Post Surgery: 4 Weeks + 6 Days / 15 Days UIRTW

I am not sure if it is a good thing for me to be consulting Dr. Google about DVT. Dr. Google is starting to scare me a little bit. I finally read through this entire article, which was very informative: http://circ.ahajournals.org/content/93/12/2212.full. However, I am afraid I might be developing an acute case of thromboneurosis, which the article explains in the following way: This clinical syndrome tends to occur in patients who have a morbid fear of the complications of DVT/PE. As another article explains thromboneurosis: [The] heightened awareness [of the potential complications of DVT/PE] has led to what may be called as 'thromboneurosis' - where both the general public and health care professionals are increasingly concerned about the possibility of missing a DVT and its disastrous consequences... Many of the patients who present with such complaints and history of thrombosis tend to exaggerate the nature of their symptoms with the huge concern for long-term disability and even death. So basically it is a mental illness. Great, that's just what I need, ha ha. But in all seriousness, it is pretty hard not to be paranoid when you read the stats on pulmonary embolisms. (Is it even paranoia if there's a very real possibility of something happening?)

On the flip side, the biology nerd in me is very much enjoying reading about how blood clots form and how my medication works. It seems that most of the medications for DVT affect something called Factor X, which is an enzyme involved in coagulation. Factor X is synthesized in the liver and requires vitamin K for synthesis, which brought me back to my conversation with the ER PA - why eating leafy greens might matter when you are being treated for DVT. Coumarins such as warfarin/Coumadin, are vitamin K inhibitors, leading to the production of an inactive Factor X. So eating a bunch of vitamin K could counteract the effects of these drugs, although apparently as long as your vitamin K intake is consistent, the dosage can be adjusted? (I say this with no authority at all.) The injection I received in the ER was a different type of drug, a heparin, which stimulates the activity of antithrombin, which is an inhibitor of Factor X. The oh so expensive tablet I'm taking regularly is known as a direct Xa inhibitor, meaning that it acts directly upon Factor X, although I have yet to find a satisfactory scientific explanation for how exactly it inhibits it. (Is it a competitive inhibitor? A non-competitive inhibitor? Or do they even know? Believe it or not, sometimes the exact mechanism of inhibition isn't even known.) So coumarins and heparins are sort of like when your students complain to the Chair, who then tells you to stop doing something, as opposed to Xa inhibitors, which would be your students telling you face-to-face to stop belittling them and making them feel stupid. LOL. I prefer face-to-face or even in-your-face, as long as it is not in the stomach.

Anyway. I've always had a slight obsession with blood; in fact, blood is one of the things that got me into biology in the first place. As one of my students once said to me, 'When you talk about blood, you are like a kid in a candy store!' Ha. And I don't even like candy; I'd much rather talk about blood. My interest in blood began when I found out, sometime in my 20s, that I have something called hemoglobin E, which is an abnormal form of hemoglobin. (This must have been around the same time that stuff started going down with my hip, too.) At the time, my doctor told me that the most important thing was for my husband to get his blood tested if we were planning on having kids (and I'm not even sure if my husband was my husband at the time or just a significant other), but otherwise gave me very little information about what it meant to have hemoglobin E. Hence, I consulted Dr. Google. Now, I'm a reasonably intelligent person, and even in my pre-biology days I could understand what a torn labrum was, or what it means to have an extra bone in my foot.* However, if you have a limited knowledge of biology, it is more difficult to understand a genetic condition than an orthopedic condition, IMHO. Heterozygous? Homozygous? Homohuh? Plus, I think the quality of information on the Internet was much lower 15+ years ago than it is now. My desire to understand hemoglobin E, combined with my desire for a doctor who would actually EXPLAIN things to me, led me to consider a career in medicine, which did not actually result in a career in medicine, but did get me into biology.

* On an interesting side note, the extra bone in my foot resulted in something called accessory navicular syndrome, which resulted in tendonitis in my posterior tibial tendon, which caused calf pain, which my PCP suspected was a blood clot, for which she ordered an ultrasound.

To sum it up: By the time this ordeal is over, I am probably going to know a lot more about blood than even your average biologist.

In more mundane news, I am not motivated to do much today. My leg pain is manageable, and I haven't had to take a pain pill so far today. I did some yard work earlier in the day, which resulted in me being really tired and feeling nauseous, which launched my thromboneurosis. However, according to Dr. Google, nausea is not a sign of impending pulmonary embolism, nor is it a side effect of any of my medications, so I'll assume it is either unrelated or all in my head.