Patient Exhibits Surprising Symptoms—A Case Study
Nathan Longbranch, a long-time patient of David Swensen, D.C., came into his office complaining of left calf pain of one week duration. At 6'3" and 280 pounds, Nathan, age 42, was a Division 1 college football player in his younger years.
Posted in Risk Management on Thursday, January 18, 2018
An avid cyclist who often participated in 75-to-100-plus mile charity rides, Nathan worked out with a trainer several times a week. He had been seen by my practice regularly during the past six years for complaints of lower and mid back pain, post meniscus rehabilitation (14 months prior) and Achilles pain, related to athletic activity.
During this appointment, Nathan reported he woke up with calf pain one week earlier, but he could not relate the symptoms to a specific injury or athletic effort. He stated the pain was medial. Nathan also presented with mild edema in his left leg and ankle that appeared in the past week. His socks were leaving a ring around his left leg, but not the right.
Atypical Symptoms Revealed
Palpation revealed mild pitting. There was an area of increased temperature of two inches in diameter, noted by palpation, over the medial calf area. The patient experienced noticeable tenderness to light touch in this same area.
Deciding that this was atypical for a calf strain and that it warranted further work up, I referred the patient to a local hospital for a venous ultrasound to rule out deep vein thrombosis (DVT). Nathan was sure that chiropractic would resolve his symptoms--an instrument-assisted, soft-tissue manipulation had helped with his previous injuries. Nathan had a trip planned to NYC after our appointment, and he was much chagrined to have to go to a hospital.
Patient Appreciative of Referral
Several hours later, Nathan called my office to thank me. The hospital physician had diagnosed a thrombus in the popliteal vein and in the posterior tibial vein, and he was admitted to the hospital for anticoagulant therapy.
Interestingly, after the fact, the patient learned of a family history of DVT. His father and uncles had also experienced thrombus formation but had not informed him of that family history. Genetic variants causing either an excess of a prothrombotic factor or a deficiency in an antithrombotic factor can lead to a greater risk of developing DVT and should be included in the family history inquiry.
Nathan fully recovered and is back to his usual exercise routine. He continues to be a happy—and grateful—chiropractic patient. His PCP has even referred a few patients to me.
The patient’s name has been changed to protect his privacy.