Tuesday, January 24, 2006

Playing "Telephone" with Doctors

So the Friday before last a little piece of one of my back molars (ironically, the only one that has never had any dental work) chipped. My first thought, as any rational person's would be, was: Oh My God! What if I swallowed a splinter, and it scrapes the lining of my stomach or intestine and I hemorhage? Upon calmer reflection, I decided that internal bleeding from a chip of tooth smaller than a Pop Rock wasn't all that likely, but that I definitely needed to call the dentist and have him check it out.

*Let me just add here, as an aside, that I love my dentist. He does great work, has a marvelous sense of humor, hates G.Dub, and admitted not long ago that Talking Heads is one of his all-time favorite bands. His staff is also very cool. As someone who spent the first 18 years of my life being terrified of dentists, I feel very lucky to have found divine Dr. K.*

So anyway, I set up a brief appointment for last Thursday so that Dr. K could have a look at my tooth and also discuss the ramifications of blood-thinning drugs on dental procedures. He said that it looked like a small filling would be needed, and that he has many patients on Coumadin and didn't feel that it would be a big deal, but that I should definitely check with my medical doctor to make sure that everything was kosher. We scheduled an appt. for this Tuesday (today). I called my clinic, found out that my doctor wasn't in, but would be on Friday, and left a message to have either her or the nurse call me back. Friday came and went. Yesterday I called the clinic again, and left another message. While I was in class, I received two messages from one of the nurses. The first one said that I needed to go off the Coumadin for five days, but then she said that she had to clarify when during that time I was supposed to have the dental work done. The second message said three days before my filling, and then stay off for the two days after the filling was done. I called back and talked to the nurse, and she reiterated the information, but wasn't sure what the risk was for going off Coumadin for five days since I've only been on it for about 6 weeks. Later I got a phone message from the Dr. herself, asking if perhaps I could just hold off on the dental work for 6 months. That irked me, since I have told her in the past that I will have to be on Coumadin for at least 9 months, and possibly for the rest of my life. I know, I know, she sees a lot of people, but jeez, check your notes! Anyway, this morning I went to the clinic to have my INR checked, and managed to talk to Dr. T's nurse directly. Much to my amusement, she wrote down my questions and information, walked around the corner to talk to the doctor, (I could still hear her voice) and then came back to give me the answer! Why couldn't the doctor just poke her head out and give me an answer? Why play telephone? Anyway, it now sounds like it won't be too big a deal to get the dental work done-- I just need to not take the Coumadin for 1-2 days before hand, and then resume that evening after my appointment. Simple, right?

Saturday, January 21, 2006

So Far, So Good

Well, I'm glad to say that I made it through my first day back at school. I had a strange moment on the drive up when we were in four lane traffic and my husband was listening to a podcast and I had to ask him to turn it off because I felt a little floaty and over-stimulated. After that it got better, and going to class was pretty easy, though I did feel tired towards the end, which was somewhat absurd, since it's only an hour and fifty minute class! I even parked in my normal spot, and didn't feel too out of breath on the walk to Keihle. I'm a bit more concerned about the trek to Riverview, since it's much farther from my parking spot, but I think that if I give myself enough time, and make sure not carry anything heavy at first, (I'm not bringing my backpack to schooI, just my three-ring binder) should be okay. I do think that as the semester progresses I will feel stronger and better, so it's really only a matter of getting past this first month or so.

After class we met up with Mom at a local coffee shop, which was nice. It turned out to be a pretty good day.

Thursday, January 19, 2006

Where Do I Go From Here?

So I've been home from the hospital now for a month. I take 4mg of Warfarin (generic Coumadin) a day, and have my INR (length of time it takes my blood to clot) tested once a week. I was back in the emergency room on January 2nd with a rapid heartbeat, which the ER Doctor thought might be due to the last bit of the clot in my leg letting go and traveling to my lungs, since an ultrasound done at that time showed the clot in my left leg to be completely gone. I was pretty upset about that, as my general practitioner had told me specifically that no such thing would happen. They sent me home and told me to "take it easy." I more or less stayed in bed for the next four days, appetite-less and feeling like crap, and had all sorts of bad dreams in which I had other, more bizarre health problems. I think in one I was told that I would have to have surgery at the State Fair if my condition(?) couldn't be brought under control. These nightmares were so vivid that I would have to wake myself up fully, usually by getting up and walking around for a bit, so that I could sort out my reality from the dream. I'm still having the occasional nocturnal visitation by freak maladies and impending surgery. I can only hope that they go away sometime soon.

I went to the hematologist last week. He told me that he thought it was highly unlikely that my rapid heart beat had been indicative of my leg clot embolising, since only new clots embolise, and the blood thinners should have prevented any from forming. He also said that he felt that two weeks was a long enough period of time for the clot to dissolve on its own. He recommended that I get a follow-up CT scan to make sure that the emboli in my lungs had resolved themselves, and told me that it was possible that I would have to be on Warfarin for the rest of my life, a discussion that will be continued in October when I return to his office. Oh, and he told me to get on with my life: go back to school, work, travel, have babies some day (pregnancies are high-risk for someone with a Factor V Homozygous Leiden, and involve blood-thinning shots and extra attention to timing) and that I could probably go back to running, provided that I wear supportive shoes to keep from bruising my feet. That said, with as tired and out of shape as I have been feeling lately, it'll be awhile before I attempt another marathon. I would settle for running my errands without feeling completely drained of energy.

School starts again tomorrow. This semester I only have three classes, which at the moment I consider a plus. With as many undergraduate credits as I have, there aren't many things offered that I still need to take. I'm a little wary of going back, of the daily commute, of my own propensity to worry beyond reasonable limits. As a friend pointed out, though: I can choose to drop classes, but not start them late. So wish me luck, and more stamina that I currently feel able to count on.

If I may wax cheesily poetic: Oh, hurry up, Spring, in whose sap-wakening days I can't help but be buoyed by green dampness and the return of evening light.

Thursday, January 05, 2006

What I Did on my Christmas Vacation

View from the 11th Floor of Fairview Riverside Hospital

So in my last post I was nattering on about how even when I'm unlucky I still manage to be fortunate. Consider that foreshadowing for my current predicament. On December 12th I was at school with nothing more on my mind then getting through finals week in one piece... So when I realized that I was having a lot of difficulty breathing, and that my heart was tripping over itself, I was almost as surprised as I was frightened. The paramedics thought I was having a panic attack at first, since my symptoms were similar, but once I told the EMT that I had been having shortness of breath for several days, and he realized that I wasn't able to lower my heart rate, I was on my way to the St. Cloud Hospital Emergency Room with oxygen and an IV, wondering what in the world could be wrong with me.

What Was Wrong With Me

When I got to the ER the Doctor, who looked remarkably like Mr. Big from Sex in the City, put me on a saline drip and had an EKG done. My heart rate was 130 beats a minute. My breathing was much better with the oxygen, so I was quite a bit more comfortable, but still pretty shocked to find myself hooked up to a bunch of machines in an emergency room. I kept thinking about the class I was supposed to have the next day, and that if I wasn't there the Prof had threatened to dock me attendance points. A chest x-ray was performed, and showed that I didn't have fluid in my lungs, ruling out pneumonia. The Doctor then told me that the next possible culprit was pulmonary emboli-- blood clots in my lungs, and said that he wanted to do a CT scan. The CT scan showed that I had multiple clots in both lungs, which is pretty damn serious. I was put on a Heparin (blood thinning drug) drip. I finally managed to reach my husband sometime after this, and it was when I heard his voice that the reality of my circumstance began to sink in-- up until that point I had kept my game face on, but all at once I realized that my condition was life-threatening, (and that I would certainly not be going to my Tuesday class.) He said that he would get to the hospital as soon as possible-- not an easy feat when leaving Minneapolis for St.Cloud during evening rush hour. As it was, he arrived shortly before I was to be transferred to Fairview Riverside hospital in Minneapolis, and so basically got to follow the ambulance back to the cities. All during the long and swaying ride I was comforted by the distinctive set of the Jeep's headlights shining in at me through the rear window of the transport.

Hospital Life

I was admitted to Fairview Riverside, the closest hospital to my house, at about 10 pm on the night of Monday, December 12th. For the next week I was a resident of the 11th floor Surgery and Telemetry wing. I was on telemetry for the first few days, so that my heartbeat, still more rapid than usual, could be continually monitored. The leads for the monitor were attached at 5 points to my torso, and once removed left itchy marks that remained even after I went home. I was also on oxygen, as well as a twice daily shot of a blood thinner called Lovenox, and 5mg of Coumadin. The first full day that I was in the hospital an ultrasound was done of both my legs; the radiologist found that I had a clot in my left leg from the back of my knee to the middle of my calf. It was from this clot that my emboli had originated. The cause? My birth control, the Nuva ring, combined with a previously undiagnosed genetic blood condition called Factor V Homozygous Leiden (actually, this test didn't come back until after I left the hospital, but it was, indeed, the cause). I'm glad to say that all of the hospital staff that I came in contact with during my stay were wonderful and caring, especially the night nurses and the third year resident assigned to my case. Dr. P. was wonderful, being one of the somewhat rare breed of doctor who is able to give one an accurate understanding of their circumstance without scaring the bejesus out of them. The first year resident, on the other hand, wasn't so tactful, and reduced me to tears (after she left the room) by telling me how lucky I was to be alive. That was a bad day.

My husband was wonderful, managing to get home to feed our dogs twice a day, and every night uncomplainingly arranging his 6'5" frame on an uncomfortable roll-away bed in my hospital room. I was also blessed to have the loving support of friends and family, especially my Noona, who was only a phone call away whenever I needed her, and drove up from Chicago to stay with me for several days when I was released. My brother arranged to have my car picked up from St. Cloud State, and my Mom and Moggie ferried it back to Minneapolis. My Dad came and sat with me, and brought me a lovely bouquet of pink roses. I had several calls from my Mother-in-Law, as well as calls from my sisters, friends, and even my husband's Grandma. Flowers arrived from several people, including an arrangement of lilies from my husband's workmates, chosen specifically, he was instructed to tell me, to match the lily bulbs that we gave as favors at our wedding this summer. An old friend brought his dog to visit, and also carry-out soup from Quang Deli, quite a treat after nearly a week of bland hospital fare. Throughout the whole experience I was touched and humbled by the love and care I received.

Finally, I was weaned off of supplementary oxygen, my blood was judged adequately thinned, my husband was taught how to give me Lovenox shots should I need them, and I was discharged. I was scared to go home, where there would be no pulse oxymeter to tell me that my heartbeat was normal and my oxygen saturation up to par. Even though I wasn't a fan of the 5:30 am blood draw and vitals check, I also found it reassuring. It was hard to leave the safety net behind and venture back into the world with a body that seemed so much more fragile than the one I thought I had.

I Thought It Would Hurt More

What was amazing to me throughout my whole ordeal was that even though I was apparently in a very perilous circumstance, I was never in pain. My heart was beating hell bent for leather and I couldn't catch my breath, but I wasn't aware of real discomfort, only that I was scared. Up until this happened, I had always thought that I would know if I were in real danger because I would be in great pain. Not so. In a way, the realization that I could be in dire straits and not even know it was as shocking and scary as everything else.