Calf Pain

[momtomany]

I recently returned to work following my left knee arthoscopy, and since my job is somewhat physical, I assumed the calf pain (below right knee) was due to the return to work. The pain has been persistent, and I even had trouble sleeping last night because of it. My leg doesn't look swollen (I am a bit overweight) or feel hot, so I'm unsure if I should worry about a possible DVT. I am probably going to phone my GP to see if she thinks I should go in and be evaluated. In the meantime, is it safe to assume that a DVT would present with redness and visible swelling?

[MaryF Administrator]

Hi it is not safe to assume that a DVT will only present with redness and visible swelling. Certainly both my legs never did, but I was very quick off the mark. Please go straight away to hospital and be firm with them in casualty regarding your history, being the week-end etc. Mary F x

[momtomany]

Thank you Mary. I spoke with my GP and am headed to urgent care. They said the doctors may refer straight to emergency based on findings. I will update later when I return.

[MaryF Administrator in reply to momtomany]

OK, just be firm if you get inexperienced scanty week-end cover with not much consultant input: rcn.org.uk/development/prac...

MaryF x

[BTR1963]

Sounds like classic DVT to me, my first was after an arthroscopy. As Mary says, don't be fobbed off.

[Bagpuss01]

Momtomany, I hope you are ok, and that it was nothing serious. I get this pain in my legs all the time, it to wakes me up at night, however I have also been diagnosed with Lupus. I am now on meds yo help, and the pain has lessened. Take Care, we all feel for you. X x

[Lucky67]

Good Luck - So right to get it checked out ...really not worth the risk and if nothing else so it doesn't go on your notes as a 'unconfirmed' DVT (I have a few of those)

I was diagnosed after a massive DVT - from calf to inferior vena cava - about 3 ft long - main vein completely blocked at hip level (and was still blocked there after 3 years of warfarin) ... 1 day before hurt a bit on walking, night before it hurt all the time but no swelling - in morning (Sunday) my ankle was a tiny bit swollen and warm and but not really red ..so slight I was in two minds whether to get it checked out ....a flat mate persuaded me to go to A&E

(I was young though -early 20s).

I was told it must have been 'growing' for a while...and if it had been caught earlier wouldn't have done so much damage ...

When I was transferred hospital after a few days the new consultant insisted on doing a venogram - didn't believe the ultrasound/CT results from previous hospital as the leg wasn't swollen at all....(still had the massive clot though)

Pre diagnosis I had a 'possible' DVT in my left calf after a long haul flight to LA (not checked out cos I had forgotten to take my insurance details - and it would have to be posted or faxed in those days) - no swelling but pain I later recognised...(so likely not what I thought - I'd pulled something when I was drunk!)

And later a 'possible' PE - diagnosed as pneumonia - must have had a symptomless DVT before...

After diagnosis I had a possible too - just pain and was kept in hospital on heparin pump - it wasn't checked out for 3-4 days -it was the long Easter weekend and there was no one to do a scan - scan was clear but was told after so long on heparin that didn't mean much - insist they check it out properly and asap!!!

[TJSTICKYBLOOD]

Get it checked out for sure when I occluded my popliteal artery (behind the knee) the only symptom was pain I had no swelling or redness.

[CaliforniaGail]

After 4 years on Warfarin and many hours of reading about APS/Lupus/Reynaud's etc etc. I am still not clear on something -- what you should do if you think you could have a clot.

(I am in the USA, INR 2-3, and have been happy with my Rheumatologist's care at an HMO, Kaiser Permanente.)

When I was worried I had a clot due to leg pain with mild swelling, redness, and warmth -- I was told I am already on the "prescription" for dealing with it -- a blood thinner. The implication was that since I was taking warfarin, that would be what they'd prescribe anyway, so why bother worrying about whether I had a clot?

When I questioned my Rheumy about this type of thinking, he replied, "If you ever have difficulty breathing or feel great pain, then get yourself to the ER." And that's been my guiding advice. I thought I've had symptoms of a DVT a time or two, and perhaps a little embolus in my lung that didn't shut down my breathing, but gave a little pain when breathing deep and I was very sluggish and tired... but I figured that slowly the warfarin would let my body dissolve it, if indeed I did have a clot. I suppose the other course of action would be to go to the ER and try to demand they do a lung scan and sonogram of the leg, and pay the $500 co pay to aleve any of my fears. And then be told to go home and watch for certain symptoms as my body will slowly absorb it....

I appreciate your comments.

I do realize we all have our individual situations so should not react the same way, nor is the advice from our doctors the same. But it is good to know how others feel about these things! My career has been in science, and it is frustrating that our conditions are so inexact.

[Lure2 in reply to CaliforniaGail]

Hi CaliforniaGail,

I have read what you have written. You wrote that your range INR was 2.0 - 3.0.

To me it sounds very low.

Most of us must be over 3.0 for not getting new clots. I was also in the hospital here in Stockholm for a suspected DVT a couple of months ago and the doctor did not act because I was on warfarin (target 2.5 - 3.5) I have had microclots. I selftest and at that day I think my INR was rather high. I try to keep the INR at 3.5!

Good question because I do not know. But I think that when we are on warfarin we can feel safe if the INR is high enough. I am going to ask my doctors.

Take good care

Kerstin

[overnighthearingloss]

I can only say what I have done when you cant get answers. I am not saying it is correct.

My warfarin has never been stable and recently my anti coag team have been extending my testing appointments. I have had a few instances of chest tightness and headaches not cleared by paracetemol and once something similar to you. Both of my calf muscles were extremely tight so that it hurt to stand up or walk. In fact I was hobbling more than walking.

I am reasonably confident that I know what is normal and what is abnormal and I have taken aspirin on these occasions and it has helped.

I wish it was easier to talk to some in the medical field sometimes. (Aspirin is a blood thinner and quicker acting than warfarin)

[Lure2 in reply to overnighthearingloss]

I Think you should tell your APS-doctor that you are taking warfarin and sometimes also Aspirin. If he does not know.

Best wishes from Kerstin

[Lure2]

The above is written to Overnighthearingloss. Thanks.Kerstin

[overnighthearingloss in reply to Lure2]

I did respond to your reply but I am experiencing gremlins on this forum today and replies are getting lost.

I used to be on aspirin in addition to warfarin but stopped taking it following my hearing loss.

It is not easy to discuss these things at a necessary point, when it occurs. To make a regular GP appointment with my GP who knows my history can take a month. An emergency appointment is only available with my GPs practice if you phone first thing in the morning. If the emergency happens later then a GP appointment is unavailable.

My anti coag team are trying to extend the time between testing and get sniffy if you want an extra test. It gets done but you can feel the disapproval. I think they have been given directions.

So sometimes I use my own initiative. Its not a regular thing, just when I get an indication that my anti coag levels may be incorrect.

If I am wrong, the system should be easier to navigate. But thanks for your concern. Really

[Lure2]

Hi Overnighthearingloss,

So sorry you have such difficulties to have the doctors to take responsibility for your illness. Hope you have an APS-doctor also because it is most important that your doctor knows what APS is and how important it is to keep the warfarin in range.

I have been on Aspirin before warfarin but they work quite different. We are so lucky here in Sweden because when they finally make the diagnose they do care for you. Take care! .

Kerstin