Children and blood thinners

• 28-Jan-22

Blood clots in veins (DVT) happen rarely. When they do happen, it happens more commonly in adults. The average incidence is 80 cases per 100,000 people. Of these 1/4th of the cases lead to a pulmonary embolism. However rarely do we encounter cases in children. I recently met a child who had a thrombosis which required consideration for anticoagulation. The FDA on June 21st, 2021 put out the following guideline for anticoagulation in children: For 1st episode of a...

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To “Second opinion” or not

• 16-Jan-22

I had two patients today who had been seen at another facility and came for a second opinion. While one might feel flattered that patients self-seek you out for a second opinion. But what does this say about us as humans. Or was this a reflection of the particular pathology they had. Or was it something deeper still, something to do with how we as a group (doctors) are perceived by the patients. I suspect that the reason is a combination of the above. And yet each...

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Gifts from and to patients – two sides of a coin!

• 12-Jan-22

Patient 1 I had a patient leave me a gift today, which appeared to be a box of cologne. I apologetically returned it. I didn’t remember the patient. Turns out that it was somebody who had come to me with a concern of having a vascular problem. On further exam, he did not have any vascular problem. So given that it was not a long consultation and the person did not have insurance, we didn’t charge him. Two  years later, with his symptoms having resolved,...

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Need an AV fistula?

• 14-Apr-21

A 36-year-old lady presented with a history of two failed attempts at an AVF creation in her left arm – both at the site of her elbow (antecubital fossa). She was right hand dominant and needed a new fistula. This is not an uncommon scenario for most dialysis patients. They have failed access and are in need of a new access. The key to success of an AVF created in a dialysis patient is from planning on this BEFORE the patient is on dialysis. Non-invasive assessment to...

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Retrieved IVC Filter

• 25-Sep-17

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IVC filter to stop clots to the lungs

• 06-Aug-17

We recently had a 50 year old gentleman who developed leg pain – a cramping, nagging pain. He then went on to develop a cough and shortness of breath. He went to the hospital and was found to have a “Pulmonary embolism”.   He was placed on blood thinners, but then developed blood in his urine and hence had to be taken off the blood thinners. So to protect his lungs and heart from further bad effects of these “clots”, an IVC filter had to be placed. Once...

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