DVT - Does ANYONE know what to expect?

[DwayneEMTP]

Hey all,

I can't remember if I posted here or not about my DVT issue.

Several months ago I got a DVT during my international flight. It's possible that sleep and tequila may have had something to do with it...(Don't you judge me!!)

Anyway, while dealing with our medical team in another country by phone I was pretty much told to piss off...

While on the phone, being told that I should go to the hospital, though this isn't an emergency, because my company insurance covers emergencies. (hospital was not possible without the company's help), I was asking the online doctor...

What can I expect from the DVT at this point? (pain 5/10 x 12hrs, very slight swelling, slightly febrile at site (Popliteal vein)

How can I expect it to progress?

What are the chances that it will simply self resolve?

What might I have on site that would mitigate it?

What are the odds that it will become a PE?

In what time frame might I expect it to become a PE (and thus die?)

While the only significant medical care for many miles, the last two were of course the most on my mind at the time.

To tell the truth I was pretty freaked out by this. I've transported, that I'm aware of, 5 PE's, and they all died really badly in the back of my ambulance. Thinking of going through that process alone was pretty horrifying...and I don't horrify easily. (Why going through it not alone might be better, I don't know, but it seems like it would be)

Since then I've tried to find answers online to the above questions, with little to no luck. Does anyone have any kind of significant experience or data on this subject?

Thanks for any help...

[jwiley40]

What I know of DVT is that they can be excruciatingly painful and potentially fatal. I know that because that was the cause of death for my mom ten years ago. Don't mess with this: go to the ER and get treated, even if it's a bare minimum of treatment. Anything is better than nothing at all.

[ERDoc]

Here's emedicine, but I'll paraphrase (cut and paste the important parts) in case you can't open it over there:

http://emedicine.medscape.com/article/1911303-overview

Deep venous thrombosis (DVT) is a manifestation of venous thromboembolism (VTE). Although most DVT is occult and resolves spontaneously without complication, death from DVT-associated massive pulmonary embolism (PE) causes as many as 300,000 deaths annually in the United States.

physical findings in DVT may include the following:

• Calf pain on dorsiflexion of the foot (Homans sign)
• A palpable, indurated, cordlike, tender subcutaneous venous segment
• Variable discoloration of the lower extremity
• Blanched appearance of the leg because of edema (relatively rare)

Potential complications of DVT include the following:

• As many as 40% of patients have silent PE when symptomatic DVT is diagnosed^[5]
• Paradoxic emboli (rare)
• Recurrent DVT
• Postthrombotic syndrome (PTS)

Lower-extremity DVT is the most common venous thrombosis, with a prevalence of 1 case per 1000 population. In addition, it is the underlying source of 90% of acute PEs, which cause 25,000 deaths per year in the United States. Other than the immediate threat of PE, the risk of long-term major disability from postthrombotic syndrome is high. Over time, thrombus organization begins with the infiltration of inflammatory cells into the clot. This results in a fibroelastic intimal thickening at the site of thrombus attachment in most patients and a fibrous synechiae in up to 11%.^[25] In many patients, this interaction between vessel wall and thrombus leads to valvular dysfunction and overall vein wall fibrosis. Histological examination of vein wall remodeling after venous thrombosis has demonstrated an imbalance in connective tissue matrix regulation and a loss of regulatory venous contractility that contributes to the development of chronic venous insufficiency.^{[26, 27]} Some form of chronic venous insufficiency develops in 29-79% of patients with an acute DVT, while ulceration is noted in 4-6%.^{[28, 29]} The risk has been reported to be 6 times greater in those patients with recurrent thrombosis.^[30]

Over a few months, most acute DVTs evolve to complete or partial recanalization, and collaterals develop (see the images below).^{[31, 32, 33, 34, 35, 36]} Although blood flow may be restored, residual evidence of thrombus or stenosis is observed in half the patients after 1 year. Furthermore, the damage to the underlying valves and those compromised by peripheral dilation and insufficiency usually persists and may progress. Venous stasis, venous reflux, and chronic edema are common in patients who have had a large DVT.

[triemal04]

Honestly, if your company is so cheap (there's another term for it, but I won't use that one) as to only cover "emergency care" while you're located in essentially a third-world country then you shouldn't feel bad about doing whatever it takes to turn your "non-emergent" problem that is a risk of your employment (those long, long flights) into an "emergency."

"Hey boss/medical gatekeeper/asshole, I just flew in and now I've got this severe calf pain, swelling, and some discoloration in my calf. Oh yeah...and I'm having trouble breathing."

Sounds like an emergency to me...

As an aside, I remember you bringing this up and saying that you take aspirin before a flight. When you're next back in the states it might be worth seeing your PCP and bringing up this situation and the reality of your employment situation. Don't know if they'd be willing to give you a scrip for lovenox to take prior to the flight, but it'd be worth looking into.

[chbare]

Dwayne, I am not in the habit of giving online advice, but this is a pretty serious situation. You likely had a DVT months ago and possibly have another one or problems relating to the prior DVT. Additionally, you have some risk factors that could exacerbate the situation. The good news is that many DVT's are conservatively managed with anticoagulation and watchful waiting. However, you are not exactly in a controlled environment.

I know you probably do not want to hear this but you need to be evaluated at a place capable of providing "progressive" medicine. I think you should come home as well and be closely followed. It sucks bro, but you have big responsibilities and people who rely on you. Please do not let this one go like the last experience. There certainly is a chance it could follow a similar course, but the stakes are incredibly high.

PM me if you want to talk specifics.

[CheekyEMT]

I don't frequent the boards enough to offer up advice, but my mom died from a PE 8 yr's ago and it was absolutely horrible. She died in hospital while waiting for hernia surgery. She developed the clot in her femoral artery which resulted in the PE....I held my mother's hand in the ICU while she coded 3 x's.

Not something to mess with.

Something you may want to be tested for or look in to is Factor V Leiden. It will test for hypercoagulability( and inherited clotting disorder). But you really need to get the necessary work up done to find/diagnos and properly treat the DVT.

[Kaisu]

Damn Dwayne you stupid son of a bitch. What would you tell a patient who is doing international flights with the frequency of Lindsay Lohan and has a DVT??? I can't believe you are trying to weigh the risks by finding out stuff. You KNOW what the right thing to do is. You take care of yourself first. You are no good to Babs or Dylan or me or anyone else dead.

If it costs you this stupid job than so be it. It's about time you joined the real world of paramedicine and the hose wanker protocol monkey paradigm the rest of us deal with anyway.

[DwayneEMTP]

Hey all...

Man, I'm sorry about the confusion...Though I am a stupid son of a bitch, I'm not suffering with this issue now.

This is still interest from several months back, I'm fit as a fiddle now, but if I wasn't I can certainly see the reason for your comments. And I'm grateful for the love and kindness behind them.

For future reference, I will in fact leave next time. I considered leaving the time that I had the problem. But it's at least three days (24hr) home, and to get into the hospital in Lae, thirdish world, would take at least as long, and I assumed, though I've no idea why I was comfortable making such an assumption, that I would be resolved or dead by then...Know what I mean?

[Kaisu]

Ok. I misunderstood. And I am sorry I called you names. I was scared.

So tell me Dwayne. Did you have the issue addressed? Were you assessed and/or treated? These things do recur and can cause all kinds of damage beyond the dreaded PE: most not as dramatic but unpleasant non the less

Working beyond the pale makes it essential that you are healthy and taking care of yourself.

[chbare]

Okay bro, my bad for misinterpreting.