Back pain, doctors suspect blood clot

[TomorrowToday]

I'm 20 weeks pregnant. I went to the GP out of hours as right hand side upper back pain. Got sent to a ward in the hospital and doctors suspect a blood clot in my lung. X-ray is fine but they want to do another test and I have to inject myself daily until they do that test.

I was given 1000mg of paracetamol on a drip and the pain has come back within two hours.

AIBU to think this is muscle pain instead of a clot?

I think I'd rather be over-treated for a potential PE that turns out to be muscular, than under treated and end up dead. You really don't want a blood clot ignored, especially if it's in your lungs!

Can they give you any stronger pain relief if the paracetamol has worn off already?

I don't know if I'm just being a woss, but the pain does feel bad. Too late to get co codomal :(

please ask for some stronger pain relief. fingers crossed its not a blood clot. pregnancy unfortunately increases the risk of blood clots, so best to be fully investigated rather than dismiss it.

Should I got back to a and e for it?

How can I be sure it's not back pain?

I had a PE caused by pregnancy, 2 weeks after giving birth. It was the most horrendous pain I’d ever felt (after giving birth with no pain relief twice). Please make sure you’re properly treated - I thought it was just a pulled muscle or a trapped nerve in my shoulder but no painkillers touched it.

111 told me I just needed a pharmacy but I took myself to A&E after the pain. I spent 10 hours in A&E having an x-Ray/bloods/CT scan I think it was and was diagnosed. I was injected in the stomach and I’m still on blood thinners now until August. If I ever was to get pregnant again, I’d have to go straight on medication and I have to take precautions on long haul flights now as well as not being allowed to be on the hormonal pill again.

Pain for me was so bad I had to be pulled out of bed by DH as I couldn’t sit up or lie down myself without crying in pain, I couldn’t swallow food, couldn’t do anything other than shallow breaths. It was in my shoulder, chest and my upper back.
Please make sure you’re okay and it’s ruled out if it’s not. If not caught and treated I’m pretty sure they can go to your heart and then it’s game over.
Hope you’re on the mend soon whatever it is and it turns out to be something lesser.

So should I go back? The medication hasn't touched it? I'm in pain unless I'm on my left side and resting.

I definitely would go back, please don’t feel you’re wasting anyone’s time.
It took me about 4 attempts to lie down and I had to lie totally still otherwise the slightest movement would cause pain. I couldn’t even hold my baby.
Being safe is the most important thing.

I would go back if you begin to feel short of breath or very unwell/like you could collapse. Or if despite the paracetamol the pain is so severe it would completely prevent you from sleeping.

If you can get into a comfortable position and you think you will be able to sleep try and get a call back from your GP tomorrow. Generally the next step analgesia they might be agreeable to prescribing in pregnancy would be codeine.

In terms of getting slightly stronger pain relief tonight not involving hospital they sell a low dose co-codamol at any pharmacy (so you'd get 16mg of codeine with your paracetamol) if you've got a late night one near by. This would be a is generally considered a safe medication for pregnancy, the pharmacist will be able to advise further.

Yes there is a perfect pose that doesn't hurt.... but after that I can be sure sitting and drive will hurt.

But how do I know it's not muscle pain?

Have they done a d-dimer blood test?

No they told me to inject and they would do another test soon.... not sure when, I was overwhelmed and hu myself

Is my baby going to die?

The risk is more to you than to your baby. Please go back to A and E. You’re not wasting anyone’s time. If it’s a pulled muscle, then fine - you can go back home. If it’s more serious they can sort it out for you.

There are diagnostic tests to differentiate a blood clot from muscle pain - CTPA, V/Q and a blood test/d-dimer are the main ones but I've no idea how pregnancy would affect how they used these.

History can be part of the picture though, although there;s a lot of overlap between what can be muscular or what is a PE, although classically it's missed PEs that end up being diagnosed as muscular pain.

Generally speaking muscular normally has a trigger - so being aware of a fall or awkward movement/sudden forceful cough. It would be much worse when you breath in and settle well if you relaxed your chest/held your breath. You wouldn't normally feel very short of breath with it. Muscular pain is normally pretty bearable at rest, it's unusual for a person with it to contemplate going back to A&E.

PE/blood clot - Normally a specific point of pain/discomfort that you just cant shake, can be moderate . More likely to affect your breathing. May also have a calf pain episode (DVT), can cause a bloody cough.

It's not one to second guess though, if it could be a PE and it certainly sounds like it could be you don't want to get the treatment wrong.

How can you know it's not muscle pain? By having the investigations that your medical team want you to have.

Hope you're ok OP. I had this with my first pregnancy and, although everything was fine, it was a really scary time.

Depending on the A&E sometimes PE/DVT clinics are only open mon-fri in hours and the test don't occur out of hours. If they think it's a small clot/you're 'well' they can send you home to start the treatment anyway, as opposed to delaying treatment for the test to become available to 'prove' that's the cause. There's also a Dr strike on at present so it's likely capacity to perform the tests is reduced on normal levels. You're having the treatment though, the injection you mentioned will be a medication that breaks down blood clots. So you not having the tests if they haven't done them isn't to be worried about, they;re treating you based on the symptoms you described.

People actually have PEs more often then realised, they're called sub-clinical PEs. People might just feel generally unwell, a little short of breath, slight ache, or nothing at all. But when they're small the symptoms are minor and people don't seek help so they're not detected or they're written off as viral etc.

It sounds like the OOGP had a concern, well founded since A&E agreed and they've started your treatment. If you begin to feel worse especially with your breathing then go back to A&E. If you're panicking/very stressed, absolutely not reassured then just go back to A&E. If you need someone official to tell you to go back to A&E call 111 - they will absolutely tell you to goto A&E and/or send you an ambulance to take you.

Thank you thank you thank you so much everyone xxxxx

The paracetamol isn't touching the pain.... it was via a drip. Should I go back?

What treatment did you have? Was anyone worried?

Paracetamol is exactly the same dose and drug whether you swallow it or have it as a drip, numerous studies show there to be no meaningful difference in the treatment of pain between the two. This is partly as the therapeutic dose which is where it has the best effect is 2g not the 1g you take in a dose. It's by taking the medication at 4-6hr intervals that gets you to the 2g therapeutic dose. Its why you sometimes hear people rubbish paracetamol but they've only had 1 dose and not got near the levels that will give the best relief from pain.

There is a psychological effect with being given an injection which is why sometimes staff big it up in hospital as they want you to feel better about your pain

@SleepyRich thanks. I'll try and have it again..... it will be on a 4 hour interval as I need pain relief now and I'm going to bed. I had a cocodomal at 3pm. So I've had 1500 paracetamol today since 3pm

Do you reckon they give it on a drip to help prevent dehydration? I thought it was a stronger dose but it was only 1000mg.