Wednesday, July 21, 2010

Modern Medicine

I mentioned in earlier blog entries that I strained my left leg calf muscle doing some canyoneering near Moab. It was just a simple jump but an ungraceful landing. It felt like the worst Charlie horse of my life. In retrospect, I really ripped some muscle tissue. To make matters worse, the rest of the vacation involved a lot of driving and walking, especially in Las Vegas. One week later my calf swelled up like a stuffed sausage and stayed that way.

Three and a half weeks later my calf was still swollen but at least the pain had subsided to the point where I could walk normally and I again resumed my three days a week gym routine. I had good mobility and near full strength but the swelling was still there. I decided I should see an orthopedist for an evaluation and scheduled an appointment.

I had x-rays done at the orthopedist’s office. Bones looked good according to the orthopedist. The orthopedist had me do a few movements to demonstrate strength and mobility to verify that nothing else was ripped, like an Achilles tendon, the other optional injury. Injuries to the musculoskeletal system usually have options. Tearing calf muscle tissue is a better option than tearing an Achilles tendon. Just like when I fractured my tibia 14 years ago skiing. The other option there is to tear knee ligaments. Fractured tibia was the better option. Bones heal. Ligaments don’t. The bottom line was time would heal my torn calf muscle. The orthopedist gave me a prescription for a compression sock to squeeze the swelling juices back where they belong, probably to the little beer keg I have going on in my belly area, just where I need it most.

My orthopedist was concerned about blood clots in my leg since muscles, when torn, tend to bleed. I was sent over to the neighboring hospital to have ultrasound done, which included both legs, an added but probably unnecessary bonus. I nice young woman had me lay back on a bed in my underwear while she moved this thing up and down my legs and looked at a screen. She found the swelling mother lode, a 3.5 by 6 cm fluid-filled cavity in my calf muscle. Unfortunately, the nice young woman also found a small clot in a vein in my calf muscle, the technical diagnosis being deep vein thrombosis, DVT for short. Off to the emergency room, ER for short.

I sat around the ER waiting room for awhile then got checked in by a nice lady RN, about my age. By this time, I was getting used to filling out forms because by now I knew all the answers. The nice RN wheeled me in a wheelchair down to Room 21 in the ER. A young guy RN came in and chatted with me and then a less younger guy Physician’s Assistant (PA, in case you’re following along the acronym trail) came in. The PA explained the two schools of treatment available, first there’s the aspirin diet for a week then they check you out again on the ultrasound, and hopefully the clot is not getting bigger and ideally is being absorbed like a bad Star Trek episode. Second treatment option is the blood thinning therapy involving a week of Heparin injections, which they will train you to do, after which you take Warfarin (rat poison) pills for three to six months while they monitor you every day for the correct dosage to make sure you don’t bleed internally like a rat (too much) or clot up (too little). As far as I was concerned, the second option was not an option. The PA said the fact that the clot was in the lower leg was good because lower leg clots rarely go anywhere. The PA said he’d discuss it with the ER doctor hidden behind some curtain somewhere in the ER not to be revealed. The PA came back a few minutes later and said that the ER doctor was down with the aspirin therapy. Whoo hoo! I was out of there.

The next day, I picked up my compression sock, measured and fitted by the pharmacist. Amazingly, within a couple days my left calf looked almost normal in size. Strangely, my belly felt a little tighter.

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