The Clot !

          It's now Saturday morning, 1-5-02.  It's only been a couple of days since my last update, but a new development made it kinda necessary, at least in my mind.  And since I'm running the show here, an update it is!

          You may recall that in the last update, I had a new pain.  This one is in my leg.  I wrote:

          "I got a new pain to replace it though.  This one started yesterday in my left leg.  I can feel it on the inside of my thigh from just below my groin to just above the knee.  It feels like I pulled a muscle or something, though I don't know how I'd do that unless I over exerted myself on our little shopping trip the other day.  It hurts when I stand or walk on it, so I'm just kind of sitting or laying down mostly, taking an Ibuprofen now and then, and hoping it goes away within a few days.  If not, I guess I'll have to see the doctor about it and hope he has a solution.  With any luck, I'll have insurance again by then!"

          This new leg pain started when I woke up on January 2nd.  It wasn't too bad at that time, and I thought maybe I strained it somehow.  I figured it would go away within a couple of days and decided to wait, watch and not worry too much about it.  I took an Ibuprofen to help with the pain, but it didn't seem to help much.  Well, it wasn't too bad, so I still wasn't too worried.  Throughout the day it got a little more intense, but still not too bad.

          The next day, January 3rd, it was a little worse, and I tried more Ibuprofen.  It still didn't seem to help, but again, the pain wasn't yet a 10 out of 10, though it did seem to get worse as the day went on.  Mom wanted to call the doctor right away, but I decided to give it one more day and see how it went.  The same day, I got informed that my medical insurance is back in good standing - A HUGE relief!

          The next day, January 4th, I woke up in so much pain I could hardly think straight.  The Ibuprofens weren't doing anything to relieve it, and I knew that if it followed it's regular pattern of getting worse as the day went on, sometime that evening I'd be on my way to the emergency room.  So I called mom and told her to make the call to my doctor and see if he could fit me in for a look-see.

          The doctor's office called me a little while later with some particular questions like, is the area warm, is it swollen, etc.  I reported that it didn't seem to be warm to the touch and didn't seem any more swollen than usual.  It just hurt like crazy and I could hardly walk or think anymore with the pain being so intense.  I'd had a pretty rough night's sleep as well, as the pain doesn't really subside all that much even when I'm not up on that leg, standing or walking.  I also reported that I did notice that there's a lump right in the middle of the action, but didn't know if it was a swollen lymph node or a lipoma.

          I have quite a few lipomas on my arms and legs and have for most of my life.  They are benign lumps of fat just under the skin, and are more of an inconvenience than anything.  When one of them gets big enough for people to start staring or irritates me in some way, I simply have it removed.  So far, I've had 3 of them removed over the years; Two from my left arm and one from my right torso, along my rib cage.

          Anyway, the nurse I was on the phone with said she'd report the info to my doctor and call me back to let me know what to do.  A short time later she called back and said he wanted to see me as soon as I could get there.  So I called mom back and she came and got me and we took the ride out to Ann Arbor to the doctor's office.

          He examined my leg and said he wanted an ultrasound of the area to see what the lump is and to check for blood clots.  So off we went to the building where they do the ultrasounds.  It was getting pretty difficult for me to get around, so I opted for a wheelchair ride instead of more painful limping at that point.

          Oh yeah... During the course of the exam, he noted that I still hadn't got the stitches out from the biopsy they'd done about two months ago.  We were going to get them out during my last visit to him, but I forgot all about them, and his last exam didn't get my pants pulled down, so he never noticed either.  Apparently, that was a bad thing.  The skin had grown up around some of the stitches and the nurse that was assigned to remove them was able to get all but one.  The knot on that one is now below the skin, out of sight, and grown in.

          She made arrangements for me to go back to the surgeon that did the original biopsy and placed the stitches to have him assess the situation.  He would have to determine if the stitch can stay as it is, or if I need another small operation to remove it.  I have to go see him next Thursday, on January 10th, and we'll see what happens.

          Anyway, back to the story.  The lady that runs the ultrasound had me drop trou and get up on the exam table, took one look at my leg and said she could tell just by looking at it that it was a blood clot and all she had to do was find it.  She really knows her business, because I couldn't really see anything different about my leg, and I see it all the time!

          She went right to it, and turned the screen towards me so she could explain to me what she was looking at and what it all meant.  As she scanned my inner thigh, she explained that the dark black round area is my vein and when she pushed down on it with the scanner, it collapsed.  She said that was good -  it's supposed to do that.  

          Then she moved the scanner down my leg a little ways and the area we were looking at went from black to gray.  She pushed again and nothing changed.  It didn't collapse.  She explained that it's because we were looking at a clot in the vein (the gray on the screen) that prevented the collapse, as well as any blood flow.

          She moved down the leg and as she did, we saw that most of it had that same gray color, meaning it was one very long clotted area that ran down my leg past the knee somewhere.  She told me she was sorry to have to give me the bad news, and I told her I considered it good news; Bad news would be if they DIDN'T see anything wrong to cause all this pain I was in.  Blood clots can be treated, I reasoned.  Also, it wasn't a swollen, painful lymph node, chock full 'O cancer.

          Actually, throughout the whole thing we laughed a bit at some little comments the two of us were making along the way.  She had a great sense of humor that I really appreciated.  It was a little on the morbid side, like mine, so we got along great.

          She called my doctor back with the results and then told me they wanted me back at his office, so off we went again to see what would happen next.  I was really hoping at that point that I wouldn't end up in the hospital again, but had a sinking feeling that I would anyway.

          Back at the doctor's office, things were closing up for the day.  There was nobody in the waiting room except me and mom, and the windows were shut at the admissions counter.  It may have been my imagination, but it seemed that some of the lights were out as well.

          As the nurse led me down the hall to an examination room she told me they had a video for me to watch.  Thinking back to that dismal video of cancer patients I'd watched at St. Joseph's during my last stay in the hospital, I groaned, "It's not going to be depressing, is it?"  She said no, it was to teach me how to give myself injections.  "WHAT??!  Injections??!  I can't give myself injections!!  Oh, crap!" I thought to myself.

          A few minutes later, mom and I were sitting in a darkened examination room watching a short video on how to self administer a subcutaneous injection.  I was NOT looking forward to ANY of it, but I paid close attention, sensing I wouldn't be able to get out of it.  Mom offered to come by and give me the injections, as she went to nursing school and knew all about it.  But of course, being the stubborn, independent guy I am, I was determined to meet this new challenge head on just like all the rest.

          When the video finished, the nurse came back in, needle in hand, and went over the procedure again briefly.  I was kind of hoping I could get out of doing that first one right then and there in front of her and mom, but it was pretty obvious that she wanted to make sure I'd be able to do it, and do it right.

          I asked her what I would be injecting myself with, thinking I'd look up the drug later to add to my growing medical knowledge base.  Her reply: "A needle."  LOL!  She had a sense of humor too!  Great!  I cut up a little more to relieve the stress I was feeling at poking myself with a needle for the first time ever (and maybe to delay the event a bit), but the time finally came.  She had everything ready there for me: The needle, the alcohol swab, my bare leg and enough determination for the both of us.  There was only one thing left to do, so I did it.

          As I summoned up the courage to stick myself with a sharp instrument full of drugs, I recalled a boy from my childhood that had to stick himself a couple of times a day with insulin because he had diabetes.  I figured if a 12 year old kid could do it, I could too, and stabbed myself really quick to get it over with.

          To my relief and surprise, it didn't even hurt.  Not even the tiniest bit.  It turns out that getting over the psychological issue of sticking myself was the toughest part.  I knew from then on I'd be able to do this with no problem.  I administered the drug, pulled out the needle and mom said she was really proud of me!  Hehehehe!  The comment made me feel like a little kid again, but that's ok - I like anything that makes me feel young again!

          I got some booklets about all of it.  One goes over how to give myself an injection, in case I need a refresher.  Another is a little booklet all about Coumadin, the new pill I have to take every day.  The third is all about Deep Vein Thrombosis, which is the medical term for the blood clot I have in my leg.

          The word "Coumadin" triggered a memory flashback of my dad.  He was on the drug for the last several years of his life to deal with the lack of blood flow in his legs from his extreme case of diabetes.  His foot turned black and eventually they had to amputate his leg.  He was a fighter too though and had a great sense of humor he kept up throughout his ordeal with it all.  I guess that's where I get it from.  It gave me a renewed determination.  Thanks again dad - wherever you are.

          The nurse explained that I would have to inject myself twice a day, twelve hours apart,  and take a Coumadin (Warfarin is the generic) pill at bedtime.  She explained I'd need to do this for as long as six months.  Six months?!  Wait a minute... what about the pain associated with all of this?!  She assured me that it would subside over the next few days.  

          The drug in the needle is Lovenox.  It comes pre-measured in the needle, which makes it a little easier for me to deal with.  She suggested that we get the prescription filled there in the hospital's pharmacy because most drug stores don't stock it.  Being in a needle, it's a liquid drug that doesn't keep forever and is rather specialized, so there's not a big demand for it at the local drug stores.  

          We took her advise, drove around to the front of the hospital and mom went in to get the prescriptions filled.  I opted to wait in the car and read the booklets I'd gotten, being too wore out and in pain to walk around anymore if I didn't have to.

          She came out a little flustered.  It turns out that the pharmacy in the hospital doesn't take my insurance!  (Here we go again!)  She had to pay about $300 to get it filled, and they only had five of the Lovenox needles in stock, so she couldn't even get the whole prescription filled.

          Remember way back, when I first got to Detroit and admitted to U of M hospital and they didn't take my insurance, so I got transferred to St. Joseph's hospital which did?  Can you believe that St. Joseph's hospital takes my insurance, but their pharmacy doesn't?!  Unbelievable!!  U of M's pharmacy probably does!  This whole insurance game is one messed up enterprise!  Now I know first hand why so many people are screaming about revising the health care system!

          Anyway, when we got home, mom called the local drug store, explained the situation, and they said they'd get the drugs stocked and have them by Monday, which is perfect since that's when I'll need them.  I've got the five, so I'll inject twice on Saturday, twice on Sunday, one on Monday morning and then get the rest of the prescription from the local drug store that takes my insurance that day, so I'll have the second one of the day when it's time.  Plus it won't cost another $300 or more!

          On Monday, January 7th, I have to go back to the doctor's office to get my blood drawn so he can adjust the amount of Coumadin I take so it will do just what he wants it to do.  He'll do that periodically till he gets the amount down just right for me.

          The next day, Tuesday, January 8th, I get my first chemotherapy treatment.  They said it's not going to be a problem doing the chemo in conjunction with these new drugs.

          Then, two days later, on Thursday, January 10th, I've got a date with the surgeon that did my biopsy to assess the buried suture problem.

          It's shaping up to be a pretty busy week, I guess.  Well, at least I won't be bored!

          Next: Chemo Man

Buck