A Farewell to Clots (7 Months + 20 Days)

Since I've been considering the possibility that I need a new orthopedist (and not necessarily the one the my current orthopedist recommends), I've been asking around about orthopedists. One of my friends, who had hip arthroscopy a few months after I did, said that she liked her doctor 'just fine.' It wasn't exactly a rousing endorsement, except then she added that she had only seen him a few times, followed by, 'You know, my hip really doesn't hurt at all anymore.' Then it struck me that I should not be shopping around for an orthopedist that I like; I should be shopping around for one with whom I will not need to have a long-term relationship. LOL.

I thought of this because I just got back from my third ultrasound for my DVT, and I realized I was becoming a regular at the imaging place. Although it is very lovely and the staff are very nice and I've had nothing but really good experiences with the techs, I don't think it's a good place to be a regular. Ha. My appointment was at 2:45, and they asked me to be there at 2:30, so of course I was there by 2:25. I hadn't even finished filling out the forms they gave me when I was called back to do my registration. Then the woman registering me informed me that I didn't need to do any of the paperwork because I had done it recently, and if they ever tried to give it to me again (i.e., when I go back on Tuesday), I should just tell them I've already done it. So 'registration' took all of two minutes, and I was back in the ultrasound room by 2:35 and back in my car before 3:00. In and out.

A fast ultrasound is a good ultrasound. This much I know. If it takes a long time, it means they are stopping a lot and taking pictures of your blood clots and drawing a line across them to show the diameter. It was a different tech this time, and unlike the one I've had before, she did not have the screen turned on that allows you to see what she was doing, but I could tell by how quickly she was going that she was probably not finding anything exciting (exciting being bad in this case). In the end, she told me that things looked much better than before. Hurray. I asked if she saw any blood clots at all and she sort of hesitated, then said, 'Well, I think once you have them...' She sort of trailed off, so I finished for her, '... then you have them forever?' (I had read this was a possibility.) She said, 'I think sometimes they never clear off the edges...' but then seemed uncomfortable stepping out of her circle of approved dialogue, so I didn't push any more. I guess I will just have to wait and see what the much smarter doctors have to say about it. (That's sarcasm, by the way.) But I feel confident. My leg really doesn't bother me at all anymore, and I've never felt misguided by an ultrasound tech before (and I've had a lot of ultrasounds).

The only bad thing about the ultrasound was that she asked me to rotate my leg, and when I did this, my hip immediately began to throb. I tried to roll my whole body a little, and basically just ended up getting goop all over my other leg. So the ultrasound itself was quite painful, and I'm slightly alarmed about how much that little bit of external rotation hurt me. But I will wait until Tuesday to worry about that. In the mean time, I am going to throw back some meloxicam and go skiing this weekend.

Book Club (8 Weeks + 3 Days)

Tonight was my monthly book club meeting, which is an event that I really look forward to. As I was walking over to my friend's house, I could not help but think of the last book club meeting, four weeks ago. I had had PT in the afternoon and was scheduled for an ultrasound the next morning, which I recounted to everyone at book club with casual amusement. At the time, I really thought everything was okay. (See: http://39andhip.blogspot.com/2014/08/post-surgery-4-weeks-3-days-6-days-uirtw.html)

It was sort of depressing to realize that things haven't changed much since four weeks ago. Four weeks ago, I struggled with pain as I walked five blocks to book club. Tonight I struggled with pain as I walked one block to book club. Just as I had PT four weeks ago, I had PT today. Four weeks ago, I wasn't able to do much at PT due to pain, which led the PT assistant to try massage to help my pain level, which eventually led to discovery of my blood clot. Today during PT, I wasn't able to do much due to pain, and my PT did massage. Déjà vu all over again.

I guess the sort of good news about this is that I do have an appointment with my orthopedist tomorrow. I know I've said that I don't feel like he can help me at this point, but I am trying to keep an open mind, seeing as how I have no other options. I was originally supposed to see him next Friday, but apparently my semi-hysterical e-mail last night prompted someone on staff to call me today and tell me that he had time to see me tomorrow. Ironically, I was actually at physical therapy, 20 feet away, when they called me, and then when I called back after I got home two hours later, they gave me the usual runaround. Fortunately, I'm pretty experienced with the runaround and realize that being pissy with front office people never gets you anywhere. Eventually, I managed to get an appointment tomorrow, which can't hurt. If nothing else, it will give me an outlet for complaining that is not my husband.

At this point, my expectations are pretty nonexistent, so anything at all helpful would be a pleasant surprise. Anything not helpful will not make me happy, but won't be a surprise. Maybe that's a bad attitude, but it's where I am mentally right now. When I was logging in via the patient portal, I noticed that my appointment was classified as a 20 minute re-check. 20 minutes? You've got to be kidding me. The only time I've ever gotten 20 minutes from my orthopedist was during surgery, and even then it was only an hour. At any rate, I'll let you know how it turns out.

Post Surgery: 6 Weeks + 5 Days / 2 Days UIRTW

Because I was distracted yesterday trying to throw a little get-together for my son's birthday, I had to work most of the day today. Between the walk to my office from the parking lot, sitting at my desk for hours, and trying to hang a ridiculously large tapestry on my office wall, I'm pretty sore tonight. To make things worse, we went over to one of my husband's semi-friend's house for dinner. I say semi-friend because this is someone my husband knows professionally, whom I've met once before, and whose wife I've never met. This was our first get-together with them, which is relevant because it means these aren't people I know well, which means I had to try to sit normally without fidgeting or putting my leg up for three hours. So... my leg is pretty swollen right now, plus both my hips hurt, despite the fact that I've been icing them throughout the day.

I think the swelling in my leg is the most irritating thing right now, because it prevents me from squatting down, which actually makes a lot of things quite difficult. For example, I mentioned that I rearranged my office last weekend, and let me tell you it was hard to unplug and replug and disconnect and reconnect all those cords and cables without being able to squat down. Now I'm still finding little things here and there that need reconnecting or tweaking and this is ridiculously hard for me. I also had to climb up onto my desk today to hang my tapestry, and while going up was not so bad, getting down was sort of a challenge. And gardening is still pretty much out of the question.

I had to resort to pain medication last night because my hips were throbbing, particularly my left hip and IT band. WTF? PT on Thursday made my left hip REALLY unhappy! Unfortunately, I think I am going to have to take pain meds again tonight if I want to sleep. I hate, hate, HATE having to do this, but it's really necessary right now. BUT, the good news is that I have not used a crutch or cane at all in several days, even to go significant distances. Also, I noticed today that I've been going up and down stairs like a normal person, for the most part, so that is progress!

Post Surgery: 5 Weeks + 6 Days / 8 Days UIRTW

Today was another day to file under the 'good days' category. We ( = my whole family) went up to my office this morning to rearrange my furniture, and make it more blood clot friendly. Blood clot friendly, ha ha, does that sound weird or what? Basically I need a way to be able to keep my leg propped up when I'm sitting at my computer, which wasn't possible before. And it was time for a change anyway.

Afterward, we went to the pool, and I was actually able to get in - for the first time in a long time (almost six weeks, to be more precise). I couldn't go in for four weeks after the surgery, I'm guessing because of the risk of infection to the incisions. And the last time we went to the pool, I could not go in because of my bleeding. However, I am happy to report that the bleeding is very much under control now, and I am extremely happy that all my hysteria was for naught. I really do not need any more complicating factors in what I hope can get back to a fairly routine rehab.

My hip... well, it is sore, but holding its own. As I was mentioning to my physical therapist on Friday, it's not just that I haven't done certain things since the surgery, it's that I haven't done certain things since long before the surgery simply because they hurt so much. A simple example is standing with my weight equally distributed on both legs. Another is stairs. Stairs are still extremely difficult for me, but they were difficult for me before the surgery. I can't remember the last time I went up or down stairs like a normal person. My therapist said he was glad I had that perspective because he was often having to remind his patients that it's not just the surgery they are recovering from, but oftentimes many months of dysfunction prior to the surgery. For me, it has been almost a year.

With that in mind, it was very exciting at the pool today because I decided to try swimming - as in actually swimming some laps. Although being a diver in a previous life means that I have spent a lot of time around swimming pools, I'm not actually a very good swimmer, and I have not tried 'real' swimming in about six or seven years. (Shortly after my daughter was born, I got talked into doing a team triathlon with my family, and since I do not like biking and hate running, I got stuck with the swimming leg. That was my only experience with 'real' swimming.) And, weirdly enough, since my hip started acting up this past year, swimming has actually hurt my hip, even just regular old freestyle. Breaststroke has been completely out of the question for a very long time. HOWEVER, I was pleasantly surprised to discover today that A. I can still swim, and B. It doesn't hurt at all. I managed to swim a total of 500 yards - not all at once, but I did one set of 100 yards, one of 200 yards, then two more of 100 yards. I got brave and decided to try the breaststroke on the last 25 yards of my last set - admittedly because I was sort of tired, lol - and... I was able to do it and it didn't hurt at all. Amazing! This made me so happy I can't even tell you.

I guess the thing with this blood clot is that it is an annoying (to put it mildly) complication from pretty routine and elective surgery. The blood clot has become a bigger deal than the surgery itself, which of course is constantly causing me to second guess my decision to have the surgery in the first place. However, despite my doubts, I've always believed it was the right thing for me to do, especially looking down the road long-term. On days like today, when I'm able to do something that I haven't been able to do in a very long time, it really confirms that despite everything, the surgery was a good decision for me. And this makes me happy.

And... icing on the cake. While I was swimming my laps during adult swim time, I noticed that there were several kids standing on the edge of the pool around the lap lane. They were standing so close that when I put my hand on the side of the pool to turn around, I actually grabbed one of the girl's toes. I could not figure out what they were doing, and it made me feel sort of self-conscious, as if they were all standing around watching me. However, it turns out that they were all lined up to take a swim test. My daughter saw the line and decided that she wanted to take the test - which is basically so you can go in the deep end of the pool. For her, the biggest thing is being able to go down the water slides, which she hasn't been able to do all summer. She can swim well enough to go from where the slide deposits you back to the edge of the pool, but to pass the test, you have to tread water for 30 seconds, then swim across the deep end, then float on your back for 30 seconds, and then swim back to the edge of pool on your back. It is the treading water part that has kept my daughter from trying the test all summer, but I think watching all the other kids take the test gave her a rare bout of courage. And... she passed! It was NOT pretty, but she did it! My daughter is extremely cautious and has some (minor) physical challenges, so things involving motor skills do not come easily to her. (It took a lot of $40 an hour private swim lessons to get to this point.) I normally try to leave my family out of my blogs, but this was a huge deal for my daughter and I was so proud of her!

All in all, it was a good way to end the summer.

Post Surgery: 5 Weeks + 5 Days / 9 Days UIRTW

I guess the good news about yesterday is that I was busy enough to miss my daily update. But my original plan was to ditch the daily updates around the time the crutches were supposed to be going away, so we are in bonus material anyway. :)

Anyway, compared to the day before, yesterday was sort of a let-down. My daughter starts school on Monday, so I took her to buy school supplies. This is the longest I've ever waited to buy supplies, but there is not really a way to push a shopping cart on crutches, and this definitely required a shopping cart. This was my first real shopping escapade since surgery, and unfortunately it just about killed me. Okay, so not literally, but by the end, I was quite literally leaning on the shopping cart and using it as a walker. We had to go to a second store to buy black and white composition books, and I had to use a crutch. And I don't mean I had to bring it just as back up; I really had to use it. Ugh, so disheartening, especially considering the shopping trip itself was just over an hour, which is how long my classes are. After we got her school supplies, I took her out to lunch. By the time we got home, I was so exhausted that I lay down on the futon and had to sleep for two hours. Needless to say, I'm feeling slightly panicked about the upcoming semester, even with my reduced teaching load.

The good news is that after the nap, I felt much better and was able to do a little bit of work in my garden. The tough part about the garden is that although I should be able to squat down now - I no longer have restrictions on my thigh flexion - the swelling in my leg still makes that impossible. In fact, trying to squat down is what made me notice the swelling in the first place, which eventually led to the discovery of the blood clot. Although I think the swelling is improving, it's still pretty significant. So if I want to work in the garden or get anything off the floor, my hamstrings get a good stretching. Good thing I'm very flexible. :)

Post Surgery: 5 Weeks + 3 Days / 11 Days UIRTW

Yup, I'm still alive. I'm still wrong, and still happy about. I'm still bleeding, but the good news is that if I am bleeding to death, it is very slowly. :)

And I have some sort of good news. It is mostly good news, I just have some mixed feelings about it. I've decided to drop to 1/2 time this semester. I e-mailed my Chair two nights ago in the midst of my hysteria, which was not the best idea, but I re-read the e-mail later and it wasn't too embarrassingly hysterical (although he did reply that we would deal with a certain issue in the future, but For now we need to manage your stress).

I've written more about this over here: http://dontcallmeprofessor.blogspot.com/2014/08/im-not-dead-yet.html.

On Wednesday, my PT asked me about the class I was teaching. I was surprised he remembered. When I told him I had to get someone else to teach it, he nodded knowingly, as if he had seen it coming. Then he asked about the rest of my classes, and he asked in such a way that suggested he didn't think it was the greatest idea for me to be teaching at all (granted, that was the day that I looked reeeeaaallly terrible). I said that I was trying to get a reduced teaching load and he said that was definitely a good idea. So, I have an endorsement from one medical professional.

I guess my biggest concern right now is over the possible long-term effects of this if I don't take care of it properly. For one, there is a realistic possibility the clot won't actually resolve, even with the medication. There's also a chance of it getting bigger, and if it spreads up to the iliac vein, it's really dangerous, even with the medication. It can also damage the veins, leading to recurrent episodes of DVT. I really don't want to have to take anticoagulants for my entire life. And besides, what if we ever need to change insurance? $400/month for life is way too much; my kids will never go to college. The saddest part of all this is that I had this hip surgery because I felt like 39 was too young to be having such terrible hip pain, yet now there is a possibility of me dealing with DVT for the rest of my life, and I feel like I'm definitely waaaaay too young for that. I feel like every time I talk to people about being on an anticoagulant, they are like, 'Yeah, my grandma has to take Coumadin and it sucks,' or, some of my colleagues who are, like, 60, tell me, 'Yeah, my dad has had to take blood thinners ever since he had his stroke; what a pain.' Seriously, this is medication that only grandparents and the parents of people who are my parents' age take!

Meanwhile, my hip is killing me. 

Ahhhhh, I'm totally dying my hair tomorrow. I need a morale boost.

I AM okay! (5 Weeks + 2 Days / 12 Days UIRTW)

I've never been so happy to be wrong before. So I live to tell about another day. :)

I'm still bleeding, but not alarmingly so. However, I lost so much blood over the past 24 hours I looked like a Geisha girl this morning. Three different people told me before 10 AM that they would pray for me. Seriously, did I look that bad?!

I went to PT this morning, and it felt good to try to get back into the swing of things. Unfortunately, my hip (oh yeah, remember my hip?) is not stellar. It's not terrible, either, but it is actually noticeably sore. Maybe it is just because the pain in my leg is actually improving so now I notice my hip pain more. At any rate, my therapist suggested taking it easy and not pushing things too hard. I was able to do a reasonable amount of exercises; the only thing I can absolutely not do right now is go up on my toes. That causes excruciating pain in my calf. 

My day-to-day plan is to just go about my daily routine, but not do anything crazy. I should try to be active, but not hard core. My PT also advised against long shopping trips to the mall. Fortunately, I don't really like shopping and I definitely don't like the mall. Ha. It's logical to think that rigorous activity might make a blood clot break loose, although there are no data that I can find about this one way or another. But better safe than sorry. Not that I have anything hard core planned considering my hip still limits me significantly (oh yeah, remember my hip?). Apparently the idea of bed rest versus ambulation is unresolved in the management of DVT, but there is little evidence to suggest that just walking around increases the chances of pulmonary embolism. And bed rest may actually make the clot grow. So... moderation seems to be the best plan.

Also, my additional consultation with Dr. Google made me realize that the ultrasound tech was right when she said it was a good thing we caught this. I mean, duh, of course it is, but when she said it, she really meant it. Given where the blood clot begins, in the proximal femoral vein, I had a huge risk of pulmonary embolism. According to this article: It has been suggested that about one half of patients with an untreated proximal DVT will develop a pulmonary embolism (PE) within 3 months. Yikes. I've been trying to find literature on the risk of PE while on an anticoagulant, and while it's obviously much improved over a 50% chance of PE, some of the articles aren't that encouraging about the long-term prognosis. It's not like once you're on medication you're totally fine. But for now I'm just trying to stay in the present, and praying all the prayers will send some healing powers my way. :)

I am NOT okay! (5 Weeks + 1 Day / 13 Days UIRTW)

I know I may seem hysterical and melodramatic, but I really don't think I am. In fact, one time one of my best friends from college wrote me a letter (back in the day of letters) telling me that when it came to trying to decipher my emotions, I was a 'Houdini.' This happened as a result of the fact that I went to visit her in California after we graduated from college, and had a great time. Unfortunately, I didn't write her a thank-you note soon enough telling her that I had had a great time, and apparently I didn't make it obvious enough that I had had a great time while I was there, and she interpreted my lack of prompt thank-you note to mean that I had had a terrible time, and wrote me a nasty letter telling me that she was sorry I had had such a terrible time. The sort of funny thing is that her letter and my thank-you letter crossed in the mail. Right after she sent her letter, she got mine, and promptly wrote me an apology, but said that I was a 'Houdini,' so how could she have known what I was thinking?

So this blog is evolving into a blog about everything except for my hip. If you are really reading this out of interest for hip arthroscopy, I do apologize.

At any rate, I feel like I need to tell a story to put what I am about to write into context. Fortunately, I've already written the story. It is here: http://39andhip.blogspot.com/p/somethings.html. The first paragraph. Yesterday I mentioned that I was nervous about taking an anticoagulant because of my occasional propensity to hemorrhage. The irony is that I stopped that entry to eat dinner, then in the middle of dinner, it started. It was as if I brought it on by writing about my worries. Now, I do realize that A. I stopped taking my birth control pills on Thursday night after the initial concern over having a blood clot, and I have not taken them since then, which could mess up my cycle; and B. I am on an anticoagulant, which will likely make me bleed more than normal. However, I am NOT okay with how much blood I have lost between last night and today. The thing is that it isn't necessarily alarming in itself - I am not bleeding to death - BUT, it is literally exactly the same as it was after my daughter was born, and that did not end well. And that feeling of losing a bowlful of Jell-O out of my uterus is something I don't care to experience again in my lifetime. It's worse than the shot in the stomach, and even worse than the cortisone shot, not to mention it is damn messy. My doctor kept telling me I would be okay, and ultimately I guess I was (I'm here to tell the story, after all), yet I was NOT okay with how it ended - with a lot of trauma and a totally unnecessary $10,000 hospital stay.

I'm also feeling a little put off because I feel like I've been voicing concern for my leg pain for a long time now, and everyone told me it would be okay. And because I try very hard to NOT be hysterical and melodramatic, I just went with the flow and tried really hard to be positive about it, even though my gut felt like I should not be having that much pain so long after the surgery. And look where that got me. My gut was right; there WAS something wrong. And while I am okay - again, 'okay' as in I'm NOT DEAD or permanently disabled - I'm sort of NOT okay with the fact that I had a blood clot that likely went undiagnosed for four weeks and now extends into my proximal femoral vein, which makes it much more risky to be toting around.

And for this same reason, I'm sort of NOT okay with everyone telling me this bleeding is going to be fine. And I'm sort of NOT okay with everyone telling me this blood clot is going to be fine. Of course, I absolutely hope everyone is right and I am wrong, but most other times when I have felt like I feel now, I'm the one who has been right.

So. I went and saw my orthopedist today. Before my appointment, I stopped by the PT room and brought my therapist some flowers from the yard, just as a little thank you for... well, finally realizing that things might NOT be okay. He was his usual stoic self, but who am I to talk? LOL.

At my appointment, I told the medical assistant about my bleeding so I at least didn't have to bring it up directly with the doctor. She reacted exactly like I figured she would: she told me it would be okay. I'm soooo sick of everyone telling me this, I just burst into tears after she left the room. I am not kidding. And even though I tried and tried and tried, and pulled out every stress management technique I have ever attempted (there are a lot of them), I could not stop crying before the doctor came in. And I cried the whole time he was in the room, which was fortunately only about three minutes. After the appointment, I kept on crying. In fact, I saw the doctor at 11:30, and it is now 3:30 and I am still crying. If I were more lucid, I would be really embarrassed, but at this point I don't even really care that much. My orthopedist didn't seem to care too much, either. He just kept talking at me as I kept crying, and it didn't matter that I wasn't paying that much attention because he wasn't telling me anything useful anyway. A summary of what he said:

• These things happen; there was a 1% chance of developing a blood clot, and I did. But it's going to be fine.
• We'll get you through this. (Yeah............. right. I'll get myself through this.)
• The bleeding is probably nothing to worry about, and it's going to be fine, but if I'm really worried ( = that much of a hypochondriac), I should see my (nonexistent) OB/GYN.
• My hip seems great.
• I should keep doing PT - I should not let the blood clot get in the way of my hip rehab. 
• Do you need some Kleenex?

A few additional points:

• If I had had my wits about me, I would have had the doctor look at my incisions, which seem a little infected to me, but... I'm sure they are fine, just like everything else. 
• I GET that an orthopedist, especially a young male orthopedist who for all I know is a virgin, doesn't know much about vaginal bleeding. At the same time, I am SO SICK of people being sooo specialized in their jobs that they literally can't tell you ANYTHING about ANYTHING other than the one little teeny tiny area they specialize in. It's no wonder my students are always asking me bizarre medical questions, as if I should know the answer to a mystery that stumped someone with at least seven freaking years of medical education and training.
• On a side note, one of my friends and former colleagues left the university to go to PA school. As a gay male, let me tell you he was dreading the OB/GYN rotation like nothing else, ha ha ha. Thinking back on the conversation we had about it at least got me to stop crying for a minute. :) (The way I see it, females are at an advantage because they have all those parts. And straight men have at least played around with all those parts!)
• The doctor did try his hand at due diligence, and asked around the office and came back to me with the name of an OB/GYN some of the females recommended.
• But, I'm sooooo over doctors right now. The last thing I have the time or energy for is another useless appointment. If everyone else is right, and the bleeding is just because I stopped taking the birth control, then it will stop within the next few days. If my gut is right, I will end up having a massive hemorrhage, and I will have to go to the ER where I will just see the OB/GYN on call, so it doesn't matter.

All I can say is that if my gut is right, I hope I bleed out all over my orthopedist's carpet and not my own.

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.

Deep Vein Thrombosis (4 Weeks + 4 Days / 5 Days UIRTW)

I guess I'm not quite out of material for this blog yet.

I barely slept last night: A. because I was stressed and B. because my leg hurt quite a bit. I had a book club meeting, which is really more of a girls' night in with some of my neighborhood friends/fellow moms. We mostly just eat and drink wine, with a little bit of book talk thrown in. My friend, colleague, and neighbor hosted this month's book club. Her house is five blocks away, and I was determined to walk there with one of my other book club buddies, who lives up the street from me. I ALMOST backed out of walking because I wasn't feeling stellar when I got back from PT, but then I decided to suck it up, mostly to give me the option of drinking wine freely :). I brought a crutch with me, but I ended up carrying it the whole way there, and back! That is the good news. The bad news is that my leg hurt quite a bit when I got back, and somehow the pain + the wine + the stress made for a pretty sleepless night.

Needless to say, I was reeeeaaallly tired when I got up this morning and had to drag myself to my 7:45 AM ultrasound appointment. But, I figured that I would just come home afterward and take a nap, seeing as how the rest of my family is still camping. Unfortunately, my morning unraveled in a very different way than I had imagined.

During the ultrasound, I tried to follow what the tech was doing, but like I've mentioned before, I can never make sense of those things. So instead of watching the screen, I watched the tech's face for telltale signs of... something. She seemed a little concerned throughout the ultrasound, although I couldn't tell if it was actual concern or just concentration. It turns out it was the former. When she told me she was done, I asked if she had found anything interesting. Sometimes techs will tell you stuff and sometimes they won't, but I always ask anyway. She looked at me and took a deep breath and replied, 'Yes. I did.' Then she went on to say that she found clotting, and that it was very extensive, going all the way from above my knee down most of my calf, which would explain why my leg hurts and is so swollen. After that she added, 'That's the bad news.' I asked what the good news was, and she said, 'It's a really good thing we caught this.'

She called my doctor, who wasn't in, and after some ado, she sent me to the ER to get treated, along with a diagram of where the clotting was and a CD of the ultrasound. The ER involved quite a bit of waiting, although I've definitely had worse ER waits. Eventually, I saw a PA, then the physician on duty, who was communicating with the physician on call for my surgeon. The PA told me I was going to get a shot of an anticoagulant, Lovenox, in my stomach, and after that I would need to administer the shots to myself twice a day. I would also need to modify my diet substantially (e.g., cut out leafy greens, wtf?) and have my blood drawn for testing every week. I think I sat there staring at her with my mouth open. Because then she added that there was actually an alternative; I could take a tablet twice a day with no changes to my diet and no need to draw blood. So of course, I'm thinking, Are you crazy? Do you even have to ASK which one I'd prefer?! Until she added, 'The only problem with the tablet is that insurance companies don't like to pay for it, and it's very expensive.' She asked what insurance I had, and when I told her, she said they were actually pretty good about paying for the tablet medication, but that it might still be $300-$400. I decided that I didn't care; I would consider it $400 well spent, and the next time I am miserable at work, I will remind myself that I am working so I don't have to inject myself in the f-ing stomach twice a day. OMG.

Eventually I got the shot, and it was super unpleasant, let me tell you. I'm pretty sure that if I hadn't already decided to suck it up and pay whatever it took to avoid the shots, I would have changed my mind after the shot. It wasn't as bad as the cortisone injection, but it pretty much sucked, and I seriously can't imagine inflicting that on myself. Once a week, maybe, but two times a day?! Uh, no thanks. And, the good news is that it turns out I have pretty stellar insurance, and the medication, rivaroxaban/Xarelto, only cost me $50, so it was a good decision.

So, to sum it up.

Bad news: Extensive clotting with the risk of it traveling to my lungs, heart, kidneys, or brain, and killing me. LOL. Lots of swelling and pain. Though apparently not as much pain as this should be causing, which is likely why it took so long to figure out. The PA actually prescribed oxycodone for pain. Seriously, it doesn't hurt that bad, which is apparently why I passed the surgeon's blood clot test with such flying colors, and no one has been worried about this for the past four weeks.

Good news: Lucky to have caught this. Thank God for my observant and competent PT assistant and my PT. And thank God, too, for good insurance. And, I guess, thank God I finally have an explanation for this pain that has been plaguing on and off since 1 Week + 1 Day post-surgery. Apparently it is going to take a long time for the clotting to resolve and for the pain to go away, but at least knowing what it is makes it a little easier to deal with.

Post Surgery: 4 Weeks + 3 Days / 6 Days UIRTW

This damn pain in my right leg. 

A while back, while my husband was working on my calf muscle, he mentioned that my calf muscle was really hot. He acted all freaked out and told me I should call my surgeon. Of course, this is my husband, who freaks out worse than I do over teeny tiny things. I told him I would, but then I didn't, and fortunately my husband has a short memory. I have to admit that my calf did feel warm to the touch, but that didn't seem like something my surgeon needed to know about.

Anyway, fast forward to today. My husband and daughter left yesterday to go camping with some friends, and this morning I drove my son up to drop him off at the camp site. (The camp site is right next to the river, and we thought two nights with an almost three year old next to a river would be a bit much, but that one night would be okay.) When I woke up, I noticed that the pain in my leg was probably a little worse than yesterday, but still manageable. I did a lot of walking yesterday, so I was thinking I was just sore. Or whatever.

I got back from dropping my son off this afternoon and realized I needed to eat something before going to PT. I decided to fix myself some potatoes, only I went into the pantry to discover that my husband had taken the whole freaking bag of potatoes with him. Since my stomach was set on potatoes, I decided to dig some out of my garden; after all, the restrictions on my thigh flexion have been lifted, so I can squat now as long as it doesn't hurt. Unfortunately, as I squatted down, I noticed that it did hurt, and quite a bit, but not because of my hip. It hurt when the back of my thigh pushed up against my calf, which I quickly realized was because the back of my leg, and especially the back of my knee, are totally swollen. Nevertheless, I managed to dig the potatoes out and grab a bite to eat before heading off to PT. While I was eating, I iced the back of my knee, because I really wanted to have a great PT session.

My appointment today was with the friendly PT assistant, Jay, whom I just adore. (I'm pretty sure everyone does.) However, I was a little worried because although he is the life of the PT room, I've only worked with him once before, so I wasn't sure how aware he was of my ongoing leg pain, and I felt like it was important for him to at least know. My regular PT knows about this pain and although he has never specifically done anything about it, he is aware of it. So I told Jay about the pain and swelling first thing, and he took a 'let's proceed with caution' attitude, which was fine. I rode the bike and then did some standing up exercises and felt okay. However, while I was doing them, Jay commented, 'Your right ankle is really swollen.' I looked down, and sure enough, it really was. WTF? My ankle doesn't even hurt, yet it was definitely ballooned out to the point that Jay noticed it from across the room.

After that, I went to do some stretching, and there was one particular stretch that was soooo uncomfortable, I actually started crying. I don't know why I started crying; honestly, it didn't hurt that bad. I think it was more just because I am soooo stressed out right about now and also frustrated because I feel like this damn leg pain is the only thing that is really holding me back. And while the pain is not horrendous, it just won't let up no matter what I do, and no one seems to know what it is. Fortunately no one actually saw me crying, but Jay could tell I was in pain and told me to stop. Then he said that he was going to try to do some soft tissue work, AKA massage, on my leg, to see if that would help.

So I rolled over, and he put some massage cream on the back of my knee and on my calf, asked me a few questions about where my pain was, and then said he would be right back. A few minutes later, he returned with AJ, my 'regular' PT. They both stood there for a minute, then AJ asked me to roll over, and poked around a little bit, and asked me a few more questions. Eventually, Jay apologized, and said he would be right back, and he and AJ stepped around the corner. At that point I was thinking, Just give me my damn massage so we can get this show on the road. LOL. When Jay came back, it was him, AJ, and some other guy, who introduced himself as Kevin, a physician assistant. Kevin repeated a lot of what Jay and AJ had done, then spoke briefly with AJ. They asked me to sit up, and then told me that while they did not want alarm me, they all agreed that I needed to go to the hospital and have an ultrasound to rule out the possibility that I had a blood clot. As Kevin explained (which I sort of already knew), there are three huge risk factors for blood clots: smoking, birth control, and surgery. And I had two of the three, plus pain and swelling in the most common area for blood clots. So while they did not really think this is what it was, and were hopeful that the ultrasound would 'just be a waste of my time,' they could not rule it out, and were not okay proceeding with any sort of treatment until this had been ruled out.

I mentioned that I had told my doctor about my pain at my two-week post-op appointment, and he seemed confident it wasn't a blood clot. Although, interestingly enough, the stretching exercise that I was doing with the PTA that brought me to tears was very similar to the 'test' that my surgeon did on me at my post-op appointment. And one of the reasons he definitively concluded that it was not a blood clot was because 'If it were a blood clot, that would have hurt a lot.' (These are times when I worry about a high pain tolerance.) Anyways, both AJ and Kevin said that although my doctor wasn't in this afternoon, they were certain this was what he would have wanted as well. They repeated that they really didn't think it was a blood clot, and that I should not freak out, but that they needed to rule it out for sure. Because if it's not a blood clot, it's just a waste of time (and money, I add), but if it IS a blood clot, it is a potentially life-threatening situation, so it is worth it to know for sure.

Apparently it was too late in the afternoon to schedule an ultrasound, so I am going in tomorrow at 7:45 AM. This was actually good news for me, because I have book club tonight, which I sooo look forward to, and I did not want to miss book club while stuck in the hospital waiting to have some ultrasound for a condition I probably don't have. And with that said, I am off to book club. It is five blocks away, and I am attempting to walk there, so wish me luck.