On February 25th, I woke up to find my right lower leg swollen and as hard as a rock. Normally, it's my left lower leg that has swelling issues due to an old scorpion sting that I got in Texas in 2007. Anyway, like most nurses, I minimized my symptoms and put on a pair of support stockings and carried on.
However, throughout the day, it didn't get any better. Then it started to ache and I started limping. The most notable sensation felt like there was an ice cube being held to the back of my right knee. Saturday and Sunday came and went without a change in the swelling or amount of pain. In my mind, the thought of it being a deep vein thrombosis (DVT) came and went many times. What baffled me was the lack of the two most-common symptoms of a DVT, namely, redness and warmth.
By the time Sunday night rolled around, I'd had enough and made an appointment to see my nurse practitioner on Monday morning. I had a gut feeling that something wasn't right, but I couldn't put my finger on what it could be.
Monday morning, as I sat alone in the clinic room, the thought of it being a DVT kept nagging at me. My provider came in and was equally stumped. She said that there was only one thing that would rule out a DVT and that was an ultrasound of my entire leg.
I drove the ten miles to the main hospital site and watched the monitor as the tech did the ultrasound. I noticed that she couldn't find any venous blood flow in my entire right leg and frequently had to recalibrate the machine, which was strange. To double check her equipment, she did an ultrasound of the left leg, which I could tell was normal.
By the time I got home, the radiologist's report was sitting in my in-box. Turns out, the venous circulation in my right great saphenous and small saphenous veins from my hip to my foot were not existent. The radiologist noted there was one, long, continuous blood clot present. Additionally, there was a huge clot obstructing my right popliteal vein... that explained the "ice cube" feeling behind my knee.
I called my nurse practitioner on the provider line and asked at what point I needed hospitalization with a heparin IV. She felt a month of Xarelto (that new blood thinner that has all but replaced warfarin) and conscientious home care would suffice. She said if I weren't a nurse, she would have had me hospitalized.
Well, as of today, I've been on Xarelto 15mg twice a day for a week and the swelling is finally subsiding. But, the back of my knee and the lower leg still hurts, which is lasting longer than expected.
I'm not on bedrest, but my provider told me to not do things like yard work, housework, snow shoveling, and so on. She (and I) are concerned about a piece of that three foot long dissolving clot breaking loose and travelling to my lungs, resulting in a pulmonary embolism (PE), which can be fatal. Statistically, I have a roughly 1 in 125 chance of getting a PE for another week and, if I get one, there's a 1 in 4 chance of dying from it. I don't like those odds, but lying around in a hospital bed wouldn't decrease the odds or change the outcome. Needless to say, I'm not exactly spooling up my activity to a normal level anytime soon. Yet, I can't sit or lie around all the time... that would be just as bad.
I'll be on Xarelto until March 19th at the earliest, and more than likely until the middle of September. I see the hematologist on March 13th; he'll make that decision then. I was planning on having surgery in May to remove some titanium pieces in my now-healed shoulder, but that's now on hold indefinitely. Additionally, I'm advised not to travel by air for at least six months. If I travel by car, I have to stop every 30 minutes and take a 5 minute walk.
Finally, something about Xarelto. I'm glad to be taking it, because if I were taking old-fashioned warfarin, I'd have to drive 20 miles every two days to have my blood drawn. Based on those results, the next two day's doses of warfarin would have to be tweaked so my blood doesn't get too thin. That said, Xarelto has a shitload of side effects. The worst one that I notice is an occasional sensation at bedtime that the veins in all four of my extremities are on fire. I can tell that I'm on the verge of getting a nosebleed at any given second. And, in the morning, I can smell perm solution... you know, the stuff the hair shop workers squirt in hair to make it curl. The smell follows me around for an hour before it subsides. I think it's the Xarelto being excreted from my pores. Finally, I read that some people get addicted to Xarelto and have trouble getting off of it. They have withdrawal symptoms and the whole nine yards and require rehab. Addiction to a blood thinner? Really?
Commercial aircraft flown in: B712 B722 B732 B734 B737 B738 B741 B742 B744 B752 B753 B762 B772 A310 A318 A319 A320 A321 DC91 DC93 DC94 DC1030 DC1040 F100 MD82 MD83 A223 CR2 CR7 E175