Are you on anticoagulants?

If you went to the ER, they'd probably first do an EKG or something like that to make sure you're heart is ok. They won't always do a CT scan especially if you're on anticoagulants but if they suspect that you're throwing clots, obviously they will. They may do d dimer test but I know warfarin may skew those results, from what I understand.

It's a tough one, and I have a hard time telling people whether they should go to the ER or not. I will say I had plenty of ER trips the first 6 months after my PE. After that, I decided to do a more thorough assessment of how I was feeling. So I'd consider: a) what's my anxiety level (if it's high, it's like all anxiety related), b) is my INR therapeutic and c) when I totally relax (like in a meditative state) what exactly am I feeling. Sometimes when I relax like that and do a body assessment, I am better able to make sense of what I'm experiencing.

I also did a couple of ER trips after my PEs--one was even by ambulance--so there's no shame in that. It can be really hard to figure out what warrants a trip and what doesn't. IMHO, if you're going to be up all night worrying about it, you might as well spend that time getting checked out just so you can sleep later.

They don't always just throw you in the CT machine. For me, both times I went, it wound up being anxiety (which can cause all the symptoms that you mention and which just seems to get worse the more you think about it). They did check out my heart, review my history, and they might have tested my INR to make sure I was therapeutic. In one case, they put me on an Ativan drip (anti-anxiety meds) just to help me relax and make sure that my symptoms were related to that. They didn't do a d-dimer on me, just because they already knew I'd recently clotted and because I have a chronic DVT (and it might pick up on that).

It might be time to check with your doc and get some anti-anxiety meds OR to ask what symptoms, specifically, should take you into the ER. The thing with the meds (assuming you're comfortable with them--not everyone is), is that you can take them if you're having symptoms. If the symptoms go away, its a good indicator that you're dealing with anxiety more than more clots. If not, time for a trip to the ER.

It can be really hard to sort this stuff out, especially early in recovery. It gets easier with time, as you start to realize that a certain ache or pain comes and goes. If you're on anticoagulants and therapeutic, you're probably in good shape and you're dealing with anxiety. If not, there's no harm in getting checked out. And, really, ultimately, you need to do what you're comfortable with. If that's getting checked out, then go do it.

Thanks for the advice. I can understand the reluctance to tell anyone what they should do, for something that is so subjective and so potentially dangerous. It finally passed sometime after I finally fell asleep. I think if it had been during the day I would have gone in just for piece if mind, but I didn't want to drag my husband and kids out of bed. It is frustrating not knowing whether it's anxiety or something else. I felt pretty anxious and hoped it was just that, but it bothered me that it wouldn't go away when I relaxed my body or fell asleep. When I went in originally with my PE I had mistaken for anxiety attacks (which I'd never had) for weeks. I think I will go pick up the anti anxiety med that a doctor prescribed me, just for times like this to help tell the difference, and feel better in the process too. Both times that I went to the ER I called my doctor first and they insisted I go straight to the ER. Then upon arrival at the ER they basically told me I'm wasting my time there unless I want to subject my body to another CT scan. And no one could tell me exactly when I WOULD need to come in, really, except for more obvious symptoms. Oh, and I am on Xarelto. I think I would have been much more scared if I wasn't, which makes me nervous to come off in a month. I have a brother who got a large DVT on Lovenox after a leg break, so I worry about there being something hereditary that makes me extra susceptible. (Won't have genetic tests until I come off Xarelto). Anyway, thanks again for your help...good advice to help me assess next time something comes up.