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.
Wednesday, April 28, 2010
Monday, April 26, 2010
My Left Leg
Last Wednesday, I felt a slight pull or twinge in my left calf. Something that happens now and then to most everybody. But stretching the calf didn't help. And resting it didn't help. And massaging it felt like a really bad idea.
But hey, the condition wasn't any real inconvenience. I could walk or run easily and without pain. And I was doing both on golf courses in South Carolina, as described below.
But by last Friday, I was getting concerned that the "slight pull" feeling was just a precursor to something else: it was feeling just like my right calf had felt several months ago -- when it was discovered I had a serious blood clot there.
The clot condition was a "DVT," or "Deep Vein Thrombophlebitis." And, in addition to making it painful to walk, the DVT could cause serious swelling and tissue damage. And, if misfortune had its way, a piece of the clot could break off and head for my lungs, my heart, or my brain -- resulting in my permanent disability or death.
Last Saturday morning (that is, two days ago), I was comfortable going to our regularly scheduled practice session of the Turks Head Jugglers. But by late Saturday afternoon, I couldn't walk without crutches. So Deb and I spent most of Sunday in the Chester County Hospital taking tests and waiting, waiting, waiting. And finally the word came back: yes a blood clot, but not a DVT. Which, for being a bad thing, may be not-so-bad, as you will see.
Now last year's right-leg DVT was understandable: such things are a not-uncommon consequence of chemotherapy, and I was right in the middle of my treatments at the time. My medical team all agreed that the chemo was probably responsible -- every one except the chemo doc, who felt the timing for developing a "DVT-caused-by-chemo" wasn't right. But he was a minority of one, and the rest of us liked the story line. I swallowed my last blood thinner pill in December of last year, was back regularly at the gym with my trainer working hard, and life was returning to normal.
But this blood clot (which has been every bit as painful and located in exactly the same place on the other leg) obviously doesn't fit with the chemo story, since my last chemo session was in late August or early September. The literature on clots suggests that just having had "certain types of cancer" makes DVT's more likely, but doesn't elaborate on which types of cancer they're talking about. The literature also suggests that long periods of inactivity make DVT's more likely, but I don't think that applies either. But maybe...
You see, last Sunday, a dear friend of mine and I drove to South Carolina for a week of golf. And Santee, South Carolina is located 11 driving hours from West Chester. But Ron and I had stopped at least six times for food, gas, bathroom breaks, refilling-Randy's-water-bottle, and so forth. So does the drive qualify as a "long period of inactivity"? I dunno...
But the plausible story line is: the trip down to South Carolina on Sunday started the clot and the trip home on Friday made it worse. (The irony here is that I was wearing a compression stocking on my right leg to help assure that the clot there wouldn't return. But didn't wear one on my left leg. I mean, why would I?)
So, did that trip (with all its walk-around stops) cause the clot? The timing sounds right... Does it matter what caused it at this point? The clot is there and now it needs to be dealt with.
Okay, the reason it isn't an official DVT: Clots are located and identified using a sonogram. So getting one of those was the first thing that happened to me at CCH. And it showed that there were no clots in the veins of my upper leg, which has the big veins that lead to the heart and lungs, according to the technician running the sonogram machine. The tech didn't examine my lower leg because, she said, the veins are too small to get a good reading and they don't pose the life-threatening breakaway possibilities that are associated with upper-leg clots.
So yes, a clot but not a DVT. Got it?
Now Deb and I are getting to be old hands at filling out medical forms and answering standard questions about my current condition and medical history. Several times during the admissions process in the Emergency Room last Sunday, the nurse asked us please to stop answering the question she was about to ask. It was getting on her nerves. (Question: "Do you smoke?" Answer: "I did. One to two packs a day -- but stopped over thirty years ago." Comment: "Arrgh.")
In addition, we knew that the stay in the ER could last a long time. So Deb took two issues of The New Yorker magazine and I took a Terry Pratchett novel that I hadn't read. (In fact, I've kept a short stack of unread Terry Pratchett novels handy for just such an occasion.)
Based on our previous DVT experience, we knew that I would likely be injecting myself with Lovenox for a week or two, starting a daily dose of Coumadin (blood thinner) for six months (Or maybe the rest of my life. Stay tuned, as this has yet to be determined.), and visiting the oncology center once or twice a week as long as I'm taking the Coumadin to make sure my blood is thin enough without being too thin.
The fact that the clot wasn't a DVT gave me one brief glimpse of hope of avoiding the above routine -- at least for a while. There was a blood test they recommended called "D-dimer" which would measure the byproducts of a clot continuously dissolving and being re-made. If the test came back with a score below 501, I would be off the hook for treatment-- at least temporarily -- and we would wait to see what developed: clot clears or clot gets worse.
The test took an hour to process, during which Deb and I sat (Deb) or lay down (me) reading or eating the lunch that Deb secured for us at the cafeteria.
Well, the test came back with a score over 1200. So the virtual "Exit" sign was switched off. Darn.
Before I left, a nurse watched me inject myself with Lovenox to make sure I did it right, and the Physician's Assistant gave me prescriptions for more Lovenox and Coumadin.
So here we go again.
On the negative side of the ledger:
-- I'm looking at the annoyance factor of self-injecting twice a day for several weeks and a six-month string of weekly blood tests. And maybe the tests (and the Coumadin) go on for the rest of my life. I'll know more later this week.
-- I shouldn't go dinosaur hunting this summer, as a bad cut or scrape in the Badlands is a not-unlikely development. But it would be a very serious issue for someone on blood thinners and a long way from medical facilities.
On the positivie side:
-- the golf trip was a huge success. Ron and I were roommates back in college, and he was the Best Man at my wedding to Deb, so our history goes back a long way and we hold each other in great fondness and respect. But we've interacted very little until the last year or so -- and it was his concern about my cancer that got us back together again. And the weather was great. (Had we done the trip this week, we would have had thunderstorms to deal with.) And the food was great. And the birdwatching was wonderful. And the golf was... umm... incidental to the overall experience.
-- waiting in the Emergency Room as long as we did (we got there around 7:00 AM and left after 2:00 PM) was a great thing to do for my leg. I kept it elevated and rested for most of that time, and it feels considerably better today than it did yesterday.
-- it sounds like I went for treatment before the clot developed into a DVT. So the likelihood of this being life-threatening is greatly reduced.
-- I've had a chance in the last day or so to re-visit Terry Pratchett's Diskworld - which is a wonderful place to be, but a place I've disallowed myself until I really need to go there. Like now. Because I don't ever want to run out of Terry Pratchett novels, no matter how long my convalescence takes.
-- I remember that, during treatment for my other blood clot, I couldn't eat solid food because my mouth was too sore. And so all my nourishment came via a food tube planted in my stomach. And my medication list was a lot longer. And... well, life was just a whole lot less pleasant. So as long as this is "just a blood clot," I am 'way ahead of where I was 10 months ago.
-- following onto the previous thought, treatment for the clot doesn't place much additional burden on my wonderful wife. So the two of us are 'way ahead of where we were 10 months ago.
-- although it's painful at this point to walk up or down stairs, and walking across a level floor is quite slow, I've found that I can drive my manual-transmission car without any discomfort. And, if the pattern of healing is the same as the pattern for last year's clot, the pain should subside and disappear completely in the next several days.
-- this may sound very strange to you. It certainly does to me. But I'm feeling an inner sense of peace now that had been mine during much of last year, but had been gradually slipping away for the last several months. Maybe it's residual from spending a week chasing a little white ball across big green lawns in springtime South Carolina. Maybe it's the opportunity to spend so much time with Ron, whose friendship has meant so much to me for decades. Maybe it's because I feel justified in setting aside a litany of small issues and annoyances and focusing on how incredibly fortunate I've been in my life.
So I'm blogging again. And, while the reason for writing this is not a happy one, it feels good to reach out to you, dear reader, and share.
But hey, the condition wasn't any real inconvenience. I could walk or run easily and without pain. And I was doing both on golf courses in South Carolina, as described below.
But by last Friday, I was getting concerned that the "slight pull" feeling was just a precursor to something else: it was feeling just like my right calf had felt several months ago -- when it was discovered I had a serious blood clot there.
The clot condition was a "DVT," or "Deep Vein Thrombophlebitis." And, in addition to making it painful to walk, the DVT could cause serious swelling and tissue damage. And, if misfortune had its way, a piece of the clot could break off and head for my lungs, my heart, or my brain -- resulting in my permanent disability or death.
Last Saturday morning (that is, two days ago), I was comfortable going to our regularly scheduled practice session of the Turks Head Jugglers. But by late Saturday afternoon, I couldn't walk without crutches. So Deb and I spent most of Sunday in the Chester County Hospital taking tests and waiting, waiting, waiting. And finally the word came back: yes a blood clot, but not a DVT. Which, for being a bad thing, may be not-so-bad, as you will see.
Now last year's right-leg DVT was understandable: such things are a not-uncommon consequence of chemotherapy, and I was right in the middle of my treatments at the time. My medical team all agreed that the chemo was probably responsible -- every one except the chemo doc, who felt the timing for developing a "DVT-caused-by-chemo" wasn't right. But he was a minority of one, and the rest of us liked the story line. I swallowed my last blood thinner pill in December of last year, was back regularly at the gym with my trainer working hard, and life was returning to normal.
But this blood clot (which has been every bit as painful and located in exactly the same place on the other leg) obviously doesn't fit with the chemo story, since my last chemo session was in late August or early September. The literature on clots suggests that just having had "certain types of cancer" makes DVT's more likely, but doesn't elaborate on which types of cancer they're talking about. The literature also suggests that long periods of inactivity make DVT's more likely, but I don't think that applies either. But maybe...
You see, last Sunday, a dear friend of mine and I drove to South Carolina for a week of golf. And Santee, South Carolina is located 11 driving hours from West Chester. But Ron and I had stopped at least six times for food, gas, bathroom breaks, refilling-Randy's-water-bottle, and so forth. So does the drive qualify as a "long period of inactivity"? I dunno...
But the plausible story line is: the trip down to South Carolina on Sunday started the clot and the trip home on Friday made it worse. (The irony here is that I was wearing a compression stocking on my right leg to help assure that the clot there wouldn't return. But didn't wear one on my left leg. I mean, why would I?)
So, did that trip (with all its walk-around stops) cause the clot? The timing sounds right... Does it matter what caused it at this point? The clot is there and now it needs to be dealt with.
Okay, the reason it isn't an official DVT: Clots are located and identified using a sonogram. So getting one of those was the first thing that happened to me at CCH. And it showed that there were no clots in the veins of my upper leg, which has the big veins that lead to the heart and lungs, according to the technician running the sonogram machine. The tech didn't examine my lower leg because, she said, the veins are too small to get a good reading and they don't pose the life-threatening breakaway possibilities that are associated with upper-leg clots.
So yes, a clot but not a DVT. Got it?
Now Deb and I are getting to be old hands at filling out medical forms and answering standard questions about my current condition and medical history. Several times during the admissions process in the Emergency Room last Sunday, the nurse asked us please to stop answering the question she was about to ask. It was getting on her nerves. (Question: "Do you smoke?" Answer: "I did. One to two packs a day -- but stopped over thirty years ago." Comment: "Arrgh.")
In addition, we knew that the stay in the ER could last a long time. So Deb took two issues of The New Yorker magazine and I took a Terry Pratchett novel that I hadn't read. (In fact, I've kept a short stack of unread Terry Pratchett novels handy for just such an occasion.)
Based on our previous DVT experience, we knew that I would likely be injecting myself with Lovenox for a week or two, starting a daily dose of Coumadin (blood thinner) for six months (Or maybe the rest of my life. Stay tuned, as this has yet to be determined.), and visiting the oncology center once or twice a week as long as I'm taking the Coumadin to make sure my blood is thin enough without being too thin.
The fact that the clot wasn't a DVT gave me one brief glimpse of hope of avoiding the above routine -- at least for a while. There was a blood test they recommended called "D-dimer" which would measure the byproducts of a clot continuously dissolving and being re-made. If the test came back with a score below 501, I would be off the hook for treatment-- at least temporarily -- and we would wait to see what developed: clot clears or clot gets worse.
The test took an hour to process, during which Deb and I sat (Deb) or lay down (me) reading or eating the lunch that Deb secured for us at the cafeteria.
Well, the test came back with a score over 1200. So the virtual "Exit" sign was switched off. Darn.
Before I left, a nurse watched me inject myself with Lovenox to make sure I did it right, and the Physician's Assistant gave me prescriptions for more Lovenox and Coumadin.
So here we go again.
On the negative side of the ledger:
-- I'm looking at the annoyance factor of self-injecting twice a day for several weeks and a six-month string of weekly blood tests. And maybe the tests (and the Coumadin) go on for the rest of my life. I'll know more later this week.
-- I shouldn't go dinosaur hunting this summer, as a bad cut or scrape in the Badlands is a not-unlikely development. But it would be a very serious issue for someone on blood thinners and a long way from medical facilities.
On the positivie side:
-- the golf trip was a huge success. Ron and I were roommates back in college, and he was the Best Man at my wedding to Deb, so our history goes back a long way and we hold each other in great fondness and respect. But we've interacted very little until the last year or so -- and it was his concern about my cancer that got us back together again. And the weather was great. (Had we done the trip this week, we would have had thunderstorms to deal with.) And the food was great. And the birdwatching was wonderful. And the golf was... umm... incidental to the overall experience.
-- waiting in the Emergency Room as long as we did (we got there around 7:00 AM and left after 2:00 PM) was a great thing to do for my leg. I kept it elevated and rested for most of that time, and it feels considerably better today than it did yesterday.
-- it sounds like I went for treatment before the clot developed into a DVT. So the likelihood of this being life-threatening is greatly reduced.
-- I've had a chance in the last day or so to re-visit Terry Pratchett's Diskworld - which is a wonderful place to be, but a place I've disallowed myself until I really need to go there. Like now. Because I don't ever want to run out of Terry Pratchett novels, no matter how long my convalescence takes.
-- I remember that, during treatment for my other blood clot, I couldn't eat solid food because my mouth was too sore. And so all my nourishment came via a food tube planted in my stomach. And my medication list was a lot longer. And... well, life was just a whole lot less pleasant. So as long as this is "just a blood clot," I am 'way ahead of where I was 10 months ago.
-- following onto the previous thought, treatment for the clot doesn't place much additional burden on my wonderful wife. So the two of us are 'way ahead of where we were 10 months ago.
-- although it's painful at this point to walk up or down stairs, and walking across a level floor is quite slow, I've found that I can drive my manual-transmission car without any discomfort. And, if the pattern of healing is the same as the pattern for last year's clot, the pain should subside and disappear completely in the next several days.
-- this may sound very strange to you. It certainly does to me. But I'm feeling an inner sense of peace now that had been mine during much of last year, but had been gradually slipping away for the last several months. Maybe it's residual from spending a week chasing a little white ball across big green lawns in springtime South Carolina. Maybe it's the opportunity to spend so much time with Ron, whose friendship has meant so much to me for decades. Maybe it's because I feel justified in setting aside a litany of small issues and annoyances and focusing on how incredibly fortunate I've been in my life.
So I'm blogging again. And, while the reason for writing this is not a happy one, it feels good to reach out to you, dear reader, and share.
Monday, March 22, 2010
The Birds of the Florida Keys
As part of my report on our celebratory visit to the Keys, I thought I would include pictures of the birds that we saw while we were there. Deb and I are a-little-more-than-casual birdwatchers, but not by a whole lot.
So please note that all these photos are from someone else's camera and website. (I plan to put together a collection of photos from our trip and post them on my Facebook page. But that's a ways off...) In collecting these, I've been astonished at how many bird-oriented websites there are on the 'net!
(All you have to do to see the photos is click on the website address -- then click the "Back" button to return to the blog.)
Yellow Warbler: http://sdakotabirds.com/species_photos/yellow_warbler.htm
Little Blue Heron: http://www.tobinphoto.com/birds/blue-heron.htm
Great Blue Heron: http://sdakotabirds.com/species_photos/great_blue_heron_5.htm
Little Green Heron: http://www.naturephoto-cz.com/little-green-heron:butorides-striatus-photo-2342.html
Snowy Egret: http://www.pbase.com/golfpic/image/42485766
Great White Heron: http://stock.tobinphoto.com/great-white-heron-pictures-448.htm
Mockingbird: http://en.wikipedia.org/wiki/File:Mimus_polyglottos1.jpg
Anhinga: http://www.naturephoto-cz.eu/anhinga-anhinga-picture-7259.html
Frigate Bird: http://www.naturephoto-cz.com/magnificent-frigatebird:fregata-magnificens-photo-2484.html
Pied-Billed Grebe: http://en.wikipedia.org/wiki/Pied-billed_Grebe
Coot: http://www.allaboutbirds.org/guide/American_coot/id
White Ibis: http://photohome.com/photos/animal-pictures/birds/white-ibis-1.html
Glossy Ibis: http://en.wikipedia.org/wiki/File:Glossy_Ibis_(Plegadis_falcinellus)_in_AP_W_IMG_3918.jpg
Muscovy Duck: http://www.avianweb.com/muscovyduck.html
Roseate Spoonbill: http://www.schmoker.org/BirdPics/Photos/ShorebirdsWaders/ROSP1.jpg
Brown Pelican: http://www.richard-seaman.com/Wallpaper/Nature/Birds/Divers/FlyingBrownPelican.jpg
Osprey: http://www.wnywildlife.com/alabama/osprey/osprey7.jpg
Merlin: http://www.squidoo.com/merlin-falcon
Kestrel: http://en.wikipedia.org/wiki/American_Kestrel
Cormorant: http://www.oceanlight.com/spotlight.php?img=15071
Common Tern: http://www.naturfoto-cz.de/common-tern:sterna-hirundo-photo-588.html
The Roseate Spoonbill was a special treat. We had seen most of the birds we had hoped for by the last day of our stay -- but we hadn't seen any Spoonbills. BUT! on our drive back up the Keys to Miami and the airport thereunto attached, one of these wonderful creatures flew across the road right in front of our car. Like he/she had been waiting in a nearby tree for us to come by, and launched her/himself in front of us to let us know that the local avian contingent wants us to return sometime soon.
I will, of course, let you know when my photos get posted -- and how to find them. (It really was a marvelous trip! Sorry you all couldn't have been along, since we've been together through so much of the reason for the trip!)
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