DVT - Does ANYONE know what to expect?

[DwayneEMTP]

Oh man, there's no apologies necessary...I'm flattered that anyone cares..

I'm willing to bet that there were plenty here waiting for me to drop dead.. :-)

Thanks to you all for your help...

But, I don't think that I still answered the question...how fast can/will they develop from noticable to dangerous?

And no Kaisu, I've not been evaluated since that time, but have had no further issues that I'm aware of..

[chbare]

Putting a "solid" time to it will be nearly impossible because the clinical course of a DVT is altered by a constellation of concepts. You can look through the literature and probably could make the reasonable conclusion that a DVT is associated with significant long term morbidity regardless of the cause.

One to get you started:

http://www.ncbi.nlm.nih.gov/m/pubmed/9299855/

[ERDoc]

Any DVT is dangerous, it's just a matter of when. There is no way to predict when you will throw off a embolus and end up with a PE or, if you have a PFO (which most people are unaware they have) you can end up with a stroke. DVTs are not something to mess around with.

[Happiness]

I have a question, If you have had DVT are you prone to get it again. And shame on you dwyane for not going and having some sort of a follow up for the last episode. I am very disappointed in you.....................and plus I have to post a pic on your wall of my b-day presents this year, as per instructions from my husband

[chbare]

Take a look at the link that I posted. It references literature that should answer your question. Bluntly stated, yes.

[paramedicmike]

From UpToDate:

After a first unprovoked VTE event, a patient has a 5 to 15 percent risk of VTE recurrence within the first year following discontinuation of anticoagulation, and a 30 to 50 percent risk of VTE recurrence within the following 5 to 10 years [99,105,116-121]. In two reviews and four cohort studies, clinical features most strongly associated with a high risk of VTE recurrence included the following [122]:

• Absence of a temporary risk factor (ie, idiopathic rather than provoked episode)
• Pulmonary embolism or proximal DVT (rather than distal DVT)
• More than two thrombotic events
• Male sex
• Residual vein thrombosis
• Presence of a vena cava filter
• Continued estrogen use
• Diabetes mellitus [123]
• Neurologic disease with paresis [124]
• Malignancy [124,125]
• Inflammatory bowel disease [126]
• Estimated glomerular filtration rate <30 mL/min/1.73 m² [127]

So... yes. There is an increased risk of a second event. Given Dwayne's frequency of international long haul flights he hasn't removed that risk factor. And he can't change the fact that he's a guy so there's that risk factor, too.

Dwayne, glad to hear you weren't writing about a second event. Hope you're getting follow up from that.

[DwayneEMTP]

Man, to tell the truth, it never occurred to me to get a follow up. I'd assumed that once it was resolved that it was like a cold, that it was over.

I have mitigated the risk factors significantly since that time (Not for age of course, but compared to those that existed leading up to this episode.) No drinking on long haul flights. On this particular flight I slept for about 10hrs straight. I don't sleep any more so that I make sure to get up and move/walk around at least every few hours. (This particular flight, scheduled for 16.5 hrs ended up instead 19.5 hrs..grrrrr), wear compression stockings (man, how old does that make me feel?) plus I pay very close attention to my hydration status.

It wasn't my intention to be macho, but instead I was operating under the uneducated assumption that before I could get to anywhere where 1st world care was possible (several days at least) that the issue would be resolved. I know that walking away to go and be evaluated seems like an easy choice, but when faced with the loss of my job, significant hospital bills "to check for problems" and the idea that it would be resolved before I could get anywhere...Leaving didn't seem, at the time, to offer any significant benefit.

It was a pretty scary time. Later the night of the call the pain had increased, maybe 7/10. I was laying in bed doing all that I really knew how to do at that point, worrying, when suddenly I felt a tiny "pop" and the pain immediately dropped to 2/10 or so. I thought, "God damn it...here we go!" I grabbed the sheets and started to hyperventilate (A well know mitigation factor for terminal PE) and waited to see if I was going to suffocate. After about 5 mins I was halfway confident that I wasn't, and went to sleep in the hopes that if I was wrong at least I would die in my sleep instead.

The next day my inner thigh was sore...I'm assuming related to the same issue...then over the next several days resolved...

I'm still pretty angry about this episode...The reason my my still discussing it so many months after...thanks all for your help!

[Eydawn]

With as much as you fly, you need to look at hooking up with a primary care doc of some flavor, getting some labs drawn, and getting set up with some anticoag therapy.

I feel you on not wanting to rack up medical bills... as mine are starting to come in from the bullshit I've got rolling... but you'd kick my ass three ways to Sunday if I wasn't following up appropriately.

God damn it, Dwayne. ~_~

Wendy

CO EMT-B

RN-ADN

[island emt]

/I\ What she said you lunkhead.