(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.