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pain possible clot
Sent to Health Experts June 14 10:59 PM

may 8th i had a spinal tap due to the worst migrane i ever had. may 11th i started to feel burning or noticable discomfort pain on my inner right thigh.i saw the doc. 2 weeks later, he said don't worry. then i started to get the same discomfort in close to the same spots but much lighter in the left leg.3rd week pain in right thigh still and now sharp pain on top and behind knee and inner side of calf. went to the er they performed a doppler ultrasound. it was neg. still with the pain (off and on again no matter at rest or exertion more i guess just standing) i went back to the er.3 days later and they did a d-dimmer (dont know the elavation) came back neg. 45 mins. later. now in the 5th week, 4 days ago left leg has a cramp, off and on,starting behind knee to almost the butt and about to mid calf. some pain in between crevase of pubic area and thigh mostly right side. also 3 days ago right calf and inner ankle dont look but feel tight, heavy,swollen with slight cramp feeling. pains in pubic area are mostly gone as of today .after my spinal tap i layed around far 3-4 days. also i am on my knees alot at work for 20-30 min at time and when i get up i lose feeling and feel faint for 5-10 mins. i am 31 my cholesrtol is 240 heart disease on both sides of family. reading all this is it possible i have a dvt? how likely is it the d-dimmer was a false neg. since it wasn't with in 3 days (3wks) if it were a dvt? could, at work, always kneeling or crouching, slowly over time, slow my blood down and cause a clot? can one have dvt symptoms off and on that aren't to the exterme pain?and how reliable is the doppler? also i suffered a panic attack after they said i need a spinal tap and been getting extreme attacks after learning about dvt. suffered in the recent past with them for a couple years now. can panic or anxiety consrict my viens enough to cause dvt?thank you very much if you could answer these ?'s

 

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Answer
June 14 11:17 PM (17 minutes and 38 seconds later)
         
REPLIEDCheck Mark
A D-dimer is a very SENSITIVE test, which is very NON-specific.

Sensitivity is a measure of the ability to detect a condition. (A high sensitivity means there is a very low chance that the test will be "false-negative")

Specificity is a measure of how likely the condition is actually present when the test is reported as "Positive" - how likely that you have a "false positive"

The combination of a negative D-dimer AND a negative doppler ultrasound is a close as you are going to get to "100%" in medicine.

Other possible causes of the pain should be investigated including the possibility that a nerve was irritated during the spinal tap. If this is the case - I would expect the symptoms to gradually improve, although it may take a while

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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 14 11:29 PM (12 minutes and 39 seconds later)
         
Reply to Family Physician's Post: but i have read a false neg. can be if d-dimmer was taken too soon after a dvt or if it were delayed for several days. would something still have showed up in the test? and what are the chances a false neg.would be there 3wks. after initial leg symptoms?
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June 14 11:39 PM (9 minutes and 45 seconds later)
         
REPLIEDCheck Mark
You are suggesting that BOTH test missed the DVT. While anything is "possible", I think it is highly unlikely that this is indeed the case. (I assume that the person performing the doppler was reasonably experienced)

Here is a study which reviews the sensitivity and specificity of doppler for detecting DVT. You will notice that the test is more sensitive in detecting proximal (closer to the center of the body - the upper leg) than distal (further from the center of the body - ie. lower leg)
The PROXIMAL DVT's are easier to detect (they are the ones more likely to cause a pulmonary embolism - a blood clot that travels to the lung)

If you are that concerned - you should discuss your concerns with your physician, and see if he would repeat the studies.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16202135&query_hl=7&itool=pubmed_docsum


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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 15 12:45 AM (1 hour and 6 minutes and 26 seconds later)
         
Reply to Family Physician's Post: sorry it took so long. my little one awoke(shes sick). what if it were in the pelvis area,could a doppler still detect that? and can kneeling like i do cause a clot over time? and i think that'll be all. thanks
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June 15 12:53 AM (7 minutes and 28 seconds later)
         
REPLIEDCheck Mark
If you had a blood clo in the pelvis it is likely that you would have other symptoms besides the cramp. I would expect swelling of the leg.

I'm sorry to hear about your little one - how old is she? What is wrong with her?

Edited by FamilyPhysician on June 15 2006 at 12:54 AM

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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 15 12:59 AM (6 minutes and 23 seconds later)
         
Reply to Family Physician's Post: shes 19 months old. she had her pox shots last week and running a small fever. and just today i noticed 2 lima bean size bumps on the back of her head about 1 half inches behide her ears. any ideas?
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June 15 1:04 AM (4 minutes and 51 seconds later)
         
REPLIEDCheck Mark
Probably enlarged lymph nodes. With the fever and enlarged lymph nodes, I would think of a possible sore throat or ear infection. Usually there isn't much reaction from the Chickenpox (Varicella) vaccine. You could try some Tylenol tonight, and if she isn't feeling better by tomorrow give her doctor a call.

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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 15 1:08 AM (4 minutes and 13 seconds later)
         
Reply to Family Physician's Post: thanks for your advice doctor. and one more last thing would a venogram give me the best acurracy. ecspecially the pelvic region?
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June 15 1:17 AM (8 minutes and 16 seconds later)
         
REPLIEDCheck Mark
I just found this excellent reference to an article that addresses the "risk".
http://www.aafp.org/afp/991201ap/tips/2.html

The tests you have had done so far are completely safe - basically NO risks.

A venogram is an invasive study - which has some potentially serious complications - one of which is the development of a blood clot from the procedure itself. Another potentially serious complication - an allergic reaction to the contrast injected.
Here is information on the venogram and risk. This is the "gold standard" - however, it does have associated risks. In your case, I don't really think that there is a need for a venogram.
http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc_name=Venogram&content_id=272




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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 15 1:31 AM (14 minutes and 38 seconds later)
         
Reply to Family Physician's Post: thanks, but i still worry that my right leg keeps feeling swollen and heavy(knee down) off and on even as we speak. would dvt stay swollen? and would the d-dimmer have shown alittle bit of something even if it was given 3wks after first symptoms?
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June 15 1:41 AM (9 minutes and 30 seconds later)
         
REPLIEDCheck Mark
I would have expected the D-dimer to be positive. As I said, the test tends to be very sensitive (I personally hate to order the test because it is so seldom negative) - and you end up having to do the ultrasound anyways in most people.

You say that your leg FEELS swollen - but is it actually larger than the other leg?

Like I said, the venogram is the "gold standard" but it carries risks.

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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 15 1:53 AM (12 minutes and 26 seconds later)
         
Reply to Family Physician's Post: it dont look bigger than the left but it feels slightly tighter and swollen inside.can dvt feel that way off and on?
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June 15 1:55 AM (1 minute and 50 seconds later)
         
ACCEPTEDCheck Mark
Possibly

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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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June 20 11:44 PM (5 days and 21 hours later)
         
Reply to Family Physician's Post: 6-20-06       pain has now met my ankle and a   couple hours ago from the back of my mid thigh to my feet are numbing and tingling off and on. any ideas
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June 21 12:09 AM (25 minutes and 13 seconds later)
         
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Family Physician -- Doctor (MD) -- 99% Positive Feedback on 3962 Health Accepts
Physician with 22 years experience in Emergency Medicine / Family Medicine
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