Sunday, March 23, 2008

Deep Vein Thrombosis

My doctor tells me a DVT is really, really bad. I just know it hurts like a bitch and all the bad things that she tells me about it that can happen should little bits plugging the vein tear loose scares the crap out of me.

I had been having occasional pains in my left calf for a couple of months that I had written off as age and being out of shape. Since the herniated disc in my neck forced me to stop taekwondo workouts last year, I have not been doing much in the way of physical exertion. I figured the aches and pains in the leg were cramps telling me it was about time to get off my butt and get back in shape. The fact that a stretch or short walk usually made the pains go away was my key data point that it was nothing serious.

The pain gradually came more frequently and then was joined by some swelling. One weekend the pain because constant and intense. The following Tuesday I went to my doctor1. I was mostly still expecting this to be something straightforward that could be treated with high strength NSAIDs. However I also knew it had the chance of being something more since I had a somewhat similar though greatly less severe episode 12 years earlier.

She spent about 2 minutes looking at my leg and sent me to the hospital to get an ultrasound to look for blood clots. I was in her office just long enough for her to tell me that if the ultrasound showed any blockage they would be checking me into a room today and I would probably be there for a week or more. The ultrasound showed a big ole clot in the poplitean vein in my calf behind my knee. Off I went to the ER to get things started.

The next several hours I spent just laying about taking up an ER bed while they ran some blood work and the ER doctor and my doctor decided whether I needed to be admitted or could deal with this at home. It came down to whether my kidneys were up to handling a newer medicine and whether Mary and I were up to giving me daily injections. Oh, joy. Needles. In my skin. Twice daily. The other choice was to be stuck in the hospital for a week or two and maybe more. Yeah! Needles! In my skin! Twice Daily! That decided it. I went to my doctor on 19 Feb and was out of work until 13 March.

The next three weeks were pretty dull. I lay about in bed keeping the leg propped up, watched crap on TV or whatever movies were about, took drugs, dreaded noon and midnight when I got to poke needles in my belly. The leg hurt quite a bit and I had to take some chemicals to dull that to be able to sleep for a few nights that week first week. After that it was just dull and worrisome waiting for the doctors to decide what the problem was and how to deal with it. I was told basically to do nothing that involved moving my leg off horizontal or put any pressure on it until the swelling went away unless it was absolutely necessary. That left TV, books, and keeping up with work email and blogs reading on the Treo. Using the laptop while laying flat on my back in bed doesn't work for me. That and being kind of stressed of it all is why I have been silent for a month.

The doctors' plan was first to get my blood clotting factors down so that my body could devour the clots that exist without having more clots forming on top of those. They started feeding me coumadin daily and checking blood every week to see went it got to an effective the level. Since coumadin is a slow starter they decided to use a a drug called Lovenox as a bridge to speed the anti-clotting affect. Lovenonx is the twice-a-day injection I mentioned before. This drug is fast acting and has a short life in the body. It is also, from what I can tell by the doctor's comments and some reading around the web, a fairly expensive drug. One report I read put the cost of each injection at about $100. Pretty pricey, but less expensive than me having to stay in the hospital for the other treatments, certainly more pleasant, and probably safer overall even counting the problems I have sticking myself with a needle.

The next part of the plan was to find out what caused the clot in the first place. I visited a hematologist / oncologist, gave him a bucket of blood to test and a CT scan to study. After sweating for a week we went back a to go over the results2. The CT scan came back clear of anything scary that could be cause. The blood test showed a couple of things that are likely causes. The main one is a genetic anomaly called MTHFR mutation. This causes an enzyme to be out of whack which can lead to, among many other things, blood clots. The good news in that the preventative treatment is really easy: I just have to take a regular dose of folic acid (Eat your spinach and collards!). More than 10% of the population have this mutation, so you can just stop thinking that it was my time around the nuclear reactor or that visit to the alien mothership that did it. For the next six months I will be taking the anti-clotting drugs and the doctor will be monitoring blood levels closely to make sure that I am taking enough. After that I will stop taking the blood thinners there will be some tests to check my liver function for some minor issues and side affects of the drugs.

The biggest concerns over the next few months is that the main clots that had formed and caused the big problem are dissolved slowly without a chunk snapping off and ending up in my lung or brain. Next is that no new clots are forming. Both of these are handled with the drugs that suppress the clotting behavior of the blood. The main negative of this treatment is that my blood won't clot as well as it should if I get a cut or other bleeding injury. So no juggling chain saws for a while.

There are no further tests to confirm that the clots have been removed. The doctors judge the likelihood of that based on the physical appearance of my leg. If he symptoms I had go away then the clots are probably gone, otherwise they are not. If the swelling and pain return the clots are back. Since they confirmed them once with the ultrasound there is no reason to do it again. Surgery to remove the clots is not really an option unless life gets really ugly with lots of really big bad clots. Surgery leads to conditions that actually cause more clots (slicing and dicing followed by lots of laying about) so that's a last resort kind of thing.

My leg is better than it was a month ago. It only swells a bit in the evenings. I still get really tired late in the day, but that seems to be getting somewhat better each day. This sucks but it's getting better. It could have been something super scary, but it is only something really scary. We are moving forward.

A note to all my relatives, especially siblings and cousins: 10% or of the population has this genetic anomaly and that's a pretty high rate, but it is an inherited trait. It is not clear from the studies I have read whether it is more likely passed from the maternal or fraternal side of the line. Certainly my siblings and children have a very high likelihood of having this same trait. My close cousins should be aware of the nature of effects of this thing. I don't think it is something that you stress and worry over, just something to watch a little closer for should you have pains in your legs. It would also probably be worth the extra look on your next annual physical to have the add the check for MTHFR to the blood work. It is common test now so should not be a big deal to add to the other blood work sent out to the labs. Again not something you should do special, but it would be worth adding in the next time you get a physical.

Or you can just eat your greens like you're supposed to, just in case (and more than just on New Years Day3).



1Would have been Monday but my doctor was not in and I was not yet scared.

2And losing 12 pounds while waiting. Well I lost it during the 3 weeks I was out, but sweating the cause of the clot was the main reason I think.

3For anyone not from the South: Ham Hocks, collared greens, and black eyed peas

1 comment:

Fuel55 said...

Get better soon dude.