Pulmonary Embolism. Please help. <br />I am a 20 year old, slightly

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Pulmonary Embolism. Please help.
I am a 20 year old, slightly overweight, female who was hospitalized for 1 week due to Pulmonary Emboli. On Aug 30, I was admitted into the hospital due to blood clots in both of my lungs...I underwent treatment with hephrin [sp?] and coumadin for 5 days and was released.
3 weeks later, I am experiencing the same symptoms as I had experienced prior to my hospital visit. I am short of breath, pressure on my chest, etc. I am very scared as I know PE is a life-threatening disease.
What could this be? Why would this happen again? I am currently on 5mg of coumadin, every other day...and 2.5 mg the days in between. My levels were tested a week and a half ago and my dr. insisted they were "perfect."
I do have a dr. appointment for tomorrow afternoon...however, I need to rest assured so I am asking someone to help me right now.
What could be going wrong....would I be clotting even more after taking the coumadin? What kind of questions should I ask my doctor tomorrow afternoon?
Please help

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It is indeed possible to have another pulmonary embolism (PE) despite having a therapeutic level on the PT/INR (the test used to measure the effect of Coumadin)

I have had a number of patients present with recurrent pain, and in most cases it isn't another PE - if their levels are good. It has been about 10 days since your level was checked and it is possible that it may have changed.

If you are indeed having the same symptoms, it is probably a good idea to go to the emergency department and get checked. Sometimes the need to insert a filter in the inferior vena cava (large vein in the abdomen) through a small surgical procedure to prevent recurrent PE.

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Reply to Family Physician's Post: Thank you for your prompt reply.

That surgical procedure sounds very intimidating and extremely painful. haha What's the likelyhood of having to undergo that treatment?

If it is not a reoccuring PE, what else could it be?? Would I need a change in my dosage of Coumadin? Does that play a large role in the symptoms I am experiencing??

I could be just some musculoskelatal pain (chest wall pain), bronchitis, pneumonia

The procedure is actually very simple (not to insult the surgeons out there)

You dose might need to be adjusted if the PT/INR is not in the right range.

If your Coumadin is not at a high enough dose - the clots can continue to get larger - and pieces can break off (causing another PE)

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Reply to Family Physician's Post: Would this pain be caused because the dosage needs to be tweaked??

Is the surgery out-patient? How big is the incision?

If it is, indeed, another PE...what should I expect? I'm currently a student and having another week-long stay in the hospital is something i want to avoid

The only way to know if the dose needs adjusted is to have it checked. The pain may have NOTHING to do with it at all. You dose might be perfect! There is no way of knowing.

The incsion is very small - in the groin usually, and the filter is inserted through the vein. You would probably NOT need to stay in the hospital more than overnight.

Based on your symptoms - I would strongly suggest that you go to the ER and get checked. If it isn't a PE - we all sleep better tonight. IF it is, it may save your life.

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Reply to Family Physician's Post: I have a 10AM appointment with my doctor tomorrow morning to get my levels checked.

Would resting this evening, with little to no movement, do more harm?? I am by myself until 4am and do not wish to go to the ER without my parent.

As you know - PE is a potentially fatal condition. When I have a patient with these symptoms I insist they go to the ER.

Waiting is a GAMBLE with your life.

Paraphrasing the Monopoly game: Go directly to the ER, do not pass GO...

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Reply to Family Physician's Post: Would waiting until 4am be too much of a "gamble."

And, I'm confused in regards to the Coumadin. COULD the wrong dosage/off levels of pt/inr cause these symptoms?

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Pulmonary Embolism. Please help!!!!

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