Post Surgery: 4 Weeks + 5 Days / 16 Days UIRTW

A few things:

• I am sort of a mess, both physically and mentally.
• Even if I were able to pull myself together mentally before Wednesday, which in itself is a huge question mark, I really don't know if I can physically be on my feet from 8-5 for five day without seriously jeopardizing my recovery and perhaps even my health. 
• So, I'm not going to find out. I've been in contact with my Chair and explained my situation, and told him that I just don't feel like I can do this, and that whatever I need to do later to make up for it, I will do. Fortunately, I have a good working relationship with the Chair - he is reasonable and knows that I work hard and do my job as well as I can and rarely make excuses or ask for things. He e-mailed back right away and agreed that I should NOT teach the class, and immediately started to work on alternatives. Luckily, he found someone else to teach the class in my place, and the details are being worked out as I write this. It is such a relief for me to have this off my plate, and I am doing everything I can to help the new instructor. I'm basically giving him all of my course material. I just finished a course copy on Blackboard, so he literally has alllll my stuff, which I would normally be pretty possessive about, but... I don't care. Having this off my plate is priceless. My Chair did say that we could always just cancel the class (after all, shit happens, even to instructors) but I would have felt bad about that because canceling a class last minute, especially this one in particular, can really screw students. Getting a replacement is the best option.
• So I now have 16 days until I have to start teaching again, and I feel like the reduced anxiety will be good for my overall recovery.
• That said, I'm actually sort of worried that 16 days won't be enough. But, whatever, it is most certainly better than 4 days. Plus, even in 16 days, I will not have to be on my feet from 8-5; it will be 3.5 hours maximum, which is a very different situation.

Other things:

• I left the ER yesterday with not very much instruction; I need to consult my PCP and orthopedist for specific information about the long-term treatment of my blood clots (AKA acute deep vein thrombosis, or DVT). 
• The PA in the ER told me that sometimes orthopedists 'don't really do blood clots,' and that my orthopedist might refer me to another doctor, perhaps back to my PCP, who might refer me to someone else. Awesome.
• Needless to say, I've been doing a lot of consulting with Dr. Google, and Dr. Google confirms that DVT is odd territory. According to this article: Patients with venous thromboembolic disease (VTE) are seen by a variety of medical specialists, including general physicians, surgeons, obstetricians, hematologists, radiologists, and chest physicians. Because thromboembolic disease forms only a small part of the practice of most of these clinicians, it is difficult for them to keep abreast of advances that are important for optimal patient care. 
• I should add that 'optimal patient care' is very important considering the sort of sobering information the article also gives: DVT and pulmonary embolism (PE) most often complicate the course of sick, hospitalized patients but may also affect ambulatory and otherwise healthy persons. It is estimated that each year 600,000 patients develop PE and that 60,000 die of this complication. This number exceeds the number of American women who die each year from breast cancer. PE is now the most frequent cause of death associated with childbirth. Women are a prime target for PE, being affected more often than men.
• Also: Patients who survive the initial episode of DVT are prone to chronic swelling of the leg and pain because the valves in the veins can be damaged by the thrombotic process, leading to venous hypertension. In some instances skin ulceration and impaired mobility prevent patients from leading normal, active lives. In addition, patients with DVT are prone to recurrent episodes. In those instances in which DVT and PE develop as complications of a surgical or medical illness, in addition to the mortality risk, hospitalization is prolonged and healthcare costs are increased. 
• In other words, this isn't necessarily a 'take these pills and your problem will go away' situation. It is something that will require long-term treatment or at least monitoring. 
• Ugh. Depressing. And sort of scary.
• I mentioned the cost of the medicine in my previous post; that the PA told me it could be $300-$400, even with insurance. What I didn't add is that she actually said $300-$400 a month, which at the time didn't register with me, because I figured you take this for about a month, so $300-$400 a month means $300-$400 total, right? 
• Wrong. Apparently the standard course of treatment is 3-6 months. Like I said, I feel fortunate that I only had a $50 copay for the tablets with my particular insurance plan, because $400 a month for six months might push me to consider stomach injections instead.
• But back to the present moment. 
• Of course, this all came down on a Friday, and I find myself not knowing what to do for the next few days. Am I supposed to be resting or walking? Heat or ice or neither? I assume massage is out, lol, but other than this, I feel like I. know. nothing. And it's not a question of icing your ankle when heat might have been better; what I do could have serious consequences. 
• And apparently a pulmonary embolism as the result of DVT is not actually that uncommon. 
• I have follow-up appointments on Monday and Tuesday, one with a PCP and one with my orthopedist. I don't know which one is better for this, but I'm not taking any chances, so I'm going to see both of them. Considering my orthopedist is the one who missed this two weeks ago because his little test didn't inflict massive pain on me, I'm not exactly feeling strong love toward him right now. Ha.
• On a sort of funny note, I mentioned the blood clot test to the PA in the ER and she knew exactly what test I was talking about. (She told me the name, but I forgot.) Then she added, 'Yeah, that test doesn't work on tough girls.' LOL. (Just an interesting observation: the PA was at least partly Asian, and about my age.)
• I mentioned that my personal PA moved recently - literally, a few days ago (see: http://39andhip.blogspot.com/2014/08/post-surgery-3-weeks-5-days.html). So I actually have no PCP at the moment. However, I do have an appointment with her supervising physician, who is my husband's primary care doctor. And my husband is pretty picky. 
• My husband texted this doctor last night, who suggested elevating my leg to reduce swelling, low heat, and absolutely no massage, so at least that is SOMETHING.
• According to Dr. Google, elevating the leg is a standard suggestion, but so are walking and exercising. Can someone explain how that works?! Ha.
• So basically as far as I can tell I should be elevating my leg when I'm sitting, but I should be walking as much as I can to improve circulation and keep the clot from getting even bigger. 
• The problem is that the swelling is still really bad and causing a lot of pain, which makes walking very difficult. The pain was actually really bad this morning, which is sort of weird. Looking back, I am certain this problem has been developing over the course of the past few weeks, ever since I started to complain about my leg pain about a week after surgery. Yet I can't help but wonder if something set this off so that it became really bad recently, or if it just hurts more now because I know what it is and am freaked out about it. In other words, is it all in my head?
• Regardless of whether it's a psychological phenomenon or not, I could not walk this morning without a crutch, and even that was very painful. At the same time, I was reading all this stuff on the Internet about how sitting still would only make this condition worse. 
• Finally my husband suggested taking pain medication so that I can walk, so that's what I've been doing. The way I see it is that I'd rather be drunk from pain medication than have a pulmonary embolism.
• It's all just a little frustrating, though. 
• Also, when I talked to the pharmacist on Friday when I was having my prescriptions filled, she asked me what specific directions I had gotten for what I was supposed to be doing other than taking the medication, and I said I really didn't get any. She went on and on about how I was soooo young to have a blood clot, and this was serious, and I needed to find out what else I should be doing ASAP. All in all, it was slightly alarming. 

And finally:

• When I left PT on Thursday afternoon, both the PT assistant and PT asked me to please call them as soon as I had any news and let them know what was up. Even though the PT office is associated with the orthopedic office, which is why my therapist was able to find a PA so quickly to do an exam and write a script for an ultrasound, I'm sure they're probably the last people to get information. Before I left, both the PTA and PT repeatedly requested that I call them directly with any results ASAP.
• So I called the office from the ER on Friday. I figured I was there because of them - and I don't mean that in a bad way - so common courtesy told me that I at least owed them the phone call they had requested. I wasn't quite sure how to leave a message, but fortunately the secretary seemed familiar with my story, so I didn't have to do an assload of explaining. At least, when I told her, Please tell Jay and AJ that they were right, I do have a blood clot, and apparently it's pretty massive. In fact, I'm at the hospital right now getting treated, she seemed to know what I was talking about.
• My therapist actually called me on Friday afternoon. He kept apologizing, saying that he was soooo sorry things turned out this way, and I had to keep telling him that I was thankful that he was on top of things, and that it certainly wasn't his fault. I guess he was sort of freaked out because somehow at the hospital got conveyed to him as in the hospital, which worried him. I assured him that I was fine, and that death wasn't imminent, at least not that I knew of. LOL.
• It was good that he called, because I was actually sort of wondering if this changes PT, and if so, how, and apparently he doesn't have much experience with DVT, either. I mentioned that I was supposed to come in for PT on Monday at 9:15, but he confirmed that we should cancel that appointment until he had had a chance to talk to my orthopedist. He said he had tried to find him today, but that he wasn't in, which I already knew due to my ER ordeal. I asked if I needed to call and cancel the appointment or if he could take care of it. He told me he wasn't actually at work - I just left - but that he would take care of it when he got in on Monday morning. So he called me from his cell phone on the way home... how sweet. And for once I'm not actually being snarky! Seriously, I'm getting a lot of feel good vibes from my PT lately.

As always, despite the fact that it goes against my nature to do so, I'm trying to stay positive and hope for the best.