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Wednesday, January 2 2013

The Truth about Blood Clots

BloodCells

Here are two words that typically never sound good together, or alone:  “blood” and “clots.”

Why is this?  After all, we need blood, and donating it is a noble action.  And tiny clots are always forming and disappearing, but they are instrumental in assisting us the most when we need to stop bleeding after injury.

Blood clots have been in the news lately after U.S. Secretary of State Hillary Clinton developed dehydration after a stomach virus, fell, and suffered a concussion.  During a follow-up exam, a clot was discovered in a type of blood vessel called a “vein” between her brain and the inside of her skull.

Whenever we hear of someone with a serious medical condition, we sympathize for the ill person and wish them well.  But many of us often wonder if this could happen to me.  Especially if we share something in common with him or her, such as age, a recent fall, or some other similar condition.

Like many topics in medicine, a medical condition can mean many different things depending on severity, location in the body and what caused the problem.  The same is true for blood clots.

Small clots in the body form and dissolve all the time without problem.  But if the clot blocks the flow of blood, a person may feel the result.  These feelings, or symptoms, depend on where the clot is located.  The seriousness of the clot also depends on the location and the size of the clot.

For example, veins are low-pressure blood vessels that bring blood back to the heart.  Because the flow of blood is slower than the high pressure arteries, blood clots can form.  If this occurs in the leg of a person who has been sitting for hours on a plane or in a car, this clot may cause swelling and pain in the leg.  If part of the blood clot in the leg breaks off, it will float up to the heart and then get stuck in the small blood vessels of the lung.  Now the person could feel short of breath, cough up blood, develop chest pain and faint from low blood pressure.  This condition of a blood clot in the lung can be life threatening.  It is called a pulmonary embolism.

Other blood clots may not cause serious conditions or may be discovered while doing a test for another unrelated condition.  These clots might have disappeared without the patient ever knowing.  But if a clot causes a person to feel a problem like swelling, pain, or shortness of breath, their doctor can prescribe medicine that help the body dissolve the clot.  These medicines are often called “blood thinners.”

Remember, not all blood clots are the same.  If a blood vessel leaks, for example, after a fall or a hit on the head, a blood clot can form outside the blood vessel.  This may cause similar swelling or more serious conditions if it is inside the skull, like: headaches, seizures and vomiting.  In these situations, blood thinning medications would not be used and a doctor might recommend surgery to remove the clot or further tests.

If you have any further questions about blood clots, or how they are treated, leave a comment on this blog….

185 Comments

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Daniel Haight, MD
Mar 18, 4:27 PM

Leslie – There are two types of clots and, from your description, I am not sure from which you suffer. Clots in the artery are more serious and can damage tissue skin and nerves right away. They often require emergency treatment. Blood clots in the veins (lower pressure blood vessels that take blood back up to the heart) often cause swelling that can irritate the leg and cause discomfort.

Based on all of your comments, it appears that this issue is making it very hard for you to keep up with daily activities. Unfortunately, I cannot call or text you directly to offer medical advice. I recommend that you contact your regular healthcare provider for follow-up and consultation. You can also ask if you should be referred to a pain specialist. I wish you the best.

Daniel Haight, MD
Mar 18, 4:25 PM

Marilyn — Without knowing all your past and current medical conditions, medications, and other information, I cannot fully answer your question about your risk for stroke. Hopefully, you do not smoke, your blood pressure is lower than 140/80, your weight is good, your cholesterol levels are normal, and you have regular exams of your cardiovascular system. However, what the tech told you is accurate. Your blood was doing what it should do when outside the body (it tried to clot), so that by itself is not a risk factor for stroke.

Daniel Haight, MD
Mar 18, 11:24 AM

Ada — You should obtain a copy of your records from your recent visit to the ER. Your physician will want to review them so that he or she will know what tests were ordered. For example, a D-Dimer test sometimes alerts doctors to the possibility of a blood clot. You may have to request the records over the telephone or in person, but soon some healthcare providers will let you access your records securely over the internet or through a patient portal.

It sounds like the CT scan was looking at your heart and lungs. This test can often reveal blood clots that might be in the tiny vessels of the lungs, as well as other serious conditions. It is good that the CT scan was normal. Other possibilities for what you experienced could be a problem at the root of one of your teeth or with your sinuses. Hopefully, you have not had any more of these episodes of numbness and trouble breathing.

Connecting regularly with a health care provider is important for everyone, and you could get better help if this happens again. Look into the Affordable Care Act to see if you can obtain affordable insurance coverage. Many individuals qualify for discounts and financial assistance based on income. There are also individuals, called Navigators, that can help guide you through the process of getting insurance through the Affordable Care Act. Go to https://www.healthcare.gov/ to look at plans and/or find a local Navigator.

Daniel Haight, MD
Mar 17, 4:32 PM

Leslie – There are two types of clots and from your description, I am not sure from which you may suffer. Clots in the artery are more serious and can damage tissue skin and nerves right away. They often require emergency treatment. Blood clots in the veins (lower pressure blood vessels that take blood back up to the heart) often cause swelling that can irritate the leg and cause discomfort.

Based on all of your comments, it appears that this issue is making it very hard for you to keep up with daily activities. Unfortunately, I cannot offer medical advice to you directly. I recommend that you contact your regular healthcare provider for follow-up and consultation. You can also ask if you should be referred to a pain specialist. I wish you the best.

Daniel Haight, MD
Mar 17, 4:31 PM

Parker — Sometimes there is no way of ruling out a DVT without a Doppler Ultrasound, but your doctor probably looked at the whole situation, including talking with you and examining your legs, and felt that the risk for a DVT was very low.

Generalized anxiety disorder (GAD) sometimes interferes in how we feel about certain aches and pains. I have had some patients receive excellent counseling that included writing short log entries about their worries and then describing why that worry is a low probability. Working with a counselor to find techniques to reduce the impact of your GAD might be very helpful.

In this case, your leg pain is without swelling, redness or tenderness and your breathing is normal, and being a nonsmoker has lowered your risk. Lastly, there can be other causes of leg pain such as a strain from activity, recent muscle cramp, or a need to do more stretching. I hope that helps ease your concerns.

Daniel Haight, MD
Mar 17, 4:25 PM

Randy — Yes, taking Warafin significantly reduces the chance that a new clot will form and reduces the chance that the current clot will get bigger or break off.

Obtaining past observations and exact numbers is difficult, but 50% of people with a significant leg clot will have an abnormal test for clots that broke off and went to the lung. On treatment, serious outcomes drop to about 2%. This does not exactly answer your question, though.

The key message is this: you appear to be taking the best standard of care that has been shown to lessen the risk of this worsening. Your doctors should also review with you the risks that may occur while on these medications, such as the increased risk for bleeding and the need for regular blood testing to ensure you are taking the best dose.

You should also try to reduce any known risk factors for blood clots.

Daniel Haight, MD
Mar 17, 4:23 PM

Marcia — Sorry to hear about this change in your leg. We try to get through our questions as quickly as possible. Unfortunately this blog cannot respond to specific medical questions that are urgent.

I agree that the unequal nature of this is always a concern. There is always the chance you experienced a minor trauma that you did not notice when it happened but was enough to cause the bruise and swelling under you sock. Bruising normally gets darker and then turns yellowish over time. The swelling should improve if there is no clot.

Keeping it elevated and seeing how it looks the next day will help you decide whether or not you should have it further evaluated. If it has gotten worse, go see your doctor sooner rather than later. I wish you the best.

Daniel Haight, MD
Mar 17, 4:22 PM

Tina — It is unclear why you had a Doppler 2 months after diagnosis. Often, the Doppler is not repeated, but instead, the physician looks for clinical improvement, such as less swelling and discomfort, before continuing treatment. If your condition was not improving, a Doppler would check for those rare cases where the clot has not gotten better. Another reason your doctor may have ordered the Doppler would be if your INR blood test was not in the best ranges (2-3).

If you are a non-smoker and are not overweight, then you have the highest chance of the clot being cleared by 6 months. Birth control pills can increase you risk for a clot, just in case you are taking this type of medication.

I can also understand your concern about the risk of off-roading while on a blood thinner. Something that could cause a bruise in a person not on blood thinners could cause a lot of internal bleeding in a person who is taking blood thinners. Any activity that puts you at high risk for trauma, such as a fall or crash, should be avoided.

Parker
Mar 13, 7:43 PM

I’m 31 years old with no risk factors except that I’m an ex-smoker for 1 year and traveled 14 hours in a weekend in October. In December I had leg pain and went to the ER twice in the month. Clear chest x-Ray and 2 neg d dimers, with no swelling, no redness or tenderness. Since then, I still had leg pain in both legs and doctors say that it’s because of my GAD. Is it likely that I don’t have a clot?

marcia
Mar 13, 9:49 AM

Hi – I’m in good shape – hike, exercise – skiied the other day (have missed a couple seasons due to a concussion – only 2 days so far this season) – gained a couple lbs the past couple days from eating badly but am at a pretty good weight (though cholestrol has shot up….) considered to be slender – I don’t usually sit for long periods of time but have lately been working on a mailing list sitting at a desk – worked for hours yest. till very late pm. When I went to take a bath, to get ready for sleep, I realized one of my socks had cut off my circulation in my calf and along w/ a deep indent ring aroung the calf, there was significant amt of bruising (which kinda was disturbing) below it on one side. This morning the bruising has darkened and my ankle and calf feel mildly crampy – nothing severe but the crampy feelings are only in this leg – no swelling….. I’m 56yrs – took a low dose aspirin just now (don’t usually) – usually have low blood pressure – I’m living in a mt. area a couple hrs from my doc (moved to a 2nd home after divorce) – the nearest hosp. is an hour away….. Do you think I should have this looked at today by a doctor? I will be driving down there tonight staying w/ a friend) for a job tomoorow am, so could, if I had to see a doc but doesn’t sound like an emergency……and I have tons to do today – just got a bit worried about DVTs……… thanks!

Tina
Mar 12, 7:26 PM

I have a dvt in my left leg since November. My last Doppler was done in January. The results show I have partially occlusive Thumbus I femorial vein and superficial femorial vein in mid left thigh. Also, evidence of reflux in left femorosaphenous junction. They keep on telling me I should only be on coumidin for 6 months but will this ever go away? We go offroading and I’m so scared to go. If I’m on the coumidian will I be safe if we go?? Please help!!

Randy Eidenberger
Mar 12, 2:00 PM

I have a blood clot in my leg discovered about 6 days ago. I started taking lovenox and warfarin . I had 6 shots, 2 a day of loevenox and 5 mg of warfarin every day and then had my INR checked on Monday and it was 2.2 so the lovenox was discontinued. Does taking warfarin reduce the chance that part of the clot will not break off and if so, how much?

Daniel Haight, MD
Mar 12, 12:24 PM

Pamela – Usually the doctor would consider clot risk factors that you may already have such as smoking, being overweight, or taking certain medications, to name just a few. Then, he or she will examine your swelling and look for other abnormalities like whether or not the swelling is just around the wound or if it is the entire foot or leg.

You may be moving less because of the injury, and that can be a risk for a blood clot. However, it is hard to tell without being able to see it and ask a few more questions.

Since your leg should be getting better and this swelling is worse, you should speak to your doctor. He or she may want to evaluate your injury further to determine if there is another issue.

leslie oakley
Mar 11, 12:22 PM

does anyone here think that what I have been experiencing with my lower left leg and foot could be some signs of nerve damage caused by the blood clot I had in that leg. see when I had a blood clot in my legs both of them had superficial clots at the surface of my skin just above knee.then one leg at a time experienced a clot. my right leg had a very small clot.but my left had multiple clots that were two the size bigger than the right had. those were located down by my outter ankle area.i got them even with treatment so that is why I ask can you still develop new or worsening blood clots.

Ada
Mar 11, 1:46 AM

I am a female, 44, 5′, 181 pounds. I was sleeping and suddenly something wake me up. I was feeling some kind of numbness on the left side of my nose, very deeper inside, and i was short of breath with an strangest pain in left side of my neck. i though it was a heart attack and went to ER. They found everything ok, except that in my blood work, one of them show up elevated, and the Doc said, it was a sing of a blood cloth. They ran a CAT-Scan on my heart and did not find it. They gave me no med and told me to follow of with my PD. I have no insurance, so I got an appointment for the 19. Could you advise me how life threatening this can be and what I should do? Please and thank you!

leslie oakley
Mar 11, 12:57 AM

yes my lower left leg around my shin area is so tender and painful that I can’t even dare have my sock on that foot and let alone my pant leg down over it like I have on my right leg.this is not the true me.been in this kind of pain and am still suffering terribly.i am really hoping to get a clue on what more I can do to get and feel a bit better.not a pain tolerated type of person.i hate pain.my cell number is 6072675290. please call or text me a clue on what I should do please and thank you very much.

Marilyn Ostermiller
Mar 10, 8:18 PM

I tried to donate blood tonight. The flow started, but then stopped. The tech told me it was because I had a lot of small clots and he showed me the one that stopped the blood flow. He said this was a normal thing, but I have donated many times Nd not experienced this. Am I at risk for a stroke because f this?

leslie oakley
Mar 10, 7:26 PM

I thank you very much for your input to my last comment. Your comment back did assure me that all is okay and that I will be alright but I still am in tremendous pain in my lower left leg by the shin area and no one knows why or what caused it at all.

pamela grunau
Mar 9, 2:36 PM

3 days ago I fell onto a floor joist and badly skinned the complete front of my shin. It bacame very warm, red and somewhat swollen…my doctor called in a prescription for Bactrim. It looks a bit better. however today each time i do just a bit of walking around the house it swells back up…for example I made a bowl of cereal and it became swollen… all other times it is elevated with heat of ice. Wondering if this is a blood clot?

Daniel Haight, MD
Mar 7, 4:06 PM

Leslie — Your risk for a new clot, or worsening of the old one, is greatly reduced when you are on the correct dose of warfarin. Everyone’s dose can be different, and the blood test called the “INR” helps determine the best dose. The INR should be between 2 and 3 for most patients.

Unfortunately, it is common to have lingering pain after a blood clot is discovered, even with the best treatment. For some patients this discomfort may be relieved quickly, but for others, the pain and swelling can remain or only slowly get better. Some doctors recommend compression stockings to help the circulation and discomfort, but they can be difficult to put on.

There may be other reasons for your swelling that you should ask your doctor about. Your blood clot may have caused damage that reduces the ability of the veins to remove blood from the lower leg, but ask your doctor if you have other conditions that might also make your leg swell.

Daniel Haight, MD
Mar 7, 4:04 PM

Kirsten — It is unlikely that the bruise on the calf caused what you may be feeling on your thigh. These veins do not connect directly. The superficial calf veins join a larger vein deep in the lower thigh and then go up to the heart. The flow does not come back up to the surface.

It is hard to tell what might cause the inner thigh tenderness. It does not sound concerning unless the leg and foot are swelling on the same side. Instead, these could be new varicose veins that might have developed naturally or, possibly, a bruise from a mild trauma that you do not recall.

If the area does not go away or gets larger with more discomfort, seek medical attention. You should also have it examined if one leg swells more than the other.

Daniel Haight, MD
Mar 7, 10:59 AM

Whitney — Years of study have shown that blood clots in the leg do not always have the same symptoms, and no one item indicates a problem. If you have any of the following risk factors, you should see your doctor for a closer examination: smoking, certain medications, dehydration, very prolonged sitting, or swelling.

Without an examination, it is difficult to say whether or not this is a muscle strain. If it is a strain, you should continue stretching and take care not to re-strain it. If the discomfort does not improve, or it gets worse, or if it begins swelling, have your doctor examine it.

A routine visit with your physician can be a good start to an effort to lose weight, learn about your cholesterol, blood sugar and blood pressure.

Daniel Haight, MD
Mar 7, 10:56 AM

Rohan – In general, any hard, bumpy area that is fixed in one place and growing under the skin needs to be looked at by a health care professional. Something that came up fast can be an insect bite, allergic reaction, or a blocked skin gland. Lipoma, cysts, skin growths, and many other causes are also possible.

A health care provider could diagnose the cause of this change. A few factors, such as your age, history of sun exposure, headaches, visual changes, smoking history, or cholesterol level, can help the doctor put this swelling into context.

You are describing a spot around the temple, and if you are over 50 years old and have any visual problems and headache, temporal arteritis could be a possibility. The swelling often looks like an enlarged blood vessel. You doctor would be able to diagnose this, and it is a treatable condition.

If indicated, a doctor can numb the area to take a sample or remove it, if that is what you decide.

Kirsten
Mar 7, 12:42 AM

I am a 38yr old woman, and due to severe winter weather, and being at home with young children, I have spent a LOT of time sitting inside over the last three months. During pregnancy, I developed varicose veins, and wore compression stockings. Following pregnancy, the veins are still visible, but don’t bulge, or hurt, and I no longer wear the stockings. A day ago, I bumped the back of my outer calf, and a small painful lump developed immediately over one of these veins. By the end of the day, the lump had dissipated, but an obvious black bruise was developing. Today, I noticed an area of tenderness on the same leg, but on the inner thigh. I don’t remember bumping my leg, yet there are a couple of small, bruise-like marks on the inner thigh just above the knee. When I touch these marks, I can feel little lumps beneath the surface of the skin. I’m now worried that I may have developed blood clots due to the bruise on my calf, and that those clots may have migrated up to my inner thigh. Should I be worried? Is there anything I should look for? Should I seek medical attention? Thank you in advance for taking the time to answer this question.

leslie oakley
Mar 6, 11:48 AM

Yeah I have been on warfarin therapy for 9 months and am still having sharp pains and major swelling in my left foot,ankle,and leg to the point I can’t bare weight on it from time to time.can that be a signal of another blood clot or something more serious going on?

Daniel Haight, MD
Mar 5, 12:23 PM

Samaira — I can understand how frustrated you must feel when there is no answer for your discomfort.

From reading about your symptoms, it sounds like you may have suffered from Bell’s palsy (facial palsy) and your doctors made sure you did not have a stroke. Bell’s palsy is a disease that harms the nerves on one side of the face. During the healing process, some of the nerves can become confused. For example, when your brain sends the signal to salivate for food, the nerve for your tear gland may be triggered and cause your eye to water. It is rare, but possible, for Bell’s Palsey to also cause tingling and weakness in the arms and legs.

Headaches often need special help since medications that might help one person’s headache could make another person’s headache worse in the long run.

I’m sorry I cannot be of more help, but I encourage you make sure that you are seeing a board certified neurologist for these problems or a neurologist that is familiar with Bell’s Palsy and headache treatment. Sometimes it is best that they examine you while you are having an episode of arm weakness to help determine the cause. In addition, there may be other illnesses, like lupus, that can be easily tested from a blood sample.

Daniel Haight, MD
Mar 5, 12:14 PM

Michelle — There are many possible explanations for your symptoms, ranging from minor problems to ones that need further attention.

For example, if you are over the age of 50 and the tender site is around your temple, this could be “temporal arteritis.” This is caused by inflammation of the blood vessels in that area, and people with this condition sometimes complain of visual problems.

Other possibilities include pain in a particular spot both before and after an outbreak of shingles; Bell’s palsy, which occurs more on the face but involves the nerves; tooth problems; or pain in your jaw joint, called TMJ. This is just a short list since there are more possibilities.

It is hard to pinpoint the cause of your pain without an exam and asking a few questions. If it does not go away, you should have a health care professional look at it. He or she will ask about any old trauma, look for rashes or skin lesions, and note what lies below the skin at the location of your pain.

Daniel Haight, MD
Mar 5, 12:12 PM

Sarel — The risk for new clots is much lower when your INR is between 2 and 3. An INR of 2.1 is good, but there is always a small chance that a new clot can reform.
The pain in the leg could be due to many different causes, and it could be unrelated to the past pulmonary embolism (PE). Your doctor can help assure you.

You can also ask your doctor if becoming a non-smoker and reducing any other risk factors changes the duration you need to stay on the warfarin. Your INR test result can change if you change your diet or add/ stop a medication, so it is important to check that regularly while on warfarin. Depending on other issues, some patients must stay on the blood thinner. Staying on warafin increases the risk of bleeding, so some patients must weigh the benefit from stopping with the serious risk of getting another pulmonary embolism (PE).

These can be tough decisions, but your physician can help you understand risks and benefits that apply to you personal health.

Daniel Haight, MD
Mar 5, 12:06 PM

Clare — One possible explanation is that your mother developed a common side effect of heparin called “Heparin Induced Thrombocytopenia and Thrombosis” (HITT). Heparin is a common medicine that thins the blood and prevents blood clots from forming. This also helps blood clots in the legs and lungs to begin dissolving without forming new clots.

For a few people, however, the heparin causes (induces) clots to be made and this leads to a reduction in the number of platelets (thrombocytes) in the blood. The suffix “-penia” means “being lower than normal”, and “Thrombosis” means “clot.” So “Heparin Induced Thrombocytopenia and Thrombosis” mean that heparin caused the platelet count in the blood to become lower because it caused the unwanted effect of forming clots.

Platelets are little particles that float in the blood with the red blood cells (that carry oxygen) and the white blood cells (that fight infection). Platelets , along with other, smaller chemicals, plug any holes in blood vessels to stop bleeding.

For some people, their body’s immune system reacts to the heparin and causes their platelets to make unnecessary blood clots (that is the “thrombosis”). When that happens, the person “runs low” on platelets because they are being used in the clots (that is the “thrombocytopenia”).

Your immune system makes antibodies that normally attack infections, but sometimes they get turned on and attack your own body. That is what is happening in HITT. The heparin has caused the person’s own antibodies to latch onto their platelets, which causes the clots to form and lowers the patient’s supply of platelets.

The best treatment for this is to stop all forms of heparin and replace it with another blood thinning medication. It is always recommended to consult with your physician before making any changes to your prescribed medical treatment plan.

Daniel Haight, MD
Mar 5, 12:01 PM

Alex — This is a difficult question, and I appreciate your concern and research into possible causes.

The problem is, not everyone who has a particular health issue has the exact symptoms described in a medical textbook. Providing good advice is difficult to do in writing and needs face to face interaction, conversation and examination.

Symptoms should always be put into the context of your risks factors including: age, family history of heart or lung problems, smoking, high blood pressure, high cholesterol, high sugar, overweight, and any other known diseases influence the likelihood of a serious problem. The sensation of shortness of breath can have different causes including muscle strain, mild asthma, or other lung disorders.

A blood clot in the lungs can have many different symptoms, and you have mentioned a few. A physician would ask further questions to determine if you have a clot. For the short term, if your shortness of breath (called dyspnea) grows worse, if your resting heart rate is well above 100 beats per minute, and/or you experience dizziness, continuous chest pain, pain that goes down the arm, or sweating while at rest, you should seek medical attention.

Because of your lack of insurance, if your community has a 2-1-1 service, you can call them to find out if there are any free clinics where you could receive treatment. Visit http://www.211.org/ to find out if this referral service is available in your area.

Also, if you have not done so already, look in to the Affordable Care Act. Financial assistance to offset the cost of insurance is available to those who qualify. You might be able to find a Navigator (a person who can help you through the process), as well. Visit http://www.healthcare.gov to view plans, find out if you qualify for assistance, and find a Navigator in your area.

Whitney
Mar 4, 8:40 PM

Hi. I am 26 years old and have had a bruised type feeling and tenderness in the side of my calf, but no bruise is visible. It hurts to the touch but feels better if I massage it then comes back. I do sit most of my day at work, and I haven’t hit it on anything hat I know of. I am also overweight. It feels a bit tight when stretching or walking, but no swelling that I can see. Leg cramp or blood clot?

Rohan K
Mar 4, 3:41 AM

Hi, I have a swelling between the end of the eyebrow and ear, and its a painless lump, just below the exterior skin. It does not pain but it also does not go away. I have nt had any fall or accident that would hurt the area. One fine day it just appeared and swoll up and then stayed the way it is. What could be the cause of this? What are the ways this could be removed?

Samaira azeem
Mar 3, 6:00 AM

Hello,
I am fallen in a sick situation that is why I was searching and readout your article.
Plz kindly help me by telling what it is in which I m involved as my all blood test are ok ,but I am still sick and no doctor is able to explain.
Actually I got facial palsy on left side 3 and1/2year before I m 35female.
After I got recovered in about two months,I realise from 4thmonth that my left eye is swelling and tear comes up when I used to eat or chew something.I also got headaches getting faster and faster and continuous intervals so severe that I can’t tell.MRI SCAN OF BRAIN WAS done, nothing came up in that.
I observed sometimes in my hands I felt svere pain on skin something was twisting for seconds and then a bruise tiny could be seen at that time.It happened very rare so no one in family when I told took it serious.
But last year February 2013 I had svere chest pain alongwith left arm and wrist,it went away but I felt as my arm was feeling weak.later it got normal.but again after one month it happened twice in March .In April it happened i.e chest pain and left arm weakness ,again and again nearly 17 days of April.
And from May 2013 this chest pain is on gradual frequent intervals and
has made My left arm so weak that I can’t lift anything for except for a while.ALSO MY left armpit to elbow feels like there is a bruised vein,left wrist ,left foot beneath heel there is bruise like feeling ,and from somedays my Left Head side is also feeling bruised on some places.
I ll be more than Grateful to you
Please please please give me suggestion what should I do to tell doctors I m damn sick as my ct scan of chest was also normal ,doctor say lung breast chest ok.,please tell me it would be the Greatest favour.
Waiting for your kind reply.
Thanx very much.

Sarel Posthumus
Mar 2, 12:20 PM

I’m on waffrin for 3and a half months now my blood test sow 2.1 is ther a risk of a nuwe clot? Had a dvt 2 years ago now got a smal pe after stoping smoking what is there to know and wat to do and not to do? Got a funny burning pain in my uper lege for 5 days now going to phone the dr tomorow

Clare Blake
Mar 2, 10:07 AM

Hi doctor, my mum has acute DVT and PE she was on herparin but was taken ill due to the clots worsening. She was told the herparin had a reverse effect and actually caused more clots. Can you explain this to me please? Thank you in advance

Alex Lopez
Mar 1, 12:18 AM

I have been feeling slight pressure around my chest lately along with a bit of shortness of breath. The pressure/pain is light and not severe but it still frightens me. This all started after not exercising for a while and began doing Push Ups and then began running. This was about a week or so ago and I am still having daily pressure on my chest along with shortness of breath, the symptoms come and go throughout the day and so far it has happened daily. I have been having this for about a week now.

Another thing I noticed is that when I am having a slight issue with breathing, I tend to yawn a lot. Another issue I have that it could possibly be is the fact that I have anxiety and am a Hypochondriac. However, after searching up my symptoms online, I believe that I could possibly have a blood clot in my lungs, the condition is called Pulmonary Embolism. The reason I believe I have this is because my job requires long hours of sitting at a office every day, about 8 hours of sitting. However, I do not sit 8 hours straight, I take small breaks when I eat, use the rest room or simply walk around, but I still sit long hours.

What I want to know is if it is possible for me to have Pulmonary Embolism or could it be something else? I don’t have insurance at the moment so going to the doctor will be an issue. Thank you for the help.

Michelle
Feb 28, 8:35 PM

Hello, I usually have a pain on my right side of my head, sometimes is sharp or light, but if I touch is there, it hurts, when I wash my heard and the water touches my head it hurts. Any idea of what it is? other than that I don’t feel anything else.

Daniel Haight, MD
Feb 27, 4:08 PM

Sara — What you describe is very understandable and fairly common. Quite a few people will feel a sensation or discomfort and worry that it could turn into a serious problem, even after having reassuring testing and being provided expert advice. I believe that the advice you received was good.

Superficial veins do become more visible over time depending on routine activities such as standing.

For your long trip, you should plan a break every two hours. Walk around the car and stretch. Drink plenty of water so you don’t get dehydrated. While you drive, remember to flex your ankles up and down as this helps with circulation, and don’t wear tight clothing.

Look into the risk factors for blood clots and do what you can to reduce these factors such as quitting smoking, if you are a smoker. Also, I recommend seeing your doctor. He or she can more accurately answer your questions after reviewing your medical history.

If you still feel fearful after you speak with your doctor, behavioral healthcare providers can provide strategies to deal with these concerns while addressing in any medical condition you may have.

Daniel Haight, MD
Feb 27, 4:01 PM

Courtnie – Leg swelling during pregnancy can be caused by a number of different conditions. Some of these can be related to blood flow changes caused by the pregnancy. There are many possible explanations for what you describe, so it is best to talk with your doctor’s office. Your doctor would need to look at your legs, measure your blood pressure and check your urine for any abnormalities. Your doctor may check for a clot if there is no other explanation.

It is especially important to see your doctor if your blood pressure is increasing since this can be more serious than a pulled muscle (e.g. a condition called “pre-eclampsia”).

Daniel Haight, MD
Feb 24, 11:52 AM

Ron – Having a breathing problem complicated by a pulmonary embolism while dealing with the high costs of health care can be a difficult situation. Unfortunately, if you stop your medication before the end of three months, you are at an increased risk for another clot forming and landing in your lung. Additionally, the risk is higher if you sit a lot, smoke, or are overweight. There are other risk factors that you might have, too. Reducing or eliminating any of these factors, while continuing your medication, will help decrease your risk of forming another clot.

Less expensive medications, such as Coumadin (warfarin), could be an option, but in addition to accessing a medical clinic for the prescription, regular lab tests are needed to keep your dose at the proper level.

If you have not done so already, look into the Affordable Care Act to find health insurance. Financial assistance to offset the cost of insurance is available to those who qualify. You might be able to find a navigator (a person who can help you through the process), as well. Visit http://www.healthcare.gov to view plans, find out if you qualify for assistance, and find a navigator in your area.

If your community has a 2-1-1 service, you can call them to find out if there are any free clinics where you could receive treatment. Visit http://www.211.org/ to find out if this referral service is available in your area.

Sara P
Feb 22, 10:39 AM

Hi Dr. I am a 30 year old female, health to my knowledge, and I have had anxiety for a couple of years now, and it’s more of a health anxiety than anything. Back in November, I had a little calf pain, so I thought, and I went to ER. They did an ultrasound on the right leg and said everything was normal, but I had superficial thrombophlebitis, and stated it was common and just put warm packs on it and take baby aspirin to help reduce the inflammation. I’ve been very cautious lately, because I’m just nervous since I google superficial thrombophlebitis and worried I will get a blood clot. I have visible veins in my legs, always have but of course as I get older they’re becoming more visible. But, in my right leg along the inner thigh/leg, there’s a long vein you can feel on the surface and little balls kind of along the vein. Is this worrisome? I didn’t know if they were clots, and we are leaving for Florida, which is a 20 hour drive, next week, and I’m worried about developing a DVT. I don’t want to live in fear. Can you please help me to understand what that is? Thank you so much

courtnie
Feb 22, 12:37 AM

I am 37 weeks. 3 days pregnant . The past week i have started swelling i my feet and ankles. Propping up often helps with this. However in my left ankle that hasnt been all that swelling i have a very tender to the touch spot right near the bend of my ankle. It feels a little like a pull but can send paib fron knee all the way to the bottom of.my foot. Is it possible i just pulled.a muscle there or could it be a blood clot. Sometimes there is also tingling. And the pain had gotten eorse over the course.of the day.

Ron
Feb 21, 3:00 PM

Had a cold for 3 weeks that didn’t go away. Also noticed that my left calf was stiff, but thought it was just from the inactivity staying home and away from gym. Then developed shortness of breath. Went to ER and subsequently spent 3 days in the hospital being treated for the very rare COP/BOOP and told that I had had a PE. Subsequent sonograms confirmed three clots in one leg and two in the other.

The pulmonary specialist put me on 15mg of prednisone for the pneumonia and 20mg of xarelto for 20 days.

However, due to no health insurance, I was not able to have the follow up with the specialist, have no refill for the prednisone prescription and can’t afford the 2nd xarelto prescription I have.

I am in pretty healthy condition in general — doctors said I responded well to all treatment — and have been monitoring my body very closely for any potential symptoms (and checking constantly with my NP friend).

The work I do involves sitting for very long periods of time, but I have been unemployed since being in the hospital — that is for the last three weeks or so, so no long sitting except at home.

The doctor spoke of cutting down on the medications from 2x to 1x day since I was responding so well, but I am of course wondering about the possibility of additional clots forming and breaking off to the heart/lungs.

I was cleared for normal activity, and am just going back to the gym tonight -1x/wk with a trainer – where I will take it very easy.

As I mentioned, I am asymptomatic but had only the calf symptom prior to going to the ER.

Don’t really want to be my own doctor but need some advice here.

Thanks!

Daniel Haight, MD
Feb 21, 11:04 AM

Emilie — The risk for developing a blood clot or pulmonary embolism does not go down to zero when a person takes blood thinners. “Chances are slim” means that about 1 out of a hundred patients could have a clot form while on appropriate treatment.

It can be hard to know what our bodies are telling us when we have the sensations you describe. Chest pain, shortness of breath, and dizziness should be evaluated when they occur because they can indicate serious conditions, including blood clots or possible heart attack. If the combination of symptoms shows a need for further evaluation, certain tests can compare the oxygen level in your blood and rule out a clot. If your doctors reassure you that there is no concern for a clot, they may be able to explain what else might be causing your symptoms.

Emilie
Feb 20, 11:39 AM

Me: 48 yr old female, non smoker, diabetes and Leiden Factor V positive.
I had multiple pulmonary embolism in 2010 and was put on Coumadin for life due to hereditary Leiden Factor IV. My doctor recently switched me to Xeralto to reduce lab time and dietary issues. I have been on Xeralto for about 4 months now and my labs are good.
I have a sharp pain under my right shoulder blade when I take a deep breath. This just started today. I have been to the ER on a few occasions for leg pain and swelling and was told the chances for my having another PE are slim due to my being on blood thinners. I don’t want to keep incurring expense and crying wolf for what has turned out to be nothing but anytime I feel pain or shortness when breathing, I get nervous. Could this be another PE?

Daniel Haight, MD
Feb 19, 5:29 PM

Heather –Monitoring change in your symptoms is an important way to discover if your condition is getting better or worse.

When you notice that you cannot feel or see any change, if the numbness or hematoma gets worse, or if you are left with continued numbness or a lump under the skin, you should see a doctor. Start with a primary care physician, either an internal medicine or family practice physician, and if more care is needed, he or she will direct you to the appropriate specialist.

Heather
Feb 17, 7:09 PM

Long story short, I was clipped by a car on the outside of my leg and skipped getting checked out as there was minimal swelling and just an overall bruised feeling, no pain. I developed a hematoma on the outer part of the lower leg where the impact happened and a large bruise on my thigh from falling on it. Nothing got worse and the bruising was gone at around 3 weeks. At about 4 weeks my leg started to feel slightly numb and heavy. The numb feeling seemed to get a little worse when I leaned on my buttock on the affected side. I self diagnosed something dealing with the sciatic nerve but there was no back pain and I could walk fine. I’m at the 6 week mark now and the numbness has gotten better but I still have this weird feeling in my leg, a sort of faint pressure/heaviness. Once again, there is no pain but the hematoma is still present. Part of it has softened up but the top part is a little knotty. I figured that overall nerves were healing but just wanted to double check in case it sounds like something else. I am a 29 year old female, 20lb overweight, non smoker, relatively healthy and walks regularly albeit not as much since the accident. I don’t have a doctor or insurance but if it’s advised to go in and have it looked at, is there a specific type of doctor I should seek out or just a primary care physician?

Thank you!

Daniel Haight, MD
Feb 17, 5:51 PM

Rachel — It was important that a CT scan was done since this test looks for serious bleeding inside the skull that you cannot see from the outside. Concussions are usually not determined by a CT scan, but rather by a combination of the incident and symptoms described by the patient, along with what the doctor sees during an examination.

For example, someone suffering from a concussion may have initially lost consciousness, and then persistently feels or sounds confused, has trouble thinking or remembering, has headaches, nausea, blurred vision or balance problems.

The swelling your friend is experiencing may be the result of healing with some scar tissue. Some people heal with extra large scars called keloids. There may also be something interfering with healing, such as a mild skin infection or dirt from the fall that was difficult to wash out. Also, if the bump is in the exact center of the back of her head, the skull normally has a small bump in that location.
If this knot is below the skin, it could be a collection of fluid, a cyst or scar tissue that her doctor should examine.

Daniel Haight, MD
Feb 17, 5:44 PM

Kessy – What you describe could be a blockage in the veins since some blockages cause swelling without pain. Or, this could be a muscle strain, signs of knee osteoarthritis, or a Baker’s Cyst.

The list of possible causes for the pain in your leg is long, so it is important that you talk to your doctor about what you are experiencing. He or she would be able to use your medical history and examine current medical conditions to discover what could be creating this problem. A careful examination of both legs can help determine the cause. Sometimes, the source of the problem can be found in the thigh, groin, or belly. (I once had a patient whose leg was swollen because a group of lymph nodes in the groin was swollen.)

Once you have been examined, your health care provider can discuss possible causes, tests to find the cause, and/or options for treatment. If it does not get better, or gets worse, you should definitely see your doctor.

Daniel Haight, MD
Feb 17, 5:34 PM

Kristy – Your concern is understandable. Fortunately, the risk of forming another blood clot is much lower now that you are on a blood thinning medication and hopefully you are reducing any other risk factors mentioned by your doctor. The discomfort that may have been caused by a blood clot in the lung should go away with time, but the amount of time needed to heal varies from person to person.

The pain in your arms could be a muscle strain in the arm or chest. If your discomfort worsens with a certain movement, it is likely a strain.

I recommend that you contact your physician with your questions and concerns. He or she can review your medical history and will be better able to respond to your specific condition. I wish you the best as you heal.

Daniel Haight, MD
Feb 17, 5:30 PM

Linda — You are at a higher risk for a clot, along with the dangerous complication of another pulmonary embolism. It is impossible to predict how high the risk is without a full history and patient examination.

If you are still taking the blood thinning medication without checking the INR, you could be at risk for life threatening bleeding.

Look into the Affordable Care Act to see if you can obtain affordable insurance coverage. Many individuals qualify for discounts and financial assistance based on income. There are also individuals, called Navigators, that can help guide you through the process of getting insurance through the Affordable Care Act. Go to https://www.healthcare.gov/ to look at plans and/or find a local Navigator.

Some areas also have free clinics if you are eligible. In some areas, you can call 2-1-1 from your telephone, and an operator will refer you to healthcare options in your community. You can visit http://www.211.org/ to find out if there is a 2-1-1 service near you.

Kirsty lovely
Feb 16, 7:55 AM

Ok thank you

When dose the achs and pains go? As I’ve been on warifin three wks soon and still have them :(

And my arms achs to or I get small pains in my arms is all this connected to the clots?

Kirsty

linda
Feb 16, 4:24 AM

Hi I’m 23 and had a pulmenary embalisim in october. I gave birth to a surrobaby and a week later had the clot. I was on medication for about two months. Then I lost my health insurance and stopped going to the clinic for INRs. I owed them almost 2k. So as of January 15 I haven’t taken anything. Sometimes I feel like I’m getting another clot, is that possible? I haven’t felt like I did the day I found out but do get worried that it will happen again

Kessy
Feb 13, 4:06 PM

I have been feeling pressure, not really pain, on the back of one knee. I have not had surgery on this leg at all. I am not very active and notice primarily when laying down. Please advise what it could be. Thank you

Daniel Haight, MD
Feb 12, 3:48 PM

Trish – Just make sure you follow the instructions and warnings on the bottle and take with food. See your doctor if this does not improve.

Rachel
Feb 12, 2:22 PM

A love one 65 years old fell and hit her head on a concrete step, afterwards she went to the ER and was given a CT Scan and was told there was no concussion, given pain meds and anti-inflammatory meds and sent home….it’s 3 months later now and she still has the HUGE KNOT on the back of her head with swelling, is this normal or should she be going back to the dr. VERY CONCERNED!!!

Daniel Haight, MD
Feb 12, 12:40 PM

Helen – What you are describing sounds like a bad bruise that settled into the ankle due to gravity. Unfortunately, an x-ray cannot see the damage done to the soft tissues and blood vessels. There is a chance that, in addition to the kick, you may have sprained your ankle. The discomfort from the kick may have initially masked the pain in your ankle.

The swelling from the bruise, or possibly a sprained ankle, could explain your problem. Some of the tendons that move the toes go under the ankle and can hurt when there is swelling around them. The more you can rest your ankle, the better. You should consider going back to the doctor for a follow up to focus on your ankle. Perhaps your doctor will recommend crutches to help keep the weight off it as it continues to heal.

If the swelling gets worse, contact your doctor immediately to rule out any new problems. If the original x-ray did not focus on your ankle, a broken bone may have been missed during the original testing. A less likely possibility would be a blood clot. Both of these situations would require further treatment.

Trish
Feb 12, 12:39 PM

I just realized the IV was in the opposite arm. Would it be alright to take a baby asprin? It feels like a dull ache not sharp pain.
Trish

Daniel Haight, MD
Feb 12, 12:36 PM

Kristy – I know that dealing with a new health issue along with day to day activities can be hard.

The best outcome and lowest risk occurs when you are on warfarin and your blood test, called INR, is within the range advised by your doctor. If the INR is a little too low, your dose may need to be increased and if the INR is a little too high, your dose may need to be decreased.

What is also reassuring is that you are well aware of your condition, treatment and what to keep an eye on through the process. You are in a much better situation than a person who develops this condition “out of the blue” with no understanding.

Unless your doctor specifically advised not to do any lifting during your day to day activities, I am not aware of any problem picking up your son may cause to your condition. A muscle strain in the chest can cause discomfort when moving or lifting.

Try to continue reducing any risk factors for developing additional blood clots. For example, if you smoke cigarettes, then quit. Your doctor will be able to provide a complete list of risk factors and instructions specific to your medical history.

Daniel Haight, MD
Feb 12, 12:29 PM

Trish – Blood clots in the arms have less complications than those that might form in the legs. Clots in superficial veins are less serious than those that form in deeper veins.

From what you have described, you may have a blockage in the vein where the IV was placed. Often, IVs are placed in a superficial vein unless it was called a PICC or MidLine. Those types of IVs, used for longer durations (i.e. weeks/months), when placed usually enter the deeper veins. Vein blood clots that form and are located in deeper veins of the arm will often cause arm swelling.

If you feel a superficial “cord” or “tiny rope” near where the IV was inserted, then a warm compress will help along with keeping the arm elevated to relieve your symptoms. Sometimes these symptoms will be very slow to disappear and you may feel the vein bump for some time.

There is also the chance that this is completely unrelated to your surgery and you may have a minor muscle / tendon strain from a routine activity you did the day before. The strain may not have caused pain at the time that it occurred, but often the next day we feel the injury.

If you develop arm swelling, chest pain, shortness of breath, or worsening arm pain, then contact your physician.

Kirsty lovely
Feb 12, 4:50 AM

I’m 33 years old female who has been diagnosed with two large blood clots on each lung I was sent home with injections for 7 days and started the warifin 3days lata been on the warifin two wks this Friday I still suffer with achs and slight pain still round my frount and top back area I had slight pains and discomfort in my chest last night but I could still breath and it lasted 3mins and went it scared me :( is all this linked to the clot and will the discomfort and pain go in time? Or should I b worried? I have good days and bad days with the discomfort I just get scared I’m goin to die even if I’m taking the warifin any advise to settle my mind would be great, I do also have to pick up my son a lot to which I suppose dosent help Ethier

Kirsty

Trish
Feb 12, 3:15 AM

I had a surgery one week ago to remove a benign breast lump. Yesterday I started getting a pain in my right arm in the area where blood is taken or where my IV was. It seemed to have moved up my arm today by about 2 inches. At first I thought it was a sore muscle but it really feels like a pain in the vein. Could it be a blood clot and if so what should I do? I am on hormone replacement therapy.

Trish

Daniel Haight, MD
Feb 11, 5:23 PM

Gladis – This may or may not be a bruise. Sometimes a growth under the skin can be mistaken for a bruise if the person bumped the area by coincidence.

A bruise occurs when the tiny blood vessels near the surface of the skin are damaged and blood leaks into the tissues under the skin. Whatever caused injury, along with the swelling from the blood that leaked out as a result, can irritate the nerves.

It takes time for the body to re-absorb the blood. During this healing process you can see the bruise going through color changes as the trapped blood ages. The numbness should slowly improve, but it depends upon the type of injury.

There can be some scar tissue from any damage, but it should not continue to be painful or get larger. Measure the size of what you can feel and continue to take note of the injured area.

If it gets larger, remains tender, or feels harder to the touch, a doctor should examine it.

Daniel Haight, MD
Feb 11, 5:19 PM

Emi – You should ask your doctors if you are suffering from a Baker’s Cyst which is fluid that forms behind the knee.

Although this condition would often be mentioned as a finding on the ultrasound, they may have only focused on the blood vessels and not the leg in general.

Your past history of knee problems can increase the chance for early arthritis that can increase knee swelling as well. Your knee might be more susceptible to injury from mild twists and turns that you may not have noticed at the time that they occurred.

Without reviewing your medical history, I am not sure what blood work you doctor is obtaining to help in diagnosing your current condition. You should ask specifically what test your doctor has ordered and what information they are looking for from these test.

If the problem worsens, your doctor may want to sample any free fluid that is collecting around the knee and/or consider an MRI of the area.

I hope you find relief and answers to your concerns.

Emi
Feb 11, 4:05 PM

Hello, Dr. Haight,

Thank you so much for taking the time to answer these questions :) Could the knee area be re-injured and produce a DVT? My left knee is a bit unlucky; it’s been in a car accident and the victim of a Flying anchor. Both injuries (2001, 2004) required stitches and involved lots of swelling and bruising.

Four years ago, I felt an itchy sensation followed by a coolness and looked down to see my knee flooded with purple and blue. Have no idea how I did it, but my GP just said to rub some cream on it and ice it. It took about two weeks to heal completely and it was ugly.

Fast forward to one week ago when I woke up to a painful, stiff and swollen knee and upper calf. The swelling gradually decreased but left bruises on the inside of my knee and a round one in the middle of my calf. When I stand up, it hurts as if the blood is all rushing into my leg and then gradually decreases as movement increases. I also experience somewhat intense shooting pains in my lower left thigh randomly.

Had a doppler done today, negative, dr. said no venous obstruction. Went to an orthopaedic doctor, and he said doesn’t seem like a bone issue, and decided to order bloodwork.

I’m a 38 year old female, never taken Birth control, light smoker (1 per day at most), participate in moderate exercise. I travel on cross continental flights twice a year, but none of these episodes occured directly after a trip.

Just wondering if the previous trauma to the area might produce symptoms like those i described. If not, which type of specialist visit/tests might help me with a diagnosis of the origin?

Much, much thanks!
Emi

Gladis Medina
Feb 11, 3:55 PM

Hi I got a bad bruise 6 months ago and since than it has gone down but its still there and recently it has been hurting a lot more to thw point that it hurts to walkI massage I and pain gets worse. Its still purple and its on my ledt thigh. When I massage it its numb and I want to know if this is bad?

Helen
Feb 11, 10:40 AM

10 days ago, I was double kicked by a horse (while riding another horse). The first kick got me in the middle of the calf on the inside, the second kick got me directly on the front shin bone. This happened on a Saturday, I have no insurance, but I went to the doctor on Monday because though everything had swollen up, the ankle turned purple and twice as swollen and painful as the calf injuries. He wanted to do MRI/Ultrasound, but with no insurance, we settled on an x-ray. Nothing is broken or cracked. He warned me the blood was pooling in the ankle and if I had trouble lifting my toes, go to an ER. Since then, things have only gotten worse. The worst of the swelling is gone, but the foot, though bruising is a bit better, is staying swollen and I am now limping a lot worse than I was. I can lift my toes, but it causes something below the ankle bone on the inside of the foot to hurt pretty bad. How do you know if the swelling is still a result of the injury or if there is a clot there I really need checked out? I leave town in 3 days to take care of my father after a surgery and can’t schedule those tests even if I could afford them. When should I really worry or should I?? Thanks in advance.

Daniel Haight, MD
Feb 10, 3:31 PM

Matt – Once a person starts taking a blood thinner, the risk for “clot propagation” or “clot growth” is made smaller. The risk that it will break off and float up to the heart is also decreased. The body makes and dissolves clots all the time, so it begins the process of dissolving any current clots once a person is on a blood thinner.

A blood clot in a vein might not completely dissolve right away but rather “re-canalizes.” This means that a tunnel forms in the center of the clot so that blood can flow through again. As the clot dissolves, the tunnel gets larger until, hopefully, it is back to the normal diameter of the vein.

Sometimes, there is residual damage that will make it harder for the vein to move blood. In these cases, doctors will often recommend a compression stocking to help the flow of blood.

Unlike arteries, veins take blood back to the heart in a variety of ways, and those ways are slightly different for each person. Because of this, when blood meets a blockage in a vein, it frequently takes an alternative route. The re-routing is not perfect, so that is why swelling develops.

The veins also have “back flow prevention valves” built into their walls that help blood flow in the right direction. Our movement (and compression socks) also assist with correct flow. If the original clots damaged the valves, the swelling and discomfort might not completely go away. It is a good sign that your legs improved quickly, but ask your doctor about the use of compression stocking. Your doctor will know if these are a good idea for your specific case.

Daniel Haight, MD
Feb 10, 3:28 PM

Abby – I am sorry to hear that you are still suffering from your fall. Even though the blood clot was not large enough to need removal or treatment, you must have hit your head pretty hard for it to have formed.
You may have suffered a concussion at the time of the fall, but you should ask your doctors because they have access to your medical history and test results. They can also review how your injury might be related to your headache, loss of smell, and vision problems.

It is important for you to keep a notebook or calendar of these symptoms, including the date, time, and severity. Take the notebook to your doctor appointments, along with key questions you want answered. Try to boil it down to your three most important questions, but bring them all, in case there is enough time to go over them. If your doctor has email, you may be able to email the questions to him or her, as well. If your doctor does not have email, you may be able to give your questions to the nurse or the office ahead of time. This will allow your doctor time to review and prepare your answers for your visit.

Although I cannot predict how long these problems will last, it is important that they do not get worse. If they symptoms do become worse, contact your doctor right away. More severe symptoms could be a sign of a new, unrelated condition, or they could mean that your current condition has grown more severe. If your symptoms become worse suddenly, seek immediate medical attention.

The hope is that these problems will get better with time, but everyone is different. Best wishes to you as you recover.

Daniel Haight, MD
Feb 7, 12:54 PM

Teresa – This could be one of a number of problems.

Contusion is another word for bruise or blood that has leaked out of damaged vessel and into the surrounding tissues under the skin. It can take a while for it to dissolve, so that could explain the lump. Contusions can become infected especially if the skin was broken. That would cause redness. Fever, drainage and red lines going up the skin toward the shoulder would be concerning.

There is also a sac near the elbow that helps cushion the elbow joint. It is called a olecranon bursa. Injury can cause fluid to accumulate and possibly get infected. This will cause swelling up the elbow. Doing an internet image search for “olecranon bursitis” will show you what this looks like.

You are also describing a problem with the nerve that could be caused by the swelling around the elbow. This swelling could interfere with the nerve that goes to your fifth finger (pinky). There is no way to know for sure without examining the arm and hand if this is the case, so you should have this looked at by you family doctor.

There are a few options to help improve your condition. If infected, then antibiotics might be prescribed. If only inflamed by the trauma, then draining the fluid or injected an anti-inflammatory might help. The only way to know for sure is to see your physician.

abby
Feb 6, 6:14 PM

I fell and hit my head on Dec 23rd 2013
a small blood clot was found. I am on no meds except a muscle relaxer.
I have horrible, headaches,
I have trouble focusing
Have trouble with sounds
Do not like to drive at night because the light bothers me
I lost my sense of smell.
How long should this last???
Thanks,

By the way you have a great site, organized and designed very well…

Matt
Feb 6, 2:51 PM

Is there any way of knowing that a leg clot is actually dissolving? Does the resolution of symptoms mean that it is? I was diagnosed with a significant clot (common femoral, femoral, deep femoral, and popliteal veins) and extensive pulmonary embolism about two weeks ago. There’s no clear reason for it. At the time of diagnosis, my leg was in severe pain and I could barely walk. It took about a week after starting blood thinners (at first Lovenox, then Xarelto), but the pain largely went away, though after two weeks stairs are a bit hard and discomfort sets in when standing. I’m only 37 and am worried about long term effects of such a large clot. Does the rather quick resolution of symptoms mean the clot is dissolving and I have less to worry about?

Daniel Haight, MD
Feb 4, 3:39 PM

Richelle – It is always good to communicate to your healthcare provider that you want more information in regards to the treatment of a medical condition.

First, if you are taking your blood thinning medications as prescribed, that is helping reduce the risk of a complications from the clot. It may not fully eliminate the clot or get rid of the swelling, but there is less of a chance that the clot will break off and travel to the lung. Share with your doctor the information if you are missing or forgetting a dose from time to time.

If you are taking Coumadin or warfarin, then make sure your blood tests are confirming that your current dosage is right for you. The test is called a PT / INR. This test is not used for other blood thinners. So for other newer blood thinners, you must make sure you are taking them as directed. Any abnormal bleeding or bruising should be reported to your doctor.

Swelling can persist after any blood clot so many doctors recommend compression stockings. They can be hard to wear, but for some patients it will reduce long term discomfort and swelling.

Sometimes a clot can partially remain and become canalized (meaning blood starts to flow better through the middle of the clot). In some cases if the clot was originally infected, it will remain and act similar to a scar by staying there while blood finds another way back to the heart. These are situations where the compression stockings will help.

Your blood specialist will help explain these issues further, but go to your appointment prepared to ask the most important questions for your peace of mind.

Daniel Haight, MD
Feb 4, 3:21 PM

Cindy – We always recommend calling your physician if their is a question regarding your health.

Sometimes a patient may need to call back a couple of times if they have additional questions or if they do not understand the explanation provided by the doctor regarding their unique medical situation. It appears that your doctor may not have been the original one who treated you in the hospital. If this is the case, your doctor will need to get your hospital records so that he/she may better answer your questions.

For most people, an INR of 4.7 is “supra-thin” or anti-coagulated more so than usual.
That means forming a blood clot is harder. With a high INR, a person should watch for any signs of abnormal bruising or bleeding.

It sounds like you have experienced other conditions in the past that interfered with normal clotting and you may have a previous history of forming blood clots. Your physician will be the best source to provide treatment information and preventative measures. Follow up with your doctor and also make sure they have all the records from your previous hospitalization so that they can provide the most up to date treatment plan.

If you are not on a blood thinning medication, then your questions is much harder to answer and you need to speak with someone who knows your entire medical history.

If you are on a blood thinning medication, then with an INR of 4.7 you have a lower risk of forming a blood clot. At the hospital, it sounds as if they ruled out the most serious explanations for your discomfort and did not see signs that might warn them of a blood clot getting through the filter and into the lungs.

A partially blocked filter is often not noticed by a patient and any symptoms of this problem would not be felt in the upper body.

Daniel Haight, MD
Feb 4, 12:32 PM

Aj – The question is too difficult to answer with a simple explanation since blood clots in the veins leading to, leading away, and inside the liver can have various levels of seriousness.

This would normally be part of a complex evaluation of any of a number of conditions that would involve liver test that are high along with other unique conditions that a patient might be experiencing.

A lot of blood flows through the liver in both arteries and veins, so blockages can lead to varying levels of dysfunction.

Daniel Haight, MD
Feb 4, 12:21 PM

Linda – You and your doctor must work together to do what is best for you given your medical history, current health and your level of worry regarding the issue. Together, you are trying to balance two issues:
(1) Efforts to lower complications caused by a blood clot and
(2) Managing the risk of bleeding that would occur if you take a blood thinner.

Your doctor is taking many things into consideration. The clot may be in a location that has a lower risk than other locations. Clots in the veins of the thigh are more concerning. Yours are farther away in the calf. Additionally, you may have fewer risk factors for the clot worsening such as being a non-smoker (quit if you smoke!) and if you do not take birth control (talk to your doctor if you do). The cause of this clot may be indirectly related to the broken foot and your healing process.

Lastly, your doctor knows that bleeding inside the brain is much harder to treat than the complications of a blood clot in the leg. Blood thinners also have other complications and significant cost.

Tough decision, but you are keeping yourself well informed and know what problems to look out for and what questions to ask. I cannot tell you to chose one treatment or the other. The doctors caring for you have all the details and can provide you with the best advice and a level of comfort with your decision. You should review these issues with your doctors and get to the point where you both feel that you are making the best decision under the circumstances.

Aj
Feb 3, 2:54 PM

If a blood clot is formed by the veins in the liver. What are the chances of anything serious occurring? I understand this is not much to go off of but the CT scan will not be done until next week. His serious is this? Especially if you already have a history of high liver numbers? Thanks a lot

Linda
Feb 1, 1:10 AM

I broke my foot 3 weeks ago and went to Dr today bc I had cramping in my calf so they did ultrasound and found small blood clot in calf. Dr. Was torn on how to treat, was afraid to do blood thinners bc I had brain bleed that required surgery back in 2000, so opted to send me home & I will go back on Monday for follow-up ultrasound. Now I am home and terrified clog will move and be fatal. Was this wise decision or would blood thinners be better. I am a mom of two young boys and am freaking out at home right now. Please let me know your thoughts. Thanks

Richelle
Jan 31, 7:29 PM

I am now being sent to a blood specialist. Its been about a month and I still have the dvt. I am scared I don’t understand whats going on. No one is telling whats happening only to take it easy. Can u give me some insight?

Teresa Drummond
Jan 31, 4:07 PM

I fell 3 weeks ago on my wooden deck and when I fell it hit about 1 inch above the elbow going towards my hand . I went to the Doctor on the 3rd. day after I fell, and was told I had a Contusion. Now 3 weeks later I still have a lump that sticks out about 1 to 1/2 inch on my arm it stays warm and if I happen to touch it a little to hard it is EXCRUIATING and the pinky finger is numb just on the outside of finger. Will this go away ?

Daniel Haight, MD
Jan 30, 10:21 AM

Elisabeth – The normal healing process of a blood clot often includes the superficial vein feeling like a cord under the skin. This should slowly get smaller and less painful. The hardness you feel may take a long time to go away.

It is good that you are watching out for infection such as fever, redness or drainage through the skin. You should be concerned if any of the these symptoms occur or if your hand and forearm begin to swell. You should also be concerned if you develop chest pain or shortness of breath.

Elevation, mild heating pad and mild medications for the discomfort is generally the best advice and if your symptoms worsen or continue contact your physician.

Daniel Haight, MD
Jan 30, 10:14 AM

Richelle – It is hard not to know the exact cause of something so important to your health. However, it is very common not to discover the exact cause of a lost pregnancy.

A blood clot such as a DVT (deep venous thrombosis) can occur for many reasons and it is also hard to pin point just one cause. For example, smoking and taking birth control pills can increase the risk of a DVT. If a person never smokes and does not take birth control, then these causes can be eliminated. A recent surgery or a having a particular disease can increase your risk of a DVT.

Pregnancy does increase the risk for DVT, but so does sitting for prolonged periods of time or being dehydrated. It is not uncommon for pregnant women to encounter one or both of these risk factors.

If one looks at the thousands of people who end up with a DVT, a significant number were pregnant at the time. However, there is always the chance there was another cause. It is very hard to point to one cause and be 100% certain it was the only cause.

Elisabeth
Jan 29, 6:13 PM

superficial blood clot in my right arm in the vein that blood is usually taken from. no known causative factor. I was given tramadol, ibprofen and told to use hot compresses. Today I saw a nurse practitioner who is trying to get me in for another ultrasound within 3 days. She is gone for the day I don’t have read streaks but it has not improved. Now the vein is also hardening below (more distal) to where it was before. Should I be concerned?

Cindy
Jan 29, 2:20 PM

I was admitted to the hospital for pain across the top of my left breast, as well as pain in my upper arms left and right, and an extreme headache and neck pain. I had shortness of breath and my throat felt like I had novacane on only half of it. The hospital thought I was having a heart attach and did a cheest xray and a stress test. I was released yesterday afternoon and now today I still have the neck pain and my upper arms are still hurting. I had an IVC filter placed in me in 2010. My blood was super thick on Monday and Tuesday of last week. When I went to the hospital my INR was 4.7. Could it have been that due to my blood being thick, a piece of a clot could have broken off and went to the filter and the clogged filter could have caused me all the pain? I am looking to see what the symptoms of a blocked or clogged filter are. I have not had much luck. Are you able to give me any direction. I do not see my doctor until Monday afternoon.
thank you

Richelle
Jan 29, 4:24 AM

I loss my baby and now the dr is trying to say the blood clot was due to pregnancy. I have children and never had an issue with this. Should I get a second opinion as to the dvt? Also the dr said he couldn’t tell why I loss the baby?

Daniel Haight, MD
Jan 28, 12:52 PM

Gayla – It is hard to tell without seeing the injured area, asking a few more questions, and doing an exam.

It sounds like you are describing a hematoma. A hematoma is when blood leaks from a blood vessel often due to an injury. So in a way it is a blood clot that is outside of a blood vessel and is the medical word for a bruise. Due to gravity, the discoloration can travel down the leg. So
Issues of concern:

The injury could have caused a small break or fracture in the bone. An examination and an x-ray would be needed to help direct treatment that would allow this to heal properly.

The hematoma, or bruise, caused by the injury can build up pressure in the leg called compartment syndrome. It normally occurs soon after the injury. The person might experience tingling, pain, swelling or numbness of the leg. This can damage the nerves in the leg and foot and would need treatment to prevent long term damage.

If there was a break in the skin, a bruise can become infected. So any redness, drainage, red lines traveling up the leg, or fever need to be treated.

Discomfort from the injury can cause a person not to move the leg as much as normal. This creates a risk factor for a blood clot to form in the leg vein over the next few days or weeks. If that were to happen, more swelling would occur and there would be an increase in the risk of complications from a blood clot. The pain from a clot can vary and for some people be mild.

As a hematoma or bruise gets better, the pain should decrease, the swelling get better and the color changes from black to blue to yellow.

So if the swelling is not improving, or if the pain is still present or worsening you should get it looked at by a health care provider.
Your comment regarding the pain near the injury still being very sharp leads me to encourage you to seek a medical evaluation.

Daniel Haight, MD
Jan 28, 12:35 PM

Bev – I can understand your concern since you are describing a significant change. There are many causes of leg swelling. Sometimes the extra fluid that may be causing the swelling may make it difficult for the skin to stay intact. Blisters can easily form and leak excess fluid through the skin. Anytime there is a break in the skin, germs can cause an infection to develop.

If a person is gaining weight, becoming short of breath and becoming more swollen, then they need to notify their doctor to be seen right away.

A person’s body needs the kidneys, heart, blood vessels, liver and medications working properly while following the correct diet to avoid leg swelling. In some cases, when the cause is exactly known, a simple adjustment in medications can help (along with eating the proper foods) and the recommended amount of salt.

With so many possibilities that may cause swelling, your friend my need to be seen by a doctor. It is important to ask and understand why this is happening, what can be done about it, and what are the possible negative outcomes if the medical advice is not followed.

bev
Jan 28, 5:14 AM

A friend called to ask, after having a blood clot in both leg and lung, currently taking warfarin, his ankles have now began to swell severly, but the skin has broke and fluid is leaking, please advise of direction to take, doctors waiting list long

Gayla
Jan 27, 5:01 PM

On Jan 12th I had the inside of my right calf near my shin bone stepped on by a sheep. (I was helping a lamb nurse) At the time it didn’t hurt too bad, but with in an hour while I was taking a shower and I could just feel it swelling, tingling and pain. It has been very painful, the bruising now extends down to my heel. The spot where I was steeped on is as hard as a rock. I have done the R.I.C.E. After icing or sitting for a long, when I stand I have a terrible sharp pain in the very spot. Is there something I should be doing different? My friends and family think I should go to a doctor and have it check out. They are afraid I could have a blood clot.

Daniel Haight, MD
Jan 27, 4:37 PM

Carrie – It is hard to predict risk for this particular problem because medical research is not complete. Your doctor has to take a lot of unique information about you into consideration before making a recommendation. As you mentioned, your doctor is carefully weighing the potentially smaller risk that the blood clot could cause a complication versus the potentially higher risk you may incur by staying on the blood thinning medicine called Coumadin (warfarin).

Every patient is different. Here are some things to consider discussing with your doctor about this decision:

- Overall, a blood clot in the jugular vein has a lower risk of complications than a clot found in the leg or thigh. Blood clots in the leg and thigh can break off and travel to the lung to cause a serious condition called pulmonary embolism. This can happen from a clot in the jugular, but it is less common. This may have been a factor in your doctor’s recommendation for you to stop taking Coumadin.

- Blood clots located in the jugular vein often cause no symptoms, so it is difficult to study this problem. If you did not have pain or swelling, then you doctor likely considered this in making a recommendation.

- A blood clot associated with an infection or a device that was placed in the vein such as a catheter can increase risk for complications. (Thinning the blood with medicine is often combined with treating the infection and / or removing the catheter from vein.)

- A doctor needs to factor in other conditions that cause blood clots like cancer, smoking addiction, or the need to take medicine that can cause blood clots in your recommendation.

- The medicines that thin the blood do have complications such as an increased risk of bleeding. This risk may have been part of your doctor’s recommendation to stop the medication.

Carrie
Jan 24, 9:35 PM

A clot was found in my jugular after surgery. 6 months of Coumadin treatment followed. the clot is still there but the doctor said the threat of taking Coumadin beyond 6 months is worse than the clot itself. So how dangerous is it to have this clot that won’t go away

Daniel Haight, MD
Jan 21, 9:16 AM

Christine – This is very difficult to answer since a doctor would need to ask a few more questions and do an exam.
During an examination, the doctor may be checking to see if the area is “rock hard”, soft, or fluid filled. Does it move a little under the skin or is it stuck in one place? Is it deep or superficial? Additionally, there may be specific changes you have seen in size, shape, color and tenderness of the area over the last few days. Be sure to share that information with your health care provider.

This could be a cyst (a small sack of fluid that may or may not be infected) or an abscess (an infection that is contained in one spot). This does not sound like a blood clot but it is impossible to tell without consulting a doctor. If it is getting larger or more painful then have a doctor take a look at it.

Some of the possibilities mentioned above might need a specific treatment that only a healthcare provider can perform. For example, a simple cyst can be easily removed if it continues to be painful. An abscess can be easily drained and the doctor can determine if you need an anabiotic. If you are at risk for a blood clot, that can be addressed.

Daniel Haight, MD
Jan 20, 4:44 PM

Ben – It is good that you are staying informed and asking questions.

Fortunately the danger from a DVT is reduced by its discovery and treatment. It is important to know what to do if develop additional symptoms including shortness of breath, chest pain, or abnormal bleeding.

Unlike other blood thinners such as Warfarin, Rivaroxaban is not effected by foods so you should be able to continue with your current diet. Make sure you continue taking the medication as directed. Weight can sometimes play a role in DVT so if you are overweight, discuss possible diet changes that address this issue with your primary care doctor. Weight loss will reduce strain on your joints and reduce the risk of future DVT.

Keep in mind that other medications can effect Rivaroxaban, so discuss any new medication with your doctor and pharmacist and make sure they know you are taking a blood thinner.

Caution should be exercised to avoid a fall including when getting up at night. First sit on the edge of the bed to make sure you are alert and adjusted to the light conditions in the room, second make sure your path is clear to the bathroom, kitchen, etc. Take your time. A good night’s sleep certainly helps you prepare for the day especially if you have recovery activities described by your surgeon.

Lastly, your activities should be based upon what your surgeon recommends since they are aware of the risk of DVT and what your specific requirements should be to help you recover and increase your circulation. Your surgeon can provide instructions that outline your daily activities that promote recovery. If you have a question about this plan, contact your surgeon.

Ben
Jan 17, 6:04 PM

Hello,
I had an ACL reconstruction suregry last week. I was suffering from a strain like pain in the back of my leg from the first day and by time it moved to my calf. After 6 days I had an appointment with my Doctor. When I told him about the pain in my calf, he referred me to ultrasound. Ultrasound revealed some clots in the back of my knee (I guess DVT). and then I was sent to the hospital emergency. The dr in emergency prescribed me Rivaroxaban for 3 months (21 days 2 pills/day, and the rest 1 /day).
I am currently so worried about my condition. since my knee is not completely recovered I need to walk with crutches, so most of the time I lay down on a bed or sofa and try to elevate my leg. I just have few questions:
1- what kind of activities should I do and what kind of activities should I avoid? can I sit and just elevate my leg while I am working with my laptop?
2- about sleeping at nights, should I take a full 9 hrs rest or I need to reduce it ?
3- what diet should I follow to help me recover faster from DVT?
4- How dangerous is my DVT?
Thanks

Christine
Jan 17, 9:20 AM

I have swelling on my upper thigh near hip. Started off feeling like a bruise even thou I didn’t remember hitting it anywhere but it wasn’t passing as days went on. I could feel something tight inside that swollen 3″ area. Now, it’s been almost 2 weeks, the swelling now looks a little more bumpy and seems to make me lean towards an issue with the vein there. I just turned 27… Could this be a blood clot? It hurts expeciouly if I touch.

Daniel Haight, MD
Jan 16, 2:35 PM

Paul – In general, your primary care doctor knows you the best and can factor in information from your past medical history that might put you at risk, along with family and social characteristics unique to your situation.

Blood clots in the lung are serious so you should ask you primary care doctor what specific items about your health would lead them to the recommendation to start blood thinners. Your doctor may point to proven research that fits your situation including any risk factors you currently experience. Your primary care doctor may also consider a more thorough search for the cause of the chest pain, rather than assuming it was solely connected to the plane trip and superficial vein.

It is good you are educating yourself about all the symptoms of a blood clot in the lung (pulmonary embolus) so you can recognize symptoms and reduce those risk factors you can control.

Paul
Jan 15, 8:48 PM

I have a large varicose vein. Recently, I was on two VERY long flights which suffered turbulence so there was not a lot of moving around.

Several days ago I began experiencing pain in that vein. And over the course of two days the pain moved down the vein. Today I began to experience some chest pain. So, I went to ER.

They found some surface clotting on/in the varicose vein that they said was not a concern and would go away. But, an enzyme was high in my blood work and they wanted a cat scan.

The cat scan revealed a VERY tiny embolism in my lung. That is exactly how it was described. VERY tiny. But, because of it’s location was probably what was causing my chest pain. It was described as so small that probably a cat scan eight years ago would not have found it.

So my options? Nothing at all and get another cat scan in a week. Or go on blood thinners. As I was not comfortable with the idea of blood thinners I opted for the former. The ER Dr. was then required to call my primary physician and discuss the findings and decisions.

My primary provider immediately disagreed and said he wanted me on blood thinners immediately for a week, followed by a cat scan.

My spouse and I will discuss this tonight but I did not accept treatment. I really liked the ER Dr. And, while I was there two nurses told me he was one of the best Dr.’s in this very well thought of Denver hospital. He definitely “led” me to this decision but my gut says it is right.

One of the things he said to me (after telling me he wished he had my EKG) was that I was in extremely good physical shape which was inferred somehow as presenting less risk from the embolism.

Anyway, tonight as I sit here typing this there are, of course, second thoughts. Just interested in a second opinion. Than You.

Daniel Haight, MD
Jan 14, 6:47 PM

Nancy – I agree with your concerns and understand how you want to better understand what is happening with your health. It may help to plan your communication so that you don’t miss the opportunity to ask your doctor important questions. Write your top three or four questions down before each of your visits. If possible, get your questions to the doctor even before you see him or her by handing the questions to the nurse before your visit or sending the questions to the doctor’s office prior to your appointment date.

It is hard to determine what your pulmonary doctor is saying without hearing more information. He might be saying that you had blood clots in the leg and lung but they were not bad enough to cause damage to the lung even though you still need to be on the treatment that is prescribed by another doctor.

It sounds like you had a ultrasound test on your leg called a Doppler test that found clots and the follow up repeat test showed the clots were gone.
I’m not sure what you meant by “I was just retested and the clots are gone.” Do you mean “gone” from the leg or the lungs? If it was a normal lung test, then it is unlikely your shortness of breath has anything to do with the clot from the past.

Sometimes the clots in the lung cause shadows on chest x-rays and coughing up blood. That takes weeks to heal. But it sounds like your lung doctor feels that your lungs are not damaged by the clots in the past. Shortness of breath can have many causes, so the Echo is looking at the heart.

The lung doctor saying “…the clots have nothing to do with him….” might mean that he is not the doctor prescribing the treatment of the blood thinners. Perhaps that doctor can give you a more complete summary of your conditions.

Hopefully some of these questions above will give you some ideas to take to your next appointment or clarify with a phone call to your doctors.

Daniel Haight, MD
Jan 13, 3:48 PM

Sarah – Aspirin should only be given to nursing mothers with caution. Further, Aspirin is secreted in breast milk in small amounts.

It is important that you speak with both your OB and Pediatrician to discuss the benefits and risks of aspirin as it relates to your specific situation. You may also want to ask about whether using warm compresses, leg elevation, and compression stockings could help so that you could wait to take aspirin until after you are no longer breast feeding. Be sure to have your doctor(s) explain what will happen if you do not take the aspirin.

Superficial clots are not as serious as deep clots, although they can be uncomfortable and cosmetically unsightly.

Nancy
Jan 12, 10:33 PM

I had a DVT in my right leg that broke apart. Was walking around for 2 months. I was misdiagnosed. I just was retested and the clots are gone. I still have shortness of breath. I went for and Echo and going for an Echo Stress test. The pulmonary doctor told me that the blood clots on the lungs have nothing to do with him. The lungs are fine just that I have blood clots on them. Never gave me a breathing test on my follow up visit 2 mos. after I got out of the hospital, my cardiologist was very surprised at that. My question is even after the clots are gone, does it still take time for the lungs to heal? I had a significant amount of clots on my lungs.

Sarah
Jan 9, 11:14 PM

I just delivered my fifth child a week ago. I had a bad varicose vein in my right leg during pregnancy. after delivery, itwas very sore and became hard. I had an ultrasound today which showed some blood clots in the superficial vein in my groin and leg area. my OB said to take 325 mg of aspirin 3 times a day. I really don’t want to do that because I am exclusively breastfeeding and everything Ihave read says aspirin is not safe to take while breastfeeding. I am eating strawberries, grapes, and drinking pomegranate juice to tryto thin my blood naturally. Do you think that will work without taking aspirin? Should I be concerned about taking aspirin while breastfeeding?

Daniel Haight, MD
Jan 6, 10:20 AM

Once a blood clot is discovered, it may be hard to know why it developed in your leg. That certainly raises the question: can it happen again? The answer after years of scientists studying and documenting research on blood clots is “yes”. That is why most physicians recommend medication to prevent blood clots from developing again for patients who have previously had blood clots.

Not only can the same risks that caused the first clot still be present, the flow of blood through the vein may not be totally normal since the walls of the vein may need time to heal after the original clot dissolves.

That is primary reason a person must be on a blood thinning medicine: It prevents a second clot from forming and more importantly, prevents a blood clot breaking off and traveling to the lung. This is called a pulmonary embolism and can be fatal.

A healthy, well balanced diet accompanied with physical activity are great, but check with your doctor. There are no vegetables that will help reduce the risk of a second clot that compare to the medication prescribed. Some vegetables, such as vitamin K rich spinach, will actually harm the benefits of the blood thinning medication Coumadin (warfarin).

Ask your doctor if you had any of the common risk factors that could have caused the first blood clot such as smoking, birth control pills, obesity, sitting for long periods of time, or other health conditions. This may help reduce the chance of another clot forming once you complete the 90 days of Xarelto.

Daniel Haight, MD
Jan 3, 3:10 PM

Lynox – Yes, the clot does dissolve rather well on medications. It is a natural process for the body to form and dissolve clots when needed to stop bleeding and continue through the healing process.

Sometimes the body is out of balance and forms more clots than it dissolves. Once a person has had a clot, the vein is sometimes mildly damaged so that it does not function as well as it prior to the clots formation. This often explains why there can be more swelling in the leg with the clot long after it has dissolved. If the problem worsens consult your doctor.

Daniel Haight, MD
Jan 3, 3:07 PM

Leslie – A Baker’s cyst often makes treating not only the cyst but the original cause (such as a problem with the knee joint) necessary.

Ask the orthopedic doctor if there is a problem causing your cyst. Treating that medical issue may address your cyst or may help you avoid the removal of the cyst.
Cyst discomfort can certainly mimic the pain of a blood clot. By itself, the cyst does not cause a blood clot. However, pain or pressure from the cyst or possible knee problems can reduce mobility and increase the risk of a clot forming.

It is good for you to discuss options and possible treatments with you orthopedist.

Jennene Reagor
Jan 2, 10:30 PM

I developed a DVT in my front inner calf. I had been eating raw greens for months every morning in my smoothie. I am health conscious and couldn’t believe it when my left leg swelled 65% more in size than the right. I ended up in the ER they put me on Lovenox injections for three days twice a day. Then my primary wanted me to go on Xarelto for 90 days. I am have issues as I bleed easily. The doctor at t he ER said the clot would be dissolved by my body. Going on Xarelto for 90 days is a bit much and it scares me as I am allergic to many things but also very active. I hadn’t been doing any cardio or walking and plan on starting to bike and walk along with doing yoga. I have no greens in my diet now. What is your suggestions as I have been given mixed medical advice?

Lynox
Jan 1, 5:52 PM

Hello Dr. I was diagnosed 2yrs ago with DVT very frighten to me since I’m a very atheletic person… My question is does the clot every completely dissolve … The leg with the clot is about 1 inch bigger than the other, will they every be the same size I’m wearing the compression stocking …

Leslie
Jan 1, 4:26 PM

Hello! I’m a 42 yr. old female. July 15, 2013, I was admitted with PE and pneumonia. During my stay in the hospital, ultrasound found bakers cyst. We think that’s the leg the PE came from. I’ve been advised to go to a Ortho surgeon, next week, to see what needs to be done. At this point, it scares me I death when I have calf pain, and the pain goes from my calf to ankle, with ankle swollen, matter of factually now. I took Lovanox with warafin two weeks after release, and am currently taking 7.5 mg warafin daily with the excitement of getting off in about 2 weeks. I want the bakers cyst surgically removed, so that if there is pain from a clot, I would most likely go to the ER, and I’d run. Get tired of the ER, but I’m scared. Is it fair and possible to try and request Ortho surgeon to remove this? Thank you so much, your response is is appreciated.

Daniel Haight, MD
Dec 31, 12:03 PM

Paul – Blood clots usually dissolve when treated with medication in a few weeks, but the clot may leave residual damage to the vein making it susceptible to blood clots in the future.

You should discuss options with your physician, but it would not be recommended to remove a blood clot since it will dissolve on its own while on medication and any procedure could inflict damage to the vein.

Daniel Haight, MD
Dec 31, 12:01 PM

Susan – Unfortunately this blog cannot respond to specific medical questions that are urgent. Non-critical medical issues may sometimes be addressed by your health insurance ‘ask an expert’ service.
Often employers offer this service to provide a resource for help in obtaining appropriate medical care more quickly.

You can always call your physician about health issues that occur in the middle of the night. Serious medical conditions or symptoms may require immediate medical care.

Daniel Haight, MD
Dec 31, 11:50 AM

Keith – The problem you are having with your ear is hard to address in writing.

I would recommend you obtain a second opinion from an ear nose and throat physician (ENT) who can treat what appears to be a clot in the ear canal.

It is likely that this is unrelated to the ringing in the ear. That usually comes from the other side of the eardrum and may be more of a neurologic problem.

Keith
Dec 31, 10:24 AM

I have a blood clot lodged in my ear which is painful when trying to prod out. Syringing the ear didn’t remove it. I also have continuous ringing in my head. How do I remove the clot which can clearly be seen blocking the ear, and cure the ringing noise. Ihave had this for months, with the clot probably for years.

paul ammons
Dec 31, 9:46 AM

On a return flight from Africa 8 years ago I got a DVT I did not know it and got a double PE at 8500 ft at my cabin. I was by myself I was found 4 days later in a comma but lived thought it. I lost the use of my right leg because laying on it for days killed my femoral nerve after 2 month stay in the hospital I rehabbed my leg back was on blood thinners for 6 mouths but was never checked for clots, I was snowboarding again. now at the age of 52 this summer I had another PE and flaking same leg same area I don’t think the clot was ever dissolved the Doppler found a large clot In my upper femoral vain.

Question: my clot is in my femoral vain in the groin area can it be removed? will it ever dissipate on blood thinners?

susan
Dec 26, 3:29 AM

I have a pain plus extreme sensitivity to touch in my right leg calf below the knee on the inside. It started a couple days ago and has gotten worse. Today I ha d to sit a lot and now my calf is swollen and painful. I can call the dr for an appointment in the morning but should I just go to the emergency room right now at 2am Christmas.

Daniel Haight, MD
Dec 20, 5:30 PM

Sharolyn, Falls can be quite serious. Your fall could have caused damage that only a doctor’s exam or x-ray could reveal but it is good that you are getting better.

Tingling in both thighs is concerning. Swelling and bruising puts pressure on nerves and these nerves send to your brain sensations that are not real such as that icy – hot tingling. Even a small broken bone can cause lingering swelling, bruising, and pain along with reduced movement or function. Sometimes damage occurs at a distant spot where a nerve begins, like the back, but the tingling is felt down by the feet.

I’m worried that you may need further evaluation if you are not getting better. A family practitioner or general internist can help reassure you that your are on a good path to full recovery. Shoulders are very hard to heal and can freeze up if not treated early.

Aside from that, look for anything that may have caused the fall and ways to reduce those risks. Examples are medications you take that might cause dizziness, carpets that have edges that can be tripped over, steps that can be missed or slippery, better lighting, etc.

Take care and hope you feel better.

sharolyn
Dec 20, 1:28 PM

I fell in my garage three weeks ago and could not move without screaming in pain because of pain on right side of my body. I was unable to move my right arm at all which became swollen and bruising from shoulder to wrist over days. My entire arm has been useless until the last few days and I am getting more mobility. However, the rest of me is suffering with stinging and hot/cold feelings, esp. my legs and feet and right hand are yet swollen with fluid puffiness. I have been going for acupuncture which is helpful, but the ‘blood’ symptoms and lymph symptoms are not ending. If you have ever used icy-hot ointment,it is that feeling. Now my thighs are also feeling that way. What is going on? Thank you.

Daniel Haight, MD
Dec 20, 12:35 PM

Nancy – Depending on the exact location on the hip and whether it hurts with certain movements, this could be irritation of the space where muscle tendons glide through as they attach up to the hip bone.

This space is called a bursa and usually has a small amount of lubricating fluid. But if inflamed (i.e. bursitis), the fluid may increase and feel tender when moving your leg.

Perhaps certain activities you do have caused this irritation in your thigh and calf. It is good that you have an appointment with your doctor and it is certainly reasonable to ask about the possibility of a clot. As mentioned in other blog posts below, if swelling develops or increased pain, shortness of breath, etc. then seek immediate medical care.

Daniel Haight, MD
Dec 20, 12:34 PM

Mary – You have mentioned that you have several risks that can increase your chance of developing a blood clot. Certainly sitting in a plane for long periods can cause swelling in both legs, but it is concerning that this happened in only one leg. But this may have been just a muscle cramp that can appear as swelling and take several days to feel better.

It is always good to take advantage of any “seat belt off” time during a flight to stand and walk around the cabin. Plus stretching helps reduce cramps along with being well hydrated by drinking water and avoiding alcohol during flights.

With recent surgeries, history of melanoma, and a recent flight, it would be good to contact your doctor. Furthermore, your asthma may appear to worsen, but it could be from another cause such as a blood clot.

You should seek medical attention if the leg pain or breathing worsens for any unexplained reason.

Daniel Haight, MD
Dec 20, 12:32 PM

Blood in veins flows at lower pressure and relies on normal body movements and valves to keep it going in the right direction (back to the heart). If a vein is damaged or becomes infected, blood clots can form and the flow may no longer work as well as it had in the past. The vein may develop scar tissue as it heals and this can further get in the way of normal flow.

Anything that goes through the skin, like a needle, can introduce trauma, disruption, and infection that can lead to inflammation in the area.
Even though the area in cleaned ahead of time and care is taken not to damage the vein, there are risks of getting blood work done.

If done properly, the benefits of obtaining lab results outweigh the risk of a complication from sticking a needle into a vein. The blood draw sometimes requires moving the needle around to obtain blood and the risk is low but still possible to have bruising, clotting, and infection. Often these are minor and easily treated, but sometime it can be more serious.

Daniel Haight, MD
Dec 20, 12:31 PM

Eva – Blood clots in the legs are much more concerning than those in the arm. Clots in the thigh can break off and are large enough to block the flow of blood from the heart to the lungs (i.e. pulmonary embolism).

Arms clots tend not to cause this problem but can lead to the swelling and pain you described. As the clot heals, there may be some scar tissue that forms at the site of the old IV. If you are on therapy and the swelling has improved, further ultrasounds may not be needed.

Daniel Haight, MD
Dec 20, 12:30 PM

Jill – I can understand your concern since you have a lot going on and you are trying to be careful.

It is good that you received reassurance that the pain and swelling can be explained and very serious problems have been ruled out (such as a clot).

Stick with your basic routine that your doctors advised regarding walking, drinking fluids, stretching, etc. Look for any out of the ordinary changes such as unequal swelling in one leg more than the other. Close communication with your OB doctor and their staff will also help when needed.

Jill
Dec 17, 11:39 AM

I am a 38YO female, 24 weeks pregnant. On 12/14 I was seen in the ER for calf pain in my right leg, (it was Saturday so I had to go through the ER).

My leg was scanned by Doppler ultrasound and I was given the “all clear” for clots. My leg is still sore this morning in two specific spots. I have no warmth, only a small amount of redness in one spot, and my leg is slightly swollen (attributed to pregnancy and varicose veins). I have very bad varicose veins on my right leg,and I expect for those veins to be sore. However, I am very very fearful that a clot was missed.

Do I need to be re-evaluated? I am an anxious person by nature and this really has me worried.

Thank you!

Eva Gold
Dec 15, 12:51 PM

I recently had a lapro surgery and the IV was inserted into my hand. The antiobiotic IV went in really fast and stung a lot – I told the nurse and she said it was normal. The second antibiotic IV was the same (painful) but the nurse agreed on taking it out because she luckily agreed it was NOT normal. The day the IV was taken out and for 2 or 3 days after the surgery my arm was swollen and red, and only slightly warm to touch (not hot). I went back to the clinic that did the surgery and they said it was probably only an inflammation and put a heparin cream bandage on it. 8 days after the surgery I still had pain, although the swelling had gone down. I went to see my regular doctor who sent me to an ultrasound. Ultrasound doctor said he didn’t see any clots but he did see the vein was inflammed. 3 more days, more pain and now in the hand also (additional hardening of veins in hand) (slow reaction!?) so I went to another doctor (sadly, a saturday so could not see the same one again) who did an ultrasound and did see a clot above my elbow. He prescribed me a heparin shot once daily 40mg and a compression bandage. Luckily tomorrow is monday and I plan on getting another ultrasound done by the first doctor (or is this over kill?) because I am very worried about the risk of DVT. Any suggestions?

Frank Bryan
Dec 13, 3:11 PM

Hi, My wife went to medical centre and got blood work done, the nurse was wiggling the needle once it was in because not enough blood was coming out and my wife said it hurt. it was painful for next few days,then starting to swell up, then about 2 weeks it really swelled up and she went back to medical centre and the doctor said you have infection, and put her on antibiotics and sent her for Doppler, they sent results back same day saying it was blood clot but dr, didn’t call us back till 4 days later after I called the Doppler place saying we didn’t get results, now the clot has gotten worse they had to take her off aspirin and put her on another thinner and gave her a shot.it is in her left arm,which worries me the most, how can getting blood work done cause all this? I think the wiggle of the needle damaged the vein,is this possible.

Nancy
Dec 9, 5:31 PM

I’ve grown concerned over a pain I’ve had in the outer left thigh, below the hip, that I’ve been having. It feels as though there is a bruise there, but there is no coloration to it at all. But, it feels like a bruise is being pressed on – even when no pressure is in that area. I’ve had this for about a week and a half. Also, I’ve had an issue with it seeming to spread to the rear thigh area a little. Maybe it’s my thoughts getting carried away, but I’ve also had a similar feeling at times on the left side of the left calf as well. Would this be a sign of a clot? I see my family doctor later in the week, but as this has been playing on my thoughts quite a bit, I thought I’d ask here in the meantime.

Daniel Haight, MD
Dec 9, 4:42 PM

Stacey, it is reassuring that the Doppler ultra sound of your leg and chest CT for blood clots in the lungs were normal.

It is also good that you are very aware of the risk of blood clots associated with reduced mobility after surgery. You may feel that you are being overly worried by mild discomforts that pass or are not associated with other serious symptoms.

Hopefully you are becoming more mobile and your recovery will progress with less swelling and pain and no further events of unexplained pain. I understand your concern over mild discomfort with normal pulse and breathing. A phone call to your physician will provide you with reassurance that you are on the path to recovery or confirmation that a visit to him or her is in order.

Daniel Haight, MD
Dec 9, 4:40 PM

Rahul, I’m sorry to hear about your loss. Any sudden change like this can be difficult. I understand your concerns about your other eye and whether another blockage elsewhere could lead to a stroke.

The blockage that caused your loss could have been a clot that traveled from the heart or the neck artery (called the carotid artery) or a cholesterol plaque in a vessel that ruptured and was taken up to the eye. There are other causes (such as very high blood pressure, inflamed blood vessels, and spasms) that can also stop the flow of blood through these tiny blood vessels in the eye, but those causes are rare.

Ask your doctor if the medicines you are taking now are intended to prevent damage from happening to the other eye.

The medicine you are taking may also be helping reduce the risk of some other problem. For example, if a person has an abnormal heart rhythm, called atrial fibrillation, blood thinners help prevent clots from forming in the heart and traveling up to the brain and eye. Similarly, a person with high cholesterol, high triglyceride (fats), who smokes cigarettes and does not follow a healthy diet may be prescribed medication as a preventative measure. These factors may cause the blood vessels to narrow and block up and can suddenly lead to a stroke or heart attack. Be sure to ask your doctor about the reasons for your prescribed medications.

The process that caused the first eye to experience a blockage in blood flow could happen again. Any sudden change in vision should be treated as an emergency and you should seek treatment.

mary
Dec 8, 2:31 PM

Hello, I returned from a business trip yesterday morning. While walking in the terminal I felt my right leg tighten up and it hurt badly. By the time we made it to the cab my right calf was swollen so huge and tight. My husband massaged it and in about and hour and a half the swelling was gone. There is still discomfort. I had two surgeries about 5 weeks ago. I have melanoma and I have severe asthma. I have to use an inhaler several times per day.
So, my questions is. Is there cause for concern now that the swelling has gone down in my leg? Thank you!

Stacey
Dec 1, 5:47 PM

Hello. I am a healthy 35 year old female. I had a sports hernia repair on November 15. My round ligament was fibrotic to my pubic tubercle, and had to be cauterized off. Felt cramp in left calf Monday. Had venous u/s done. It was negative, Tuesday repeated ultrasound, still negative. D dimer was 4700… Doctor said normal…with negative doppler and recent surgery. Friday still had pain, negative doppler again. Sunday, chest pain, normal ct scan,… A few days later, repeated d dimer and down to 1700. I feel like my d dimer was specifically high due to surgery….I was very swollen. Obviously there is no clot….do I need to look more into this.

Rahul
Nov 30, 6:24 AM

Hello Doctor,
I was diagnosed with CRAO(Central Retinal Artery Occlusion) in my Left eye 2 months ago. I have lost that eye but I wanted to ask what happened to the blood clot that caused CRAO. Am I still at a risk of another stroke or any blockage. What exactly happens to the clot after some time. Does it dissolve or stay same always. I am taking a blood thinning medicine. What else can I do to dissolve the clot. Please help?

Daniel Haight, MD
Nov 19, 5:56 PM

Shaylee, with blood clots in the vein, there are no perfect predictors of a blockage. For example, having cold feet does not predict a vein blockage. In addition, some people feel a cord-like lump while others may not. Sometimes the cord is just in a minor vein near the surface of the skin and does not a promote a problem (like a minor varicose vein).

Specific problems that need medical attention would be swelling of the leg, unexplained worsening pain (or pain that does not improve), shortness of breath, or dizziness.

A pulse comes from a different kind of blood vessel called an “artery”. It is normally harder for an untrained person to feel the pulse in the foot. It can be felt by pushing down with your three fingers on the top part of your foot. Another spot to detect a pulse is on your “ankle bone” located on the inside of your ankle. An internet image search for “posterior tibial pulse” and “pedal pulse” will provide several examples of this technique.

In a young person, the blockage of a pulse is very rare unless they are a smoker. This type of blockage, often seen in older people, is a medical emergency and the person should seek medical attention.

It is hard to tell what is causing your sensation of discomfort since there are so many possibilities. Some possible causes may be minor and symptoms should improve in time. Seek medical attention if the problem worsens.

Shaylee
Nov 19, 4:13 PM

Hello doctor I’m concerned I may have a blood clot. I fell asleep in a very awkward, uncomfortable position on Sunday and when I woke up I had a charlie horse sensation in my left inner thigh. I got up and walked around and flexed my legs. That pain went away, but last night while I was taking a shower I felt pain in the lower left outer thigh behind and a little to the left of the knee. There was also the cord-like lump I’ve been reading about as well as slight swelling. It only hurts when I touch it not when I walk or stand. This morning when I woke I noticed my feet were very cold, particularly the left foot. I tried feeling the pulse in my feet but I either can’t find it or can’t feel it. There is also another slightly painful raised area on my anterior right leg just below the knee.

I am 29 years old, female, and obese. I’ve never had blood clots before and as far as I know no one in my family has had clotting issues. What do you think?

Daniel Haight, MD
Nov 19, 12:56 PM

Susan, There can be a number of explanations why a person may not be feeling well including a change in the issues you mentioned in your post such as blood sugar, blood flow through the artery in the belly that has enlarged (abdominal aneurysm), an abnormal heart rhythm that has changed (Afib), nervousness, or even a new medical issue. They may contribute to his loss of appetite as well.

Both calling the primary care doctor that is aware of the diabetes, Afib, etc. for advice now about the appetite change along with the surgeon may be helpful.

It is important on the day of surgery to alert the doctors caring for your father of any new health problems or symptoms. Providing additional information regarding your father’s current health will help the anesthesiologist and surgeon who want to ensure that the surgery goes smoothly and that a successful recovery follows.

Daniel Haight, MD
Nov 19, 11:30 AM

Michele, Your description of your symptoms were helpful. I can understand how worrisome the pain can be and the potential impact it may have on your daily activities.

Recovery time is different for everyone based on numerous factors including size of the blockage, location and personal health differences.

Generally, your symptoms should slowly improve everyday and if you see worsening (or shortening of the time in which you can stand) then re-evaluation is recommended.

As mentioned in the previous blog post regarding this topic, there is a risk of chronic discomfort that you can discuss with your health care provider.

Keep a log in a notebook or calendar of your daily progress with goals in mind of increasing your activities slowly and safely. Hopefully, you will be able to increase your weight bearing abilities on the injured leg by a few minutes every few days. Share with your doctor the activities you want to return to and they will be able to help you set goals and a timeline based on your progress of healing.

Also remember that eliminating or reducing any other risk factors such as smoking, weight, etc. may also help in the healing process. I hope you continue to improve.

Susan
Nov 18, 10:38 PM

My father has a blood clot in his right
leg that has been causing him pain
for 4 weeks. He was scheduled for
surgery last Thursday and waited
and was rescheduled for his surgery
this Thursday because of an emergency. He still has the same
pain in his leg today but he says
he really has lost his appetite. He
has other problems in his body.
He has an abdominal aneurism
that has been watched for 1 1/2
years by the same surgeon, he has
aFib and is a diabetic. I’m worried
that something will happen to him
before his surgery on Thurs. Would
the blood clot cause loss of appetite ?
I’m sure some of it is anxiety about
the surgery. Should he contact his
Dr. or only if his pain gets worse
or he feels dizzy? Thanks.

Daniel Haight, MD
Nov 18, 10:17 AM

Eve, Yes it is always a good idea to let your doctor know about any change that may be related to a medication or a condition that previously caused a hospitalization.

Any chest pain, shortness of breath, dizziness, heart palpitations, leg swelling or coughing up of blood may need to be evaluated right away.

It is hard to know what is causing your discomfort, but your symptoms should be improving each day. If your symptoms fail to improve or worsen you should be assessed by a healthcare provider.

Michele Carroll
Nov 17, 1:24 PM

I was diagnosed with a DVT Mon Nov 11th. I am 62 year old female and healthy and active. I had symptoms from the previous Wed Nov6th. I thought I must have injured my leg, not sure how, but rested my leg Fri, Sat and Sun. No improvement. Weightbearing for for more than a minute or two resulted in pain and the inability to bend my knee.

Treatment consisted of self injections of Lomitil and starting warfren and blood test daily. My blood levels are within the correct range and I no longer have to do the injections.

My question is this, what is the time range for this clot to disolve. I know the medications do not effect this process. I still cannot bear weight for more than a minute or 2. The clot is in the inside of my thigh. I am wearing a compression stocking elevating and using a geating pad. The calf seems to have returned to normal size.

I realize everyone is different. At what point should this be re evaluated. I am a very active person and this predicament is really effecting my mental health and quality of life

Daniel Haight, MD
Nov 14, 10:56 AM

Colette, I am not a specialist that deals with superficial vein clots.

In regards to your post, what you have explained may no longer be a “clot” because the clot can be replaced over time with scar tissue (called fibrosis). So clot dissolving injections may not help and there is no liquid blood that can be easily removed.

Since blood can take many different paths back to the heart via the numerous veins we have, the blockage of one vein near the surface usually does not cause a problem. But as you mentioned, it is irritating or unsightly.

Surgery could remove the fibrosis with that segment of the vein, but there are risks of scar and infection that the surgeon could better explain.

Colette
Nov 13, 6:14 PM

There is a clot on the top of my right hand as a result of IV infiltration from 7 mos ago. My PCM referred me to a hand surgeon, but since that consult, I have used massage on the area and reduced its size. I asked both doctors about attempting to withdraw blood from the site or injecting a solution to break it up, but they thought the mass was solid and that it could not be remedied that way. It seems to me since massage reduced it some that there must be something more to try in lieu of dissecting it! Is a saline solution such a bad idea or is there a known drug for this particular concern? It’s from a superficial vein that appears to no longer be active.

Eve
Nov 10, 5:16 AM

I am a 41 yro woman and hospitalized a few weeks ago with a PE. I was started on Xarelto 15 mg BID for 3 weeks and then to go down to 20 mg once a day for the remaining 6 months. So I just went down in dosage a few days ago and ever since my back has been hurting again like it first was when they found the PE’s, especially at night when I lay down. Is this normal or should I be concerned and call my MD?

Daniel Haight, MD
Oct 29, 4:40 PM

Judy, I am so sorry for your loss. Not knowing the exact cause of a loved one’s sudden passing can be a unsettling.

It is often impossible to know for sure what causes a blood clot to form and travel to the lung.

Leg injuries in the past that limit normal movement years later, or injuries that damaged the veins, could increase the risk of a leg clot.

Unfortunately, blood clots, and clots that travel to the lung (called a pulmonary embolism), have many other causes that may increase a person’s risk of a serious outcome.

Since the medicines to prevent blood clots have serious side effects, a person with a leg injury but no obvious vein or clot problems would not normally take a blood thinning medication.

The passing of a loved one is heartbreaking and again I am sorry for your loss.

Take care,

Daniel Haight, MD
Oct 29, 9:05 AM

Stacey, You are right in considering multiple causes for your neck discomfort.

Missing a dose of a blood thinning medication, like lovenox, can increase the chance for a clot to form.

You may not feel any warmth or see any swelling if a clot is not infected or not completely blocking the vein. The head drains blood through other veins and that may explain why a partial blockage does not cause a lot of pain or swelling.

Other causes can include muscle spasm, “pinched nerve” from arthritis of the spine but you should have this evaluated by a doctor for the following reasons:
It could be a clot since you have a condition that leads to clots and it is hard to predict the effect of missing an occasional dose of blood thinning medication.

Another reason to see your physician is to let the doctor know that the injections are causing soreness and this causes you to miss doses. There may be some other alternative or other strategy for treatment they may want to consider. You may want to ask about newer pills that are alternatives to coumadin, but they may not be recommended for your condition.

Judy Horne
Oct 29, 8:47 AM

My 38 year old daughter died from a blood clot to her lung. She had a very serious leg injury about 10 years earlier could this have caused the clot?

stacey
Oct 28, 10:54 PM

I have factor leiden 5 prothrombin gene mutatation. I have had 2 seperate PE’s and several DVT’s. I now have a greenfield filter. For the past few days I have been experencing short unexplainable bursts of nauseating pain along my right juglar vein. They come and go sometimes every few minutes. The pain shoots up alongside of my head and stops just above my ear. It also radiates to the back of my neck. Its almost contraction like…no swelling, redness nor warm to the touch no other symptoms as in visual, motor skills, behavior or speech. Could this be just muscular related? Also I am on 150 of lovenox sub q once daily that I occasionally miss due to my stomach being so sore. My body would not regulate on the coumadin.

Daniel Haight, MD
Oct 16, 10:08 AM

Jennifer, A blood clot in a “vein” will usually not stop the pulse of blood in an “artery”.

A “pulse” is a wave of blood coming directly from the heart with every beat. This blood is in a special type of blood vessel called an “artery” that was designed to handle blood traveling at high pressure. Our bodies are designed to locate these blood vessels deeper and in more protected areas than veins. You can feel a pulse in your wrists or in your neck to one side of your Adams Apple.

“Veins” are the low pressure blood vessels that return blood back to the heart. Blood moves slower and relies on body movements to help the flow back up to the heart. The larger ones travel deep but many others can be seen on the surface of the skin. They do not have a pulse that you can feel although some doctors looks at the waves seen in the large veins near the neck.

Clots are more common in veins because sitting for long periods, dehydration and other risk factors can slow the blood and make it more likely to form a clot. Birth control, smoking, and certain diseases increase the risk of blood clotting in the veins.

Arteries can develop diseases that can cause damage or narrowing. Cholesterol is a good example and a blood clot can form in an artery that is narrowed because of disease. This type of blood clot can stop a pulse. Bad things result when this happens such as a stroke, heart attack, or a foot becoming cold, blue and painful (but not usually swollen).

Daniel Haight, MD
Oct 15, 12:53 PM

Angelica, A blood clot in the leg can occur quickly. Birth control (BC) is just one of many risk factors.

Pain in the calf along with swelling of the foot or leg needs to be evaluated without delay.

Call your doctor for specific advice and decide what your best option is such as going to a diagnostic center, urgent care, or emergency department.

There is the possibility that an “ultrasound Doppler test” of the veins in the leg would be recommended, but that is for your doctor to discuss with you.

This is something you would not want to wait and watch, but rather calmly take action to determine the cause and best treatment.

Angelica
Oct 15, 11:59 AM

I just recently started on a BC patch two weeks ago to help with a fibroid. I now have a pain in my right calf. The area where the pain is, is red and very sensitive to the touch. My leg and foot are swollen. I’ve not been bitten by anything, I haven’t hit my leg on anything, and it felt very heavy all day yesterday. Can a blood clot occur that quickly?

Jennifer
Oct 10, 12:12 PM

I have had two blood clots in my left leg in my vein and they were in the same spot. The second one left a scar on my ankle. What caused the scar was from my blood did not have anywhere to go so it was seeping out my ankle. My question is, will I have a pulse in my foot, if I have a blood clot like before?

Daniel Haight, MD
Oct 7, 9:47 AM

Kerry – Shortness of breath is also called “dyspnea”. It is a feeling (or symptom) that can have many causes.

The shortness of breath that you first felt should slowly get better with treatment. But if it’s not or if the symptoms are getting worse, you need to be evaluated by your doctor or the emergency department.

If the symptoms are worse — A doctor may need to investigate the symptoms further by asking you additional questions followed by an examination and possible some tests to ensure the lungs are working properly and that there is not a repeat of new blood clots in the lungs. For example: When does the shortness of breath occur? While lying down? While at rest? Does the shortness of breath occur only when standing, walking or when you are active? Are there any other symptoms such as chest pain, leg swelling, dizziness, anxiety, dread, sweating or palpitations (e.g. feeling the heart beating fast)? Does the heaviness spread down your arms? Are your legs swelling? Do you have a cough and if so, what are you coughing up?

They may also want to ensure there are no new problems with your heart.

Your doctor will already know if you’ve had problems with smoking in the past that could be causing emphysema or bronchitis.

The blood tests that check the effectiveness of the Coumadin are important. It is called the PT / INR.

Lastly, your doctors may have discussed with you the possible causes of the blood clot (DVT) that formed in your leg. Hopefully, you have been able to avoid or reduce those risk factors if there were any.

Bottom line: a blood clot that goes to the lung is a serious condition and needs to be watched carefully and communication with your physician is key.

Daniel Haight, MD

Kerry Maughon
Oct 3, 10:07 PM

I have suffered from shortness of breath since last December. Three weeks ago I was diagnosed with a DVT behind my left knee. A Q/V scan demonstrated multiple blood clots in my right lung. I was on heparin and then injections in my belly fat. I am now on coumadin. My major problem is that I still have a type of shortness of breath and my chest is heavy. What do you think is happening to me. Thank You, Kerry

Daniel Haight, MD
Sep 23, 11:17 AM

Cindy, your father is fortunate to have you so involved in his care and participate in the health care of your family.

Unfortunately, the risk of another blood clot forming and traveling to the lung is too high to stop medicines that reduce blood clots (i.e. blood thinners). After surviving one blood clot in the lung, which is called a pulmonary embolism (PE), the risk of developing a second one is increased. A blood clot in the lung can be rapidly fatal.

A person might have other contributing risks factors too, for example: other medical problems (heart failure, abnormal heart rhythm like A-fib, obesity, cigarette use, and cancer). Depending on the health details for a particular person, each of these problems adds additional risk.

Previously, a person who had a blood clot in the leg that was treated with a blood thinner but then developed a more serious blood clot in the lung would always need a lifelong blood thinner like coumadin (warfarin). They would also require regularly scheduled blood test to monitor the condition.

Now, there are alternative medications that reduce blood clots and do not need ongoing scheduled blood tests. In other words, the doctor does not need to check the PT/INR blood test (which times how fast the blood clots in a test tube under certain conditions as with coumadin).

These other medicines may still cause bleeding, but as with anything, the risk is lower compared to the bad outcome of a blood clot in the lung.

One last issue to address: these newer medicines can be very expensive and you would need to research the cost and your insurance coverage.

Another treatment that may be mentioned to you as an alternative is an IVC filter that is placed in the large vein called the “inferior vena cava” (IVC) that runs between the legs and the heart / lung. This vein is located deep in a person’s belly. The filter is like a tiny metal basket that could catch blood clots. But it is not meant to be used by itself for long periods of time. So this is not a good option.

Lastly, there is no test that can be done to see if a person still needs a blood thinner like warfarin. But experience and research for many years proves that a blood clot can happen again with disastrous results. That is why it is recommended to stay on the medicine.

50,000 people in the US die every year of blood clots in the lung. Some of them get blood clots even though they are taking daily warfarin. However, the number of folks who develop a blood clot while being treated for blood clots is much less than those who do not take this protective medicine.

I hope this helps in your future discussion with you family’s doctor.

Cindy Gilmore
Sep 16, 12:44 PM

This is in regards to my father. He has experienced 2 blood clots. The first in his leg, which they cleared out with surgery. Then they put him on warifrin. Then, due to some rectal bleeding they pulled him off the Warifrin instantly(cold turkey), which I feel caused the 2nd clot in the lung. He has now been living with me since April, where I have him walking and on a great diet ( no dairy or gluten). which tend to cause inflammation. My goal is to get him off ALL meds. which I have been doing. However, due to the effects of warifrin this will be the last one I will work with. So, the question is: is there a test he can do to see if his body even needs the warifrin? I know that the INR is the one that confirms the thinness of the blood and they want that to be at 2.5. But I want to find out if his body needs his blood to be adjusted at all? Just because he had blood clots in the past, I don’t believe this is something that would continue in the future. I would have him on Supplements to keep his body strong and healthy too as I do now. As you can see I am not a found believer in allopathic meds. So, just to be clear with my question, what test can be done to see if he REALLY needs the warifrin and by what kind of doctor would be able to preform this test? Look forward to hearing from you SOON.
Peace, Love and Blessings,
Cindy

Daniel Haight, MD
Sep 9, 3:14 PM

Kit, It is possible you have post-thrombotic syndrome (PTS), also called post-phlebitic syndrome. Your doctor needs to talk to you and do an examination, which may include additional tests to determine if there could be other causes for your pain.

When a blood clot first develops, there is pain from the blockage and swelling. Once blood thinning medicines are started, the blockage (clot) begins to dissolve and frequently the initial pain gets better. However, there may have been damage done by the blood clot that leads to the veins not working as well as they used to.

Some people have chronic pain and swelling after a blood clot is initially treated even if they receive the best treatment right away. This can happen in up to 50% of patients with a DVT. If the veins in the leg are not functioning as well as they used to because of the clot, this could lead to other problems such as skin damage and skin ulcers (sores).

There are some approaches your doctor might recommend to help with the discomfort including special “graduated” elastic stockings that help the flow of blood. These compression stockings are specially fitted, expensive and hard to put on especially in the hot summer months. But these stockings do help many patients. Frequent elevation of your leg may also be recommended.

Staying off your feet for long periods of time is a general recommendation, but keeping active is also important. How much to walk to be allowed is a very important concern. Too much rest can lead to problems, but your doctor will be the best person to determine the best course of action based on your individual health.

Recovery time and the rate the pain level decreases may be frustrating. Tell your doctor how important it is for you to be mobile and ask what the plan is to help the discomfort become more manageable. Your doctor can advise you as to exactly how frequently and for how long you should elevate your leg.

The doctor can determine if there is another cause of your discomfort, but if it is PTS, it can be hard to predict how long the discomfort will last.

Daniel Haight, MD
Sep 9, 2:47 PM

Shelle, some blood clots do not need the same treatment as others depending on the location and size of the clot. Symptoms of a blood clot can vary depending on the person.

The list for causes for headaches can be an extremely long list. What causes a person’s headache one month might not be the cause of a headache in the future.

Like any problem with an unknown cause, a person should:
Note when the problem occurs including what you were doing at the time the pain began and exactly how it felt. (Is it stabbing, throbbing, aching, burning, or any other descriptive term) This information will help when you speak with your doctor.

Make a note of the exact location in your head the headache occurred and if the discomfort traveled to other areas. For example, does it start in the neck and go to the back of the head? Also when speaking with your doctor be sure to mention what makes the pain worse or what makes it better.
Does the pain wake you up at night or occur at a particular time each day?
On a scale of 1 to 10, how severe is the pain of the headache? Does it cause nausea or give you double vision?

Headaches could be associated with caffeine, so consider how many soft drinks you consume along with coffee or tea when tracking your headaches.

It may be interesting to note that sometimes pain medication that is taken chronically, can lead strangely enough to chronic headaches.

It is impossible to determine the cause of headaches without sitting down face-to-face with a healthcare provider who can hear the whole story along with performing a complete examination and ordering any labs or tests if necessary.

I wish you the best in your search for relief.

Stokes
Sep 6, 9:12 PM

Have a blood clot in my leg. On warfarin. Was wondering how long I’ll be in pain. . . Is it better to stay on bed rest until the pain stops or grit my teeth and walk?

shelle
Sep 6, 4:59 AM

I was hospitalized about a monitth ago and I was told that I had a small blood clot and it was drying. By itself. But I have headaches alot. Why?

Daniel Haight, MD
Sep 4, 4:50 PM

Arle, A clot (called a thrombus) in a deep vein (called a DVT) can occur anywhere from the calf on up to the thigh and higher. The risk for PE increases if the clot was found above the knee (the back of the knee is called the popliteal area) As the veins travel up from the feet and closer to the pelvis & body, the larger the vein becomes. A clot in this large vein increases risk. Clots found further away, in the calf, and those treated with heparin then coumadin, greatly reduce the risk of breaking off (called embolizing) and traveling up to the heart and lodging in the lung where the vessels get small again. This is called a pulmonary embolism. The risk of a pulmonary embolism varies depending on the specifics of each patient.

Risk of developing a pulmonary embolism for those who smoke, are unable to walk, and have an INR level of 1 (INR is the blood test that checks how well the coumadin is helping stop blood clots from worsening). It is good that your INR is almost 2 . That helps the natural process of your body to dissolve the clot.(This is especially true when the INR is between 2 and 2.5.)

Your risks are lower because you had the DVT recognized early, you know the likely cause, started treatment, and have been made aware of what symptoms to look for in the future. These symptoms may include sharp chest pain when taking a deep breath, shortness of breath, and in rare occasions coughing which produces blood. Some people who develop a pulmonary embolism may have had no warning resulting in inadvertently delayed treatment. If you know where the clot is exactly, that may also help gauge your level of risk (i.e. further from the heart, the better – - so, calf is better than in the thigh).

Ask your doctor if you have any further questions and discuss the chance for future DVT. There is a small risk of recurrence and your doctor will know more about your individual level of risk for this.

Daniel Haight, MD
Sep 4, 4:48 PM

LeeAnne, These sensations, feelings and symptoms would cause most people to search for answers.
Are you spending hours researching this on the internet or rushing to the urgent care clinic only to find out that the doctors cannot find a condition that is causing the sensation you are worried about?

When consulting a healthcare provider regarding particular symptoms, they will look at vital signs first to help decide how serious a condition is and the progression of the symptoms. Once that determination has been made then the tests you mentioned may be performed to help rule out important, treatable, or dangerous situations.

It appears from your post that this may be what you have experienced as you seek answers. There is some reassurance that at the time of your clinical visits, a clot needing immediate treatment was not present or a different course of action would have been taken by your physician. The dizziness you are experiencing may need to be assessed by a neurologist. Any additional new symptoms may also need to be evaluated.

A clot can usually be found, so if tests looking at your chest (High resolution CT scan) and legs (venous Doppler ultrasound) showed no clot, then it is unlikely that a clot is causing your symptoms.

Find a doctors that you feel comfortable with that will explain the process of each test and their strategy for ruling out if you have a certain condition.

At the same time you are addressing treatment for a possible new symptom (such as a neurologist for the dizziness) you should consider a behavioral health counselor to help you with coping strategies.
There are medications that may help along with counseling that put these sensations in perspective and may help you better navigate medical problems so they do not disrupt your day to day life.

Sorry I could not help more, and these comments may not apply to your particular situation, but I hope you find relief.

Arle Seaton
Aug 29, 3:19 AM

I am a 38 yr old male who until this year was a very healthy individual. In the past 3 months I have found out I have ulcerative proctitis, had a severe disc herniation which led to back surgery last Wednesday, which led to a DVT that I just found out about on Sat. I wasn’t hospitalized. I am on Heparin injections daily for 5 days along with warfarin for the past 4 days. My INR is at 1.8 and I am supposed to get between 2-2.5 . My question is this… Since I wasn’t hospitalized (they did ultrasound to find it) does that mean it wasn’t as bad as others with a DVT? What percentage of DVT ‘s turn into PE’s? My mind races about the fear of a PE, so any insight would be greatly appreciated!

LeeAnne
Aug 24, 12:28 AM

Hello, I’m a 25 year old female who has been having leg pain, chest pain, and horrible dizziness for almost a year now. I’ve been to many, many, many different doctors including a cardiologist and hematologist. None of them have found anything wrong with me except the MTHFR gene mutation (I’m homozygous). I know you can’t diagnosis online, but I’m asking could my chest pain and dizziness be from a small clot in my chest? How long can a clot last without breaking free and causing more serious symptoms? I’ve had a ct of my chest and it was normal and an echocardiogram of my heart and it was normal.

Dr. Daniel Haight
Aug 19, 10:48 AM

Luz,

There is no way to confirm what dissolving blood clots feel like. Any out of the ordinary sensation in the chest is worth questioning your doctors. The cause can be one of many possibilities. With regards to blood clots, the most important issue is to make sure the blood thinning medicine is at the right dose so as to reduce the risk of more clots.

Other possible medical conditions causing the issue should be evaluated and your doctor should ask (or already knows) about other factors such as:

Your age
Smoking history
Other medical problems and operations (heart disease etc.)
Family history of heart problems, blood clots, etc.
When does the “icy / hot” feeling happen? Are you active, walking, upset, breathing heavy, working, etc?
Does this feeling travel anywhere like down your arm?
How long does it last?
What makes it better?
What makes it worse?
Do you know of anything that triggers the sensation?
Does it happen at a particular time of day?
Does it ever wake you up?
Do you get dizzy?
What is your pulse at the time? (see previous post or search the Internet regarding how to take your own pulse)

These questions are best asked and answered face to face with your doctor. Depending on some of your answers to these questions, there may be additional questions that need to be asked. The answers you provide may also lead to changes to the kind of exam the doctor might perform.

Do not respond to this website, but take the answers to these questions to your next doctor visit.

Dr. Daniel Haight
Aug 19, 10:05 AM

You are not alone: almost every nursing and medical student develops symptoms of at least a few of the conditions they read about or see. I was convinced I had a pneumopericardium (as soon as I figured out what that was!).

There are many conditions that could cause your symptoms including a bruise, strained muscle, a baker’s cyst (collection of fluid in a person who kneels a lot), superficial varicose veins, pain from something else nearby (knee or Achilles tendon), and possibly a blood clot to name a few. A bruise is blood that has leaked out of a blood vessel. The medical term for this is “hematoma” and when it is close to the skin, it can be seen as a bruise. Bruise can also happen deeper where you cannot see them under the skin but you might be able to feel them.

The “clots” in this forum are the ones that form inside a blood vessel such as a vein. They often lead to swelling of the leg if located in the calf and are sometimes tender. This is very different than a bruise because a clot in the vein can move with the flow of blood. This is called an embolus. If the clot gets stuck in a smaller vessel, blood flow will stop. Risk factors that contribute to this condition include taking birth control pills and recent lengthy travel where you may have been sitting for a long period of time. You mentioned the other risk factors that you do not have.

Generally, a clot is more concerning than a bruise. From what you describe, I cannot be sure if it is a bruise, a cyst (such as a baker’s cyst that is a mild collection of fluid behind and below the knee), or a clot in the leg vein. Also, if your foot swells on the side you have the tender calf; this could be something more serious than just a bruise, such as a clot.

For a bruise, a possible cause of blood leaking out of small blood vessels would be trauma and that can explain why it would be tender. Bruises naturally go through color changes as the blood breaks down and is absorbed by the body such as reddish / blue to green and then fading to yellow before disappearing. Tenderness should get better even though a lump might be present for some time. It should not get larger or more painful. If it is getting worse, then it needs medical attention. Large bruises or bruises that develop for no certain reason also warrant medical attention.

If this does not get better, or becomes worse, you should see your doctor.

Sara
Aug 16, 10:37 PM

I’ve been reading this forum, and I used to live in Lakeland, FL. My primary hospital I’d go to was Lakeland Regional, wonderful hospital. I do have a question. I am 29 year old female, about 30lbs overweight, I am a Unit Secretary, but I am always up, moving around, and I walk at home and have children who I am constantly chasing around. I do not smoke, I drink plenty of water, and I am working on losing weight. My question is, I’ve developed a bruise on my right calf, back of my right calf, and it only hurts when I push on it, like a bruise would. Does this mean I have a blood clot? I am going through nursing school, and of course I am very hypochondriac at this point, and I don’t know if a bruise points to a clot. There’s no swelling, redness, it’s not hot, it doesn’t hurt when I flex my foot either up or down, but I am always worried about clots, so I constantly make myself move around. I’ve been reading everything you’re listing, and you’re very informative, and I really appreciate it! I’ve been walking alot the last few days, so I am assuming it’s more towards that reason. I’m not asking you to diagnose me over the internet, because I know being a in the medical field you aren’t supposed to unless I am your patient. I’m just wondering if a bruise , normal looking bruise, that you press on and it hurts can be considered a blood clot, just because of it’s location. It only bothers me because of the location obviously. THank you!! :)

Dr. Daniel Haight
Aug 14, 2:27 PM

The clots referred to in this blog are blockages in low pressure veins. Some of these types of clots can break off and flow from the legs to the lung causing serious problems.

In your father’s situation, you may be describing a blockage in a higher pressure blood vessel called an “artery” that carries blood from the heart to the legs.

Blockage in an artery is serious due to the reduction of the flow of oxygen rich blood to the muscles of the legs and skin. This can lead to pain and other problems including skin changes and risk of serious infection. Blockage may also occur due to narrowing of the inside of the artery attributed to cholesterol, smoking, sugar diabetes, and fatty foods.
The risks for these problems can also run in the family.

In this case, treatment options may include diet, medication and sometimes surgery to add a blood vessel that will transport blood around the blockage (a bypass). Sometimes, if damage has already occurred, the doctors might recommend removing the damaged areas if the body cannot heal itself with other treatments.

Treatment and options are based on individual’s situation and health condition. Everyone is unique in regards to their overall health and risk factors. Arrange to connect with your father’s doctor face to face so that they may answer your questions and address your concerns directly.

Monica
Aug 12, 4:04 PM

My dad had a bypass last year for clots in his leg. I found out today they have come back and the doctor said there isn’t anything else they can do. So, how serious is it and what does that mean exactly? Thanks.

Luz
Aug 9, 1:37 PM

How does it feel when clots r disovling i have lung clots n now taking a pill blood thinner but i experinced like a icy hot feeling on my left side chest n went to the doctor n he said it could be my clots dissolving felt so scary :( need 2nd opionions

Dr. Daniel Haight
Jul 31, 3:07 PM

Elsa, That is a really hard question to answer. A dermatologist may need to look at it and ask more questions.

A doctor looking at this problem will wonder if these are bruises or a skin reaction. There can be many causes.

These may not be clots, but rather, normal veins that are more visible than others.

Sorry I could not be of more help, but for overall good health, a visit to a general doctor might be the best place to start. Consider a family practitioner or an internal medicine physician.

Daniel Haight, MD

Dr. Daniel Haight
Jul 31, 2:45 PM

Pam, Thank you for sharing your question. There is no way to say for certain what is causing these episodes

Fortunately this has only happened rarely and not caused you to pass out or fall. If these become more frequent, longer in duration, or happen along with new problems, then seek medical attention. But otherwise, during your next visit with you doctor you should discuss these episodes. Here is some advice that will help you describe your problem to your physician:

Physicians and patients often benefit from a carefully obtained history of the problem and a complete exam. It is good that you can provide some helpful descriptions but more information would be needed by your doctor to help.

It is good to note when these sensations occur on a calendar or a notebook. Consider journaling this information:
- How long do these episodes last? Seconds or minutes? Time the episode when they next occur.
- What time of the day did the episode occur?
- What position were you in: standing, sitting or laying down?

Your doctor may ask what were you doing at the time:
- Had you just stood up within the last 5 minutes? Are you on blood pressure medications?
- Had you just turned your head and neck to the side and/or up?
- Did you feel your pulse at the time by placing your index and middle finger over the artery on the underside of your wrist? What was the heart rate (by counting the beats in one minute). Was it between 60 and 100? Were the beats regular or were there pauses between some beats making it irregular?
- Do you drink coffee or other drinks with caffeine? Or take diet pills?
- Do you smoke or take birth control pills?

Moving up from the heart:
- Have you ever had problems with your thyroid?
- Did your vision change during this episode like a curtain coming down from the top? Was it in one eye or both? Or did your near black out seem like a fading picture?
- Any ringing in your ears?
- Did the room spin?
- Did you have trouble walking?
- Any trouble talking or thinking?
- Did anyone around you at the time notice anything out of the ordinary?

Family History:
- Has this ever happened to siblings or parents?
- Any diseases run in the family?

Your doctor will want to listen carefully to your heart and to the flow of blood in your neck arteries. He or she will exam your thyroid. There is more to the examination and perhaps some tests depending on the information above.

One clue about blood clots: they almost always cause problems on just one side of the body and not both. While you can “never say never” in medicine, it would be rare for blood clots to cause problems on both sides. Feeling light-headed has many possible causes and often needs a doctor to check for problems that could get worse.

It would be better not to answer these questions over the internet or in a reply, but rather use the information above to prepare for a doctor’s visit if you feel these episodes are getting worse.

Take care,
DH

Pam
Jul 30, 8:52 PM

I am a 51 year old female in excellent health. Occasionally (maybe 4 or 5 times in the last 3 years) I feel suddenly light-headed as if it continued I would black out, then I feel a release as if a clot? passed through a tight space, then things go back to normal. There is no pain and I am not exercising at the time. It take about 2 seconds. This release feeling has been in my head a few times and once in my chest. Is this normal? Any explanation of what could cause this?

Elsa
Jul 26, 1:20 AM

I keep getting blood clots on the scalp of my head. I don’t wear tight hairstyles….so, what could this possibly mean?

Dr. Daniel Haight
Jul 25, 4:04 PM

Peggy – I am sorry to hear about your condition, and I can understand your concern.

One person’s blood clot in the leg can be very different from another’s. For example, the veins take almost random paths back to the heart and branch in a variety of ways. So the location of one person’s clot is often different than another’s clot. One person’s clot might be more inflamed, or even mildly infected, causing it to take longer to return to normal. Blood flow may not be as effective after a clot or during the healing process so there can still be some swelling. It is important that none of these problems get worse. Oftentimes, it will stay the same for a while or slowly get better.

That is the key issue – it takes time to see if the discomfort fully resolves. The hope is that it will and for you it is still early. If it is ok with your doctor, try wearing special elastic compression stockings that help the leg. Sometimes they are recommended for using up to two years. They might be expensive, hard to put on, and hot in the summer, but they help the flow of blood out of the leg. The goal is to get you back to activities you enjoy.

If the discomfort continues, you are not alone. For some patients, if many months go by with the same discomfort, it is called postphlebitic syndrome. Each person might experience this differently, but problems would include chronic leg swelling, visibly enlarged veins and pain. For some it is mild but it can a bigger problem for others.

The patients who have the most problems with this are those who are recovering from a second DVT in the same leg. So discuss with your doctor how to prevent this from happening again. If a person was a smoker or taking birth control pills, that would put them at risk. Planning a long drive or flight can increase the risk of DVT. And in your case, future surgeries that limit the movement of your leg can increase the risk.

Peggy
Jul 22, 9:44 PM

I am 52 yr old female; recreational runner, good health. I had medial meniscetomy surgery 2 weeks ago. One week out surgery developed pain in leg behind knee and sent for doppler; found 2 blood clots in leg. Sent to ER for lovenox shots and coumadin. I want to know if after finishing a regime of coumadin due to blood clot which resulted from surgery. Will I always have Pain in my leg. In other words did this DVT create a situation where my leg will never be pain free where I can stand for 8 hours?

LJ
Jul 20, 1:58 AM

I had a supposed PE discovered by accident while undergoing a CT for a different reason. I had and have no symptoms of any kind. ER declined to use Heparin while I was being observed but sent me home with Lovenox and Warfarin, mumbling something about malpractice otherwise and advised that I was going to have a long difficult talk with my GP about whether or not to be on Warfarin. Right. The appointments aren’t long enough for a difficult talk. I’m now on Warfarin, and the restrictions in diet and activities and the potential for harm from Warfarin have made a serious dent in quality of life. Moreover, I suspect the diagnosis is incorrect, partly because mistakes can be made in interpreting a CTA and because the diagnosis was made in the absence of the patient, family history and information about other possible causes. It’s been a difficult wait to get a second qualified opinion. Finally, I was loaded with significantly more than a maintenance dose of Warfarin in the initial ramp-up which I since have learned is counter-productive for anti-coagulation and does not create added benefit for thrombosis protection. The frustrating part is there is no time to have a rational discussion with anyone. You would think a visit to a pulmonologist or a hematologist would be would be standard fare for someone put on Warfarin because of a PE.

Cecile
Jul 12, 8:29 PM

I was diagnosed 10 yrs ago with a dvt. I went through 6 months of anticoagulation. Recently I went to the er with rapid heart rate and dyspnea. CT of the chest was negative for PE. Ultrasound was done on my legs. Non occlusive Clot showed up in the same leg same place as 10 yrs ago. Some say your body absorbs the clot others say that it never dissolves but new tiny vessels grow through the clot in the vein so blood flows. What is true? And could this new found clot really be the same clot from 10 yrs ago. Please relieve my questioning on this as I am over weight and trying to srart a new weight loss program and don’t the worry. Thanks so much. Cecile

Krystal R
Jan 25, 6:47 PM

Thank you for your reply. You have a great way of explaining things and you share some really valuable information here.
I will follow up with a primary care doctor and see what this is about.
Again, thank you so much.

Daniel Haight
Jan 25, 4:12 PM

Those are good concerns and when there are unexplained symptoms, such as pain, further visits are helpful. But in this situation, it would not to go to an ER if there are no new problems.

Yes, a person can have chronic blood clots but the most serious clots will produce more than just pain (such as swelling and skin discoloration). Not having those other problems does not bring the chance down to zero. Very little in medicine can be described with the words “always” or “never” – - so there is a possibility and it is good to have this rechecked for reassurance if the pain remains.

You may already have one, but the best place would be a primary care doctor that knows you well (or can get to know you). They may see minor changes in your leg examination that will help them find the cause.

Sometimes, by talking with a person, you learn that they may have worked in a job where they knelt on their knees a lot. That causes a “baker’s cyst” to form in the upper calf. It is a small sack of fluid that the doctor might feel when touching your leg.

There are other problems like arthritis;

There is also something called “referred pain” where you feel it in the calf, but the source of the pain really is the knee or the tendons around the knee or from the ankle or back.

It is often good to ask the doctor for a list of what could be causing the pain. Then, for each possible cause, ask what are the chances and why a test may or may not be needed.

Krystal R
Jan 25, 2:26 PM

Thanks for the information. I have had pain (feels like a headache in the leg) in the back of my right calf just below the knee on and off for a little over two years now… no swelling or anything else.
One year ago, after a little more than a year of having the pain, I went to the ER and the physician took one look at my leg, listened to my symptoms (pain) and told me there was no way I had a blood clot… and that even if I did at one point, it would have attached by that time.
That made me feel better, but here it is a year later and I still have this pain.
I know you can’t and wouldn’t want to diagnose over the internet… and I understand. But my question is, could a person have a blood clot for over two years with no other symptoms other than pain and would it still be in danger of breaking off and traveling?

I appreciate your information… thank you.

Dr. Daniel Haight
Jan 18, 11:06 AM

Since everyone’s medical care is unique, sometimes an answer to a question may be incomplete if not answered by the doctor who meets the patient face-to-face for a discussion, examination, and review of all test results.

But in general, heparin is quick acting and is used first when a blood clot is discovered. Its blood thinning effect can be controlled and monitored easily in a hospital by using a special blood test. It is either given through the vein by dripping it in continuously or injected just under the skin. Its thinning effects on the blood can be reversed by slowing it, stopping it, or giving the patient a medicine that reverses its effect.

Coumadin (warfarin) has the advantage of being a pill, but it works too slow to be used when a blood clot is putting the patient in danger. Vitamin K reverses the blood thinning effect but it is not easy to fine-tune the effect quickly like heparin. It cannot be used in pregnancy, so a woman who needs her blood thinned at home would need to inject heparin (or a similar medicine) each day.

So it is understandable that if a person develops a blood clot in a blood vessel, the first step would be to start heparin and then begin coumadin. When blood tests show that the coumadin is fully working, the heparin can be stopped and the person can go home on coumadin. This person would need frequent blood tests to make sure the coumadin dose is right for them because many things affect how coumadin works such as a person’s diet.

It is also common to use a low dose of a medicine similar to heparin for patients who cannot get out of bed in the hospital (to prevent blood clots).

There are other blood thinning medications available for various uses, but that would be better to discuss later as it is a lengthy subject.

If the blood is too “thin”, bleeding can occur. If too “thick”, blood clots can form. “Thick” and “thin” are not scientifically accurate terms, but do get across the message that the action of blood clotting (or not) is a delicate chemical balance that our bodies do daily. Truly Amazing!

Mike
Jan 14, 8:55 AM

How is heparin different than
Ccoumadin and what therapies indicate its use over Coumadin?

Dr. Daniel Haight
Jan 10, 3:01 PM

That is a common question and as you point out, it can be frustrating not to know the exact reason.

Many times, a disease cannot be blamed on an exact cause and a satisfying answer can never be given. But the next best approach is to learn about what would increase the risk for a disease or condition to appear.

First, a pulmonary embolism can occur for no reason in an otherwise perfectly normal and healthy person. You mentioned one risk factor, birth control pills, that may increase the risk of blood clots but the risk is still small. In fact, some birth control pills are designed so as to lower the risk further.

Other risk factors include:

  • Smoking
  • Dehydration (being dry and thirsty)
  • Sitting for many hours without moving
  • Being in a family that suffered blood clots in the past
  • Pregnancy
  • Certain cancers
  • Being overweight
  • Recent surgery
  • Heart valve problems
  • High blood pressure
  • Experiencing a blood clot in the past
  • It is understandable to be concerned, but it is good that you have discussed steps to help reduce the risk of future pulmonary emboli such as the filter. To learn more about your personal treatment options and risks, please ask your personal physician since it is hard to answer some questions without an in depth discussion, examination, and review of all medical records.

    A person who has never had this problem does not know what it feels like, but your experience helps you understand the problem you had in 2011 and knowing to seek medical attention if a concern arises.

Shandria
Jan 9, 4:21 PM

I was hospitalize in July of 2011 for P.E. and no one knows how it formed. Only thing the doctors can tell me was it probably came from birth control. I’m scared to the day because I really don’t know how it formed. I have an IVC filter in my right leg, will that prevent clots from forming?

Dr. Daniel Haight
Jan 4, 2:49 PM

To bring one of these example full circle:

A blood clot stuck on the inside wall in the heart, called a mural thombus, could break off and float down stream inside a blood vessel. This is called an thrombotic embolus. The problem is that this inside of a blood vessel normally become smaller and smaller to the point where an embolus gets stuck and blocks the flow of blood.

If this happens in the brain, it will cause a stroke.
If it happens in the small blood vessels of the lung, a person cannot get oxygen into the blood.
If it happens in the small blood vessels in the foot, a toe might turn blue.
If it happens in many places, or if a large embolus gets stuck in a large blood vessel, too much blood flow will stop and the blood pressure will fall to dangerously low levels.

Each of these problems would normally alert the person, or a family member, of something seriously wrong and the need to go to an emergency room

To review:
- Hematoma is a bruise and is made out of clotted blood
- Embolus is something solid floating in the blood stream (could be a clot, foreign object, a clump of germs, or a clump of cholesterol)
- Thrombus is clotted blood inside a blood vessel
- Mural means wall
- A blood thinning medication helps clots dissolve but can cause bleeding in certain circumstances

Dr. Daniel Haight
Jan 4, 10:03 AM

A hematoma is a collection of blood outside of a blood vessel. The more common name for a hematoma is a bruise. It is made up of clotted blood. This is often caused by an injury. A blood clot that forms inside a blood vessel or the heart is never called a hematoma. This is called a thrombus.

Here is how these terms are often used:
A blood clot stuck to the inside wall of the heart is called a mural thrombus.

If a person injures their head and causes bleeding outside of the blood vessel between the brain and the covering around the brain (called the “dura”), this is called a subdural hematoma. This would never be treated with blood thinners since that type of medicine might cause further bleeding.

A boxer after a fight who suffered a black eye would thus have a peri-orbital hematoma. Peri-orbital is another word for “around the eye”.

Terry
Jan 3, 10:45 PM

How does a blood clot differ from a hematoma?

Dr. Daniel Haight
Jan 3, 2:08 PM

Yours is a great example how rapid treatment for a pulmonary embolus can save lives.

I’m glad you mentioned the key issue of prevention. For some patients it means taking a blood thinner like Coumadin (a.k.a. warfarin). How much it “thins” the blood is monitored closely to make sure the dose is most effective since that might change over time. Have a wonderful New Year.

Jacqueline
Jan 3, 12:13 AM

LRMC saved my life 7 years ago when a ER doctor found that I had bilateral pulmonary conboli. I am thankful for Dr. Escois (not spelled correctly) and would like to express my gratitude! I am still on coumadin as a precaution but doing well. If it wasn’t for advanced care and amaxing doctors at your facility I would not be here. Thank you!

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