Medical emergency: DVT led to a PE

[WonnabeBiker]

Your life can change in seconds. While in the shower, I felt woozy and had trouble breathing.

The ambulance came and took me to a small private clinic. There they x-rayed my chest repeatedly, drew blood and prepared for IV drips. Then they started calling other hospitals...

Hours later, in the next hospital's ambulance, I told the doctor that I thought I had a thrombosis. Henceforth, the issue appeared to be a pulmonary embolism. My right calf was visibly swollen vs the other leg.

There was someone with credit cards and I also had insurance. I'm mentioning this to explain that fear of non-payment could be excluded as explanation for the long wait. (At the first hospital, the bill was paid in full without bothering with an insurance claim. And the first ambulance never presented a bill. They were manned by volunteers and we plan to thank them and to make a donation. Please check out which ambulance service to call - they are not all the same.

There is something about this experience which keeps bothering me.

Why wasn't I a) diagnosed quickly and then treated in a timely fashion?

1. X-rays don't show blood clots. <deleted>?

2. Why wasn't I allowed to drink for more than half a day? (Just wondering)

3. Surely they had an ultra sound machine and could have seen the blood clots within seconds - as they did, once they used this tool.

During the 2 days at the hospitals, they x-rayed me a dozen times. What's up with that?!???

Granted, I have no medical knowledge. But with ultra sound, they can see the shape of the heart (mine was grotesquely deformed). The heart's muscle straining against a blockage etc. And see blood clots within seconds.

...

Is this normal? Letting a patient lie there for over 6 hours without bothering to do the ultra sound test in the light of having heard of a "thrombosis"?!?

• Is it fear of making decisions?
• Is it to save money and avoid costly diagnostics? The blood test included a "D-dimer" value which was 9,000 instead of 500.
• I'm ungrateful but can't help noticing how bloody s l o w the doctor reacted. Inject the blood thinner once that CT scan was done. Just order a nurse to do it. Is there something wrong with their process at the ICU?

Maybe a mistake is made - and a patient dies. But by playing it safe and letting hours pass one dreads to think what will happen when a patient is in worse shape than me. (And there had been moments when I thought I would be dying in agony).

[Lefty]

Twice I have has DVT episodes, first was blood clot moved to lungs.Was at home and very painful,taxi to Bumrungrad emergency room Diagnosed in about 15 minutes and corrective action taken to address clot. Took 10 days to recover at hospital. 2ND episode was blood clot to abdomen -same hospital ,about same time to diagnose ,was in hospital about 8 days. When it's serious --go to a serious hospital.

Both cases resulted from long airline flights-I now fly only business class.

Lefty

[Sheryl]

You certainly lost time as a result of being taken to a small clinic rather than a large hospital.

The various "volunteer" ambulance services not infrequently receive kickbacks from small private facilities to bring patient to them. even when not, they are not staffed by personnel with adequate training to assess and decide where best to bring a patient.

Should always where possible get a taxi to a hospital you have pre-chosen. If unable to do so, call that hospital for an ambulance - all hospitals have ambulance services.

It is highly unlikely that the person you spoke to in the ambulance was a doctor. In fact may have had no medical training at all, and may have had no dea what you were saying.

As to what occurred once at the hospital, I can't say, not knowing what signs were present on your arrival. The multiple repeat Xrays suggest they were considering other possible diagnoses. The differential diagnosis for PE is pretty long and the abnormalities seen on Chest film, as well as the presenting symptoms, are common to a number of other conditions. Though indeed the presence of calf pain and swelling should have been a strong indication.

The not being allowed to take anything by mouth initially was a precaution in case surgery became necessary or you lost consciousness (risk of aspiration).

BTW it is not always possible to see a DVT on ultrasound, though apparently they could in your case.

[WonnabeBiker]

Twice I have has DVT episodes, first was blood clot moved to lungs.Was at home and very painful,taxi to Bumrungrad emergency room Diagnosed in about 15 minutes and corrective action taken to address clot. Took 10 days to recover at hospital. 2ND episode was blood clot to abdomen -same hospital ,about same time to diagnose ,was in hospital about 8 days. When it's serious --go to a serious hospital.

Both cases resulted from long airline flights-I now fly only business class.

Lefty

Lefty, I'm glad to hear you got diagnosed and treated that quickly!!

Care to share the cost? My bill was >150 k for 2 days, one in a regular room.

You should increase the blood thinner for those long flights. Are you on Coumadine or something? The Praxada 150 mg tablets are way more expensive than in my home country. Will switch to Warfarin based pills...

...

YMMV, but I found that some light exercise helped with the swelling in my right leg.

[WonnabeBiker]

You certainly lost time as a result of being taken to a small clinic rather than a large hospital.

The various "volunteer" ambulance services not infrequently receive kickbacks from small private facilities to bring patient to them. even when not, they are not staffed by personnel with adequate training to assess and decide where best to bring a patient. Possibly. But then, even a small clinic has a doctor and an ultra sound machine...

Should always where possible get a taxi to a hospital you have pre-chosen. If unable to do so, call that hospital for an ambulance - all hospitals have ambulance services.

It is highly unlikely that the person you spoke to in the ambulance was a doctor. In fact may have had no medical training at all, and may have had no dea what you were saying. Well, I spoke with her. She was an intern and her presence added 3,000 Baht to the bill. The hospital generated a form on which the PE as likely diagnosis is written and signed by her. Her English was exceptionally good. *** There might have been bad internal communication or f e a r of saying something a superior might reserve the right to diagnose? (At a rural government hospital's dental clinic, a young dentist had to step aside for the big boss who was motivated to make the foreign pattient come to his private clinic... She could have handled that extraction without "help" and I wonder how she felt?)

As to what occurred once at the hospital, I can't say, not knowing what signs were present on your arrival. No chest pain. Very low oxygen level. A thrombosis in the left calf muscle - with huge swelling. The multiple repeat Xrays suggest they were considering other possible diagnoses. Why r e p e a t them?!? This doesn't make sense to me! Not when ultra sound shows the heart muscle and its SHAPE. Mine was grotesquely "deformed" in response to the blockage. The differential diagnosis for PE is pretty long and the abnormalities seen on Chest film, as well as the presenting symptoms, are common to a number of other conditions. Though indeed the presence of calf pain and swelling should have been a strong indication. Is it the bloody HIERARCHY? An experienced nurse could have manned the ultra sound machine and identified the DVT. Can it be that due to some weird power play inside that hospital they wouldn't even try to proceed with diagnostics for hours?!?

The not being allowed to take anything by mouth initially was a precaution in case surgery became necessary or you lost consciousness (risk of aspiration).

BTW it is not always possible to see a DVT on ultrasound, though apparently they could in your case. ? Both clots (in the lung and my leg) were hard to overlook.

Wish someone could share their bill at the famous B. hospital. I ended up at a big hospital near Victory Monument.

Am speechless - "15 minutes" vs all these HOURS. But we cannot have some >lowly nurse< invade a doctor's sphere of competence?!?

Why can't they let some young trainee doctors try real life diagnostics if the Big Doc's busy?

[rak sa_ngop]

Both cases resulted from long airline flights-I now fly only business class.

Lefty

One of my ex-work colleagues developed DVT and he had just flown in from Australia in Business Class!

[rodknock]

when i had my DVT in the states, i drove myself to the hospital. with in 10min., i was laid out with 2 IV lines and various injections. was lucky no PE. left leg was so swollen and painful. at least i got some good pain meds, hydro-morphene, not available in Thailand as far as i know.

that was on 2005, have been on warfarin ever since, test weekly, have two machines(Alere and Roche). maintain a pt/inr of 2.0-3.0.

[rodknock]

forgot to include; wear compression stockings or compression socks!!

[rhythmworx]

X-rays don't always show blood clots.

In the UK they also don't use ultrasound for a PE or DVT.

You wouldn't have got much better service in the UK, which some people claim is the worlds best healthcare system.

The multiple x-ray technique is Medically wrong though.

[Langsuan Man]

My story is not as dramatic as the OP's but enlightening none the less

Experienced pain in my right leg while walking as recommended by my US physician after an left knee fracture. Went to Pattaya International Hospital and was immediately scheduled for an Ultrasound and a large blood clot was discovered in the right leg and a smaller one in the left leg. Immediately started on daily Heparin injections for approximately two weeks and then another ultrasound. After another two weeks of Heparin injections every other day was switch over to oral Wafarin

Weekly INR (international normalized ratio) blood tests were then ordered and wafarin adjusted accordingly.

When I returned to the US my doctor there also ordered Ultrasounds of both legs and determined that the blood clots were almost all gone.

Since no definitive explanation for the DVT was determined I have been on daily regimen of wafarin for the last four years and according to every doctor I have talked to I will be on it for the rest of my life. Fortunately I am now able to do my own INR testing using a machine provided by a service in the US, who also reports my twice a month reading to my Hematologist back in the US

[Thailand J]

You certainly lost time as a result of being taken to a small clinic rather than a large hospital.

The various "volunteer" ambulance services not infrequently receive kickbacks from small private facilities to bring patient to them. even when not, they are not staffed by personnel with adequate training to assess and decide where best to bring a patient.

Should always where possible get a taxi to a hospital you have pre-chosen. If unable to do so, call that hospital for an ambulance - all hospitals have ambulance services.

It is highly unlikely that the person you spoke to in the ambulance was a doctor. In fact may have had no medical training at all, and may have had no dea what you were saying.

As to what occurred once at the hospital, I can't say, not knowing what signs were present on your arrival. The multiple repeat Xrays suggest they were considering other possible diagnoses. The differential diagnosis for PE is pretty long and the abnormalities seen on Chest film, as well as the presenting symptoms, are common to a number of other conditions. Though indeed the presence of calf pain and swelling should have been a strong indication.

The not being allowed to take anything by mouth initially was a precaution in case surgery became necessary or you lost consciousness (risk of aspiration).

BTW it is not always possible to see a DVT on ultrasound, though apparently they could in your case.

I think the volenteers will take u to any hospital you chose, you just have to tell them.