Since there’s a specific bit of medical slang that basically applies to your mother—internal multi-trauma (meaning severe or chronic issues affecting three or more organ systems)—it is absolutely impossible to make any meaningful comments regarding her prognosis or chances of recovery until she actually gets admitted to a hospital. It’s also quite interesting that she only seems to develop this fear of doctors when she’s being hospitalized, yet she has no problem showing up for outpatient ultrasound appointments or blood work. My colleagues, who are suggesting there might be a malignant ovarian issue, aren't entirely off base here. A tumor marker on its own doesn't actually mean anything, but when you pair it with an ultrasound showing a mass in the abdomen—which could very well be an enlarged ovary—it points strongly toward malignancy. Further testing in that direction is completely justified. And honestly, given all her other symptoms, getting diagnosed through inpatient care at a proper hospital is a much better move than this endless outpatient pilgrimage through various private clinics, which will ultimately just end up referring her to a hospital anyway.
So, if the lady wants to know what is actually happening, which organs are failing, and what treatment options—if any—exist, she needs to get over her fear and check into a hospital. If the 64 years she’s lived are more than enough for her, and if she’d rather spend her final days at home surrounded by loved ones without ever truly knowing why her life was cut short—which is also a perfectly valid choice—then fine, let her choose that path. But there really isn't a third option.
You can always reach out via private message again (though honestly, maybe you should try someone else this time), but the bottom line is that whoever you finally talk to needs to actually put two and two together and take action. Look, since bone marrow functions as a hematopoietic organ, we have to consider the facts: bleeding at the usual spots is completely off the table here—you can skip the GI capsule entirely because isolated bleeding in the small intestine is incredibly rare—which means HOCM absolutely has to be considered as the cause of this anemia. And quite frankly, it requires treatment, period.
driftinggull83 said:Quick little update here, if anyone has a moment and feels like weighing in. 🙂 Two months of peace, and then her hemoglobin crashes again. This time she caught the symptoms early and made it to the hospital with a hemoglobin level of 66. A hematologist took over her care; they performed a bone marrow biopsy, which came back normal. And today, after receiving four blood transfusions, she was discharged with clear results.
In the meantime, she had a small bowel series, which was normal. Gastroscopy and colonoscopy were both fine, as were all the abdominal ultrasounds. She also saw a cardiologist. Heart rhythm is steady at about 70 bpm, heart sounds are clear. There’s a coarse systolic murmur over the precordium, primarily over the apex, intensity 2-3/6. Diagnosis: obstructive hypertrophic cardiomyopathy, SAM +/ mPG approx 115 mmHg! Sudden Cardiac Death risk score for HOCM is 3.03%. They aren't recommending an ICD implantation just yet. The gynecologist found some fibroids that need to be removed. Next up is a video capsule endoscopy for the small intestine. But since they can't find any bleeding anywhere, I'm hoping that comes back normal too. We'll see what happens. Who should we reach out to for a second opinion? Thanks in advance.
Good grief... so HOCM turns out to be the culprit behind the hemolysis. Honestly, you don't need to go looking for more opinions on that—you need to find someone who can turn that HOCM into HNCM. Or just plain old HCM. Whether that means finding a cardiologist skilled in TASH or a cardiac surgeon who can excise the part of the septum causing the obstruction (that HOCM blockage), it really depends on whether the mother has diseased coronary arteries or not. And you determine that through a coronary angiogram. That same procedure can identify the specific septal branches for an alcohol septal ablation. So, first step: find a cardiologist who actually knows what they're doing. Calculating the risk for sudden cardiac death because of HOCM is all well and good, but it doesn't solve the actual mess the HOCM is making. It's hemolytic anemia, for heaven's sake!
There are several different things that could be driving that low eGFR. Were you actually hydrated when they drew your blood? I mean, were you "dry"? Also, do you have any other underlying health issues—like diabetes, for instance—that could be causing kidney damage? And are you currently taking any medications that might be nephrotoxic?
Now, let’s be clear: this is nothing more than a massive assumption. And we all know that an assumption is often the root of every single mess you can imagine—this particular assumption is basically the granddaddy of all screw-ups—but regardless.
If that "heart murmur" (regardless of how intense it is on a scale of 1 to 6, or I to VI for those who prefer Roman numerals) was actually caused by aortic valve stenosis, and if there aren't any signs of pancytopenia (meaning low leukocytes and platelets), then simple hemolysis caused by highly turbulent blood flow through a severely calcified aortic valve is actually a plausible explanation. Honestly, I’ve even personally seen a case like that before. Of course, I have to stress again that this is purely speculative, so none of this is necessarily correct. Pneumonia could also be a factor, though I find that less likely at this moment, especially if Mom isn't currently battling full-blown, severe sepsis.
You could start by filing an official complaint with the medical board. I'm not entirely sure about the exact step-by-step procedure they follow—I can't write out the whole legal manual for you—but I do know for a fact that the option exists.
Why not just go straight to the surgeon who actually removed the tumor? Or even better, talk to whoever was managing your care—they’ve been in the trenches with you and likely know more about your specific situation than anyone else on this planet. Honestly, it seems like the only logical move here. As for the risk of a recurrence, unless there were microscopic metastases hiding somewhere, you should be fine, but hey, who knows what's actually happening deep down inside?
Brandon Newman95 said:Great, she can sue the medical board. What will that achieve? Nothing. Though I guess it would actually mean something if they actually handed out punishments around here.
We’ll find out once they decide whether or not to take any further action on this. But look, what this *will* achieve is making someone—unless they are genuinely so delusional that they believe they are incapable of being wrong—actually stop and think about whether another one of these complaints is going to pop up. Because sure, you can report him to the HLK, but a lawsuit—even though I used that word loosely earlier—is a different beast entirely. And that is just the first, most basic step. A step that, frankly, has plenty of merit if one were to file a legitimate lawsuit with the proper authorities.
So, how exactly did they land on a Hashimoto diagnosis for you?
Basically, your lab work probably shows elevated antibody levels, which is why they’ll tell you to keep a close eye on those thyroglobulin numbers too.
I’d say we should get you back on therapy—honestly, bumping it up to 75 or even 100 mcg might be the way to go, but I’ll leave that final call to my colleague when they see you in person. We definitely need to follow up with some bloodwork—specifically checking those TSH levels—in about 2 to 3 months. That note regarding the thyroglobulin being lowered? It just means those antibodies are actively targeting the same thing.
I know you were talking about Color Doppler, which is obviously a standard component in any modern ultrasound machine, but Kimberly Morris correctly called me out on my nonsense there. When we're actually looking for a DVT, the ultrasound itself—specifically the imaging part—is way more critical than the Doppler. You track the vein and apply pressure with a linear probe; if you can't compress it, you've found a clot. Honestly, you could skip the color altogether and still get the job done.
Just take a look at what Wells is saying and follow that lead. In that case, the unit is almost certainly ug/L.
Nicholas Johnson8 said:Please give me your thoughts on this lab result. My mom, 74 years old, had a D-Dimer test because of some knee pain and slight swelling. The results showed a D-Dimer value of 1800. All her other blood work was within the normal range. Her primary care doctor sent her straight to the ER immediately due to suspicions of thrombosis. At the ER, they performed an EKG, a chest X-ray, and a venous ultrasound on her right leg (where the knee pain is located). All those tests came back fine, and she was discharged home with explanations that DVT had been ruled out. They just told her to follow up with her own doctor. I'm a little worried about that high D-Dimer—what else could it be for, and is a leg ultrasound enough to truly rule out deep vein thrombosis?
Ugh, D-Dimers. They’re absolute lifesavers when they come back negative, but they are a total nightmare when they come back positive.
A value of 1,800... what are we even measuring here? $\mu$g/L? That seems most likely, but who knows. What is considered the "normal" threshold for whatever unit they used? If it's actually mg/mL, then anything up to 740 $\mu$g/L might be considered normal since the lady is over 50—you take age into account and multiply by ten for the upper limit. I ask because I'm used to seeing values around 0.5, so I really need to double-check those units, even though they're probably $\mu$g/mL.
If all the other findings were okay, does that mean the D-Dimer at the ER was also okay? Honestly, that's entirely possible.
You're stressing out, so why don't you do some digging on the medical sites yourself? Look, D-Dimers are incredibly sensitive, but they are notoriously non-specific, which is infuriating. It means they can be elevated because of practically anything, or even for no reason at all. You're the one seeing your mother in person; we aren't. For starters, go calculate the Wellsov score: https://www.mdcalc.com/wells-criteria-dvt
Then you'll have a better idea of what's going on.
An ultrasound can't settle everything here; neither can a CT or an MRI. An experienced doctor using ultrasound can look for signs of a clot in the major veins of the legs with pretty high probability, but even then, it's never 100%. The ER staff did their job by saying suspicion of DVT was ruled out based on their assessment, but that doesn't mean DVT itself is impossible.
Look, if we're basing this on just one single data point, it’s probably not the case. But honestly, what was the actual reason they even ordered an abdominal ultrasound in the first place? Was it just some random finding? Has anyone from the medical team actually weighed in yet on what could realistically be causing that cyst?
LAC refers to lactate levels. A reading of 2.0 is perfectly within the normal range. An HCO3- level of 19.3 mmol/L? Honestly, that could still pass as low-normal. And look, definitely make sure to ask for some clarification at the follow-up appointment in two weeks if you're still feeling uneasy about it.
Alright, here we go. And just to wrap this up—for anyone actually paying attention—the standard reference value for D-dimer after you hit fifty is calculated as 0.01 times your age. So, based on that math, your mother’s level is sitting at 0.62, which puts her right above the threshold.
Assumption is the mother of all screw-ups. None of what you guys just listed actually factors into any of the clinical scoring systems. Look, D-dimer is incredibly sensitive, sure, but it is also wildly non-specific. What that means in plain English is that if the result comes back negative, you can pretty much rule out DVT or PE. But if it’s elevated? That tells you absolutely nothing about whether one of those two is actually happening. It’s all well and good to go online and look up how to calculate some "score"—whether we're talking Wells, PESI, or Geneva—just to get a vague ballpark idea of the situation. But if you try calling an ER doctor tomorrow and spout that nonsense over the phone, they’ll laugh you off the line before you can even blink. And who exactly was the genius claiming it's a good idea to check D-dimer levels right after someone recovers from a heart attack? I have no clue who said that, but it was clearly the first person to speak, and likely someone profiting from the confusion. DVT = deep vein thrombosis PE = pulmonary embolism
First off, why were they even bothering to run D-Dimer tests in the first place? Second question: what’s the actual statistical likelihood here of dealing with a DVT or a PE? Third, what does the combined score look like when you tally up the Wells, PESI, and the Geneva criteria? And finally, what was the reasoning behind whoever actually ordered those D-Dimers to begin with?
Jessica White95 said:Is this really the response I get? Like, she’s basically doing zero work—she just writes a prescription for the medication and calls it a day. As if that’s somehow sufficient.
Exactly. It’s high time she actually starts doing her job instead of just checking boxes.