Age:40 Gender:F Height:average Weight: I can survive a famine

Medical History: It’s complicated but relevant includes chronic lymphadema of my left arm secondary to blood clots in my inner elbow (multiple veins impacted, collaterals developed) that led to a RIND (Reversible Ischemic Neurological Deficit)/Stroke (residual weakness persisted long term) due to Lupus Anticoagulant; possibly related had a PICC line from December 2021-last week and a replacement port placed two weeks ago on the opposite side

Medication: I could run a pharmacy, but I think Xarelto is all that is relevant - due to a pharmacy issue I have been without this for several days (I have it now to resume tonight)

Question: I am a big girl, so it’s a little harder to notice if the lymphadenopathy swelling increases. However, for the past few weeks, it has felt almost like my upper arm has a moderately tight band or tourniquet around it about midway from elbow yo shoulder. I finally decided to measure my arms and the left arm appears yo be 2-3” bigger around than the right. There is no warmth or redness present and no pain, just the tightness. I have an ultrasound scheduled but my primary doctor was pushing for ER. He is highly over cautious and has sent me to ER for a few things that were not ER worthy. But I also have a history of compensating very well for dangerous situations/issues (like sepsis). And I have been without the Xarelto for about. Is an ER visit necessary?

Thank you so much!