Recurrent DVT? Two-point ultrasound says no

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Recurrent DVT? Two-point ultrasound says no

Postby runcyn » Mon Nov 17, 2008 6:55 pm

I have a history of recurrent DVTs while on Warfarin due to APS. I am quite aware of what my symptoms are of a DVT, which are not often typical (I do not always have swelling, color changes, or temperature changes in calf). Often I have found them due to discomfort and heaviness in my leg with extreme tenderness behind and/or below the knee, and occasionally with pins & needles in my feet. Since I am a runner, I usually stop and wait a week or so to see if it's just a muscle strain, then head to the ER for an ultrasound with compression to find the nasty thing. The doctors don't know what to do with me when they find them, since I'm already quite thinned out on Warfarin (my range is 3-3.5).

So this last week when the symptoms presented themselves, I quit running and called my rheumatologist who had me go straight to get an ultrasound, but at a different hospital than I normally go to. This hospital did a quickie two-point ultrasound, where they check femoral and popliteal veins, then cheerfully dismissed me with a "no clots!" diagnosis. How can this two-point ultrasound possibly be as thorough and definitive as a regular, whole leg ultrasound? We're talking about a 5 minute exam as opposed to a 20-30 minute one!

Unfortunately, the pain has simply increased to where it is uncomfortable to walk. Not only that, but yesterday, my OTHER leg started with same symptoms! My rheumatologist wants me to come in for a visit this week, but doesn't think it's DVTs since the ultrasound didn't show one.

So what now? Do I demand a whole-leg ultrasound of BOTH legs? I'm sure they must think I'm a hypochondriac. But I'm afraid to start running yet...what if they are all wrong and a clot breaks loose? Then I'm done running for a long time.

Thanks for any advice and help.

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John Kenyon, CNA
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Re: Recurrent DVT? Two-point ultrasound says no

Postby John Kenyon, CNA » Tue Nov 18, 2008 9:38 pm

Hello Cynthia -

Yes, in my considered opinion you ought to demand a full-leg US of both legs, and perhaps a D-dimer blood test as well. With your history you require a more thorough workup than someone with a passing concern about DVT. You also have, at this time, sufficient cause to be worked up far more thoroughly. Your concern is warrented, and unfortunately, with the problem you've inherited, things that might otherwise be easily dismissed ought not be. Please do either go back or to a different facility and be adamant that you receive a proper workup to rule out DVT. You may not have any (and I certainly hope you don't), but this is the only reasonable way to approach these symptoms in a person with a history such as yours. We want you to stay healthy, not take up gambling!

Best of luck to you. Please follow up with us as necessary.
John Kenyon, EMT, CCT
Non-invasive cardiology tech, Emergency and Critical Care technician, Critical Incident Stress Mgmt. specialist

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