Saturday, March 27, 2010

My Experience With Deep Venous Thrombosis (DVT) [Part One]

This is intended to be the first of several posts relating my current experience with DVT. I wrote most of this in the days right after my diagnosis. Rather than waiting until I can write the whole story, I decided to go ahead and post this much.

My first memory of the term "DVT" is on the referral form given to me by my doctor, requesting an ultrasound scan of my "lower left extremity". I didn't know what it meant but I knew that we were trying to find out why my left leg sometimes felt like I was wearing a rubber band above my knee. This had been going on for about four weeks. It was Tuesday, February 23 2010.

I'm less clear on the onset of this discomfort -- it must have been gradual -- but particularly recall the night at the end of January when I came home with pain in my left calf along with a "puffy" feeling, desperate to put my foot up. My wife Evelyn brought me blankets to elevate it and a hot pad to make it feel better. I called upon The Google and soon concluded that the most likely causes were dehydration or shin splints. There was a third possibility, but it was much less likely; I was happy to exclude it: a blood clot.

There followed four weeks of careful stretching, drinking more water, elevation when possible, and moderate gentle exercise. I also tried massaging the calf, but usually had to stop quickly. It seemed to discomfit my entire leg below the knee. The feeling was difficult to describe. Not a pain, but a funny sort of ache: if you can imagine a limb feeling faint then that's pretty close.

The acute discomfort I felt at the end of January did subside, but only to a vague ache. The calf felt stretched and my ankle was a little puffy. Sitting in certain cars began to be uncomfortable. And it wasn't getting any better.

I had to explain to my work colleagues why I wouldn't go jogging with them, and why I was putting my foot up more. "Shin splints" was a good explanation for a week or so, but after that at least one of them gave me that most basic of advice, "See a doctor."

Thursday February 18th I took a short flight from San Jose to San Diego and my discomfort increased. The return flight Saturday was a little better, but only because I sat in an exit row and could fully stretch out. I told myself that I'd see a doctor as soon as possible the next week.

Sure enough, come Monday I called my employer's in-house health clinic and took their next available appointment that Thursday. Using the clinic would minimize my time off work, and having endured this condition for weeks already, another few days didn't seem important.

But Tuesday morning I awoke in somewhat greater discomfort. Not only did my calf feel inflated and achy, but my hands felt puffy too. As I got in the car to drive to work I started to worry a little.

Among my friends are at least two who have had strokes. The results aren't pretty and even partial recovery takes a long time. I really didn't know enough to say whether my symptoms could lead to a stroke (they don't), but it reminded me that some of these conditions can be completely mitigated if caught early enough, and can be life-changing or fatal if not.

I started to worry a little more. Before I got on the main road I was calling my regular doctor.

His response was pretty impressive -- I left a message describing my symptoms and within five minutes his office called back and asked me to come in right away. They are on my way to work so I was there in about ten minutes.

This is where things could have gone awry with a less thorough doctor. My physical symptoms were not very impressive: no discoloration and only a small amount of swelling. He thought it was probably just a strain injury, but ordered tests to make sure: one of them was an ultrasound scan for DVT.

This is also where things could have gone awry with a less motivated patient. I had two weeks before my followup appointment and therefore could easily have waited to schedule my tests. But I didn't. As soon as I left the doctor's office I called the hospital vascular lab to schedule the ultrasound. I asked if they had something "today" and they fit me in.

The Ultrasound Test

Debbie, the attractive and friendly ultrasound technician, does DVT scans all the time.She joked about there being a "special on DVT scans" that day -- I guess she'd had a bunch of them. At the hands of an expert they are pretty fast, and mostly negative.

Trousers off, I couldn't help warming at her touch. But of course she is all business. Starting with the ultrasound probe at my crotch, she scanned down my left femural vein, explaining as she did that we were viewing a cross section. Most of us have seen neo-natal sonograms of unborn children. This test is similar, but also employs Doppler sonography to measure the velocity of blood moving through the vein.

It was looking fine until she got to my knee, where she immediately said, "Oh, there's a clot." All I could see on the ultrasound was a shadow, but Debbie showed how it was really an obstruction inside my vein. Besides measuring its size, she also employed the scanner to measure the degree of obstruction by squeezing the vein lower in my calf and checking the change in blood flow.

I guess most patients react with fear or horror, but my own reaction was relief: now I knew why my leg was bothering me. My doubt was replaced by certainty: there was no longer an unknown foe, but something that could be named and treated.

But I have to admit that I was surprised how quickly things moved from there. Debbie called my doctor and told him of her findings. They put me on the line: he wanted me to go to the emergency room where they would start treatment immediately with "blood thinners".

I was about to become a patient.