Modern Medicine II

I've never had a "doctor" as in "whose your doctor?"  The only time I see a doctor is my annual occupational physical, which I dread.  It's a pretty comprehensive physical that includes blood work, spirometry (blow!), EKG, chest x-ray (which they always manage to screw up), and a hearing (which I fail because I used to listen to rock ... LOUD! ... what?).  Every year it's a different doctor and sometimes it's a female doctor sticking her fingers under my testicles and asking me to cough.  Based on my random sampling, there are no cute female occupational physicians.  The attractive female physicians become OB-GYNs, like the two that delivered my boys.

As requested, I scheduled an appointment with a bona fide "doctor", what you would refer to as a family physician.  He seemed gravely concerned about the clot in my calf and he didn't like the whole aspirin thing I was doing as suggested by the ER dude.  I gathered from our conversation that it sparked some of dialog among the various professionals who I've had the pleasure of seeing over the last week or so.

Conveniently there was an opening at the ultrasound place.  Again, I took my pants off, laid down on a tissue paper-covered table, while an attractive young women rubbed a thingee over my leg and talked into a microphone.  Modern medicine isn't all bad.  The downside was that the clot was still there.

Back I went to my official doctor, who is actually turning out to be an OK guy.  Modern medicine convinced me that the Warfarin blood thinning therapy was the way to go.  It would be for three months until my body figured out that my calf was healed up and needed to back off the clotting alert.

I scheduled an appointment with the blood-thinning clinic where the nice nurse started me on 7.5 mg a day.  I got the prescription filled and headed home.  It was lunch time so I decided to make a tuna melt.  While slicing cheese with a mandolin slicer I sliced my thumb open.  I know it's bad when you look at it once and think maybe it isn't real then look a second time and see all the blood and you know it's real.  So it was back to the clinic with my thumb wrapped in a couple sheets of Brawny paper towels to get my thumb sewn up.

I have now been on the Warfarin diet for almost two weeks.  I go in every few days to have my clotting factor checked.  Normal is a "1" but I need to be between 2 and 3, the ideal range to reduce further clotting but not so thin that my skull fills with blood.  I made a lame chart in Excel which shows my daily Warfarin dose in milligrams (mg) and the measured clotting factor.  I showed my chart to the nurse and she said "You must be a computer expert!"  Geez, it's really quite a lame chart.  I think I'll add a 3-D effect for my next appointment and really blow her mind.

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.