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Re: 1st Post Got Messed Up - Doctors Please Help URGENTFrom: Hannah (anonymous@obgyn.net)Mon, 7 Jul 2003 21:00:41 -0500 (CDT)
Oh, you're right and I completely agree: good clinical judgement saves lots of time, anxiety, pain and money. And your point about whether her sister is actually concerned is a good one. But here's why I think it's important to be cautious in this case: 1. DVTs are potentially deadly, but if caught can be treated before complications occur. 2. They occur in somewhere between 1 and 5 of every 1,000 pregnancies, but are much more common in those with a genetic predisposition -- the fact that the non-pregnant sister had one as a young, healthy woman raises a red flag. 3. Often the sole presenting symptom is painful swelling in one calf but not the other. 4. Lack of concern on the part of the patient does not mean, alas, that there is no reason for concern (I've had to convince quite a few patients with DVTs that yes, it's serious and yes, it must be treated). 4. The rule-out test is an ultrasound: it's quick, fairly cheap, non-invasive, and entirely painless. Of course, the physical exam DOES make a difference, and the doc's lack of suspicion may have been justified. But based on the bare bones of the story presented here, I'd have ordered the ultrasound pronto.
At Mon, 7 Jul 2003, Ocean wrote:
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