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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5330
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Last Sunday I came home from a 12 car trip. I had mild leg

Customer Question

Last Sunday I came home from a 12 car trip. I had mild leg cramping on my left calf and slight swelling so I went to the ER on Monday. The ER doctor ordered an ultrasound on my left leg to rule out possible DVT. He sent me home with a diagnosis of muscle cramps and a prescription muscle relaxer. On Wednesday night I noticed the muscle cramps had moved to both legs, and on Thursday my left calf felt achy. I saw my GP on Friday who felt the pulse at the bottom of each foot, said I had slight swelling in both legs that could be related to walking a lot on vacation, and sent me home with a fluid pill to take daily for 10 days. Today I took the fluid pill but now feel pressure near my rib cage, it isn't only when I breathe but sometimes when I move certain ways, sometimes it's burning type of pain, sometimes it feels like gas. It comes and goes. I'm unsure if this is related, or if it could be from the cold and mild cough I'm just getting over. I took the muscle relaxer given to me at the hospital and it hasn't changed much in an hour, still on and off. Pressure and flutter in my rib cage area. Also the fact that DVT was on my mind could an influence because I do get bouts of health anxiety and panic. This didn't start that way but perhaps the idea of DVT or PE has worried me. I'm also concerned that they could have missed something by not looking at my right leg. I cannot afford useless trips to the ER and I am currently home alone with my child and no vehicle so I am trying to asses how serious this situation is. I appreciate any help.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

Ultrasound is not a perfect test and can miss some DVTs, particularly if only one leg is imaged. There are other tests that can be preformed if clinical suspicion is present. Your doctor could order a d-dimer blood test. If PE is a consideration due to cough, chest pain or shortness of breath, a thoracic CT would be in order.

Customer: replied 1 year ago.
But I would assume clinical suspicion was not present for my doctor whom I followed up with? Since he gave me a fluid pill and a follow up in 10 days? What would be some signs that it's an emergency? As I stated I'm alone with my child and no vehicle so I don't want to panic for no reason. Is the non-consistent occasional pain an sign of PE? Is it more likely since I've been checked up by 2 doctors that this is something else? Just looking for a suggestion on what I should do here. It's not an extremely Terrible pain just pressure that comes and goes.
Expert:  Dr. Bob replied 1 year ago.

The work up is driven by clinical suspicion. It sounds like the first doctor had considered DVT because he ordered the ultrasound. While a normal study is very reassuring, it does not rule out a DVT completely. That said, there are other possible explanations for your symptoms such as muscle strain, edema, etc. Without examining you, I could not say what is most likely causing this. Certainly, the mild and intermittent nature of your symptoms is also reassuring, but this does not rule out a DVT or PE completely, either. Classic symptoms include calf pain, distal swelling, a "cord" in the upper calf and if there is a PE, chest pain, cough and/or shortness of breath. If these are present you should be re-evaluated. If they are not present or come and go and you feel well between, then there may be other explanations. If things are improving overall, this is also a suggestion that the cause is benign or the condition is resolving. Just don't ignore your symptoms or your instincts. If they remain high, get evaluated again and ask about the tests mentioned above.

Expert:  Dr. Bob replied 1 year ago.

Hi Ashley. How are your legs today? How about the rib pain? Have these symptoms improved? Let me know if you have any follow up questions. I would be happy to help further.