Patient: The disease started on September 27, 2009, with swelling, numbness and pain in the left leg After the disease was sent to the doctor for treatment on September 27, 2009, the swelling slightly subsided; the next day the leg swelling became more serious and was treated in bed as recommended by the doctor, and now it has been nearly half a month, and the main drugs that have been administered are urokinase, Clinox, low molecular weight heparin, cephalosporin, etc. The swelling has slightly decreased, but it is still severe. He is still hospitalized and bedridden. He was diagnosed with deep iliac vein thrombosis in the left lower extremity when he was hospitalized, and later had a pulmonary CT, which did not reveal any abnormality. Other symptoms of the patient: fatty liver, mild pneumonia I would like to ask
1.In this case, is it still possible to do screen embolization? The local medical condition is limited, and we were not suggested to do screen embolization at that time. We don’t know whether to do it or not, so we want to consult.
2.What is the most effective way to treat the current situation and what is the treatment plan?
3.Will there be a risk of pulmonary embolism at present? How to prevent pulmonary embolism? Will pulmonary embolism occur in the future?
4.Is it appropriate to transfer to Beijing for treatment in the present situation? Is it possible to get a specialist number and is there a ward for hospitalization?
Doctor: It is possible to be hospitalized and the treatment will be better.
Patient: The current situation is multiple thrombosis in the iliac vein. It has been more than 20 days since the thrombolysis, and the swelling of the calf and foot has gone down, but the thigh is still obviously swollen. The doctor said that he has already treated the thrombosis by thrombolysis and does not recommend to do embolization, so is it still necessary to lower the filter? If I do not remove the screen, will it be life-threatening in the future? Are there any side effects if the screen is removed? Is there any danger? Is there any difference between a disposable screen and a permanent one? What is the approximate cost of removing the filter at Anzhen Hospital?
Doctor: Usually you don’t need to put the filter, and the later treatment time will take 2 months.
Patient: If the filter is not placed, is it more likely that the thrombus will be dislodged later? Is there a high possibility of embolism at the location of the screen due to the placement of the screen? The interventional department recommends the placement of a screen to prevent life-threatening thrombus dislodgement, while some vascular surgeons and Chinese medicine doctors do not recommend it, saying that the screen has side effects.
Doctor: It’s up to you to make up your mind, each treatment has advantages and disadvantages, what you decide, which doctor you want to see, you listen to the advice of which doctor.
Patient: On October 20, the patient was discharged from the hospital. the swelling of both the calf and foot went down at the time of discharge, but there was still significant swelling in the thigh. on October 27, it was found that the part of the calf that had gone down, was somewhat swollen and hard again. is this condition recurrent? How can I treat it?
Doctor: The disease is not fully healed, and it is necessary to continue treatment, otherwise things that aggravate the progress, still exist. Do not be careless, the disease will not wait for people.
Patient: After being discharged from the hospital, the doctor prescribed aspirin and is taking it as prescribed. I have since heard that warfarin is better. Our local doctor did not prescribe warfarin and I don’t know what the reason is. I wonder if there is a difference between the two? Which one is better for patients? Is it appropriate to switch to warfarin now?
Doctor: Warfarin is more effective. However, it is very difficult to adjust the dose and constant blood tests are needed.
Patient: It has been more than 2 months since the onset of the disease and after the treatment described above, but the thighs and knee joints are still swollen, the whole limbs and feet are numb, and the patient cannot walk on the ground, if he walks, it hurts, and the swelling increases.
Doctor: It seems that the recovery is not too satisfactory, vascular ultrasound examination to see how it is. At present, you can take oral herbal treatment to improve the efficacy.
Patient: I’m going to try warfarin, I don’t know if it’s too late or not? Do I need to wear elastic stockings? Do I need to use warfarin with Spironolactone? If so, how do I use it together?
Doctor: Warfarin 2.5mg, one tablet per day, coagulation test after 7 days, need to wear elastic stockings, no need for Sulforaphane.
Patient: Thank you doctor, at first we tested blood on the fourth day, then changed to 7 days, currently the patient has been taking warfarin for 1 month according to the test results, now the dosage is 1.25 tablets, request to do blood test once a month from today. At present, he can walk, but if he walks for 10 minutes, the leg will be significantly swollen, and the swelling will go down after 1 day of control. I wonder if this will get better? Or is it the after-effects of the disease that will appear like this.
Doctor: the situation will also improve, do not worry, at present you can intravenous drip sparing blood injection to see, leg swelling can still subside, if necessary, you can take Chinese medicine effect is also good.
Patient: Thank you for insisting on replying to me, I feel much more secure. At present, the patient started to use elastic stockings, and the situation is better than before. I went to the hospital again, wanting to assist in the treatment, but the doctor said that the patient is still taking warfarin, and does not recommend the use of Chinese medicine, saying that it is not good to judge the effect on the amount of warfarin. I asked the TCM doctor and the TCM doctor said it was OK. So it is very doubtful. At present, the patient is also taking the medicine of Myclobutanil and pancreatic kininogenase enteric soluble tablets, and has been taking the medicine continuously for more than 1 month. I would like to ask the doctor: 1. Is it possible to take Chinese medicine at the same time while taking warfarin? 2. Is it possible to stop taking the two drugs, Mizarin and pancreatic kininogenase enteric soluble tablets? I am worried that taking too many anti-inflammatory drugs is not good for my health. If I stop, will it have any effect on the amount of warfarin?
Doctor: It is possible to stop the pancreatic kininogenase enteric soluble tablets. I suggest it is better to add herbal medicine with more benefits for recovery.
Patient: Is there a better Chinese medicine? Or should I see a Chinese medicine doctor and get a prescription to boil the medicine myself?
Doctor: Take oral pulsatilla granules.
Patient: Okay, thanks, I’ll prescribe some first and try
Doctor: Good luck with your recovery.