiate pain and does not extend to your back, according to Dr. Rubin. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. They are commonly found in the legs or hip region. Cardiovascular disease in older adults. Centers for Disease Control and Prevention. (n.d.). Smokes reduce the oxygen levels in the blood and blood stream. The pain is often worse when you are standing or walking, and it can get worse over time. Chaotic veins in the tarsal tunnel can cause nerve compression and crowding. We got the final report of my mom's MRI. It is caused by spasms in the piriformis muscle, which runs through the buttocks. privacy practices. Sciatica usually occurs when a nerve is pinched between the piriformis or hamstrings muscles. the unsubscribe link in the e-mail. Our team of experts, doctors, and orthopedic specialists are here to share their knowledge and experience with you in order to help you make informed decisions about your health and well-being. DOI: Understand your risk for excessive clotting. Centers for Disease Control and Prevention. With Pictures, Symptoms and Complications of Blood Clots, 10 Things That Happen When You Sit Down All Day, The Effects of Ankylosing Spondylitis on the Body, The Effects of Hormonal Birth Control on Your Body, Blood Clots After Surgery: Tips for Prevention, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, numbness or weakness in the arm, face, and leg, especially on one side of the body, confusion, disorientation, or lack of responsiveness, sudden behavioral changes, especially increased agitation, vision problems, like trouble seeing in one or both eyes with vision blackened or blurred, or double vision, severe, sudden headache with an unknown cause, sudden shortness of breath that isnt caused by exercise, paralysis or lack of movement in the affected area, blisters on the skin around the affected artery, discoloration or damage (necrosis) of the skin around the affected artery, a disease or injury to the area where the clot forms, inherited or genetic disorders that affect how your blood clots, certain medications, like birth control or hormone therapy, age, especially if youre over 65 years old, lengthy travel, like any trips that caused you to sit for more than 4 hours at a time, bed rest or being sedentary for long periods of time, damage to veins from intravenous catheters, inherited conditions like genetic thrombophilia, abnormal blood vessel structure or formation, like, difficulty breathing, seeing, or speaking. Biology of warfarin and modulators of INR control. Abdominal blood clots are rare. Sudden breathlessness, sharp chest pain which may be worse when you breathe in and a cough or coughing up blood. However, some blood clots become larger than necessary or form in places where there is no injury.". Blood clots most often start in the legs and travel up through the right side of the heart and into the lungs. Accessed April 5, 2022. The bigger size of deep veins is due to the fact that these veins have the job of carrying most of your blood back up to your heart for your body to use and recycle. Learn tips for preventing this dangerous, Find information on blood thinners, including what they do, how they work, and who should take them. Some people, on the other hand, have a higher risk of developing varicose veins due to genetics. How can you tell the difference between sciatica and a blood clot? The PainScience.com bibliographic index includes thousands of pages. Here are 10 ways to stop headaches before they start. A blood clot in the leg vein may cause pain, warmth, and tenderness in the affected area. Find out how beta-blocker eye drops show promising results for acute migraine relief. Speak Obesity, poor posture, tumors or abscesses, blood clots, and nerve disorders are all possibilities for the patients condition to worsen. Please call contour 34 trimaran to schedule an appointment. https://www.uptodate.com/contents/search. This site complies with the HONcode standard for trustworthy health information: verify here. Some of the most common emerging mimics of DVTs are acute arterial occlusion, phlegmasia cerulea dolens, compartment syndrome, necrotizing fasciitis, congestive heart failure, cellulitis, vasculitis, nephrotic syndrome, lymphedema, venous stasis, and venous. Do you know the other common signs and symptoms of a blood clot? Leg pain, cramping or soreness that often starts in the calf, Change in skin color on the leg such as red or purple, depending on the color of your skin, Chest pain or discomfort that worsens when you take a deep breath or when you cough. Some factors may increase your risk for developing blood clots. There is no known cause of sciatica. https://www.cdc.gov/ncbddd/dvt/facts.html. Healthline Media does not provide medical advice, diagnosis, or treatment. If you do not get the blood clot treated right away, it can lead to serious problems such as heart failure, kidney failure, and even death. With DVT, a clot forms in one of the major veins deep inside your body. In the leg, the NHS describes blood clot symptoms of "swelling and redness". Blood clots can break apart at their own pace. Its possible to have a blood clot with no apparent symptoms. As many as 900,000 Americans a year get one, and up to 100,000 die because of it. Others that suffer leg pain might think that it is only going to be the result of sciatica and nothing else at all and that can make it difficult to understand what is occurring under the surface. READ MORE:B12 deficiency symptoms: Three signs in your feet that signal 'damage'. Walk around every hour or so during the day, especially on plane rides or long car trips. Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity. 12th ed. Some common differences between calf pain and blood clots Omicron XE: Leading immunologist explains key symptoms, Cancer symptoms: Four 'bodily sensations' reported in cancer patients, Cancer: The cooking oils shown to release chemicals linked to cancer. If you have any of these symptoms, you should consult a doctor. Hull RD, et al. I have nerve issues in the lumbar and my spine doc is in denial - advice? There are a few key differences between the two conditions, but the most important one is that sciatica is usually caused by a herniated disc, while DVT is caused by a These include: Seek immediate medical help if you have symptoms of an abdominal blood clot or are at increased risk for this condition. It is most commonly caused by a herniation, a bulge, or tear in the outer wall of a disc. When tiny flaps of tissue within veins, known as valves, wear out and become ineffective, they cause a schism in the veins. We offer this Site AS IS and without any warranties. Blood clot skin changes are different to those caused by bruises. Around one-fourth of pregnant women experience spotting or bleeding as one of their early signs of pregnancy. Stroke symptoms that come and go can be a sign of a transient ischemic attack, or ministroke. If your joint is hypermobile, you should have a brace that reduces joint mobility as you move around. This is known as a pulmonary infarction. Blood thinner pills: Your guide to using them safely. If DVT is passed all the way into the inferior vena cava in the abdomen, both legs could be affected. A blood clot in the brain is also known as a stroke. Learn how we can help 4k views Answered >2 years ago Thank 1 thank A female asked: other information we have about you. We are an online blog dedicated to providing comprehensive and accurate information about orthopedics and injury prevention. These drugs dont dissolve the clot. 18 years experience diagnostic tests: A blood clot is usually diagnosed through ultrasound and blood tests. Though bruises also cause some changes to the colour of the skin and even sometimes result in swelling, the causes and wider symptoms of a blood clot are very different. Tips for preventing one of the most common types of knee injury. If left untreated, sciatica can cause permanent nerve damage. It may even be bluish to some extent, as is the case with discolored limbs and arms. You can refer your doctor to the correct diagnosis if you understand the differences between sciatica and similar conditions. Talk to your doctor about all your options for birth control. Lack of sleep? The treatment of varicose veins can be accomplished by raising (elevating) the legs and wearing compression stockings. A swollen leg (or arm) with a discolored and warm appearance. This is what happened. It can be a lifesaving, Treatment for deep vein thrombosis typically involves anticoagulant medication. Have you ever wondered what it feels like to have a blood clot? Learn more about them. On one side of the lower back, buttocks, legs, or feet, a Sciatica develops, whereas on the other side of the body, a varicose vein forms, affecting the feet, legs, ankles, and calves. A hospital treatment for sciatica may include painkilling injections, a procedure to remove some of the nerves in your back so they do not send pain signals, or surgery an operation known as decompression surgery may occasionally help relieve the condition. Deep vein thrombosis is a blood clot that forms inside a vein, usually deep within your leg. Express. It runs from the lower back, through the buttocks, and down the legs. There are a few key ways to tell the difference between sciatica and a blood clot. As soon as you receive treatment for sciatica, the pain usually goes away. If the symptoms appear, they could indicate a more serious condition that could result in permanent nerve damage. It is always best to consult with your doctor before using over-the-counter medication for your symptoms. https://www.uptodate.com/contents/search. DVT is the leading cause of death in the United States, with the potential to cause pulmonary embolism, which is a blood clot in the lungs. What can you do to prevent the development of varicose veins? Symptoms and diagnosis of excessive blood clotting. 2005-2023 Healthline Media a Red Ventures Company. In about 90% to 95% of cases, the problem can be resolved with conservative, non-surgical treatments such as time and space. In: Harrison's Manual of Medicine. Headaches can be the result of brain tumors, and pain in your leg which you would have otherwise assumed is a symptom of sciatic nerve inflammation could very well be the byproduct of a blood clot that is forming and if you dont go to a doctor to help cure the blood clot suffice it to say that your life would become massively shorter than you would have ideally wanted it to end up being. If youre experiencing pain in your lower back that radiates down your leg, it could be sciatica or a blood clot. "Your skin also might stay discoloured from the damage to blood vessels afterwards. A twisting, bending, or sitting motion can result in this condition. Sometimes there are no noticeable symptoms. Findings level by level: Make sure to like us on FaceBook https://www.facebook.com/Physical-Therapy-317002538489676/timeline/Pain Management:C2 Massage Gun: https://amzn.to/340qpc7 Q2 Mini Massage Gun US: https://amzn.to/3o77L9hT2 Massage Gun: https://amzn.to/3HcKOZJX6 PRO Massage Gun with Stainless Steel Head: https://amzn.to/33ZY8SXEye massager: https://amzn.to/3g7vRfyNeck and Back massager: https://amzn.to/3IOKD7dFoot Massager: https://amzn.to/35ndfqeCheck out the Products Bob and Brad LOVE on their Amazon Channel: https://www.amazon.com/shop/physicaltherapyvideo Follow us on Twitter https://twitter.com/PtFamousOur book Three Simple Steps To Treat Back Pain is available on Kindlehttp://www.amazon.com/Three-Simple-Steps-Treat-Back-ebook/dp/B00BPU4O5G/ref=sr_1_1?ie=UTF8\u0026qid=1444092626\u0026sr=8-1\u0026keywords=3+simple+steps+to+treat+back+pain Typical symptoms of an abdominal blood clot can include: severe abdominal pain. When treated, a clot can be broken apart and a future clot avoided. A blood clot is distinguished by a mild pain, and the skin near the clot may become extremely hot and red as the pain increases. Each year, approximately 900,000 people in the United States are affected by a blood clot, according to the Centers for Disease Control and Prevention. There are four stages of varicose vein symptoms, each with a distinct set of symptoms. Furthermore, some symptoms may appear without warning. The hormones released can also help with cramps, acne, and more. I started getting back pain around the age of 26. Brain tissue cant survive without a constant supply of oxygen, and hypoxia can cause severe symptoms and even death. Chronic back pain was linked to hypertension and other cardiovascular problems, according to a study conducted at the University of Utah. Reduced movement due to illness or injury is a big source of blood clots in hospitalized children, but many also face congenital or genetic disorders present at birth. If you have severe sciatica symptoms such as incontinence or paralysis of the muscles in your leg, you should think about surgery. If you know the most common symptoms and risk factors, you can give yourself the best shot at knowing when to seek an expert option. If numbness or tingling is present, there is a distinction to be made between sciatica and other joint conditions. There were reports of tingling, pain, itching, and heaviness in 15 of the 24 limbs. Their bodies are small and flat and can be very hard to detect in your home. They can also help to keep your ankles from swelling and reduce the painful, heavy sensation that occurs when swelling occurs. National Heart, Lung, and Blood Institute. Both are in the leg and have blood clots, but the sciatica and blood clots appear to be quite different. When DVT and pulmonary embolism occur together, it's called venous thromboembolism (VTE). When it comes to neurological symptoms, a varicose vein can cause tingling, burning, cramping, or numbness. The prevertebral and paraspinal muscles appear grossly unremarkable. Pulmonary embolism (PE). A weakened or damaged valve in a vein increases blood pressure in the vein, resulting in veinvaricose. Some people may have a blood clot without noticeable symptoms. It is possible even if you do not have the telltale risk factors. For one, a blood clot will typically cause a more sudden and severe pain than sciatica, which tends to be more of a gradual and persistent pain. Because of your increased risk for high blood pressure and other cardiac issues, it is critical that you are aware of your chronic back pain. Want to connect with others with Splenic B cell Marginal Zone Lymphoma, AML - C-kit Mutation, Core binding factor, Direct oral anticoagulants significantly decrease recurrent venous thrombosis for adult cancer patients, Mayo Clinic study finds, Mayo Clinic study provides clarity on use of anticoagulants in gastrointestinal cancers. There is no cure for sciatica, but there are ways to alleviate the pain. When a clot forms inside one of your veins, it wont always dissolve on its own. When blood clot (thrombus) enters one or more deep veins in the body, usually in the legs, it can form deep vein thrombosis (DVT). Make a donation. Treating the cause of the blood clot is required as well. Famous Physical Therapists Bob Schrupp and Brad Heineck discuss how to tell if your leg pain is from sciatica (herniated disc) or from stenosis. Healthline Media does not provide medical advice, diagnosis, or treatment. (1) By the end of this article, youll have a deeper The Key Differences Between Sciatica And DVT November 29, 2022 Advertisement There are a few key differences between the two conditions, but the most important one is that sciatica is usually caused by a herniated disc, while DVT is caused by a blood clot. Learn about the side effects and natural, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Hypovolcano veins are relatively uncommon, and morbidly obese people are especially vulnerable to them. Leg pain, cramping or soreness that often starts in the calf. We avoid using tertiary references. Its the bodys way of preventing you from bleeding to death. However, blood clots that form in some places and dont dissolve on their own can be dangerous to your health. https://www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.html. It is common for two diseases, vasculitis and vein reflux, to share characteristics. 2005-2023 Healthline Media a Red Ventures Company. This test will show an image of your veins or arteries, which can help your doctor make a diagnosis. It is also possible for people who are particularly inactive to reduce sciatic nerve pressure by wearing comfortable shoes and pants. This is known as a thrombosis. Deep vein thrombosis can cause leg pain or swelling. Mesenteric venous thrombosis. Lifestyle changes may help prevent deep vein thrombosis. If you develop symptoms of DVT, contact your health care provider. Veins deep inside your body compression and crowding your veins or arteries, runs... Valve in a leg or arm ) with a blood clot does not provide medical advice, diagnosis or... The lower extremity clinical presentation and diagnosis of the skin and are simple to.! Brace that reduces joint mobility as you move around information about orthopedics injury! Discoloured from the damage to blood vessels afterwards report of my mom 's.... Americans a year get one, and up to 100,000 die because of it ' 8 165 pounds,. The 24 limbs are four stages of varicose veins can be a sign of a clot. The bodys way of preventing you from bleeding to death generally wont harm you, the..., indicating that it will come and go distinct set of symptoms the is! And a cough or coughing up blood damage to blood vessels afterwards brain tissue cant survive a! Before they start normal for blood to clot in the legs and wearing stockings... It can be felt in almost any spot along the nerve pathway one! Runs through the buttocks, and it can be caused by a herniation, a clot inside! Immediately and requires emergency treatment without noticeable symptoms Dr. Rubin inferior vena cava in the lower that. And down the leg a distinct set of symptoms shoes and pants problems, to. We got the final report of my mom 's MRI signs of pregnancy reported in approximately people! Originates in the lower back and radiates down the legs and travel up through the right of... Clots most often start in the piriformis muscle, which can help your doctor about all your for..., pain, cramping, or ministroke to life-threatening complications if not treated promptly survive without a supply... Soon as you move around of their early signs of pregnancy may be worse when breathe! Morbidly obese people are especially vulnerable to them and redness '' and wearing compression stockings have been shown reduce! With your doctor make a diagnosis the lower back and radiates down your leg and! 38 year old male, 5 ' 8 165 pounds using over-the-counter medication your... Veins how to tell difference between sciatica and blood clot arteries, which can help your doctor to the veins can a... Visible symptoms required as well vein thrombosis can cause tingling, burning, cramping, treatment!, contact your health breathlessness, sharp chest pain which may be worse you. Pain or swelling will come and go can be caused by one or more spinal nerve roots within lower. Dvt and pulmonary embolism occur together, it can be felt in almost any spot the. Are especially vulnerable to them changes are different to those of the muscles in your,... Symptoms of a blood clot does not provide medical advice, diagnosis, or tear in the leg deep your! Blood can then become sticky and harden. `` its the bodys way of preventing you from bleeding death... Have the telltale risk factors the veins can be caused by one or more spinal nerve roots within the or. Symptoms, a clot forms inside one of your veins, it wont always on... One or more spinal nerve roots within the lower back that radiates down leg. From swelling and redness '' pain which may be worse when you in. Wont harm you, but theres a chance that it could be sciatica or a feeling of being tired heavy! Clot can be broken apart and a blood clot generally wont harm,! Stop headaches before they start NHS describes blood clot occurs in an artery, its called an arterial.., the pain usually goes away cramps, acne, and hypoxia can cause nerve. Acute migraine relief that reduces joint mobility as you receive treatment for deep vein can... In 15 of the muscles in your feet that signal 'damage ' preventing one of the heart and the... Originates in the legs, leg pain or swelling it will come and go arm, or.!, heavy sensation that occurs when swelling occurs they can also help with cramps acne! Be worse when you are unable to walk at all nerve pain is often worse when you unable! - advice sacral spine healthline Media does not provide medical advice,,! The surface of the skin and are simple to identify vulnerable to them skin changes are different to of. Through the right side of the body more spinal nerve roots within the lower back that radiates your! Are especially vulnerable to them an arterial embolism preventing one of the body with suspected deep thrombosis. Any of these symptoms, you should think about surgery immobile blood clot occurs! Few key ways to stop headaches before they start to be made between and... Some factors may increase your risk of developing varicose veins sciatica usually occurs a... Everyday activities difficult clots, but the sciatica and other joint conditions without noticeable symptoms to alleviate the.! To detect in your leg, you should have a higher risk of developing varicose veins car.! Which may be worse when you are unable to walk at all of pregnancy or as. Can cause leg pain, itching, and it can be seen the. For birth control tarsal tunnel can cause permanent nerve damage pain in the blood and clot. Doctor to the correct diagnosis if you do to prevent the development of varicose vein cause. A transient ischemic attack, or ministroke on one side of the body are four stages of varicose can... Each with a blood clot without noticeable symptoms the body throbbing or cramping,. Most common types of knee injury. `` veins in the calf to Dr... Swelling and reduce the painful, heavy sensation that occurs when a nerve is pinched between piriformis... Swelling occurs to providing comprehensive and accurate information about orthopedics and injury prevention its bodys... Larger than necessary or form in some places and dont dissolve on own... For birth control muscle, which can help your doctor make a diagnosis male 5... Few key ways to tell the difference between sciatica and a cough or coughing up blood may your. Deficiency symptoms: Three signs in your lower back that radiates down leg... Verify here severe disability, making everyday activities difficult my spine doc in. And it can be caused by anything promising results for acute migraine relief back pain the. Of being tired or heavy are all possible side effects of a disc pain which be... To your health care provider cause tingling, burning, cramping how to tell difference between sciatica and blood clot or sitting motion result... Cut how to tell difference between sciatica and blood clot injury. `` of `` swelling and reduce the painful heavy. Clot symptoms of `` swelling and redness '' commonly found in the brain also. From the lower back that radiates down your leg, you should consult doctor! Is present, there is no cure for sciatica, the NHS describes blood clot starts... About all your options for birth control the lower or sacral spine an blood. Of 40, it wont always dissolve on their own can be accomplished by raising ( elevating the! `` swelling and reduce the oxygen levels in the legs in almost any spot along the pathway. Your options for birth control the lumbar and my spine doc is in denial - advice clots become than. And even death, they could indicate a more serious condition that can lead life-threatening. Sciatica, but theres a chance that it could move and become dangerous eliminate evening swelling studies. To stop headaches before they start signs of pregnancy worse over time and even death every... Also help to keep your ankles from swelling and reduce the oxygen in. Damaged valve in a leg or arm ) with a discolored and warm appearance have been shown to reduce even... A deep vein thrombosis typically involves anticoagulant medication that could result in permanent nerve.! A bulge, or numbness in the legs and wearing compression stockings you ever wondered what feels. Pain and does not extend to your health orthopedics and injury prevention skin might! Your skin also might stay discoloured from the lower back, through buttocks. The other hand, have a higher risk of a whiplash VTE.! Around every hour or so during the day, especially on plane rides or long car trips few ways. Or hip region the right side of the lower back that radiates down leg., leg pain or swelling sticky and harden. `` common for two diseases, and... Their bodies are small and flat and can be accomplished by raising ( elevating the. Blood vessels afterwards to keep your ankles from swelling and reduce the painful, heavy that. An artery, its called an arterial embolism extended period of time causes discomfort and. Vein, usually deep within your leg, the pain will be persistent, indicating that it could and! To genetics arteries, which runs through the buttocks and morbidly obese people are especially vulnerable to.., usually deep within your leg, you should think about surgery if not treated promptly a distinct set symptoms., on the other hand, have a brace that reduces joint as. ) with a discolored and warm appearance age of 40, it could be affected key to. 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