December 2010


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Lisa Mekenas <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Tue, 7 Dec 2010 13:36:32 -0800
text/plain (103 lines)
Don, question authority? Seriously? I obviously spend more time with him than you. Sorry Don, just had to reply.
To question is the basis of science and investigation. Don's are always educational. 
I have to say, also, my experience of serial following many calf thrombi is that they don't prop vs they do. But I leave the DX and treatment to my MD.
Every thrombi has a different story, I like to think of the storyline and 
what I am seeing, you know that "the whole patient" thing, no one answer.
Ben Franklin-I could hang with him, he definitely had an imagination and 
could come up with fun things to do, definitely not boring.Reminds me more of Jerome, don't you think Don?

Just having fun in San Diego.


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Don Ridgway
Sent: Monday, December 06, 2010 9:21 PM
To: [log in to unmask]
Subject: Re: Superficial vs. deep

Bill, my problem with pouncing on an isolated gastroc clot with anticoagulation is that the treatment might turn out to be more harmful than the condition. I think your suggestion to the referring doc, "We can rescan in a few days," or something like that, makes the best sense. 

I've seen gastroc clots propagate, but not so very often. And I've seen heparin cause trouble when administered for isolated calf clot; I recall one patient who bled into the knee joint of the other leg, and was still limping a year later. 

Ben Franklin? 

Don Ridgway

-----Original Message-----
From: UVM Flownet on behalf of Bill Johnson
Sent: Mon 12/6/2010 3:17 PM
To: [log in to unmask]
Subject: Re: Superficial vs. deep
Bill Johnson, Port Townsend, WA.

Don Ridgway to UVMFLOWNET

Don, I always love discussing things with you, mainly because you always
question authority.  I believe to this day that was Ben Franklin's Major
issue with the world. I am still in awe at his ability to understand things
that seem so simple today but were so complex then.

I fear the issue here is not about what constitutes a deep vein.  No, it is
more about what we tell the referring source that will determine how they
treat our patient.  Deep vs. superficial?  The real issue is not anatomical,
it is about best care.  I know you know that and I respect that you teach
that, but there is always so much we do not know it makes me shiver.  I
accept your definition of "muscular" veins, since it makes greater sense
than many definitions.  I have been faced many times with the question
"Gastroc veins, is that a deep vein thrombosis???"  "Muscular veins" might
mitigate that, but if the issue is providing appropriate care to the
patient, I would always say, yes, this is Deep Vein Thrombosis, they are
certainly not superficial, and I have seen them many times extend into full,
dangerous, deep vein thrombosis.

*Gastrocnemius veins accompany sural arteries, so are those deep veins? I
wouldn't label them "deep veins,", though they are deeper than superficial
veins; I like the term "muscular veins." They also fall into the category of
"if they propagate..."*

These are subtle distinctions that not all referring docs are interested in.
 How to treat?  Fortunately or not, we do not have to answer this question,
but unfortunately, we are often asked.

I think it is important that we are asked , as much as I think it important how
we respond to that question.

> Subject: Superficial vs. deep
>  Bill Johnson, Port Townsend, WA
> Carol wrote;
> "*Bill et all,* (Not the Bill you asked, I am another Bill)
> *I have a question.  I've had a couple pts recently with superficial
> thrombosis extending into a perforator (beneath the fascia) but not into a
> tibial vein.  I say this is DVT, my medical director does not think so.
>  Who
> is right?  **Thank you *
> *Carol Wise, RN, RVT, RDCS Technical Director, Vascular Laboratory"*

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