If interested, I can help you to clarify the ultrasound report If you post it to this forum. Spent fair aount of time studying venous anatomy and ultrasound technology after my DVT.

Went to my dr today or my INR check. My number was 3.3. My dr can't understand why I got another clot as I have been on treatment for 2 years this September. It is a new clot. The entire time my numbers have been spot on. I go see the hematologist on Thursday afternnon. I hope to get some more answers to my questions.

Okay so I went to the hematologist appointment last week..... My appointment was at 230, didn't see dr til close to 4. That started it all off bad. I understand there is other patients and such but that much of wait is crazy to me. When I did finally see dr she looked at leg asked few questions and that was bout it. Entire appointment with the dr was maybe all of 10 minutes. I truly go no more info or answers than I already knew. Said we may change your range but we could leave it where it is at. Told me she would like another untrasound in a month to look at and see me the week after that. She didn't even want to do any lab work....
Feeling totally confused and powerless

Ugh... having an appointment like that is just frustrating. A couple of suggestions for you...

(1) You're not powerless! If you're not happy with that hema, go see another one. Or go back to your primary and ask more questions. There's no reason to assume that one hema is the end-all-and-be-all.

(2) Make appointments first thing in the morning. Doctors aren't running behind yet and they aren't as tired/crabby as they are by the end of the day. I hate being up early for appts, but this is totally the best way I've found to avoid getting blown off as much.

(3) Write down your questions and refuse to leave until the doc answers them all. You're paying for their "expert" advice so might as well make sure that you get it. This is no time to worry about being a "bad" patient.

(4) I don't remember what you've already been tested for, so its hard to say if the doc had any more tests to run. I'm not surprised she didn't look at your leg much. I don't think my hema cared what my leg looked like one way or the other. The big issue was WHY was I clotting. Legs aren't really the focus of the hema visit.

Hang in there! Decide what you really want an answer to and figure out who is most likely to get you that answer (primary, specialist, hema) and go from there. You've got this.

Here is the actual report from the ultrasound. Thank you
Result:

CLINICAL INDICATION: History of venous thrombosis with increased swelling and

erythema.



TECHNIQUE: Sonographic evaluation of the left lower extremity veins was

performed utilizing B-Mode/gray scaled imaging and Doppler spectral analysis

and color flow.



COMPARISON: 9/15/2014.



Findings:



TECHNIQUE: Sonographic evaluation of the left lower extremity veins was

performed utilizing B-Mode/gray scaled imaging and Doppler spectral analysis

and color flow. The contralateral common femoral vein was interrogated for

assessment of symmetry, for evaluation of possible pelvic venous thrombosis.



FINDINGS: There is intraluminal thrombus seen within the left common femoral

and iliac veins. The left femoral and popliteal veins are unremarkable.

IMPRESSION: Positive examination for deep venous thrombosis involving the left

common femoral and iliac veins.


Back to the Test Results List

I had a list of ?? for the dr and did my best to ask them, but she insisted that wearing compression stockings were useless. I didn't need to change my routine or diet. I wasn't expecting miracles on the first vist but a bit of compassion would have gone a long ways. I stopped at my dr this afternoon. My range is now 2.5-3.5 instead of 2-3. My inr today was 2.7.
I guess at this point I am just numb with confusion.

Here is some clarificaiton of the ultrasound report
erythema-reddening of the skin
They used doppler and color flow. This is useful to check out the flow through the vein (but not as accurate as venography). They also checked out the veins in the right leg in the pelvis (i.e. iliac veins) for clots, but these veins are fine.

So the result is. The common femoral vein and the Iliac vein have clots. The common femoral vein is located high up the thigh (around 3/4) . It starts where the femoral vein meets the deep femoral vein. In the Pelvis (around the inguinal ligament) it changes to the iliac vein. intraluminal- means within lumen or tube/vein. The femoral and popliteal veins have not clots. The Popliteal recieves blood from all the calf muscle veins and starts below knee cap and ends just above the knee and extends into the femoral vein runs up most of the thigh., i.e until it becomes common femoral.

Following the ultrasound report, I have few questions
1) The DVT you got in 2014, where did the clotting take place? Do you have that ultrasound report? Are the doctors sure this is a new DVT but not old clots from a previous DVT.
2) The fact that you are prone for clotting, have a DVT in the femoral and iliac veins in the left leg, the question is whether you have been checked out for May-Thurner syndrome. Then risk of May thurner appear to be greater for women than men and occurs mainly in the left leg. It involves a compression of the iliac vein.
3) Have the doctors offered explanation for the itching in the upper thigh?

Few other comments related to previous messages
1) With regard to the hema visit, then it is too early to check out for clotting factors. You are on anticoagulation which will bias results for most clotting factors.You can have another ultrasound after some time, but you may want to wait a longer than month if these are expensive.
2) Recent study have shown that compresion stocking do not reduce the risk of PTS. HOWEVER, they can reduce swelling symptoms, and as such useful.

Wow! Thank you so much for the English version!! As for the first ultrasound 2 years ago. I have no idea what that one said. all I was told is I had a clot from upper leg to lower leg. The hospital gave me lovanox injections for a wee, cumadin and a pain killer. Was told to follow up with a dr. All ultrasounds have been done a same hospital so I am willing to bet I can look into it. They can't tell me if it is new clot or first one.
Again thank you so much for the English understanding of the report. I tried to look it up and even asked the hema dr but got nothing.

OK, so based on what you say then it is not clear whether the clots you have now are new ones or residual clots from the 2014 DVT. This is kind of important to know. If you have a new clots, then anticoagulation treatment is necessary to stop further clotting, during which the body breaks down the clots.

However, if these are the residual clots from the 2014 DVT episode, i.e no new clots, then anticoagulation treatment is unnecessary, UNLESS, the risk of another DVT event is high, in which case a lifelong anticoagulaiton treatment may be necesary.

Separating between very fresh (few days) and residual (several months to several old clots) is generally easy,. However, if the clots have hardened a bit, it can be difficult to separate from residual clots using ultrasound, i.e and takes lots of training. There are other methods to verify if the clots are old or new. Venograph can be helpful.

I would get an optinion of an other doctor (e.g vascular surgeon) to verify whether the clots that are picked up by the ultrasound are new or old. To me that is important to know with respect to the appropriate treatment.

A radiologist can asses the scans/reports and usually can determine of it's residual clot vs new clot. If they can tell it's an old clot, it's usually noted by the radiologist on the report. So, it truly may be that it's undetermined, and that's the reason for the doctor ordering a second ultrasound..

If it were me, I'd just wait and have the second ultrasound and see what that reveals. Most docs run behind, but specialists really run behind. I suspect she may have felt there was not enough information at the time to really make an assessment, particularly if you're a new patient. If after your second appointment, you feel like it's going nowhere, I'd get with your primary and just be frank that you want a different approach or different hema. I agree with Toss to take control, and sort out what you feel you are looking for. If you're most comfortable with your primary, start there.

Sorry you're frustrated. I know it's hard when you feel like you have no answers or that you're not being heard.

Well when to the hema on June 9. saw her for all of bout 10 min if that. told me to do what ever I feel I can. Not to wear compression stockings as they make things worse. along with get another ultrasound and see her the following week. Had second ultrasound 2 weeks ago and saw her last week. in her office all of 5 minutes to be told it is primary clot from 2 years ago and she sees no reason to treat me or see me anymore. Needless to say I was put off by this and got in touch with my primary. They are removing the hema from the referral list. I see my primary in few weeks for INR check and will discuss my options then.

Hi Yes it seems that your doctor is quite arrogant. Did she provide reasons for not using a compression stockings. If these reduce symptoms, I assume it would be useful to have those. If the clots are residual clots from the DVT from 2 years ago, then your doc is probbaly correct, and perhaps there is no need for further full anticoagulant treatment. If these are the clots from 2 years ago, then these are not going to change in the years to come, and will (if not already) part of the vein (overgrown by scar tissue). The question is whether the residual clots are slowing down the blood flow or not. If they do not, then there is no need for anticoagulant tretment. If they do, then perhaps some anticoagulant treatment is necessary,. This can be checked by having a venogram. If you are concerned, then you can take baby aspirin (75mg per day is enough) or low dose of xarelto. These have some limited use in reducing the risk of clotting, but far from as effective as full anticoagulant treatment. However, the bleeding risk would be low.

Arrogant, sure. Most docs are. My take is she just has a lousy bed side manner. The finer point is whether her clinical assessment makes sense and she probably doesn't need to see you. That's a positive. What she's saying seems to make sense. . Some docs don't recommend stockings. But you can try them if you want. Stockings can sometimes make your leg more painful so that may be what she was getting at.

I know it sucks when we feel sort of dismissed or when the doc just has poor skills when it comes to talking to us. I've had that too. You just have to sometimes set that aside to determine if their assessment seems to make sense.