Blood clot

[philmcintyre]

My wife is 58 yrs old, was active, good health generally, no medications,
only vitamins. She broke her ankle in january 2005, was taken to the local
ER and casted immediately by an orthopedic surgeon. Cast ran from foot to
knee. Instructions were to make appt with his office for a month later for
follow up. In the meantime, her foot turned black, tremendous amount of
swelling occurred, and excessive pain. She called the doctor and was told
that this was "normal". The cast came off in a month. Pain and swelling
did not stop. I called the doctor and he ordered an ultrasound which
indicated a large blood clot. Hospitalization followed and now daily
coumadin. I have further since learned that casting immediately is not
standard at any other hospital around because of the complications that
arise. Icing and immobilization are the norm until the swelling subsides.
My question is this? is it possible that the blod clot occurred because of
the severe impedance of blood flow due to the excessive swelling inside the
cast? In the alternative, could the immediate casting and ensuing swelling
have been a contributing factor to the blood clot?

[Enoch Choi]

A "screaming wheel" is an appropriate level of concern for the symptoms that could represent gangrene from loss of blood flow to the affected area.  I agree, be the squeaky wheel and get a second opinion.

Thanks, caregiver, for being more appropriate in your level of concern...  I can't be directive to questioners, but you as a contributor can, and your comments are really valuable.

Enoch Choi, MD

[caregiver222]

Your wife's treatment, followup, and monitering in my humble opinion does not meet the legal standard "of the reasonable and prudent man." On the other side, people make mistakes. Often advice is provided by a temp answering the physicians telephone who may not even have a high school diploma. If any mention of a blackened foot was made it was clear your wife should have called 911, and that was the advice that should have been given. Not having been on the telephone I cannot say what transpired. I am very concerned about infection and gangrene and possible loss of the foot. At this point you have a multitude of problems and an overlapping of interests. A wound care specialist consult should be a muist, and you must be a squeaky wheel or you will not get the grease. At this point you need to be a screaming wheel. Most likely you are still in the "orthopedic service". I'm not sure that is the proper service. I would get her into another hospital. That is one person's opinion. Mine alone.