Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

In one sense, we are all living on borrowed time. How hard should we look to find the ticking time bombs? When we find one, what do we do?

In terms of knowing whether we’ve made good decisions, we only connect the dots looking backwards. Still, I wonder what the right balance is – between “looking harder” and “ignoring what may go away on its own.”

Some background.

Two years ago, I fractured my left fibula. It was treated with 8 weeks of bracing. When I took the brace off, my calf was enormous. Not what one would expect with decreased use – and even predicted atrophy. I had zero pain. A doppler venous flow study showed extensive deep venous thrombosis, affecting calf veins going up into deep veins of the thigh. Rut roh.

The orthopaedic surgeon called my mobile as I left the doppler test, exhorting me to go straight to my internist – to start anticoagulation. I was already in my internist’s parking lot.

I did 12 weeks of Xarelto. I started wearing compression hose. All was well.

Fast forward two years.

Ten days ago, I went cycling. I’m an avid cyclist. I’m one of the older guys in the group. My compadres are fast. And it’s hell to keep up with them. We rode for 60 miles at a blistering pace. When we finished, my right calf was sore. No surprise. I figured it was a sore muscle and it would get better on its own.

It didn’t.

It was still sore 5 days later, a Thursday. And tender.

There was no swelling or bruising. I was leaving for a meeting in Miami the following day.

I thought, this couldn’t be a DVT, could it?

Nah.

To reassure myself, I ordered a D-Dimer test, fully expecting it to be negative.

I flew to Miami on Friday.

The D-Dimer results came back Friday afternoon at 4:50 PM. Naturally.

It was positive. The reference range was 0 to 0.5 mg/L. MY value was 5.0 mg/L.

Adopting Apollo 13’s command pilot, Jack Swigert’s famous line, “Miami, we have a problem.”

I was at a medical meeting and asked locals if they knew where I could get a venous Doppler flow study to rule out DVT on this late Friday afternoon – other than spending the night in an emergency department.

I called two vein treatment centers. One was closed. Another was fully booked with zero open slots. No luck.

I made the leap I had what I had. I went to Walgreens at 5:55 PM. They had already closed their register. Nonetheless, good fortune ruled. I was able to “score” 10 Xarelto pills.

Treatment had begun though the presumed diagnosis was unconfirmed. Still, the Xarelto bought me time.

Candidly, I felt relief.

That evening, I found a website touting portable diagnostics. They’d bring a Doppler ultrasound to a doctor’s office. They would also bring it to my hotel room. I scheduled the test online and put down a deposit. I was on for 9AM, Saturday. You gotta love the “innovations” and new services of the 21^st century.

9AM passed. No show.

10 AM, I received a call. The company was sorry. They don’t work weekends. The scheduling module on their website should have blocked out weekends. It didn’t. They could do the test on Monday. I explained I’d be back in North Carolina then. They apologized profusely and said they “comp” me a free Doppler test next time I’m in Miami.

AWESOME. THANKS!

Well, I made it back to North Carolina. Doppler venous study showed a localized DVT in deep muscle (gastrocnemius) veins. There was adjacent trauma to the muscle – from that brutal cycling ride.

My internist believes these two events were “provoked.” Regardless, past tests to look at how thrombotic I might be were negative.

He suggested 12 weeks of Xarelto. Again. Plus, compression stockings.

The literature (as summarized in the updated guidelines from American College of Chest Physicians) is not definitive on whether patients with isolated distal DVTs even benefit from full anticoagulation. The risk of PE is not high. Another option is doing serial Doppler scans to see if the clot propagates to become a proximal DVT. The literature IS definitive on treating proximal leg DVTs with full anticoagulation. The Guidelines conclude the best course of action is shared decision making with one’s physician. Of course.

More unknowns. How soon could I go back to brisk exercising?

Plus, my wife and I will be heading to northern Finland for a long-overdue vacation. Right, northern Finland in the winter. I’ll report back. What if I have a medical problem in Lapland? I have no idea how sophisticated the hospitals are in the tundra.

Back to where I started. Most of us likely would have ignored the symptom as being self-limited. The pain and tenderness in my unswollen calf abated 8 days after it started. It would have been easy enough to ignore. Most of us would have ignored it. Even physicians. Even physicians with a prior provoked DVT. I was close to being that person.

Makes me wonder what other time bombs are looming. Anyway, we live to fight another day.

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.