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Sep 3

I answer a patients question regarding a superficial vein thrombus our ultrasound discovered

Dear Patient AB,

Thanks for the email.  I am not an MD nor have I ever attended medical school, so my opinion is based on my career as a Registered Vascular Sonographer only, so please don’t take it as medical advice.  I can explain to you treatment trends I have seen in my career. I will reply to each topic. Remember, I am not a doctor and I know nothing of your medical history except what we discussed. Please consult your physician.

On Sun, Sep 2, 2012, this patient wrote:
Hi Joseph,
(1) I went to my doctor, they didn’t give me (another) ultrasound check again (after this patient was found positive for isolated superficial vein thrombus SVT in the small saphenous vein SSV with no propagation into the deep popliteal vein causing a DVT or deep vein thrombus.) ,due to your report didn’t write about it, before I heard you talk about (the doctor may choose to) “check again”, am I right?

I remember we discussed the isolated SSV (Small Saphenous Vein) thrombus we found in your leg and reported to your doctors. We discussed how SSV superficial vein thrombus can propagate into the deep system. If your symptoms have gotten worse, causing an increase in pain and swelling, I would suggest you see your MD, immediately, who ordered the original exam or go to an emergency room. Sometimes, thrombus will extend into the deep system and you may need to have another ultrasound and/or treatment, if this is the case. When this happens, it would mean that your superficial vein thrombus (SVT) extends into the deep venous system and would now be considered a DVT, deep vein thrombus, which requires urgent attention. It sounds like you went back to your doctor, so you did the correct thing by seeking more attention to the swelling that has returned. Is this a family or primary care MD you are seeing? You may ask to seek a vascular MD opinion, to get a second opinion. Many people forget that they can ask for a second opinion, it is your right as a patient.

(2) According the report, I look like no thrombosis except a little in lesser saphenous vein. I not know why my leg edema and tight after sit down a little longer time.

That is correct, according to the report was sent to your physician that was signed by the reading radiologist, you only had a superficial thrombus present. I will attach a study on superficial vein thrombus (SVT) below. Are you in a seated position for long periods of time and your legs remaining in a ‘dependent position’? If yes then the gravity causes blood flow to be pulled to the feet. This increased hydrostatic pressure draws fluids and blood to the feet, ankles and calves. I recently read an article suggesting 15-20 minutes of leg elevation over the heart for every 4 hours worked. But, this is only a temporary fix in a patient with valve insufficiency (reflux) disease where the venous valve structures are absent through genetics, structurally weak and leaking (usually in women to genetics or post child birth), or because the venous valve structures have been destroyed due to presence of a thrombus. Vein Thrombus, both deep and superficial, destroy valves and are often a result of venous thrombosis. You might be swelling due to reflux, the seated position you say you sit in for long periods of time or because of the thrombosis process you have been diagnosed with, albeit superficial vein thrombus (SVT). SVT alone can cause a leg to swell, as can deep vein thrombus and the valve damage that the thrombosis process causes. Please note this paper on SVT. It is very informative and since you are involved in medicine, you may find it of interest. To read, please cut and paste this link: http://www.veithsymposium.org/pdf/vei/4056.pdf

(3) What are your doctor and your opinion?

As far as giving medical advice, I don’t get an opinion. Since I am a registered ultrasound technologist in vascular ultrasound by the ARDMS (American Registry of Diagnostic Medical Sonographers) as a RVT (Registered Vascular Technologist) and RDCS (Registered Diagnostic Cardiac Sonographer) with no medical school training, I am not an MD. If you were interested in speaking with an MD specializing, I can recommend two vein doctors; I would recommend you get an order to see (depending on your insurance) Dr Raymond Shaheen in Mountain View, CA at 305 South Drive #7 Mountain View, CA 650 965 1909.  Ask you current MD about getting a second/ vascular opinion. They know thrombus treatments and contraindications. If your problems persist or get worse, get back to your doctor or local emergency room immediately.

I hope this helps,

Joseph Matthews RVT, RPhS

Smart Health Screening

Ultrasound Laboratories, Inc. dba SmartHealth Screening & SonoTech Imaging. We provide abdominal, cardiac and vascular ultrasound imaging services to physicians offices and patients homes. We accept most insurances including Medicare and Medi-Cal. 1-408-829-6486. Office with Saturday appointments at 305 South Drive, suite 7, Mountain View, CA