Patient of the Week

December 2, 2009

As I slid along the pavement of Southwest Broadway at 20 mph, I was not feeling much gratitude toward the person who had just cut me off in the rain. Gratitude would come a week or so later when I was having trouble breathing.

It seemed like a minor accident: a broken mirror, some scratches on my elbow and scooter, a twinge in my left knee. The driver apologized, saying I had been in his blind spot. His daughter helped pick up the bike and asked if I was OK. I moved my arms and legs, tilted my head, wiggled my fingers. Except for the elbow and knee, I felt fine. We talked for a few minutes, exchanged phone numbers, then went our separate ways.

Within an hour, my knee was swelling, and I could barely walk. In the emergency room, X-rays showed no broken bones, but they wouldn't know if I'd torn anything until the swelling went down.

They gave me crutches, a prescription for pain medication, and instructions to stay off my feet as much as possible.

That was Monday afternoon. I could not walk without crutches until Thursday and could take only a few steps without them until Sunday. For six days I rested on the couch, moving as little as possible.

One week after the injury, I returned to work, bringing my crutches as a precaution. I worked a full day, my wife picked me up and we stopped for dinner. Afterward, I felt a tiny pinch in my chest when I took a deep breath but didn't think much of it.

When I got home, I tried to pull off my shoe by tugging at the heel with my other foot. It felt as if I were ripping the calf muscle on my injured leg, so my wife untied my shoes and slipped them off. At 8:30, I limped into bed and fell asleep.

I awoke at 12:05 a.m. and it hurt to breathe. Even shallow breaths hurt much worse than what I had felt after dinner. When I tried to walk I realized after three or four steps that my leg didn't hurt nearly as much as when I went to bed. My calf felt better. For the first time since the accident, I was able to walk heel-toe.

Walking was now much easier -- but breathing much more difficult. What was going on? I felt the two must be related.

Then I remembered something the driver had told me a few days earlier.

He had called me three days after the accident to see how I was feeling. He said he felt very bad that I was laid up and in some pain. We spoke for 20 minutes about the accident, insurance companies, motorcycle riding, pizza and our families. I learned his wife had passed away a few years earlier.

"From ankle surgery, of all things," he said.

During her recuperation, she had developed blood clots, which broke loose. "I took her to the hospital and they said I got her there in time, but one got through to her heart and she died."

Which got me to thinking: Could I have developed a blood clot that somehow broke loose and migrated from my leg to my chest? Is that why I could walk but not breathe easily?

My wife drove me to the emergency room. The nurse taking my vitals said a blood clot was possible, but she thought it was something musculoskeletal-related. An EKG was taken and I waited for the doctor.

It came back normal. The doctor asked me a lot of questions. I recounted my motorcycle accident, my recuperation and the pain that brought me to the ER. I told him I wondered if I might have passed a blood clot. He said he was thinking the same thing, so he ordered a CAT scan.

Bingo!

I had blood clots in my lungs. The technician administering the scan wheeled me to the computer screen to show me multiple clots, which appeared as grayish splotches on a field of black. One of them he called significant.

The doctor who ordered the CAT scan came back to my exam room seemingly in a good mood. We both smiled, happy with our diagnosis. The only thing missing was a high five.

A nurse gave me a shot of Lovenox, an anti-coagulation drug I would inject in my belly twice a day for the next eight days, and admitted me to the hospital.

The attending physician told me no one had ever told her pain had migrated from their leg to their chest. She also explained that blood clots often form in the leg when people suffer a traumatic injury there or have to stay immobile for a long period. She said I probably could go home right away and be fine, but she suggested that I stay overnight.

Thirty-six hours after entering the hospital, I was on my way home, armed with prescriptions for anti-coagulation medicine and pain relievers. Pulmonary emboli -- the technical term for blood clots -- can hurt. For me, the pain comes and goes.

When I saw my primary care doctor a few days later, he told me the echocardiogram showed no congenital defects. I'm not at extra risk of a heart attack or stroke from these emboli, which eventually will be absorbed by my body.

He also told me the doctors and nurses at the hospital were pretty impressed with the self-diagnosis and called me "patient of the week." I can laugh about that now. It doesn't hurt.

It has been several weeks since I was discharged from the hospital. All things considered, I'm doing fairly well, though my life will be different for the next three to six months, perhaps longer.

I'll be taking an anti-coagulant pill, Warfarin, and getting regular tests of my blood's viscosity to make sure I don't clot too easily or bleed profusely if injured. Because the risk of bleeding is greater, I won't be riding my scooter or putting a razor to my face every day (wife's orders), and I now wear a medic alert bracelet warning that I take a blood thinner. According to my doctor, taking blood thinners gets me a ride on a life flight instead of an ambulance in case of a serious injury. I love helicopters but can probably do without that ride.

Fatigue sets in early most evenings. Often I'm falling asleep by 9 p.m. Pain is rarely a factor, but I sometimes get winded with otherwise mundane tasks, like walking upstairs or moving furniture.

The driver still doesn't know I went to the hospital with blood clots in my lungs. Nor does he know that telling me of his wife's passing is the reason I put two and two together, listened to my body, and drove to the ER with chest pains.

Someday soon I'll call to thank him. I owe him that much.