Jump to content

do you need a referral to go to clevland clinic?


Recommended Posts

hey folks...

I am wondering. I seen dr. Fouad back in 2003.. for evaluuation and official dx of POTS.. and I havent been back to see her since then..

I need to have a blood volume test done.. and they dont do them here and the closest place to have one done is cleveland clinic...

SHould I make an appointment to see dr. fouad and discuss things with her? She tried to do a hemodynamic blood volume test on me in 2003.. but was unable to gain IV access... they tried for like 45 minutes to get a vein to pop up.. and tried everything too!

in the end they ended up just getting a small IV in to do the TTT... and as it turned out they diditn need to use the IV anyways ! my HR went nice and tachy all on its own.... :P

I have one more question..(forgive me for sounding stupid here..LOL) OK blood pooling is the blood and plasma and what not being able to "pool" carry up tot he upper half of the body right? so is that what turns you legs and feet so purple? and blotchy red looking?

and blood volume.. is that the amount of blood and stuff you have?

How do they measure blood volume? and how do they know where it is pooling? (aside from the obvious of course..) like how would they be able to tell if your pooling in your stomach?

thanks for reading and answering my crazy questions...!

Link to comment
Share on other sites

Blood volume and blood pooling are two different things.

Blood volume measurements are made by dilution studies. They give you a dose of some radioactive stuff, wait a bit for it to get mixed into your bloodstream, and then measure the concentration of the radioactive stuff in a blood sample. Since they knew how much radioactive stuff they gave you, and they know the final concentration, they calculate the volume into which it has been mixed. They use a radioactive iodine tracer for plasma volume and a radioactive chromium for the red blood cells. Thus, they give you two measurements, your total red cell mass and your plasma volume. If your total red cell mass is low, then you are anemic. It is hard for a lot of doctors to understand this concept. They have been taught to think of anemia in terms of the hematocrit (red cells as a percentage of volume of a blood sample) and hemoglobin content of a blood sample. However, if your plasma volume AND your red cell mass are low, you can have a normal hematocrit and hemoglobin even though you are really severely anemic. If you aren't fortunate enough to be going to a doctor who already understands this, take some literature from www.daxor.com with you to your appointment.

If you need to have a blood volume study done, you might call Daxor and find out who has their equipment.

Blood pooling refers to blood staying in the intravascular space (i.e., within your blood vessels) but tending to accumulate in the downward (i.e., "dependent") portions of the body. This generally means the legs, but it could also mean the splanchnic vessels (i.e., the vessels of the internal organs of the abdomen). That's why waist-high compression stockings work better than knee-high stockings in counteracting POTS.

Blood pooling is a totally different thing from internal bleeding (or what doctors call "third space" losses). In blood pooling, the blood stays inside the blood vessels, where all sorts of mechanisms work to keep it flowing. If the blood leaves the blood vessels, it will probably clot. It won't re-enter the circulation.

Orthostatic intolerance (including POTS) is generally attributed to poor return of blood to the heart. This could result from low blood volume (e.g., a healthy friend of mine was POTSy for about a week after he lost a lot of blood when he was hit by a car). Poor return of blood to the heart can also result despite normal blood volume if too much blood shifts downward to the legs under the force of gravity. Of course, if you have low blood volume and blood pooling, you are in double trouble.

Link to comment
Share on other sites

No you don't need a referal, but I did have to wait for my insurce to go thought to go as I live in Iowa. I took a while but I got in, and it was worth it. I found out I had low blood volume and MTT. SO it was good to know what was going on. Good luck!


Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Create New...