What (I Think) I Know About Blood Clots

It isn't what you think. At least, it isn't what I thought...

And some of what I think I know may not be right anyway. so if you have more information, please feel free to contribute. Then we'll all be smarter!

A blood clot is a clumping of blood cells somewhere in the body. Duh. Clots in veins (which return blood to the heart) are a lot more common that clots in arteries (which send blood out and away from the heart). I think that's because the pressure in arteries is higher because the blood is closer to the pump, i.e., the heart. So the blood is "pushed harder" there, and the pressure gradually decreases as the blood gets farther away from the heart. Lower pressure means a higher likelihood of clumping. That's my guess, anyway.

Since the hardest "push" is getting the blood back up from the legs (it's all uphill, you know...) it's more likely that a clot will form in a vein in the leg rather than an arm (since an arm is closer to the "pump" and gets moved up and down a lot, providing better circulation). Got it?

And there seem to be a raft of reasons that a clot might form. As previously reported, my docs (well most of them, anyway...) were ready to ascribe my last clot to my chemo sessions. But that clearly doesn't explain why this clot developed. Yes, the long drives to and from South Carolina were probably the triggering events, but that doesn't explain my proclivity to clotting. After all, there were thousands of drivers on I-95 for both trips, and very few if any of them got clots as a result.

So a clot is often recognized (as it was in my case) by painful swelling in the affected area. But here's where it gets a little tricky:

The pain is dissipating fairly quickly, and I should be off crutches in a matter of days. But the clot, I know, will be there and barely affected by the rest and the medication with which it's being treated. We (my docs and me) expect the clot to be there for months, and that's certainly what happened last time. So thankfully, the pain goes away but the cause of the pain remains. Don't know why that is, but that's how it works.

Currently, I'm injecting myself twice a day with Lovenox, which is meant to accelerate the blood-thinning process early in the treatment. And I'm taking Coumadin in pill form as the long-term medication to keep my blood thin. (And yes, Coumadin -- or "Warfarin," as it's otherwise known -- was originally developed as a rat poison. Makes you feel great to know... oh, never mind.)

But the purpose, as I understand it, of the blood thinning medication is not to break up the existing clot, but to keep new ones from forming. It's assumed that nature and time will dissolve the clot that's already there. So I will be getting sonograms for a couple of months to check on the progress of that dissolving. But whatever it is that caused the initial clot may cause additional clots unless something is done to prevent that. So that's why the Lovenox and Coumadin. (My previous clot was initially treated with intravenous Heparin during a hospital stay -- and then the Lovenox and Coumadin. I guess that was for an even quicker jump start on blood thinning, which wasn't as necessary this time around, since the clot was not a DVT, as reported in the previous posting.)

So I will have to get my blood tested once a week or so for months ahead to confirm that my blood is thin enough to prevent additional clots from forming, but "thick" enough to clot if I should cut or scrape myself. And the dosage of Coumadin will be readjusted again and again to keep the clotting factor in the proper range.

Taking the Coumadin is not a big deal. And the testing is no big deal either. But the restrictions on my activities while my blood is thinned out is a big deal. No dino hunting. Maybe no unicycling. Extra care doing yard work. And so on and so on...

So I don't know why this clot occurred at all. And I don't know what causes the pain, since the clot will exist long after the pain subsides. And I have no idea what the docs will find (if anything) to explain why the clot happened or how to prevent the next one without blood thinning medication.

And so it appears that what I don't know may be greater than what I do know. Hmmph.