Should I go to the ER? Calf pain after travel but with snowflake!

March 25, 2013 11:23 AM

I flew to Seattle for a couple of days. I climbed a lot of stairs. My calf hurts. Do I need to go to the ER? Doctors' advice in particular appreciated.

So I know that calf pain after air travel is a big DVT symptom. However:

1. Flight out and flight back were each about 3 hours long and I got up once during each flight. I did not drink as much water as websites recommend (One to two cups per hour of flight time! Seriously?) but I did drink water during the flights. I also wiggled my ankles every twenty minutes or so. I am short and did not feel especially cramped in my seat. Supposedly, DVT risk rises with long flights of more than four hours, not so much with short flights.

2. In Seattle, I climbed a lot of stairs and hills in a one day period - way more than I ever do here.

3. My calf was a little sore the day of the flight but before I was even at the airport.

4. My calf is a little tender to the touch but not red, swollen or warm.

5. I do not have any of the other DVT risk factors except that I'm kind of fat.

So do I need to go to the ER right away? I would rather not, as I was in the ER last week for something totally unrelated and hate to be a frequent flyer.

YANAD, or if YA, YANMD.

posted by Frowner to Health & Fitness (14 answers total)

Response by poster: Oh, "DVT" is "deep vein thrombosis", known to us all as a life-threatening blood clot.
posted by Frowner at 11:23 AM on March 25, 2013

I'd call a consulting nurse here in Seattle.

Consulting Nurse Help Lines

The following Consulting Nurse help lines (hours vary) give free medical advice and information and physician referral to the general public. Typically they refer only to the hospital with which they are affiliated. All of these operate 24 hours a day, 7 days a week.

Downtown Harborview Community Care Line 206-744-2500
NE King County Evergreen Medical Center 425-899-3000
Central Seattle / Downtown Swedish 206-215-2100
posted by spinifex23 at 11:28 AM on March 25, 2013 [1 favorite]

Also, if you have health insurance, they may have their own dial-a-nurse hotline.
posted by spinifex23 at 11:29 AM on March 25, 2013 [1 favorite]

Not a doctor, don't know about DVT: but if what's stopping you from going to the ER is not wanting to go too often, GO.

That is (and I mean this gently) not a reasonable reason to avoid a needed ER visit.
posted by insectosaurus at 11:33 AM on March 25, 2013

Is Urgent Care an option for you? It is less unpleasant and cheaper under most health plans (and certainly cheaper if you don't have insurance). I would probably see a doctor just for peace of mind.
posted by something something at 11:39 AM on March 25, 2013

There is a quick blood test (D-Dimer) that they can do at an urgent care that can help a doctor rule out clots in about 15 minutes.
posted by sweet Annie Rich at 11:43 AM on March 25, 2013 [2 favorites]

Response by poster: But urgent care won't be able to do an ultrasound, right? That's what they'd do to exclude DVT - I've had it done before (since I'm a health neurotic, I admit, and have had a couple of episodes of calf pain in the past). I don't think that physical examination will reveal anything to a doctor that it doesn't reveal to me in this particular case (this isn't something I think true of most medical situations at all, but I'm fairly familiar with the whole DVT thing by now).
posted by Frowner at 11:44 AM on March 25, 2013

Call the nurse line, tell them your concerns, and tell them everything you have told us here (including the fact that you have had calf pain before, had it before flying, and did a lot of climbing). Then decide. Not every health problem requires an ER visit, and it is absolutely reasonable to try to avoid one.
posted by Wordwoman at 11:51 AM on March 25, 2013 [1 favorite]

You're right, but the urgent care provider might be willing to just do D dimer and skip the ultrasound. I cannot speak for them but with a negative D dimer you don't necessarily need one. On the other hand, if the D Dimer is positive they will feel obligated to get more imaging. in most places I have worked the D dimer takes a lot longer than 15 minutes, too.

I definitely do not want to give you advice on what to do here, but if you do go to a medical provider, be sure to tell them the calf hurt before the flight happened.

You shouldn't be asking the Internet whether it thinks you have a DVT.... It cannot tell you.
posted by treehorn+bunny at 11:52 AM on March 25, 2013

I went to an urgent care clinic for the same concern. They did the aforementioned blood test (don't recall how long mine took, but it wasn't terribly long) but it was positive. My urgent care clinic was able to get me into an ultrasound the same day without sending me to an emergency room (but this was in Chicago; I'm not sure where you are). (There was nothing wrong with me beyond a pulled muscle--hope you're similarly fine!)
posted by crush-onastick at 12:27 PM on March 25, 2013

Response by poster: Okay, I have gone to the urgent care clinic at the Large Land Grant University where I work. The doctor said she generally didn't bother with D-Dimers for calf pain - she felt that it should be an ultrasound or nothing. But then she looked at my calf and took a very thorough history and said she felt like it was a pretty classic muscle strain. I asked her if she'd treated many DVTs and she said she had and gave me a HIPAA-compliant version of a recent example.

So I am not completely anxiety-free, since I know that sometimes doctors miss DVTs, but I am substantially reassured.
posted by Frowner at 1:25 PM on March 25, 2013 [1 favorite]

Response by poster: She also told me that strained muscles are typically worst on the 2nd/3rd days after the strain.

I dunno, this all seems pretty reasonable to me. I did climb a lot of stairs in Seattle.

So let's hope it's all good.
posted by Frowner at 1:27 PM on March 25, 2013 [1 favorite]

Yeah usually D dimer is used for low risk patients for pulmonary embolism rather than DVT. It just depends how low the risk is and what they have available. Glad you were reassured.
posted by treehorn+bunny at 3:20 PM on March 25, 2013

I strained my calves similarly, and they took quite a while to completely stop being sore. Calves are weird sometimes. But that was a stress/running strain, so you should be fine in a couple of days.

I would not worry anymore. You already had almost none of the risk factors for DVT, and you got the all clear from a doctor.
posted by gjc at 6:23 PM on March 25, 2013