Friday, June 13, 2008

Bloody hell

As regulars to this blog may know, I was diagnosed with a blood clots (DVT) in my lower leg last February. After completing a three month regime on anticoagulants I went off my medication about two weeks ago. My doctor had run extensive tests on me and everything had come back normal. She and I both hoped that the clotting had been produced by poor sitting habits when I write, causing pressure and decreased blood flow.
Absent any other chemical or genetic risk factors I started counting down. Mentally I had been looking forward to that moment when I'd be med free, and also when I wouldn't have to watch every single cut or abrasion since it could produce a lot of bleeding. Physically I had been lifting weights again and feeling fit once more.
Last week however I noticed my left ankle swelling a lot. The other one too but not so much. It was weird to look at it. I felt like it was someone else's ankle, like my body had become a stranger to me. I went for a couple of days with it like that, and then Beth prevailed upon me to call the doctor. The doctor couldn't see me and so she recommended that I go the ER, again.
I had planned on golfing that very afternoon with my friends; I considered going to the course and then going to the ER but Beth and her friend Meg, who is a naturopath, disabused me of that idea in a hurry.
Ten minutes later I was sitting in the hospital waiting.
Everybody there kept telling referring to my "history" and what a good idea it had been for me to come even though it might be too early for anything to show up on the ultrasound. Show up it did however. Clots in my upper calf and my ankle area. The ER doctor informed me that I'd spending the night in the hospital for observation. I was told that I'd have to start over with the self administered injections for one week and also the oral meds that I'd just been on for the past three months.
I couldn't believe it was happening all over again. For one thing, the next day was the final day of final exams at the high school. I was completely unprepared for the notion that I would not be able to say goodbye to my students before they left for the summer. It's interesting in retrospect to observe how slow I was to let go of what I had decided was important based on earlier and now somewhat outdated information. Perhaps it was because I didn't understand how to assign importance to this new and unwanted part of my life. I called my principal and arranged for a sub. I told where I had hidden my final exams, one set was under a phone book, another was beneath a stack of papers in an organizer on a bookshelf. I was a bit bemused to have to disclose my security-through-obscurity approach to filing important papers.
When my doctor's partner showed up, he told me that it used to be standard practice to hospitalize someone with DVT for ten days. Nowadays they don't think normal activity hurts anything. He decided to discharge me that evening but not before reviewing with me the warning signs of a pulmonary embolism...shortness of breath, chest pain, a general sense of unease or panic.
I went home that night but not before getting a cheeseburger, fries and a pop and then dropping in at my classroom and getting everything organized for my sub. Mentally I began making plans for dropping by the next day at the end of each test period. Once home I did my best to debrief for Beth, but there were no answers to satisfy either of us.
The next day I did indeed sneak over to the school twice in order to collect exams to grade and say goodbye. I took Colm with me. It was a much needed tonic. Word has seeped out about my condition and so I had to reassure them that everything was okay. I could see that they were filled to the brim with anticipation for the beginning of summer. I couldn't help but be a little intoxicated by their energy. I waved goodbye and collected Colm who was hiding at the door. He ran to the elevator and made ready to push the buttons.
The next few days saw my ankles return to something approaching normalcy. People kept inquiring about my health. I kept telling that I felt fine, which was true. I also told them that the only problem was this information I was carrying about this material adhering to the insides of my veins. More people than I can count volunteered stories about relatives who had suffered embolisms, most had died. They'd finish their story and we'd stand there together shaking our heads ruefully...weird.
Then, the day before yesterday Beth took the kids to Portland to see our friends over there. That same day I saw my doctor again. She expressed puzzlement over my condition and told me that she was going to send me to see an oncologist to see if he had any ideas or tests that he might be able to suggest. I wore my poker face. She gave me clearance to work out again, when I asked specifically about walking a round of golf, she almost snorted, as to say, you call that exercise?
I was elated, and the next day I was out on the course with John and Phil.
The weather that day was the first genuinely summer day we'd had since, well, last year. It was warm, very warm, almost too warm for my heavy pants. But I didn't mind because it was like being released from a pen. There were some early quips like "If you see me clutch my chest and fall to the ground, get your sand wedge and spray some sand on me and say a few words."But then the three of us settled quickly into our old and familiar habits and for a couple of hours there was no thought of clots.
That night I showered and slipped into bed feeling spent. I set the phone on the night stand telling myself that Beth might call, though it was pretty late for that. Really though, I think I was trying to be prudent. What if I needed to call someone in a hurry?
I was so tired in fact that I forgot to put Sammy in his kennel. He slept beside my bed on a pile of clothes. I awoke in the middle of the night feeling a familiar discomfort, cramps in both feet. It wasn't unusual for me to get these especially after physical exertion. I tried to pronate my ankles to ease the tightness. It worked but only temporarily. I had to keep doing it. After some time fending off cramps in this manner, I suddenly felt them penetrate upward through my calves. Cramps in calves are painful and I immediately stretched my calves by bending my toes back towards me. Unfortunately I couldn't make the cramps go away, but, even worse, and somewhat alarmingly, the cramps now began to spread into both thighs. They were excruciatingly painful. For a moment I couldn't decide how best to tackle the situation, on my back or standing. And then another thought intruded and this one thought managed to burrow right into the center of my consciousness...what if I was having an event?
My initial response was to tell myself that these were cramps. I'd had cramps many times; I knew cramps, but, then again, there was something about the way these pains had migrated upwards that put me in mind of the nightmare scenario described by my doctor and countless other people over the last few days. In spite of myself I grabbed the phone. I wasn't ready to call but I had no idea how much time I'd have to make a call should it become clear to me that an embolism was in progress. I clutched the phone, squeezing it hard, and I struggle to my feet. By now the cramps were fierce in my thighs and I was crying out in loud sharp groans, cursing here and there for good measure. It occurred to me that I could scream as loud as I wanted.
It felt like my thighs were being pulled backwards through a hole in my femur. I staggered stiff legged into the kitchen and with my free hand got a glass of water. Then I ate a banana. All of these things were, I knew, much too little and much too late to relieve the pain I was in, but they helped me persuade myself that what was going on was what I hoped was going on, not what I feared. Sammy had wandered into the kitchen and was now underfoot, yawning loudly. I decided to go back to the bed and try being horizontal.
Back in bed I fought to find a calm space. I managed to breathe more regularly and that seemed to help everything. My legs were quivering, and I was on tenterhooks, afraid to change positions. I began to question myself. Why shouldn't I call 911? Every decision I'd made to go to the ER in the past three months had been justified. Why not this one too? Maybe I should drive myself...the thought almost made me laugh out loud. I imagined myself ramming the gas with an outstretched foot and then colliding with a power pole or street sign. Absurdly, I imagined forgetting to call someone about Sammy. As I calmed down, I seemed to think more and more imaginatively, casting all sorts of scenarios in which I might suffer an "event." Me in the bus knocked unconscious by the windshield, me in the garden next to some of Sammy's droppings, me on the floor of the house reaching for my bathrobe, the phone still in one hand, the dial tone ringing.
Slowly and by degrees however I regained my trust in myself and in what I thought I knew about my body. These were cramps. The doctor had said nothing about cramps, only shortness of breath and chest pains...and general unease. The unease I was experiencing derived, it seemed to me, from trying to tease some subtext out of the doctor's words and it derived from my own very particular physical symptoms...there was nothing general about it. In this way I argued myself, albeit in a somewhat sophistic manner, into inaction. At length the cramps subsided. I lay in bed sweating from exertion and unable to sleep. I remembered Sammy. I struggled up and took him out in the back yard. He peed and yawned again. He went inside his kennel without complaint. Gingerly I got back in bed.
Not knowing what else to do, I turned on my laptop and began googling "leg cramps embolism". For another hour I read abstracts of studies, journal articles and chats on subjects related to those search terms. I learned a few things...for example, many if not most embolisms are diagnosed several days after they occur. Mostly I just read to see what would come first, enlightenment or sleep. I kept the phone handy. Sleep won out. In the morning I woke up alive but perhaps no wiser.


Anonymous Kristine VO said...

Nice timing with Friday the 13th...I hope you are feeling a little better, or at least are a little more at ease. Take care-Kristine (exchange in Perpignan...)

7:04 PM  
Anonymous Anonymous said...

Sheesh, Dad! I'm glad you're okay! Love, Erin

3:52 PM  

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