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Suggest Treatment For Shortness Of Breath And Superficial Clots In Right Leg
Question: I have been dealing with s.o.b for past 3 mo. With classic s/s of p.e and dvt, have had ct of lungs done and no sign of p.e and ultra sound of leg no sign of dvt, but have supperficial clots in right leg. Im always cold now where in past have always been hot can you help me understand what might be going on. I have history of p.e and dvt. Just started eliquis to see if that would maby help, its a stab in the wind. As my dr said. I also have cough for past 3 mo.
Brief Answer:
Other possibilities need to be ruled out.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:
1. You seem to be having shortness of breath and cough since last three months. You have been diagnosed with superficial clots in the legs and have started on eliquis as per your doctor's advice.
3. I would like to know, whether a ct scan of the lungs was done or CT pulmonary angiography (CTPA) was done. A CTPA is more sensitive at detecting any pulmonary embolism. What was the ct thorax findings?
4. Do you have any history of smoking? Any significant illness in the past except the ones mentioned? When were u diagnosed with PE and dvt in the past?
5. Was a pulmonary function test / Ventilation perfusion scan or d dimer levels done ? What were the exact findings of colour doppler of the legs?
Please do let me know the details , so as to help me me answer accordingly.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Other possibilities need to be ruled out.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:
1. You seem to be having shortness of breath and cough since last three months. You have been diagnosed with superficial clots in the legs and have started on eliquis as per your doctor's advice.
3. I would like to know, whether a ct scan of the lungs was done or CT pulmonary angiography (CTPA) was done. A CTPA is more sensitive at detecting any pulmonary embolism. What was the ct thorax findings?
4. Do you have any history of smoking? Any significant illness in the past except the ones mentioned? When were u diagnosed with PE and dvt in the past?
5. Was a pulmonary function test / Ventilation perfusion scan or d dimer levels done ? What were the exact findings of colour doppler of the legs?
Please do let me know the details , so as to help me me answer accordingly.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Spontaneous phasic venous throughout deep veins no sign of dvt right leg.
A cta chest was done with no signs of p.e.
I have never smoked, dvt and p.e was in 2002, with 3 dvt to right leg and 15 p.e between bases of both lungs. Was found 3 days after being released from hospital stay of 8 days for pneumonia.
Pft was done showing severe airway restriction, d dimer levels done and were 0.43
Was diagnosed with mthfr c667t gene mutation
Up untill this week if i had over done it at work my face color and lips would become a grayish blue color and would get very light headed also felt exhausted and would have to go sit down. Im not sure if the eliquis is making things better but as of this week i have not felt odd and not lost color in face and lips. Is it possible the eliquis is helping and if so how or why
A cta chest was done with no signs of p.e.
I have never smoked, dvt and p.e was in 2002, with 3 dvt to right leg and 15 p.e between bases of both lungs. Was found 3 days after being released from hospital stay of 8 days for pneumonia.
Pft was done showing severe airway restriction, d dimer levels done and were 0.43
Was diagnosed with mthfr c667t gene mutation
Up untill this week if i had over done it at work my face color and lips would become a grayish blue color and would get very light headed also felt exhausted and would have to go sit down. Im not sure if the eliquis is making things better but as of this week i have not felt odd and not lost color in face and lips. Is it possible the eliquis is helping and if so how or why
Brief Answer:
You have a past history of Thrombo-embolic phenomenon.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. You have a past history of Thrombo-embolic phenomenon.
2. However at present there seems to be no evidence of pulmonary thromboembolism.
3. If superficial clots in right leg are evident in current investigations, then eliquis may be of help, in consultation with your physician.
4. Sometimes, CTA can miss micro embolisms in the early stages.
5. Considering that your previous pft showed severe airway restriction, a repeat pft can be done to monitor airway function.
6. Another important parameter is your oxygen saturation or SpO2 and also get a 6 minute walk test or stress test done.
7. A cardiology evaluation including 2d echo examination will also help.
8. Thus a clinical evaluation with a Pulmonologist is recommended for your current medication.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
You have a past history of Thrombo-embolic phenomenon.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. You have a past history of Thrombo-embolic phenomenon.
2. However at present there seems to be no evidence of pulmonary thromboembolism.
3. If superficial clots in right leg are evident in current investigations, then eliquis may be of help, in consultation with your physician.
4. Sometimes, CTA can miss micro embolisms in the early stages.
5. Considering that your previous pft showed severe airway restriction, a repeat pft can be done to monitor airway function.
6. Another important parameter is your oxygen saturation or SpO2 and also get a 6 minute walk test or stress test done.
7. A cardiology evaluation including 2d echo examination will also help.
8. Thus a clinical evaluation with a Pulmonologist is recommended for your current medication.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I did see a cardiologist and had a stress test on treadmill done earlier before breathing got real bad did 2d echo and results from dr were its not your heart its your lungs go see your family dr. I then got into my pulmonary dr and he talked to whole 5 min for first time seeing me, said was allergies ordered allergy tests which came back neg no allergies. So after getting no where my family dr decided to try eliquis and see if it would help. Said if ct and ultra sound missing something or clots could be to small to find, the eliquis may help if then we will be on right path.
As for the breathing though im not sure i see a difference but i have only been on it for 6 days, how long should it take before i may know if it is going to help with breathing in the event that there may have been a to small p.e not showing up on ct?
Do you know do you have to have you levels checked while on eliquis, a protime or pt inr? Is there anything i need to be aware of while taking eliquis?
As for the breathing though im not sure i see a difference but i have only been on it for 6 days, how long should it take before i may know if it is going to help with breathing in the event that there may have been a to small p.e not showing up on ct?
Do you know do you have to have you levels checked while on eliquis, a protime or pt inr? Is there anything i need to be aware of while taking eliquis?
Brief Answer:
There may be a micro embolism in the early stage.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. As mentioned earlier "Sometimes, CTA can miss micro embolisms in the early stages." Considering your past history, and current symptoms, your family doctor has started eliquis.
2. Normally a blood monitoring of INR is not required while on Eliquis. Be under regular follow up of your family doctor and do not stop the medication abruptly.
3. Symptomatic relief can be expected in 4 to 6 weeks time.
4. However PFT and spo2 monitoring needs to be done during your medical visits.
5. Always be prepared for emergency medical services visit in case of sudden increase in breathlessness or chest pain, if it happens.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
There may be a micro embolism in the early stage.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. As mentioned earlier "Sometimes, CTA can miss micro embolisms in the early stages." Considering your past history, and current symptoms, your family doctor has started eliquis.
2. Normally a blood monitoring of INR is not required while on Eliquis. Be under regular follow up of your family doctor and do not stop the medication abruptly.
3. Symptomatic relief can be expected in 4 to 6 weeks time.
4. However PFT and spo2 monitoring needs to be done during your medical visits.
5. Always be prepared for emergency medical services visit in case of sudden increase in breathlessness or chest pain, if it happens.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you for all the answers you have given me.
I have a nother question
Is it normal to feel like have no energy and need a nap on a normal basis with whats been going on?
Also i have always been hot blooded most of my life but since all this started 3 mo ago its like i cant get warm and am always cold is it due to this or could it be because im getting old. But I'm only going to be 39yr old.
After having a few coughing spells today i feel exhausted and feel like my o2 is lower than where it should be, but on my pulse ox it says its 97% which is a good reading to drs. So why can i feel like my o2 is lower i feel like im not getting enough o2?
And the chest gets a tight feeling which over time with out coughing does settle down.
I have a nother question
Is it normal to feel like have no energy and need a nap on a normal basis with whats been going on?
Also i have always been hot blooded most of my life but since all this started 3 mo ago its like i cant get warm and am always cold is it due to this or could it be because im getting old. But I'm only going to be 39yr old.
After having a few coughing spells today i feel exhausted and feel like my o2 is lower than where it should be, but on my pulse ox it says its 97% which is a good reading to drs. So why can i feel like my o2 is lower i feel like im not getting enough o2?
And the chest gets a tight feeling which over time with out coughing does settle down.
Brief Answer:
Additional investigations may help.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. You may get your thyroid profile done - serum T3,T4 and TSH levels.
2. If your oxygen saturation is 97%, that's good enough. However you can do one simple test. Just walk normally for 6 minutes on a level ground and then again check the saturation after 6 minutes walk, if it falls by more than 3%, then you need to visit your doctor.
3. A fresh pulmonary function test will help assess any airway cause of your breathlessness.
4. How is your overnight sleep quality - Is it compromised? Do you snore during sleep? Do you feel sleepy on normal days? Are you over weight? If the answers to any of these questions is Yes, then you need to get a sleep study done to rule out Obstructive Sleep Apnoea.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Additional investigations may help.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. You may get your thyroid profile done - serum T3,T4 and TSH levels.
2. If your oxygen saturation is 97%, that's good enough. However you can do one simple test. Just walk normally for 6 minutes on a level ground and then again check the saturation after 6 minutes walk, if it falls by more than 3%, then you need to visit your doctor.
3. A fresh pulmonary function test will help assess any airway cause of your breathlessness.
4. How is your overnight sleep quality - Is it compromised? Do you snore during sleep? Do you feel sleepy on normal days? Are you over weight? If the answers to any of these questions is Yes, then you need to get a sleep study done to rule out Obstructive Sleep Apnoea.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Prasad
I dont snore, i feel like i sleep good at night, i am over weight, but normally active person. I do have boarderline low thyroid . Again today at work got winded and chest felt tight with pain apon inspiration, to point that the pain was slightly better if held breath for second before taking in another breath.
Brief Answer:
Weight reduction and thyroid monitoring are recommended.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. Weight reduction should help you as sometimes it is also responsible for chest discomfort.
2. Borderline low thyroid requires close monitoring of thyroid hormones and a consultation of Endocrinologist. This could be one of the factors associated with increased weight.
3. Be under regular follow up of your Doctor / Pulmonologist.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Weight reduction and thyroid monitoring are recommended.
Detailed Answer:
Hi,
Thanks for posting the follow up information on HCM. After going through it, I would like to comment the following:
1. Weight reduction should help you as sometimes it is also responsible for chest discomfort.
2. Borderline low thyroid requires close monitoring of thyroid hormones and a consultation of Endocrinologist. This could be one of the factors associated with increased weight.
3. Be under regular follow up of your Doctor / Pulmonologist.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Shanthi.E
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