Posts tagged ‘DVT’
A tale of two blog posts
Earlier this month, I had a new blog post take over the top spot for “total hits”. Here is a plot of the hits for the top two over time…
The long-time front-runner was published back in November of 2010. You can see that it shot up to about 300 hits through the end of the year. Then it leveled off through most of 2011, before recording another 200 hits or so at the end of that year. Now in 2012, it has leveled off again.
The other post was published just over a year ago in May 2011. It had a modest showing through the summer before picking up the pace and consistently gaining ground on the front-runner. Finally on May 4th, it had accumulated enough views to put it into the #1 spot.
So what were these posts, and why such different behavior?
Well – the former leader (in red) is easy enough to explain. It’s a post with images that I created for Advent. When that time of the Church liturgical calendar arrives, people start searching for things to put on their bulletin covers. Voila! Hits on that post.
The new leader (in blue) is a post about my DVT. It gets hits mostly because there seems to be a constant stream of people interested in both the causes of DVTs and the picture of the human circulatory system (which is borrowed from Wikipedia). It’s popularity still surprises me, but it is fairly consistent in receiving two or three hits per day.
At this point, there doesn’t appear to be any other post that could overtake the current leader. Maybe I should start getting controversial!
Late nights
One day ago at this time, I was beginning one of my unpleasant late-night experiences at the synchrotron. I worked way past my bedtime, left at 3 a.m. this morning, and didn’t get much sleep. It could be worse, I suppose. I occasionally have to work all-nighters.
One year and one day ago at this time, I was also beginning an unpleasant late-night experience… in the emergency room. I was up way past my bedtime, finally got admitted into a hospital room after midnight, and didn’t get much sleep. That also could have been worse. I’m thankful that it wasn’t.
Suddenly, late nights at work aren’t quite as bad.
Luxurious accomodations
I just came across this picture from my hospital stay last October. It was taken by my webcam. I forgot that I had it.
Doesn’t look like a real inviting place, does it? I see that I’m dressed in the latest fashion. And apparently, I have a heart beat (note the monitor behind me). Also, you may notice my heparin cart in the background.
(But to be perfectly honest, I have nothing but good things to say about Edward Hospital.)
My blood clot: no causes; just commentary
One of the most frequent questions that I get regarding my DVT is about the cause. If it happens to be a medical professional doing the asking, they immediately run through a list of tests, usually related to finding a genetic abnormality. Unfortunately, all of these tests have now come back negative. Twice.
I am only able to share two bits of information in response to these questions. First, my DVT seven years ago damaged my veins, thereby making last year’s occurrence more likely. Second, DVTs are more likely to occur in the left leg because of the positioning of the veins. Yesterday, I came upon an interesting picture related to this point: Wikipedia’s featured picture of the day.
In this image, the person is facing you (anterior view). In other words, the person’s left leg is on the right side. Arteries are shown in red, and veins are in blue, as is typical.
Now, if you look closely at where the vessels branch into the legs (the iliac veins and arteries), you’ll notice that the artery runs over the vein as it enters the left leg (right side of the picture). However, the vein to the other leg runs unobstructed. The pressure of the artery is able to exert force on the vein running under it, potentially obstructing the smooth return of blood to the heart.
None of this actually explains why I would have developed the clot in the first place. But as my physician said, the cause doesn’t really matter any more. It’s happened twice, so now I’ll likely be treated for it for the rest of my life. I’ve heard of some new drugs recently approved by the FDA for similar conditions. They perform the same function (blood thinning) as my current medication (coumadin) without having to worry quite so much about hemorrhaging or constant INR monitoring. I see my specialist next week, so we’ll see what develops…
5 km for my health
This past Saturday, Laurelville held its first ever Spring Classic – a 5 km run/walk, a 1 mi run/walk, and a 200 meter junior jog – organized by Brian Paff, Director of Communications and runner extraordinaire.
A few months ago, I thought I should try to participate in the 5 km run. It would be a goal in my ongoing recovery from my DVT. Well, I didn’t manage to get in shape for the run (and I’m not sure that my leg would have allowed it anyway). However, I did manage to walk the full 5 km.
Here are a few pre-race photos:
Number 5 is ready to go!
Can anything slow him down?
No! He’s speedy!
And here is a cute little video of the race route. (I carried my GPS so that I could plot the route in Google Earth.)
I finished in under 50 minutes which isn’t saying anything. But hey – the last time I was at Laurelville I could hardly walk.
Health update and New Year’s resolutions
I see that I haven’t given an update on my leg since before Thanksgiving. In early November, I had been fitted for compression stockings in order to treat post-thrombotic syndrome, which resulted from my DVT. Well, the stockings arrived, and I couldn’t wear them. In general, they were uncomfortable, but it was the incredibly strong compression behind my knee that was the problem. The stocking acted like a strong rubber band and cut into the tendons behind my knees (the hamstrings). The pain from that kept me from wearing the stockings for any length of time. The last attempt was when we travelled to Goshen for Thanksgiving.
After that, I purchased some knee-high stockings. I wear them on just one leg, and they don’t cut into the tendons. They also aren’t quite as tight (20-30 mm Hg, instead of 30-40 mm Hg). They actually work quite well, as far as I can tell. If I don’t wear them, the leg is swollen and slightly painful (3 to 4 on the pain scale) by the end of the day. If I do wear them, I don’t feel any pain during routine activities.
(Here’s a little tidbit to gross you out… My leg acts like memory foam. I push on my shin bone and cause an indentation in the swelling. But it doesn’t spring back. It looks really disgusting. That’s the post-thrombotic syndrome I mentioned earlier.)
Over Christmas, I pushed my limits a bit and walked about five miles with my dad along a converted rail bed with a gentle incline. With an extended effort like that, I could feel some swelling after a few minutes. I’d stop and rest for a few seconds, and the stocking seemed to help alleviate the pain. I was encouraged that I wasn’t too stiff the next day.
Recently, I read about Laurelville’s first annual Spring Classic – a 5k run to be held on Association Weekend. In a moment of great delusion, I thought I’d challenge myself to run in the race. It would be a way of speeding my recovery.
What was I thinking?
Last week, I tried to run 1 km. I did about three-quarters before I had to switching to walking. Too much pain. I was sore for the next four days.
But this week, I’ve increased my distances – 2 km on Monday and 3 km today. (I’m going to be feeling it tomorrow.) I’m still walking for roughly half that distance, but I also have three months to train. Hopefully, I can grow some new vessels to help get oxygen to those muscles.
That’s all the update for now. Things are going well, aside from some long-term effects that are manageable.
Orthotic blogging
In today’s DVT update, we’ll be discussing your new vocabulary word: orthoses. Before that we’ll also discuss the 10-point pain scale. But up first: the crazy price of health care…
Mini-blog #1 – Health care costs
I recently received the billing summary from my hospital stay and said a little prayer of thankfulness for health insurance. Although I had joked about my “$1000 per night hotel room”, it turns out that I missed the actual cost by a bit. Ok, by a lot. It was really a $2000 per night room. And that didn’t include the medicines, the consultations with various physicians, the blood tests, the temporary stop in the emergency room, and the ambulance ride.
(And here, I’d like to interject a bit about that ambulance ride. It was roughly ten miles from the ER in Plainfield to the hospital in Naperville. A twenty-minute ride. A $3000 ride. It wasn’t even very comfortable – pretty much like riding in the back of a pickup truck. And they didn’t even flash the lights for me.)
Now, I am not complaining about any of my care. It was excellent. I had good nurses, technicians, physicians, and specialists. I was kept comfortable and my care-givers knew what they were doing. I have nothing but praise for Edward Hospital.
But I’m amazed at the total cost, which was roughly 30% of my yearly salary.
A cost which I will not have to cover at all – not even one cent – because I have good health insurance.
And this is why I support recent efforts to improve the health care system in this country. If my family didn’t have insurance, we’d be bankrupt many times over. I don’t have to choose between my health and my financial security. Neither should anyone else.
Mini-blog #2 – Pain scale
I’m frequently asked about pain these days. Nurses and doctors seem to all use a 10-point scale, so I’ve also become accustomed to speaking in numbers. However, it’s also relative – someone’s ’3′ may be someone else’s ’7′. I thought it would be interesting to try to describe my scale with some comments:
- Back when my clot was forming (but I wasn’t yet certain that it was a clot), I started getting worried and suspicious after about three days between ’3′ and ’4′.
- When it increased to ’5′ and ’6′ while we were at Laurelville, I was pretty certain I was dealing with a clot, and I thought that I should go in to see the doctor on Monday when we got home. (In retrospect, the moment I was pretty certain that I had a clot would have been the moment when I should have been in the ER.)
- By the time it got up to ’7′, I was in agreement with my Perceptive Spouse: no waiting for Monday. Call the doctor and convince him that I need to visit the ER.
- This time around, the pain only got above ’7′ twice: once briefly in the hospital late at night when I was cold, sleepy, and generally unable to cope with stress (’9′), and once for an extended time when I tried to go back to work too quickly after my hospital stay (’8′).
- Most of my pain has been temporary. By shifting positions and elevating my leg, I’m able to reduce it. That’s certainly the case now that I’ve been off the pain meds for a number of days.
Mini-blog #3 – The word of the day
Time to get back to that vocabulary word. Orthoses are…
devices used to control and/or guide and/or limit and/or immobilize an extremity, joint or body segment for a given reason; to restrict movement in a given direction; to assist movement more generally; to reduce weight-bearing forces for a particular mobility purpose; to help with rehabilitation from fractures after the removal of a medical cast; or to otherwise correct the shape and/or function of the body to provide easier movement capability and/or reduce pain.
from Wikipedia
In my case, I have post-thrombotic syndrome, which is caused by damage to the valves in my veins. To deal with the pain and swelling, my physician has prescribed compression stockings (my orthoses! how stylish!) which are supposed to exert an additional pressure of 30 to 40 torr on the blood in my veins. I visited Hanger earlier this week to be fitted for them and had a choice of two stylish colors: beige and black. I decided to go with black. They’ll be in next week. Can’t wait to show them off.
Five that should have been for Friday… health questions
(Ok – so I’m a day late. But I started this post yesterday!)
Given my recent hospitalization, I anticipate getting asked a few questions multiple times. I’ll try to anticipate some of those. I am not a doctor, nor do I play one on TV.
1) What happened? I had a blood clot that ran the length of the vein in my left leg for the second time in my life. The last time was seven years ago. The doctors still don’t know what’s causing them, although having the first one increased the possibility of the second. All of the blood tests for various things have come back negative, including the test for Factor V Leiden. Since that one is hereditary and is known to be in my family, it was the first suspected cause seven years ago. But I’ve now tested negative twice.
The other usual question that the medical people ask is whether I’d been on any long trips. In both cases, the answer was ‘no’. I may not have done myself any favors by going to Laurelville while I had the clot, however. But I did have enough sense to take rest stops frequently.
2) What is the pain like? More severe than any other pain that I’ve experienced. It is most intense in my thigh. The knee has some sharp pains when it bends too far. And the calf feels swollen and tight. Thankfully, given my experience seven years ago, we caught this clot sooner, and it didn’t cause as much pain as the last one.
Also, now that I’ve been on blood thinner for 5+ days, the pain is receding. I still have a few more days that I can devote to resting, and when I’m doing that I only feel a low-level throbbing. Walking still becomes hard after about a minute or two, but pain medication helps. Interestingly, simply standing in one place is difficult.
To deal with the pain, I’m taking a drug called Norco, which is related to Vicodin. They don’t completely remove the pain, but they do make it manageable. Hopefully, the need for that will gradually decrease over the next week or so. One challenge in the future will be dealing with non-leg pain. Usually, I prefer ibuprofen for headaches, muscle aches, etc. However, ibuprofen interferes with my blood thinner, so I need to try to avoid it. More on blood thinners below.
3) What are the dangers from a blood clot? There is the immediate danger to the leg. The tissues are being stretched in ways that are dangerous. Also, if the blood clot isn’t removed, it damages the valves in the vessels. This allows blood to accumulate in the leg, rather than returning naturally to the heart. It’s likely that this kind of damage from the last clot contributed to the formation of this one.
The other big danger is the possibility of part of the clot breaking off and lodging somewhere else in the body – most likely in the lungs. A clot in the lungs is called a pulmonary embolism (PE). That could potentially be very nasty.
4) How do you treat the clot? Since this is my second clot, the goal is to establish a long-term, therapeutic level of coumadin (a.k.a. Warfarin – the rat poison that I mentioned yesterday) to thin the blood. However, when coumadin is first introduced to the body, it actually thickens the blood before it thins it. So the hospital uses a second blood thinner (heparin) in combination with the coumadin in order to start treating the clot. Interestingly, heparin is derived from the intestines of pigs. Makes me wonder how many pigs died for my health.
I think that the primary reason for being in the hospital was to monitor my health until the clot could be stabilized and somewhat dissolved. After a few days on blood thinner, the risk of the clot breaking apart (and resulting in a PE) is decreased. At that point, they could safely send me home (as they did this past Wednesday). However, I still needed heparin until the coumadin was at a good level. Therefore, I got to inject myself with enoxaparin. Now I have little bruises all over my mid-section where I poked myself with syringe needles.
5) What happens now? My hematologist is still looking for a reason for these clots. But, he says, “in some ways it doesn’t really matter.” Since I’ve now had two clots, I’m going to be treated long-term with blood thinner, probably for the rest of my life. This means that I’ll have to remember that I’m susceptible to bleeding and bruising, especially if I hit my head. I need to keep my diet consistent (don’t overeat leafy greens or drink too much alcohol, among other things). The antidote to coumadin is vitamin K (the leafy greens), so I’ll just need to enjoy Ordinary Spouse’s garden in moderation during the summer.
When I’m back at work next week, I’ll look for spots where I could hit my head on our beamline equipment (there are quite few) and I’ll start adding padding in those areas.
When travelling, I’ll have to be extra careful to take regular rest stops.
And I’ll have to limit my participation in contact sports. Clearly, no one informed the medical community that fatherhood is a contact sport.
Rat poison
From Wikipedia:
In the early 1920s, there was an outbreak of a previously unrecognized cattle disease in the northern United States and Canada. Cattle were hemorrhaging after minor procedures, and on some occasions, spontaneously. For example, 21 out of 22 cows died after de-horning, and 12 out of 25 bulls died after castration.* All of these animals had bled to death… [It was] determined that the cattle were ingesting moldy silage made from sweet clover.
* I’m not sure exactly what constitutes a “minor procedure” but we won’t argue that now.
The chemical cause of these deaths was determined in the 1930s: an anti-coagulant called dicoumarol. By mid-century, it had been modified into a form commonly known as Warfarin, and marketed as rat poison. Warfarin and similar compounds are still popular today as rodenticides.
And it’s helping to protect my life.
Seven years ago, I developed a blood clot in my leg. No idea why. It’s not typical for someone younger than thirty to get a DVT (deep vein thrombosis) without some good cause. If you are a medically trained person, you’ll probably know all of the questions to ask, but believe me – I’ve been asked them all multiple times. Even multiples of multiple times.
I was in the hospital for three days and took medication for six months after that. And that was that. A fluke in my medical history.
Until this past week.
I noticed the pain in my leg before we left for Laurelville last Wednesday. I tried to discount it – I’ve had pain off and on in that leg for seven years. Lingering damage from the blood clot. It usually showed up when I was active (jogging or long walks) and was never real severe. It usually didn’t last longer than a day and usually much less than that. But last week, you might have guessed that this was not a typical pain, even if I tried to downplay it. The fact that I bought a bottle of aspirin before we left would tip you off: aspirin is a pain killer and a blood thinner. In the back of my mind, I was slightly worried.
Nevertheless, we were off to Laurelville. And by the middle of the weekend, I was pretty sure I had another blood clot. (It’s an interesting coincidence that seven years ago, I was also at Laurelville walking around in pain.) On Saturday, I predicted to Ordinary Spouse that I was going to be treated by Monday. On our way home on Sunday, she clarified for me: “You are going to call your doctor when we get home. You aren’t waiting until Monday.”
And that is how I found myself in the emergency room Sunday night, followed by my first ever ride in an ambulance**, and then three nights in my “$1000 per night hotel room”. I was immediately treated with heparin to keep the clot from getting any larger and to allow my body to start dissolving what wasn’t meant to be there. Pain killers also helped. (Seven years ago, I experienced the worst pain that I’ve ever had. This time around, the pain helped me to know what was happening early. Hence, it didn’t get to the same level of severity.)
** It wasn’t an emergency ride. I was just being transported. No lights were flashing on my behalf.
I’m out of the hospital again – discharged Wednesday afternoon. But since the doctors still don’t know the cause of these clots, I also need to be treated long-term with a blood thinner in order to keep other clots from forming. And that blood thinner is…
Rat poison.
